Safety and efficacy of very low calorie diet in patients receiving haemodialysis therapy.

Background: Very low calorie diets (VLCDs) are an obesity treatment option in the general population, but their efficacy and safety in patients on haemodialysis (HD) is unknown. Methods: Prospective single arm study of VLCD in haemodialysis patients. All participants received 2.5-3.3 MJ/day for 12 weeks. Weekly assessment of VLCD, pre- and post-dialysis weight, inter-dialytic weight gain, and blood electrolytes occurred for the first 4 weeks, then fortnightly for another 8 weeks. Linear mixed models compared the change in weight over time as well as biochemical outcomes including potassium. Results: Twenty-two participants [nine home HD (HHD) and 13 satellite HD (SHD)] enrolled with 19 completing the 12-week intervention. Mean post-dialysis weight declined from 121.1 kg at baseline to 109.9 at week 12 resulting in average decline of 0.88 kg per week (95% C.I. 0.71, 1.05, P < .001) with 12-week mean percentage weight loss9.3% (SD 3.5). Mean post-dialysis body mass index declined from 40.9 kg/m2 at baseline to 37.1 kg/m2 at week 12 (95% C.I. 0.25, 0.35, P < .001). Serum potassium rose from week 1 to 3, stabilized during weeks 4 to 6, and fell from week 8, returning near baseline by week 12. Six of the nine (66.6%) HHD participants and seven of the 13 (70%) SHD participants had at least one episode of hyperkalaemia (K > 6 mmol/l). There were no clinical changes in serum sodium, corrected calcium, or phosphate levels during the study. Conclusion: VLCD with dietitian supervision was effective in producing significant weight reduction, with an acceptable safety profile in patients treated with haemodialysis.

A Cross-Sectional Study of Sports Food Consumption Patterns, Experiences, and Perceptions amongst Non-Athletes in Australia.

Sports foods are designed for athletes, yet their availability, type, and sales have increased over the past decade, likely driven by non-athlete use. This could lead to detrimental health outcomes via over/misuse or unwanted side effects. The aim of this study was to describe sports food consumption patterns and associated drivers, consumption reasons, perception of risks, and side effects experienced amongst non-athletes in Australia. In 2022, n = 307 non-athlete Australian adults (18-65 years) completed an online cross-sectional survey including closed-ended (consumption patterns, factors, and exercise participation) and open-ended questions (reasons for consumption, risk perception, and side effects experienced). Descriptive statistics (frequency and percent) described the sample. Ordinal logistic regression was used for univariate associations and a multivariate model was used to determine relationships between sports food consumption proxy and significant univariate associations. The themes were analysed via inductive thematic analysis using NVivo 14. Females consumed sports foods most frequently, 65% of participants consumed three or more sports foods, and participants with higher sports food consumption/frequency were less likely to perceive risks or experience side effects. The main reason for consumption was protein intake, digestion/stomach issues were the main perceived risks, and the main side effect was bloating. Despite understanding the risks and side effects, non-athlete consumers continue to use numerous sports foods, which appear to be influenced by sociodemographic factors and packaging labels. Tighter regulation of packaging-label information would ensure safer and more informed consumption.

Visual communication design: a neglected factor in nutrition promotion via packaged food labels.

Packaging design is a communication device and a critical component in branding strategy, and has relevance for food policy. Presently, packaging-related nutrition policy initiatives focus on the role of regulated claims, nutrition information panels and front-of-pack nutrition labels to help guide consumer food choices and address high prevalences of discretionary and ultra-processed food consumption in many countries. However, these nutrition labelling systems are not optimized as public health policy tools as many consumers do not use them to inform their food choices. Visual communication design theory posits that a designer orders the elements and principles of design into hierarchies that prioritize certain elements over others, and that some of these elements are more dominant and given more emphasis than others. The overall design of the package thereby directs consumer attention to some aspects of pack design (e.g., characters, contents of the package) and away from others (e.g., nutrition details). Dual processing frameworks propose that food decisions are made with the interplay between automatic and rational thinking processes. Packaging designs affect whether consumers rely predominantly on automatic or rational thinking to select a food. This narrative review outlines the role of food packaging design and how it impacts the clear communication of nutrition aspects of food products and how the use of nutrition information by consumers to make decisions may depend upon design structures in packaging. This article attests that nutrition scientists and policy makers should incorporate visual communication design into research on the food packaging as a public health promotion tool. A stronger focus on the communication of regulated front-of-pack nutrition information can be made with a re-evaluation of the hierarchy of elements in the front-of-pack design enabling consumers to make healthier decisions.

