ISSUE ADDRESSED:For widespread and sustained health impacts, community health interventions need to be effective, embedded in regular service delivery and maintained over longer periods. METHODS:This review followed the Cochrane Rapid Review method to: (1) characterise Australian community primary prevention interventions that focus on diet improvement and have been delivered at scale; (2) describe the pathway to implementation at scale; and (3) identify the intervention elements that contribute to success and sustainability. Eligible interventions were those (1) delivered to an Australian healthy population group with dietary intake reported; (2) where delivery was by a service or organisation; and (3) where investment in the large-scale delivery of the intervention exceeded research funding. A systematic search was undertaken in three databases for original studies published from 2009 to February 2024. Additional publications relating to the same intervention or programme were also retrieved and extracted. A Mixed Methods Appraisal Tool was used for quality appraisal of primary papers, and narrative synthesis was undertaken to characterise interventions. RESULTS:Twenty-five programmes met the eligibility criteria, of which 22 were state-based (82% in NSW or Victoria), and 3 were national programmes. Programme settings included primary schools (n = 6), community spaces (n = 5), childcare centres (n = 5), multiple (n = 4), home (n = 3), and other (n = 2). The lead delivery agency for programmes was most often state or local government, or a not-for-profit organisation. Twenty percent of programmes did not demonstrate effectiveness in improving dietary outcomes. Programmes were reported in 3.3 ± 1.7 evaluations (range 1-6). A range of processes was identified for scale-up across programmes including delivery-partner-initiated programmes, researcher-led interventions that were successfully scaled up, and collaborative partnerships. Frequently cited facilitators to scale-up represented inner (e.g., leadership) and outer (e.g., resources) contextual factors, as well as process-related factors and intervention characteristics. The same factors were cited as barriers; however, barriers were cited less frequently. CONCLUSIONS:This study examining the characteristics of real-world community interventions that achieve at-scale delivery found interventions that varied widely in their target population, duration, delivery format, intensity, and development. Most programmes were not scaled-up beyond state boundaries despite Australia's national dietary health challenges, and it is recommended that the barriers to nationwide scalability of programmes be investigated. SO WHAT?: This study highlights the value of closer collaboration between researchers and community health promotion practitioners to strengthen the design and implementation of community health programmes by addressing real-world barriers to uptake and sustainability. Consideration should also be given to how scaled programme models can transcend state boundaries.

The consumption of sugar and non-nutritive sweeteners has been associated with poor health outcomes. The aim of this paper was to provide a comparison of the range of sweetened or flavoured beverages between two high-income countries in the Asia-Pacific region: Australia and Singapore. Following the FoodTrackTM methodology, nutrition, labelling, and price data were collected from major Australian and Singaporean supermarket chains and convenience stores. The nutrient profiles of products were tested for differences using Kruskal–Wallis and Mann–Whitney U tests. The greatest number of products collected in Australia were from the ‘carbonated beverages’ category (n = 215, 40%), and in Singapore the greatest number of products were from the ‘tea and coffee ready-to-drink’ category (n = 182, 35%). There were more calorically sweetened beverages in Singapore compared with Australia (n = 462/517 vs. n = 374/531, p < 0.001). For calorically sweetened products, the median energy of Singaporean products was significantly higher than Australian products (134 kJ vs. 120 kJ per 100 mL, p = 0.009). In Australia, 52% of sweetened or flavoured beverages displayed a front-of-pack nutrient signposting logo, compared with 34% of sweetened or flavoured beverages in Singapore. These findings also indicate that the consumption of just one serving of calorically sweetened carbonated beverages or energy drinks would exceed the WHO maximum daily free sugar recommendations.

