Development of the Australian National Meal Guidelines for home-delivered and centre-based meal programs for older adults.

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 (SLR), (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. Further 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.

Collaborative, interprofessional nutritional care within head and neck cancer teams: an international multi-site qualitative study.

Evidence-based guidelines (EBGs) for patients with head and neck cancer (HNC) recommend that nutritional care is delivered by an interprofessional team inclusive of dietitians, doctors, nurses, and speech pathologists. Barriers to collaboration exist within interprofessional teams. However, research on this is currently lacking in the HNC setting, particularly with regard to the provision of nutritional care. This study aimed to explore what facilitates collaborative nutritional care for patients with HNC from the perspectives of different healthcare professionals. This qualitative study used a grounded theory approach. Healthcare professionals from two radiotherapy departments in the United States and two in Australia were interviewed. Forty-six interviews were completed with 17 radiation-oncologists, 12 nurses, eleven dietitians, and 6 speech-pathologists. Collaborative nutritional care for patients with HNC was underpinned by three categories and six sub-categories: access to dietitians (facilitated by funding for dietitians and the strength of evidence), communication (facilitated by team meetings, communication systems, and multidisciplinary clinics), and role-clarity (facilitated by non-clinical activities and respect). This study highlights opportunities for enhancing collaborative nutritional care within HNC teams. Further studies on the impact of the dietitian, interprofessional education, team meetings, and multidisciplinary clinics are required to promote collaborative nutritional care for HNC patients.

Effect of walnut consumption on markers of blood glucose control: a systematic review and meta-analysis.

Type 2 diabetes mellitus is a chronic disease increasing in global prevalence. Although habitual consumption of walnuts is associated with reduced risk of CVD, there is inconsistent evidence for the impact of walnut consumption on markers of glycaemic control. This systematic review and meta-analysis aimed to examine the effect of walnut consumption on markers of blood glucose control. A systematic search of Medline, PubMed, CINAHL and Cochrane databases (to 2 March 2019) was conducted. Inclusion criteria were randomised controlled trials conducted with adults which assessed the effect of walnut consumption on fasting blood glucose and insulin, glycated Hb and homeostatic model assessment of insulin resistance. Random effects meta-analyses were conducted to assess the weighted mean differences (WMD) for each outcome. Risk of bias in studies was assessed using the Cochrane Risk of Bias tool 2.0. Sixteen studies providing eighteen effect sizes were included in the review. Consumption of walnuts did not result in significant changes in fasting blood glucose levels (WMD: 0·331 mg/dl; 95 % CI -0·817, 1·479) or other outcome measures. Studies were determined to have either 'some concerns' or be at 'high risk' of bias. There was no evidence of an effect of walnut consumption on markers of blood glucose control. These findings suggest that the known favourable effects of walnut intake on CVD are not mediated via improvements in glycaemic control. Given the high risk of bias observed in the current evidence base, there is a need for further high-quality randomised controlled trials.

Nutritional Care of Patients Admitted to Hospital for Alcohol Withdrawal: A 5-Year Retrospective Audit.

AIM: The aim of this study was to describe the characteristics and the nutritional approaches implemented with patients undergoing alcohol withdrawal. METHODS: A retrospective analysis of medical records for patients admitted to a tertiary hospital for alcohol withdrawal was completed over a 5-year period 2013-2017. Data on nutrition-related assessment and management were extracted and descriptively analysed. RESULTS: A total of 109 medical records were included (M = 73, F = 36), with the mean age of patients 47.3 years (SD ± 11.2, range 22-70). The average length of stay was 3.7 days (SD ± 3.9, range 0.70-27.8). Approaches towards nutritional care emerged from micronutrient assessment and supplementation and/or dietetic consultation. Nutrition-related biochemistry data was available for most patients, notably serum levels of sodium, urea and creatinine (102 patients; 93.5%) and magnesium and phosphate (66 patients, 60.5%). There was evidence of some electrolyte abnormalities on admission to hospital. Eight patients had serum micronutrient status assessed; no patients had serum thiamine levels assessed. Parenteral thiamine was provided to 96 patients (88.0%) for 1.9 days (SD ± 1.1, range 1.0-6.0) with a mean dose of 2458.7 mg (SD ± 1347.6, range 300-6700 mg). Multivitamin supplementation was provided to 24 patients (22.0%). Only 23 patients (21.2%) were seen by a dietician of whom 16 underwent a comprehensive nutritional assessment and 3 were screened using the malnutrition screening tool. CONCLUSION: Inconsistent nutritional assessment and management practices were identified across a diverse population group, whilst nutritional professionals were underutilized. Future research should benchmark current guidelines and multidisciplinary approaches considering the role of nutritional specialists in the team.