Australian Stakeholder Perspectives on Healthier Retail Food Environments for Toddlers-The Era of "Band Aids and Small Inroads".

Background: A healthy diet in young children is crucial for optimal growth and development. However, many toddlers (1-3 y) consume suboptimal diets, and as a result, are at a high risk of experiencing negative health outcomes. Moreover, minimal progress has been made to improve the healthiness of retail food environments for toddlers to date despite the potential and advocacy for the issue. Objectives: To gain insight into stakeholder perceptions and opinions on the healthiness of Australian retail food environments for toddlers, as well as perspectives on the options and barriers to improve their healthiness. Methods: Qualitative, online study utilizing semi-structured individual interviews with 27 key stakeholders from food industry, academia, nongovernment organizations, public health, and government in Australia. Results: Most stakeholders agreed that retail food environments for toddlers were not health promoting. Stakeholders identified that a multifaceted approach including nutrition education and strong government mandated regulation were essential to improve the healthiness of retail food environments for toddlers. Interviews also highlighted the main perceived barriers to progress, and reasons for policy inaction in this area are the food industry and government support. Many stakeholders were concerned that child health is being undermined due to the government favoring business needs over public health. Conclusions: Stakeholders in this study overwhelmingly agreed that there is more that can and should be done to create health promoting retail food environments for toddlers in Australia. Stakeholders identified a range of strategies that can be used to improve the healthiness of toddler food environments, but advocacy efforts are being undermined due to government inaction. Stakeholders believed that strong governance is required to create equitable, sustainable healthy retail food environments for young children. Improving the healthiness of retail food environments for young children will not only reduce diet related disease across the lifespan but will help to address financial and societal costs of a poor diet.

Perseverance, partnerships and passion: ingredients for successful local government policy to promote healthy and sustainable diets.

BACKGROUND: Local government authorities are well-placed to invest in evidence-based food policies that promote a population-wide shift to healthy and sustainable diets. This study describes the contextual factors that facilitated or impeded policy-making related to healthy and sustainable diets within a 'best-performing' local government in Victoria, Australia. METHODS: Guided by the Consolidated Framework for Implementation Research (CFIR), data from semi-structured interviews with individuals involved in developing the City of Greater Bendigo's Food System Strategy were analysed using the seven-stage Framework Method. RESULTS: Semi-structured interviews (n = 24) were conducted with City of Greater Bendigo employees (n = 15) and key stakeholders working for local organisations (n = 6) or at a state or national level (n = 3). Interviewees mostly held positions of leadership (n = 20) and represented diverse areas of focus from health (n = 7), food systems (n = 4) and planning and public policy (n = 3). Data analysis revealed 12 cross-cutting themes; eight facilitating factors and four impeding factors. Facilitating factors included perseverance, community engagement, supportive state policy, effective leadership, a global platform and networks, partnerships, workforce capacity and passion, and the use of scientific evidence. Impeding factors included access to secure, ongoing financial resources, prohibitive state and federal policy, COVID-related disruptions to community engagement and competing stakeholder interests. Overall, this study suggests that the City of Greater Bendigo's success in developing an evidence-based local food system policy is built upon (i) a holistic worldview that embraces systems-thinking and credible frameworks, (ii) a sustained commitment and investment throughout the inner-setting over time, and (iii) the ability to establish and nurture meaningful partnerships with community groups, neighbouring local government areas and state-level stakeholders, built upon values of reciprocity and respect. CONCLUSIONS: Despite insufficient resourcing and prohibitive policy at higher levels of government, this 'best performing' local government in Victoria, Australia developed an evidence-based food system policy by employing highly skilled and passionate employees, embracing a holistic worldview towards planetary health and harnessing global networks. Local government authorities aspiring to develop integrated food policy should nurture a workforce culture of taking bold evidence-informed policy action, invest in mechanisms to enable long-standing partnerships with community stakeholders and be prepared to endure a 'slow-burn' approach.