Dairy and non-dairy (plant-based) alternatives are promoted as an essential component of a healthy diet. The purpose of this study was to evaluate the range of dairy milks and plant-based milk alternatives in supermarkets in Australia and Singapore, and to explore nutritional differences within the category, and between countries. Product information was collected in store from packaging. Products were sorted into dairy milks and plant-based milk alternatives, and further categorised as (i) breakfast drinks (12 % of products); (ii) plain milks (62 %); or (iii) flavoured milks (26 %). The nutrient profiles of products were tested for differences using Kruskal Wallis and Mann-Whitney U tests. Flavoured products contained almost double the median sugar content of plain products (8.3 g v. 4.6 g, p = 0.005). Two-thirds of the product range were dairy milks, which contained nearly four times the median saturated fat content (1.1 g v. 0.3 v, p < 0.0001) and more than double the amount of sugar (5.1 g v. 2.6 g, p < 0.0001) of plant-based milk alternatives, but three times more protein (3.3 g v. 1.0 g, p < 0.0001). Between countries, generally, calcium contents were similar across products, likely due to fortification of plant-based milk alternatives. Compared to Singapore, dairy milk and plant-based milk alternative products sold in Australia were generally higher in energy, protein and fat, but lower in carbohydrate content. Food supply differences between Singapore and Australia may be cultural and have nutritional implications.

Beverages contribute significantly to dietary intake. Research exploring the impact of beverage types on nutrient intake for Australian Aboriginal and Torres Strait Islander people is limited. A secondary analysis of the Australian Aboriginal and Torres Strait Islander Health Survey 2012–2013 (n = 4109) was undertaken. The daily intake, percentage of consumers, and contribution to total nutrient intake was estimated for 12 beverage categories. Beverage intake contributed to 17.4% of total energy, 27.0% of total calcium, 26.3% of total vitamin C, and 46.6% of total sugar intake. The most frequently consumed beverage categories for children (aged 2 to 18 years) were water, fruit juice/drinks, soft drinks, and cordial; and for adults, water, tea, coffee and soft drinks. The primary sources of beverages with added sugar were fruit juice/drinks (for children), tea (for people living remotely), coffee (for adults in metropolitan/regional areas) and soft drinks (for everyone). Actions to modify beverage intake to improve health should maintain the positive nutrient attributes of beverage intake. This analysis of a large-scale national dietary survey provides benchmarking of beverage intake to support program and policy development to modify intake where this is determined as a priority by the community.

Food-based dietary guidelines (FBDGs) provide country-specific guidance on what constitutes a healthy diet. With increasing evidence for the synergy between human and planetary health, FBDGs have started to consider the environmental sustainability of food choices. However, the number of countries that discuss environmental sustainability in their guidelines is unknown. The purpose of this Review was to identify countries with government-endorsed FBDGs that made explicit mention of environmental sustainability and to examine the breadth and depth of the inclusion of sustainability in FBDGs. The Food and Agriculture Organization of the UN identified 95 countries with FBDGs. We assessed 83 countries against our inclusion criteria, of which 37 mentioned environmental sustainability. Relevant content was assessed against a set of criteria based on the Food and Agriculture Organization's guiding principles for sustainable healthy diets. The depth to which environmental sustainability was discussed varied and it was often restricted to general explanations of what a sustainable diet is. Few FBDGs addressed why sustainability is important, how dietary changes can be made, or provided quantified advice for implementing sustainable diets.

Pre-prepared, or ready meals (frozen, chilled and shelf-stable) are increasingly available in supermarkets in developed countries. This study aimed to investigate how the range of ready meals in Australian supermarkets has changed from 2014 to 2020, and how products vary by price, serving size, nutrient composition and Health Star Rating. Product information was obtained from the FoodTrack™ packaged food database for the years 2014 to 2019 and from an instore audit of products available in Adelaide, Australia for 2020. There was a 13% annual average increase in the number of ready meals available in supermarkets. Serving size did not change (median 350 g, p-trend = 0.100) and price increased modestly from 2014 to 2020 (median $1.67 to $1.79/100 g, p-trend < 0.001), with chilled ready meals being the most expensive. A modest decrease in sodium density from 2014 to 2020 (median 275 to 240 mg/100 g, p-trend < 0.001) was seen. However, the category has a wide range in Health Star Ratings and nutrient composition, highlighting the importance of appropriate consumer choice to optimise health benefits. With the increasing availability of ready meals, global improvements within this category should be encouraged and consumers guided to choose healthier products.