Nut consumption in a representative survey of Australians: a secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey.

OBJECTIVE: Nut consumption is associated with a range of health benefits. The current study aimed to examine nut consumption in the 2011-2012 National Nutrition and Physical Activity Survey (NNPAS) and to investigate associations between nut intake, nutrient intake and anthropometric and blood pressure measurements. DESIGN: Secondary analysis of the 2011-2012 NNPAS. Usual consumption of nuts in the 2011-2012 NNPAS was determined, and nut consumption was compared with population recommendations of 30 g nuts per day. The relationship between nut consumption and intakes of key nutrients, anthropometric outcomes (weight, BMI and waist circumference) and blood pressure was examined using linear regression for participants aged over 18 years. SETTING: Australia. PARTICIPANTS: Australians (2 years and older, n 12 153) participating in the representative 2011-2012 NNPAS. RESULTS: Mean nut intake was 4·61 (95 % CI: 4·36, 4·86) g/d, with only 5·6 % of nut consumers consuming 30 g of nuts per day. Nut consumption was associated with significantly greater intakes of fibre, vitamin E, Fe, Mg and P. There was no association between nut consumption and body weight, BMI, waist circumference, or blood pressure. CONCLUSIONS: Exploration of nut consumption in a representative sample of Australians identified that nut intake does not meet recommendations. Higher nut consumption was not adversely associated with higher body weight, aligning with the current evidence base. Given the current levels of nut consumption in Australia, strategies to increase nut intake to recommended levels are required.

Unwrapping nutrition: Exploring the impact of hospital food and beverage packaging on plate waste/intake in older people.

Food and beverage packaging is increasingly used in hospital food service provision. Previous research has identified that the packaging used in New South Wales hospitals can be difficult to open by older adults. As older adults experience high rates of malnutrition, it is important to understand the effects of packaging on actual consumption of food and fluids. The aim of this study was to explore the impact of hospital food and beverage packaging on dietary intakes of 62 independently living older people (65 years and over) in a university simulated hospital ward in NSW, Australia. Participants were allocated to either a breakfast and snack meal or a lunch and snack meal on two occasions one week apart. Meals were served in a shared ward environment and each participant experienced a 'sealed' and 'pre-opened' meal and snack condition. The nutritional status of participants was measured using the Mini Nutritional Assessment - Short Form (MNA®-SF) and intake was estimated through an aggregated plate waste method. Overall findings were not significant for dietary intakes and the 'sealed' versus 'pre-opened' conditions. However, for the seven participants classified by the MNA®-SF as 'at risk' of malnutrition, packaging impeded intake for breakfast (η2 = -0.34) and the high protein snack (cheese and biscuits) (η2 = -0.24) meals. This finding has implications for the provision of packaged high protein snacks (cheese portions) and breakfast meals for the older inpatient. Further research is required for nutritionally compromised and frail older people in the hospital environment to investigate the impact of packaging on food and beverage consumption in detail.

Dietary Patterns and Cardiovascular Disease: Insights and Challenges for Considering Food Groups and Nutrient Sources.

PURPOSE OF REVIEW: The relationship between dietary patterns and cardiovascular disease has been the subject of much research, but an important methodological consideration is the interdependence between the nutrient composition of foods and the recognition of healthy dietary patterns. This review considers some of the challenges in researching dietary patterns with implications for translation to public health promotions. RECENT FINDINGS: A number of statistical methods have emerged for analysing dietary patterns using population dietary data. There are limitations in the assumptions underpinning food categorisation, but this research is able to consistently identify foods and dietary patterns that are positively related to health. Aligned to this activity is the ongoing development of food composition databases which has its own limitations such as keeping up to date with changing foods and newly identified components, sampling of foods, and developments in chemical analytical methods. Finally, dietary patterns form the basis for current dietary guidelines and related public health-oriented programs, but the issues raised for research (e.g. food categorisation and cuisine influences on dietary patterns) can also translate to these settings. The study of dietary patterns in cardiovascular disease prevention presents with a number of methodological challenges relating to the way food groups are formed and the limitations of food composition databases. Added to this are new considerations for the environmental impact of recommended dietary patterns. Future research across the entire knowledge chain should target more accurate methods in a number of analytical areas.