Profiling ultra-processed foods in Thailand: sales trend, consumer expenditure and nutritional quality.

BACKGROUND: Ultra-processed foods (UPF) are associated with adverse health outcomes. This study aimed to analyse the national trends in retail sales, consumer expenditure and nutritional quality of UPFs in Thailand. METHODS: The study used data from the Euromonitor Passport database for analysis of retail sales and consumer expenditure, and from the Mintel Global New Products Database for nutritional analysis using the WHO Southeast Asian Region nutrient profile model. RESULTS: The study found the highest per capita sales volume and value of UPFs in 2021 were sauces, dressings & condiments (8.4 kg/capita) and carbonated soft drinks (27.1 L/capita), respectively. However, functional & flavoured water, ready-made meals and baked goods had the highest observed (2012-2021) and expected (2021-2026) sales growth. Supermarkets were responsible for most of the UPF sales since 2012, but convenience stores had larger growth in retail values. Growth in consumer expenditure per capita on UPFs from 2012 to 2020, ranged between 12.7% and 34%, and till 2026 is forecast to grow between 26% and 30%. More than half of UPFs exceeded at least one nutrient cutoff, 59.3% for total fats, 24.8% for saturated fats, 68.2% for total sugars and 94.3% for sodium. CONCLUSIONS: The findings suggest a need for regulatory and non-regulatory measures such as UPF taxation and marketing restrictions, and market incentives for producing non-UPFs. A system for regularly monitoring and evaluating healthiness (both nutritional and processing aspects) of food products, especially UPFs, is required.

Corrigendum: A novel food processing-based nutrition classification scheme for guiding policy actions applied to the Australian food supply.

[This corrects the article DOI: 10.3389/fnut.2023.1071356.].

Choosing an effective food classification system for promoting healthy diets in Thailand: a comparative evaluation of three nutrient profiling-based food classification systems (government, WHO, and Healthier Choice Logo) and a food-processing-based food classification system (NOVA).

Introduction: This study aimed to assess the nutritional quality of food and beverage products in Thailand by comparing four different food classification systems: the nutrient profiling-based food classification systems by the Department of Health (DOH), the WHO South-East Asia Region (WHO SEA), the Healthier Choice Logo (HCL), and the food-processing-based food classification system, NOVA. Methods: This study used secondary data from the Mintel Global New Products Database (N = 17,414). Food subgroups were classified differently based on these four systems. The DOH classified food products into three groups: Group A-healthy pass or meeting standard, Group B-not meeting the standard, and Group C-far below standard. The WHO SEA classified food products into two groups: marketing prohibited products and marketing permitted products. The HCL classified food products into two groups: eligible products for the logo; and ineligible products for the logo. The NOVA classified food products into four groups: unprocessed or minimally processed foods (MP), processed culinary ingredients (PCI), processed foods (P), and ultra-processed foods (UPF). Descriptive statistics (percentage and frequency) were used for analysis. Agreement analysis was conducted using Cohen's kappa statistic between each pair of food classification systems. Results: Of the total sample that could be classified by any of the four classification systems (n = 10,486), the DOH, the WHO SEA and the HCL systems classified products as healthy (Group A, marketing permitted or eligible for HCL logo) at 10.4, 11.1, and 10.9%, respectively. Only 5.6% were classified as minimally processed foods using NOVA and 83.1% were ultra-processed foods (UPFs). Over 50% of products classified as healthy by the nutrient profiling systems were classified as UPF according to the NOVA system. Products that were eligible for the HCL had the highest proportion of UPF products (84.4%), followed by the Group A products (69.2%) and the WHO marketing-permitted products (65.0%). Conclusion: A hybrid food classification approach taking both nutrients and food processing into account is needed to comprehensively assess the nutritional quality of food and beverage products in Thailand.