This chapter describes common features regarding the health of indigenous minority groups, particularly as it relates to diet and nutrition, and discusses important principles relating to working for improved health for indigenous minority groups. The high burden of disease and disability in indigenous communities can decrease mobility for food collection and preparation, influence dietary requirements, increase poverty due to decreased capacity to work and diversion of resources to manage the disease or disability. High rates of tobacco, alcohol and other substance use and misuse in indigenous communities have many different effects on food intake. In some indigenous communities of Australia, where western-style employment for indigenous people is scarce, a large proportion of the population receive government social security payments, which are known as 'sit-down money', acknowledging that it requires no physical activity to obtain. A practitioner should carefully reflect on the aims and purposes of their educational work with indigenous communities, and be realistic about what is possible.

The aim of this study was to describe and compare the mean usual dietary intakes of adults with type 1 diabetes (T1D) and without diabetes living in Australia. Our hypothesis was that adults with T1D have similar dietary intake profiles to adults without diabetes. Data from the National Nutrition and Physical Activity Survey 2011-2012, which formed part of the Australian Health Survey 2011-13, were used and participants >= 18 years of age with T1D and without diabetes were included in the analyses. T1D status was assigned to participants who reported a diabetes diagnosis at age <25 years and still had diabetes at the time of survey completion. Mean usual intakes of energy, macronutrients and carbohydrate-rich food groups, measured by 24-hour recall, were compared between groups using Analysis of Covariance after adjustment for age, sex, socioeconomic status, smoking status and body mass index. The number of adults classified with T1D and without diabetes was n = 43 and n = 8844, respectively. The T1D group had a mean energy intake (%E) of 7873 kJ/day with 45%E from carbohydrates (213 g/day), 31%E from fats (67 g/day) and 20%E from proteins (88 g/day). There were no significant differences in energy or macronutrient intakes between groups (P >= .07), except individuals with T1D reported higher intakes of whole grains and high fiber cereals, after multivariable adjustment (2.4 vs 1.7 serves/day; P = .02). In conclusion, adults with and without T1D had similar reported energy and macronutrient intake profiles that are consistent with current dietary recommendations for T1D management and healthy eating guidelines for the general population. (c) 2020 Elsevier Inc. All rights reserved.

We aimed to examine the association between chili intake and cognitive function in Chinese adults. This is a longitudinal study of 4852 adults (age 63.4 ± 7.7) attending the China Health and Nutrition Survey during 1991 and 2006. Cognitive function was assessed in 1997, 2000, 2004 and 2006. In total, 3302 completed cognitive screening tests in at least two surveys. Chili intake was assessed by a 3-day food record during home visits in each survey between 1991 and 2006. Multivariable mixed linear regression and logistic regression were used. Chili intake was inversely related to cognitive function. In fully adjusted models, including sociodemographic and lifestyle factors, compared with non-consumers, those whose cumulative average chili intake above 50 g/day had the regression coefficients (and 95% CI) for global cognitive function of −1.13 (−1.71–0.54). Compared with non-consumers, those with chili consumption above 50 g/day had the odds ratio (and 95% CI) of 2.12(1.63–2.77), 1.56(1.23–1.97) for self-reported poor memory and self-reported memory decline, respectively. The positive association between chili intake and cognitive decline was stronger among those with low BMI than those with high BMI. The longitudinal data indicate that higher chili intake is positively associated with cognitive decline in Chinese adults in both genders.