Changing psychosocial determinants of physical activity and diet in women with a history of gestational diabetes mellitus.

BACKGROUND: To investigate how a behavioural lifestyle intervention influences psychosocial determinants of physical activity and dietary behaviours in a population at risk of type 2 diabetes (T2DM). METHODS: Fifty-nine women with a body mass index of ≥25 kg/m2 and a history of gestational diabetes mellitus (GDM) participated in a randomized controlled study. The intervention group (n = 29) received 2 face-to-face and 5 telephone lifestyle-counselling sessions with a health professional. The control group (n = 30) received care as usual. At baseline and 6 months, psychosocial determinants related to physical activity and diet were measured with a self-administrated questionnaire. Linear regression analyses were applied to test for intervention effects. RESULTS: The intervention was effective in improving social support (ß = 3.5, P < 0.001; ß = 2.1, P = 0.02), modifying self-efficacy (ß = -2.2, P = 0.02; ß = -4.3, P < 0.001), and reducing barriers (ß = -3.5, P = 0.01; ß = -3.8, P = 0.01) for, respectively, physical activity and diet from baseline to 6-month follow-up in the intervention group compared with the control group. The intervention reduced the following barriers to a physically active lifestyle: lack of energy and lack of motivation. Physical activity barriers like lack of time and lack of childcare were unchanged. The intervention reduced the following barriers to a healthy diet: lack of time, costs, having unhealthy snacks at home, and having cravings for sweets. CONCLUSION: This lifestyle intervention influenced psychosocial determinants relevant for overweight women with a history of gestational diabetes mellitus (GDM) in prevention of T2DM.

Identifying usual food choices at meals in overweight and obese study volunteers: implications for dietary advice.

Understanding food choices made for meals in overweight and obese individuals may aid strategies for weight loss tailored to their eating habits. However, limited studies have explored food choices at meal occasions. The aim of this study was to identify the usual food choices for meals of overweight and obese volunteers for a weight-loss trial. A cross-sectional analysis was performed using screening diet history data from a 12-month weight-loss trial (the HealthTrack study). A descriptive data mining tool, the Apriori algorithm of association rules, was applied to identify food choices at meal occasions using a nested hierarchical food group classification system. Overall, 432 breakfasts, 428 lunches, 432 dinners and 433 others (meals) were identified from the intake data (n 433 participants). A total of 142 items of closely related food clusters were identified at three food group levels. At the first sub-food group level, bread emerged as central to food combinations at lunch, but unprocessed meat appeared for this at dinner. The dinner meal was characterised by more varieties of vegetables and of foods in general. The definitions of food groups played a pivotal role in identifying food choice patterns at main meals. Given the large number of foods available, having an understanding of eating patterns in which key foods drive overall meal content can help translate and develop novel dietary strategies for weight loss at the individual level.

Dietary Modeling of Foods for Advanced CKD Based on General Healthy Eating Guidelines: What Should Be on the Plate?

Chronic kidney disease (CKD) is a major public health problem with significant clinical, societal, and psychosocial burdens. Nutrition therapy has been an integral part of the medical management of patients with CKD for more than a century, with the main goals of preserving kidney function and preventing complications. Nutrition abnormalities may emerge well before dialysis therapy is initiated and are associated with poor outcomes. It is therefore important to revisit nutrition management in the advanced stages of CKD to gain a broader insight into its role and effect on patient outcomes. Traditionally, nutrition recommendations have focused on the prescription of energy (calories) and macro- and micronutrients. Today, dietary modeling also focuses on the evidence for food consumption on health. This review argues that advanced non-dialysis-dependent CKD nutrition requirements to a large extent align with healthy eating guidelines for the general population and should not be based on deprivation or be unusually restrictive. The best currently available evidence for the CKD diet is likely to be derived from CKD nutrition prescriptions in conjunction with evidence underpinning national dietary guidelines and evidence of healthy dietary patterns, such as Mediterranean-style and Dietary Approaches to Stop Hypertension (DASH)-style eating. Positive messages from these dietary patterns should improve acceptance of CKD dietary interventions among patients.