Local government policy to facilitate healthy and sustainable diets and the broader policy hierarchy: insights from Milan Urban Food Policy Pact cities.

BACKGROUND: Local government authorities are well positioned to change the way food is produced and consumed through the implementation of integrated food policies. By facilitating the uptake of healthy and sustainable diet-related practices, integrated local government food policy can trigger change throughout the food supply chain. This study aimed to provide insights as to how the policy hierarchy surrounding local governments may be influencing local government's capacity to create integrated food policy. METHODS: Content analysis was conducted on local government food policies (n = 36) from signatory cities of the Milan Urban Food Policy Pact were mapped to seven global regions. A set of 13 predetermined healthy and sustainable diet-related practices, organized into three categories: "where to source food", "what to eat" and "how to eat", was used to assess the level of integration of each local government food policy. Additional policies from the broader policy hierarchy that were mentioned in each local government food policy were sourced and then screened for relevancy, charted according to their level of administration (local, national, global region, international) and analysed to consider which diet-related practice(s) each broader policy was likely to promote. RESULTS: Analysis revealed three key insights: (i) local government food policies across all included global regions (n = 4) mostly promoted practices in the "where to source food" category, (ii) local government food policies across all global regions referred to policies from higher levels of administration (local, national, global region and international) which tended to also promote practices in the "where to source food" category and (iii) regarding the level of integration, local government food policies in Europe and Central Asia targeted the highest number of diet-related practices. CONCLUSIONS: The level of integration of food policy at national, global region and international levels may be influencing that of local governments. Further research is required to understand why local government food policies are referring to some relevant policies and not others, and to determine whether a greater focus on the diet-related practices of "what to eat" and "how to eat" in policies from higher levels of government would support local governments to also prioritize these practices in their food policies.

Sports foods are not all they shake up to be. An audit of formulated supplementary sports food products and packaging in Australian retail environments.

Objective: To determine store availability, total number of products, and types of Formulated Supplementary Sports Foods in Australia, along with their stated nutrition content, sweeteners added, total number, and type of claims displayed on the packaging. Design: A cross-sectional, visual product audit of mainstream retailers. Setting: Supermarkets, pharmacies, health food stores, and gym/fitness centres. Results: A total of 558 products were captured in the audit, 275 of which displayed the correct mandatory packaging attributes. Three categories of products were identified, based on the dominant nutrient. Only 184 products appeared to display the correct energy value based on the listed macronutrient content (protein, fat, carbohydrate, dietary fibre). The stated nutrient content was highly variable across all product subcategories. Nineteen different sweeteners were identified, with most foods containing only one (38.2%) or two (34.9%) types. The predominant sweetener was stevia glycosides. Packages displayed multiple claims, with a maximum of 67 and minimum of 2 claims. Nutrition content claims were most frequently displayed (on 98.5% of products). Claims included regulated, minimally regulated and marketing statements. Conclusion: Sports food consumers should be provided with accurate and detailed on pack nutrition information, to ensure informed choices are made. However, this audit showed multiple products which did not conform to current standards, appeared to provide inaccurate nutrition information, contained multiple sweeteners, and displayed an overwhelming number of on-pack claims. The increase in sales, availability, and products available in mainstream retail environments, could be impacting both intended consumers (athletes), and general non-athlete population. The results indicate underperformance in manufacturing practices which preference marketing over quality and stronger regulatory approaches are needed to protect consumer health and safety, and to prevent misleading consumers.

Measuring Adherence to Sustainable Healthy Diets: A Scoping Review of Dietary Metrics.