It is important to understand the role of beverages in population dietary intake in order to give relevant advice. Population estimates were derived from one-day food recall dietary data from 12,153 participants in the 2011–2012 Australian National Nutrition and Physical Activity Survey. Almost all Australians (99.9%) consumed at least one beverage on the day of the survey, accounting for 16.6% of the total energy intake for adults (aged 19 years and over) and 13.0% for children (aged 2–18 years). Similarly, beverages contributed 26–29% to calcium intake, 22–28% to vitamin C intake, and 35–36% to sugar intake. Water was consumed on the day of the survey by 84.1% of Australian adults and 90.5% of children. For adults, the greatest beverage contributors to total energy intake were alcoholic drinks (5.6%), coffee (3.1%), and soft drinks (1.9%), and for children, plain milk (3.1%), flavoured milk (2.8%), and fruit juice (2.6%). Coffee (10.6%) made the greatest contribution to calcium intake for adults; and plain milk (9.9%) and flavoured milk (7.6%) for children. The greatest contributors to vitamin C intake were fruit juice (13.4%) and alcoholic drinks (6.1%) for adults; and fruit juice (23.4%) for children. For total sugar intake, soft drinks (8.0%), coffee (8.4%), and fruit juice (5.9%) made the highest contribution for adults; and fruit juice (9.8%) and soft drinks (8.7%) for children. The type and amount of beverage consumption has considerable relevance to dietary quality for Australians.

Lactose requires an enzyme (the lactase enzyme) to split the two sugar units before they can be absorbed into the body. The lactase enzyme is on the surface of the mucosa of the human small intestine. Production of the enzyme is therefore vulnerable to conditions impacting on the mucosal brush border (such as severe infection) resulting in secondary lactase deficiency. Primary lactase deficiency in adult life, or genetically determined lactase non-persistence (LNP) is the ‘normal’ human condition, and much more common than lactase persistence (where adults have the continuous ability to produce high levels of lactase throughout adult life) which results from a number of distinct genetic mutations1. The common condition of LNP is therefore the natural decline in intestinal lactase to a low level which leaves adults with minimal ability to digest lactose2.

Diet is a major determining factor for many non-communicable chronic diseases (NCDs). However, evidence on diet-related NCD burden remains limited. We assessed the trends in diet-related NCDs in Australia from 1990 to 2015 and compared the results with other countries of the Organization for Economic Co-operation and Development (OECD).

Background/aims: Indigenous people experience a higher burden of nutrition-related conditions and are more likely to experience food insecurity compared to non-Indigenous people. Consequently, they remain at increased risk of malnutrition; particularly when residing in regional or remote areas. This study aims to compare and characterise the burden and nature of malnutrition among a representative cohort of Indigenous and non-Indigenous Australians admitted to regional hospitals for medical inpatient care. Methods: This was a cross-sectional survey conducted in three regional hospitals in the Northern Territory and Far North Queensland of Australia from February 2015 to September 2015. A total of 1606 adult medical inpatients were screened for eligibility. Of these, 608 eligible patients were screened for malnutrition using the validated Malnutrition Screening Tool and assessed for malnutrition using the Subjective Global Assessment. Socio-economic and health-related variables and anthropometric measurements were collected to identify the correlates of malnutrition. Results: Of the 271 Indigenous patients and 337 non-Indigenous patients screened and assessed for malnutrition, 250/608 (41.7%, 95% CI 40.1-52.3%) were found to be malnourished. Significantly higher rates of malnutrition (46.1%, 95% CI 40.1-52.3% versus 37.1%, 95% CI 31.9-42.5%) were found in Indigenous patients compared to non-Indigenous patients (P = 0.024). Higher rates of malnutrition were observed in Indigenous patients residing in Central Australia (56.7%, 95% CI 46.7-66.4%) than in the Top End of the Northern Territory (40.7%, 95% CI 31.7-50.1%) and in Far North Queensland (36.7%, 95% CI 23.4 -51.7%). Factors independently predictive of malnutrition for both Indigenous and non-Indigenous participants included residence in Central Australia (OR 4.31, 95% CI 2.63-7.90, P < 0.001); an increased Charlson Comorbidity Index prognostic score (OR 1.37 [per incremental score], 95% CI 1.19-1.59, P < 0.001); and an underweight Body Mass Index (OR 29.97, 95% CI 3.68-244.0, P < 0.001). Of the 250/608 patients who were malnourished, the positive predictor value (PPV) for malnourished patients who were underweight was 96.6% (95% CI 88.3-99.6%); for Indigenous Australians who were malnourished and underweight, the PPV was 100%. A mid-upper arm circumference of less than 23 cm demonstrated a strong PPV for all patients who were malnourished (96.1%, 95% CI 89.0-99.2%). Conclusion: This is the first study to characterise malnutrition in adult Indigenous Australians in a hospital inpatient setting. Compared to non-Indigenous patients the burden and pattern of malnutrition was both higher and markedly different among Indigenous patients. These data highlight the critical importance for actively screening for and responding to malnutrition in this vulnerable patient population in regional and remote settings. (c) 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