A Diet Enriched with Red Sorghum Flaked Biscuits, Compared to a Diet Containing White Wheat Flaked Biscuits, Does Not Enhance the Effectiveness of an Energy-Restricted Meal Plan in Overweight and Mildly Obese Adults.

OBJECTIVES: Whole grain sorghum is a promising ingredient in foods, especially those targeting satiety and weight control. This study aimed to test weight loss effects of a whole grain red sorghum product incorporated into an energy-restricted diet. METHODS: Sixty subjects (46 females) were randomized to either a sorghum (intervention) or white wheat (control) group, receiving 45 g of flaked cereal biscuits to include daily in their prescribed diets for 12 weeks. Primary outcome was weight loss. Secondary outcomes included plasma glucose, glycosylated hemoglobin (HbA1c), insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triacylglycerides (TAG), interleukin (IL)-1ß, IL-6, IL-8, tumor necrosis factor alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), and total antioxidant capacity (TAC; measured at 0 and 12 weeks). RESULTS: After 12 weeks, there were no significant differences in weight loss or any clinical variables between a wheat control and sorghum cereal group in an energy-restricted diet. Equivalent amounts of weight were lost (p = 0.369) in both groups, and the majority of clinical indices such as fasting glucose, insulin, cholesterol, and key inflammatory biomarkers showed significant beneficial changes over time (p < 0.05). CONCLUSIONS: Although both groups experienced significant weight loss and general improvement in a number of clinical measures, no effects appeared specifically related to sorghum consumption. Further clinical trials are necessary to establish an evidence base for weight loss effects from chronic sorghum intake. Sorghum represents a viable, gluten-free grain alternative in the formulation of novel food products.

Impact of food supplementation on weight loss in randomised-controlled dietary intervention trials: a systematic review and meta-analysis.

Dietary trials provide evidence for practice and policy guidelines, but poor adherence may confound results. Food supplementation may improve adherence to dietary interventions, but the impact of supplementation on study outcomes is not known. The aim of this review was to examine the impact of food supplementation on weight loss in dietary intervention trials. The databases Scopus, PubMed and the Cochrane Library were searched for dietary intervention trials published between January 2004 and March 2015 using the following keyword combinations: 'trial' OR 'intervention', 'food' OR 'diet', 'weight loss' and 'adherence' OR 'adherence'. Studies were included if food was provided to at least one study group and both 'weight change' and 'adherence' were reported. Random effects meta-analyses were conducted to assess weighted mean differences (WMD) in body weight (change or final mean values). The included studies formed two groups: trials involving an intervention group supplemented with a food and a control without food supplementation (food v. no food), and trials in which food was provided to all subjects (food v. food) (PROSPERO registration: CRD42015017563). In total, sixteen studies were included. Significant weight reduction was reported in the food v. no food studies (WMD -0·74 kg; 95 % CI -1·40, -0·08; P=0·03, I 2=63 %). A non-significant increase in weight was found among the food v. food studies (WMD 0·84 kg; 95 % CI -0·60, 2·27; P=0·25, I 2=0 %). Food supplementation appeared to result in greater weight loss in dietary trials. Energy restrictions and intensity of interventions were other significant factors influencing weight loss.

Easy to open? Exploring the 'openability' of hospital food and beverage packaging by older adults.

Food is increasingly a packaged commodity, both in the community and in institutionalised settings such as hospitals, where many older people are malnourished. Previous research with patients aged over 65 years in NSW public hospitals identified difficulties opening milk, water, juices, cereal and tetra packs. The aim of this paper was to assess the ability of well older people living in the community to open food and beverage items routinely used in NSW hospitals in order to gain further insights into the older person/pack interaction and the role of hand and finger strength in pack opening. A sample of 40 older people in good health aged over 65 years from 3 community settings participated in the study. The attempts at pack opening were observed, the time taken to open the pack was measured and the correlation between grip and pinch strengths with opening times was determined. Tetra packs, water bottles, cereal, fruit cups, desserts, biscuits and cheese portions appeared to be the most difficult food products to open. Ten percent of the sample could not open the water bottles and 39% could not open cheese portions. The results were consistent with the previous research involving hospitalised older adults, adding emphasis to the conclusion that food and beverage packaging can be a potential barrier to adequate nutrition when particular types of packaged products are used in hospitals or the community. The ageing population is rapidly becoming a larger and more important group to consider in the provision of goods and services. Designers, manufacturers and providers of food and beverage products need to consider the needs and abilities of these older consumers to ensure good 'openability' and promote adequate nutritional intakes.