Comprehensive metrics that provide a measure of dietary patterns at global and national levels are needed to inform and assess the effectiveness of policy actions that promote sustainable healthy diets. In 2019, the Food and Agriculture Organization of the United Nations and the World Health Organization reported 16 guiding principles of sustainable healthy diets, but it is still unknown how these principles are considered in dietary metrics. This scoping review aimed to explore how principles of sustainable healthy diets are considered in dietary metrics used worldwide. Forty-eight food-based, investigator-defined dietary pattern metrics assessing diet quality in free-living, healthy populations at the individual or household level were assessed against the 16 guiding principles of sustainable healthy diets, which was used as a theoretical framework. A strong adherence of the metrics to health-related guiding principles was found. Metrics had a weak adherence to principles related to environmental and sociocultural aspects of diets, except for the principle related to diets being culturally appropriate. No existing dietary metric captures all principles of sustainable healthy diets. Notably, the significance food processing, environmental, and sociocultural aspects of diets are generally understated. This likely reflects the lack of focus on these aspects in current dietary guidelines, which highlights the importance of including these emerging topics in future dietary recommendations. The absence of quantitative metrics that comprehensively measure sustainable healthy diets limits the body of evidence that would otherwise inform national and international guideline developments. Our findings can help grow the quantity and quality of the body of evidence available to inform policy activities to realize 2030 Sustainable Development Goals of multiple United Nations. Adv Nutr 2022;x:xx.

A novel food processing-based nutrition classification scheme for guiding policy actions applied to the Australian food supply.

Unhealthy diets are a leading risk factor for non-communicable diseases and negatively impact environmental sustainability. Policy actions recommended to address dietary risk factors, such as restrictions on marketing and front-of-pack labelling, are informed by nutrition classification schemes (NCSs). Ultra-processed foods are associated with adverse population and planetary health outcomes, yet the concept is rarely incorporated in nutrition classification schemes for policy actions. This study aims to develop a novel food processing-based nutrition classification scheme for guiding policy actions. A secondary aim is to validate the scheme by classifying food and beverage items in the Australian food supply (face validity) and comparing them to the classifications of existing NCSs (convergent validity). Two versions of a model were developed, classifying foods and beverages in two steps, first using the NOVA classification system and secondly by applying upper thresholds for added free sugars and sodium, producing a binary output of either healthy or unhealthy. All food and beverage items (n = 7,322) in a dataset combining the Australian Food Composition Database (AUSNUT 2011-2013) and Mintel's Global New Product Database (2014-2019) were classified using the two models. The same dataset was also classified by the Health Star Rating system (HSR), The Australian Dietary Guidelines (ADGs), The Pan American Health Organization's Nutrient Profile Model (PAHO NPM), and the NOVA classification scheme, and pairwise agreement between all NCSs and the two models was determined (using Cohen's Kappa coefficient). A higher proportion of food categories consistent with dietary patterns that are associated with positive health outcomes, such and fruits, vegetables, and eggs were classified as healthy. And the clear majority of food categories consistent with dietary patterns associated with adverse health outcomes, such as confectionery, snack foods, and convenience foods were classified as unhealthy. The two versions of the model showed substantial agreement with NOVA and the PAHO NPM, fair agreement with the ADGs and slight to moderate agreement with the HSR system. A model NCS combining level of processing and nutrient criteria presents a valid alternative to existing methods to classify the health potential of individual foods for policy purposes.

Nutrition Classification Schemes for Informing Nutrition Policy in Australia: Nutrient-Based, Food-Based, or Dietary-Based?