The Asia-Pacific Conference on Clinical Nutrition is a biennial conference held within the Asia-Pacific region. The 2017 meeting was a joint meeting of the Asia-Pacific Society of Clinical Nutrition, the Nutrition Society of Australia and the Nutrition Society of New Zealand. The meeting was hosted by CSIRO Health and Biosecurity in collaboration with the University of South Australia, the University of Adelaide, Flinders University and the South Australian Health and Medical Research Institute. The theme of the meeting was Nutrition Solutions for a Changing World. Four hundred and thirty-eight registrants attended the conference and 432 papers were presented. This issue presents the proceedings of this meeting in the form of abstracts for each paper that was presented at the conference.

Population studies of the association between zinc intake and mortality yield inconsistent findings. Using data from Jiangsu Nutrition Study, we aimed to assess the association between zinc intake and mortality among Chinese adults.

BACKGROUND AND OBJECTIVES The objectives of this study were to identify and validate a screening tool to detect malnutrition among Indigenous and non-Indigenous Australian patients. METHODS AND STUDY DESIGN This study included medical patients admitted into three regional hospitals in Australia. A literature review was undertaken of current screening tools before the Malnutrition Screening Tool (MST) and the newly developed Adult Nutrition Tool (ANT) were used to validate a screening tool for use among participants against the Subjective Global Assessment (SGA) tool. The sensitivity and specificity of both the MST and ANT were determined for all study participants as well as according to participants' Indigenous status. RESULTS A total of 608 participants were enrolled into the study, of whom 271 (44.6%) were Indigenous. The area under the curve (AUC) when utilising ANT was higher in all participants compared to the MST (0.90, 95% CI 0.88-0.92 versus 0.81, 95% CI 0.77-0.84, p<0.001). The AUC was also significantly higher for Indigenous participants when utilising ANT compared to the MST (0.88, 95% CI 0.84-0.92 versus 0.78, 95% CI 0.73-0.83, p<0.001). An ANT >=2 demonstrated superior sensitivity for both Indigenous and non-Indigenous participants (96.0%, 95% CI 92.8-98.7%) than the MST (84.0%, 95% CI 78.9-88.3) but with inferior specificity (59.5%, 95% CI 54.2-64.6) than the MST (70.7%, 95% CI 65.7-75.3). CONCLUSIONS The ANT is both a valid and accurate tool for Indigenous and non-Indigenous Australian patients. Further research is required to validate ANT to aide in the detection of malnutrition in other clinical settings.