New Horizons for the Study of Dietary Fiber and Health: A Review.

Dietary fibre has been consumed for centuries with known health benefits, but defining dietary fibre is a real challenge. From a functional perspective, dietary fibre is described as supporting laxation, attenuating blood glucose responses and assisting with cholesterol lowering. The problem is different types of dietary fibre have different effects, and new effects are increasingly observed, such as the influence on gut microbiota. Thus, a single definition may need to be described in more generic terms. Rather than being bound by a few functional definitions, we may need to embrace the possibilities of new horizons, and derive a working definition of dietary fibre based on a set of conceptual principles, rather than the limited definitions we have to date. To begin this process, a review of individual fibre types and their physiological effects would be helpful. Dietary fibre is a complex group of substances, and there is a growing interest in specific effects linked to fibre type. Different fractions of dietary fibre have different physiological properties, yet there is a paucity of literature covering the effects of all fibres. This paper describes a range of individual fibre types and identifies gaps in the literature which may expose new directions for a working definition of dietary fibre.

What an anticardiovascular diet should be in 2015.

PURPOSE OF REVIEW: Given scientific and public debate about optimal diet to prevent cardiovascular disease, and interest in diet and other chronic diseases, we propose that following a few simple dietary principles would reduce chronic disease incidence. RECENT FINDINGS: Nutrition research has been criticized for focusing on individual nutrients and foods, treated like drug therapy. With a few important exceptions, clinical trials of supplemental nutrients have not shown benefit. Although highly specific nutrition information is elusive, diet patterns have provided consistent answers, important for public health. Observational cohort studies have found that some dietary patterns are reported with high reliability over long periods and predict future cardiovascular and other inflammatory-related diseases. Two randomized clinical trials confirmed this finding. There are many common features of Mediterranean and prudent diets, particularly the plant-centered aspect, coupled with variety of foods eaten. A dietary pattern characterized by high fruit, vegetable, legume, whole grain, nut, berry, seed, and fish intakes, and possibly by intakes of dairy, coffee, tea, chocolate, and alcohol (not in excess), but low meat and detrimentally processed foods is associated with reduced incidence of cardiovascular disease and rates of noncardiovascular, noncancer chronic inflammatory-related mortality. SUMMARY: A plant-centered diet may be broadly recommended.

Fermented dairy food and CVD risk.

Fermented dairy foods such as yoghurt and cheese are commonly found in the Mediterranean diet. Recent landmark research has confirmed the effect of the Mediterranean diet on reducing the CVD risk, but the relative contributions of fermented dairy foods have not been fully articulated. The present study provides a review of the relationship between fermented dairy foods consumption and CVD risk in the context of the whole diet. Studies show that people who eat healthier diets may be more likely to consume yoghurt, so there is a challenge in attributing separate effects to yoghurt. Analyses from large population studies list yoghurt as the food most negatively associated with the risk of weight gain (a problem that may lead to CVD). There is some suggestion that fermented dairy foods consumption (yoghurt or cheese) may be associated with reduced inflammatory biomarkers associated with the development of CVD. Dietary trials suggest that cheese may not have the same effect on raising LDL-cholesterol levels as butter with the same saturated fat content. The same might be stated for yoghurt. The use of different probiotic cultures and other aspects of study design remain a problem for research. Nevertheless, population studies from a range of countries have shown that a reduced risk of CVD occurs with the consumption of fermented dairy foods. A combination of evidence is necessary, and more research is always valuable, but indications remain that fermented dairy foods such as cheese and yoghurt are integral to diets that are protective against CVD.

Intake of total and added sugars and nutrient dilution in Australian children and adolescents.