Background: Policy makers are increasingly using nutrition classification schemes (NCSs) to assess a food's health potential for informing nutrition policy actions. However, there is wide variability among the NCSs implemented and no standard benchmark against which their contrasting assessments can be validated. Objectives: This study aimed to compare the agreement of nutrient-, food-, and dietary-based NCSs in their assessment of a food's health potential within the Australian food supply, and examine the conceptual underpinnings and technical characteristics that explain differences in performance. Methods: A dataset combining food compositional data from the Mintel Global New Products Database and the Australian Food Composition Database (AUSNUT 2011-2012) (n = 7322) was assembled. Products were classified by 7 prominent NCSs that were selected as representative of one or other of 1) nutrient-based NCSs [the Chilean nutrient profile model (NPM), Health Star Rating (HSR), Nutri-Score, the WHO European Region's NPM (WHO-Euro NPM), and the Pan American Health Organization's (PAHO) NPM]; 2) food-based NCS (NOVA), and 3) dietary-based NCS [Australian Dietary Guidelines (ADGs)]. Results: The PAHO NPM classified the lowest proportion (22%) of products as "healthy", and the HSR the highest (63%). The PAHO NPM, NOVA, WHO-Euro NPM, and the Chilean NPM classified >50% of products as "unhealthy," and the ADGs, HSR, and Nutri-Score classified <50% of products as "unhealthy." The HSR and Nutri-Score had the highest pairwise agreement (κ = 0.7809, 89.70%), and the PAHO NPM and HSR the lowest (κ = 0.1793, 53.22%). Characteristics of NCSs that more effectively identified ultraprocessed and discretionary foods were: category-specific assessment, the classification of categories as always "healthy" or "unhealthy," consideration of level of food processing, thresholds for "risk" nutrients that do not penalize whole foods; and no allowance for the substitution of ingredients. Conclusions: Wide variation was observed in agreement of the assessment of a food's health potential among the NCSs analyzed due to differing conceptual underpinnings and technical characteristics.

The Design and Evaluation of Online Interactive Learning in an Undergraduate Nutrition Course.

Understanding factors that promote student engagement with online learning environments is important for benchmarking and improving the quality of teaching in a digital era. This study aimed to describe the online interactive content created for delivery of an undergraduate nutrition course and to evaluate student engagement with the online interactive content. We collected online questionnaire data in 2018 and 2019 from two cohorts of students enrolled in a Deakin University undergraduate nutrition unit. Two-sample unpaired t-tests were used to examine differences in participant engagement with online topic guides between static text-based and interactive content. A total of 89 participants (19-56 years) were included. Sixty four of students reported always/usually reading static text-based topic guides most weeks and 64% perceived them as moderately/highly effective. While 60% of participants reported reading the online interactive topic guides most weeks and 93% perceived them as moderate/highly effective. Most participants indicated the interactive topic guides were more effective than static text-based topic guides they experienced in other courses (76%). Hours dedicated to the online interactive topic guide were higher (6.4 SD 2.9 vs. 1.7 SD 1.7 h; P < 0.001) as was the rating of how engaging the topic guides were (7.2 SD 1.6 vs. 6.7 SD 2.5; P = 0.008). These findings suggest that interactive content is more engaging. However, this content may not be accessible to all students, and so familiarization and training prior to engaging in an interactive online unit may be needed.

Regulated nutrition claims increase perceived healthiness of an ultra-processed, discretionary toddler snack food and ultra-processed toddler milks: A discrete choice experiment.

There has been a prolonged increase in the sale and consumption of ultra-processed, discretionary foods and ultra-processed milks for toddlers, which display numerous on-pack claims that influence health perceptions. This study investigated the relative impact of different regulated and unregulated claims on parent perceptions of the healthiness of a toddler snack food and milk in Australia. Participants aged 18+ years completed an online survey, including discrete choice experiments for an ultra-processed, discretionary toddler snack food and an ultra-processed toddler milk, which displayed combinations of claims across nutrition, health, and other domains. Participants were asked to choose the 'most and least healthy' products between three alternatives over seven choice sets. Data were analysed using an ordinal logistic regression model. Likelihood-ratio tests revealed the most important contribution was variation in regulated nutrition-content claims. For the toddler snack, participants were nearly 14 times more likely to perceive a product with the regulated nutrition-content claim "no added sugar, no added salt" as most healthy (OR 13.71, p < 0.001), compared to when no regulated nutrition-content claim was present. For the toddler milk, participants were more than two and a half times more likely to choose a product that contained the regulated nutrition-content claim "2 serves = up to 50% of RDI recommended dietary intake of 14 vitamins and minerals" as most healthy (OR 2.65, p < 0.001) compared to when no regulated nutrition-content claim was present. In Australia, regulated nutrition-content claims can be displayed on packaged foods regardless of healthiness. These results indicate that such claims increase perceptions of healthiness of ultra-processed, discretionary toddler snack foods and ultra-processed toddler milks. Further controls are required to regulate the use of nutrition-content and health claims to facilitate informed consumer choice.