The burden of malnutrition in Indigenous people is a major health priority and this study’s aims are to understand health outcomes among Indigenous and non-Indigenous patients. This cohort study includes 608 medical inpatients in three regional hospitals. Participants were screened for malnutrition using the Subjective Global Assessment tool. Hospital length of stay, discharge destination, 30-day and six-month hospital readmission and survival were measured. Although no significant difference was observed between Indigenous participants who were malnourished or nourished (p = 0.120), malnourished Indigenous participants were more likely to be readmitted back into hospital within 30 days (Relative Risk (RR) 1.53, 95% CI 1.19–1.97, p = 0.002) and six months (RR 1.40, 95% Confidence Interval (CI) 1.05–1.88, p = 0.018), and less likely to be alive at six months (RR 1.63, 95% CI 1.20–2.21, p = 0.015) than non-Indigenous participants. Malnutrition was associated with higher mortality (Hazards Ratio (HR) 3.32, 95% CI 1.87–5.89, p < 0.001) for all participants, and independent predictors for six-month mortality included being malnourished (HR 2.10, 95% CI 1.16–3.79, p = 0.014), advanced age (HR 1.04, 95% CI 1.02–1.06, p = 0.001), increased acute disease severity (Acute Physiology and Chronic Health Evaluation score, HR 1.03, 95% CI 1.01–1.05, p = 0.002) and higher chronic disease index (Charlson Comorbidity Index, HR 1.36, 95% CI 1.16–3.79, p = 0.014). Malnutrition in regional Australia is associated with increased healthcare utilization and decreased survival. New approaches to malnutrition-risk screening, increased dietetic resourcing and nutrition programs to proactively identify and address malnutrition in this context are urgently required.

Twenty-first-century challenges for food and nutrition security include the spread of obesity worldwide and persistent undernutrition in vulnerable populations, along with continued micronutrient deficiencies. Climate change, increasing incomes and evolving diets complicate the search for sustainable solutions. Projecting to the year 2050, we explore future macronutrient and micronutrient adequacy with combined biophysical and socioeconomic scenarios that are country-specific. In all scenarios for 2050, the average benefits of widely shared economic growth, if achieved, are much greater than the modelled negative effects of climate change. Average macronutrient availability in 2050 at the country level appears adequate in all but the poorest countries. Many regions, however, will continue to have critical micronutrient inadequacies. Climate change alters micronutrient availability in some regions more than others. These findings indicate that the greatest food security challenge in 2050 will be providing nutritious diets rather than adequate calories. Research priorities and policies should emphasize nutritional quality by increasing availability and affordability of nutrient-dense foods and improving dietary diversity.

Background & aims: Almost one in ten Chinese adults has chronic kidney disease (CKD). However, the link between dietary patterns, dietary cadmium intake and CKD has not been studied in China. Method: Adults (n = 8429) in the China Health and Nutrition Survey who had at least one 3-day 24 h food record in combination with household food inventory in 1991, 1993, 1997, 2000, 2004, 2006, and 2009 and estimated glomerular filtration rate (eGFR) measured in 2009. Dietary pattern was identified using factor analysis. CKD was defined as eGFR <60 mL/min/1.73 m(2). Results: There were 641 (7.6%) cases of CKD in the sample. After adjustment for demographic, lifestyle factors (i.e. smoking, alcohol drinking, physical activity) and chronic conditions, the odds ratio (OR) for CKD was 4.05 (95%CI 2.91-5.63, p for trend <0.001) for extreme quartiles of estimated cumulative cadmium intake. A traditional southern dietary pattern (high intake of rice, pork, and vegetables, and low intake of wheat) was associated with more than four times increased prevalence of CKD (comparing extreme quartiles, OR 4.56, 95%CI 3.18-6.56). A modern dietary pattern (high intake of fruit, soy milk, egg, milk and deep fried products) was inversely associated with CKD (for extreme quartiles, OR 0.5, 95%CI 0.36-0.71). The association between dietary patterns and CKD were attenuated by cadmium intake. Conclusion: Traditional southern dietary pattern is positively associated, and modern dietary pattern is inversely associated, with CKD among Chinese adults. However, these associations can be partly attributed to cadmium contamination in parts of the food supply. (C) 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.