This analysis aimed to examine the association between intake of sugars (total or added) and nutrient intake with data from a recent Australian national nutrition survey, the 2007 Australian National Children's Nutrition and Physical Activity Survey (2007ANCNPAS). Data from participants (n 4140; 51 % male) who provided 2×plausible 24-h recalls were included in the analysis. The values on added sugars for foods were estimated using a previously published ten-step systematic methodology. Reported intakes of nutrients and foods defined in the 2007ANCNPAS were analysed by age- and sex-specific quintiles of %energy from added sugars (%EAS) or %energy from total sugars (%ETS) using ANCOVA. Linear trends across the quintiles were examined using multiple linear regression. Logistic regression analysis was used to calculate the OR of not meeting a specified nutrient reference values for Australia and New Zealand per unit in %EAS or %ETS. Analyses were adjusted for age, sex, BMI z-score and total energy intake. Small but significant negative associations were seen between %EAS and the intakes of most nutrient intakes (all P<0·001). For %ETS the associations with nutrient intakes were inconsistent; even then they were smaller than that for %EAS. In general, higher intakes of added sugars were associated with lower intakes of most nutrient-rich, 'core' food groups and higher intakes of energy-dense, nutrient-poor 'extra' foods. In conclusion, assessing intakes of added sugars may be a better approach for addressing issues of diet quality compared with intakes of total sugars.

Exploring the views of parents regarding dietary habits of their young cancer-surviving children.

PURPOSE: Adult survivors of childhood cancer have a poor dietary intake. These habits may be manifesting themselves soon after treatment completion. This qualitative study aimed to assess parental views regarding the dietary habits of young child cancer survivors. METHODS: The parents/carers of 18 young child cancer patients (YCCP) treated at Sydney Children's Hospital, Australia (<5 years since treatment completion and <13 years of age), participated in this study. Eighteen age- and sex-matched healthy controls were recruited from Sydney-based community organizations. The interview schedule was semi-structured, and the interview was conducted over the telephone. Interviews were conducted until thematic saturation was reached. Coding and analysis was facilitated by qualitative analysis software. RESULTS: Three main themes emerged regarding parental perceptions of YCCP current intake as compared with their pre-diagnosis eating habits: (1) decreased fruit and vegetable intake, (2) increased consumption of "junk food," and (3) increased portion sizes. Parents also described a continuation of poor eating habits that were established during their cancer treatment. The eating habits of YCCP were substantively different to that described by parents of the control group. CONCLUSION: This exploratory project revealed parental concern regarding their child's dietary intake once the cancer treatment had been completed. The varying habits of YCCP are likely multifactorial and may be related to treatment-related side effects and food habits established during the cancer treatment.

Physiological Effects Associated with Quinoa Consumption and Implications for Research Involving Humans: a Review.

Quinoa is a pseudo-grain consumed as a dietary staple in South America. In recent years, consumer demand for quinoa in the developed world has grown steadily. Its perceived health benefits have been cited as a driving force behind this trend, but there are very few human studies investigating the impact of quinoa consumption. The aim of this review was to identify physiological effects of quinoa consumption with potential for human health. A critical evaluation of animal model studies was conducted. The quality of identified studies was assessed using a methodological quality assessment tool and summative conclusions were drawn to guide the direction of future human research. The majority of studies were of fair quality. Purported physiological effects of quinoa consumption included decreased weight gain, improved lipid profile and improved capacity to respond to oxidative stress. These physiological effects were attributed to the presence of saponins, protein and 20-hydroxyecdysone in the quinoa seed. The implications of these findings are that human studies should investigate the impact of quinoa consumption on weight gain and lipid levels. The role of quinoa as an antioxidant is still unclear and requires further elucidation in animal models.

Foods and food components in the Mediterranean diet: supporting overall effects.

The recent publication of the PREDIMED trial provided definitive evidence that a Mediterranean diet provides protection against cardiovascular disease. Two articles published in BMC Medicine provide further understanding of why this may be the case, by considering contributory effects of olive oil, a core food in the diet, and polyphenols, a class of identifiable protective compounds. Using a number of statistical models, analyses were conducted to show around a 35% cardiovascular disease risk reduction in the highest consumers of olive oil and a similar degree of risk reduction for all-cause mortality comparing highest to lowest quintiles of polyphenol intake. The effects were an advance on cohort studies not related to trials. This suggests that it may be necessary to have better control of the background diet to enable exposure of the value of individual foods and nutrients in a dietary pattern, bearing in mind that, by nature, it is difficult to separate out effects of foods, nutrients and whole diets.