Dietitians Australia position statement on healthy and sustainable diets.

It is the position of Dietitians Australia that to promote human and planetary health, a food system transformation is needed that enables the population to adopt healthy and sustainable diet-related practices. A healthy and sustainable diet must (i) be nutritionally adequate, healthy and safe, (ii) have low environmental impact and be protective of natural resources and biodiversity, (iii) be culturally acceptable and (iv) be accessible, economically fair and affordable. Dietitians Australia acknowledges that it is critical to prioritise Indigenous knowledges in consultation, policy-making and implementation processes to achieve these recommendations. In facilitating the uptake of healthy and sustainable diets, dietitians are contributing to the transformation of our current food system that is urgently required to nourish present and future generations within planetary boundaries. In developing this position statement, opportunities for future research have been identified including those to advance the professions' capacity to improve environmental sustainability outcomes across all areas of practice. To achieve a population-level shift towards this diet, Dietitians Australia recommends: (i) the development of a National Food and Nutrition Strategy which honours Indigenous knowledges on food systems, (ii) the integration of sustainability principles in Australia's dietary guidelines, (iii) the reorientation of our food environment to prioritise access to healthy and sustainable foods, and (iv) investment in capacity building activities to equip the current and future nutrition and dietetics workforce.

Toddler foods and milks don't stack up against regular foods and milks.

AIM: To compare the cost and nutritional profiles of toddler-specific foods and milks to 'regular' foods and milks. METHODS: Cross-sectional audit of non-toddler specific ('regular') foods and milks and secondary analysis of existing audit data of toddler specific (12-36 months) foods and milks in Australia. MAIN FINDINGS: The cost of all toddler-specific foods and milks was higher than the regular non-toddler foods. Foods varied in nutritional content, but toddler foods were mostly of poorer nutritional profile than regular foods. Fresh milk cost, on average, $0.22 less per 100 mL than toddler milk. Toddler milks had higher mean sugar and carbohydrate levels and lower mean protein, fat, saturated fat, sodium and calcium levels per 100 mL, when compared to fresh full fat cow's milk. CONCLUSIONS: Toddler specific foods and milks cost more and do not represent value for money or good nutrition for young children.

Evaluating intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model.

PURPOSE: To investigate intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model. METHODS: Dietary intakes of 12,153 participants from the Australian Health Survey (2011-12) aged 2 + years were evaluated. Food items reported during a 24 h recall were classified using the NOVA system. The Pan-American Health Organization Nutrient Profile Model (PAHO NPM) was applied to identify processed and ultra-processed products with excessive content of critical nutrients. Differences in mean intakes and prevalence of excessive intakes of critical nutrients for groups of the population whose diets were made up of products with and without excessive content in critical nutrients were examined. RESULTS: The majority of Australians consumed daily at least three processed and ultra-processed products identified as excessive in critical nutrients according to the PAHO NPM. Individuals consuming these products had higher intakes of free sugars (ß = 8.9), total fats (ß = 11.0), saturated fats (ß = 4.6), trans fats (ß = 0.2), and sodium (ß = 1788 for adolescents and adults; ß = 1769 for children 5-10 years; ß = 1319 for children aged < 5 years) (p ≤ 0.001 for all nutrients) than individuals not consuming these foods. The prevalence of excessive intake of all critical nutrients also followed the same trend. CONCLUSION: The PAHO NPM has shown to be a relevant tool to predict intake levels of nutrients linked to non-communicable diseases in Australia and, therefore, could be used to inform policy actions aimed at increasing the healthiness of food environments.