Modeling the Impact of Substituting Meat and Dairy Products with Plant-Based Alternatives on Nutrient Adequacy and Diet Quality.

BACKGROUND: Novel plant-based meat and dairy alternatives are designed to mimic and replace animal-sourced products, yet their nutritional composition differs from traditional alternatives such as legumes and beans. The nutritional impacts of switching from animal-sourced to traditional or novel plant-based alternatives remains unclear. OBJECTIVES: This study aimed to model the impact of partial and complete substitution of animal-sourced meat and dairy products with traditional or novel plant-based alternatives on diet quality and nutrient adequacy in a nationally representative sample of Australian adults. METHODS: Dietary data (1 24-h recall) from the Australian Health Survey 2011-2013 (n = 9115; ≥19 y) were analyzed. Four models simulated partial or complete substitution of animal-sourced meat and dairy with traditional or novel plant-based alternatives. Diet quality was assessed using the Dietary Guideline Index (DGI), and nutrient adequacy was determined using age- and sex-specific nutrient reference values. Modeled diets were compared to a baseline diet using survey-weighted paired t tests. RESULTS: DGI scores improved by 0.3% to 6.0% for all models across all sex and age groups compared to baseline. Improvements in diet quality were greatest for the complete substitution to traditional alternatives (5.1% average increase in DGI). Overall, inclusion of plant-based alternatives (complete or partial) decreased saturated fat and increased dietary fiber. Long-chain n-3 polyunsaturated fatty acids decreased to below adequate intakes for all complete substitution models. Substitution with traditional alternatives decreased sodium and increased calcium, whereas substitution with novel alternatives increased sodium and decreased calcium. CONCLUSIONS: All models using traditional alternatives, and the partial substitution using novel alternatives, showed small but statistically significant improvements in diet quality. Nutrient adequacy varied between models, with nutrients including saturated fat, sodium, calcium, and long-chain fatty acids implicated. Findings highlight the importance of informed choices when switching to traditional or novel plant-based alternatives to prevent suboptimal dietary intake.

A scoping review of approaches used to develop plant-based diet quality indices.

Plant-based dietary patterns are comprised of a range of foods, and increasingly, diet quality indices are used to assess them and their associations with health outcomes. As the design of these indices varies, a review of existing indices is necessary to identify common features, strengths, and considerations. This scoping review aimed to synthesize the literature on plant-based diet quality indices by examining their 1) basis for development, 2) scoring methodology, and 3) validation approaches. MEDLINE, CINAHL, and Global Health databases were systematically searched from 1980 to 2022. Observational studies were included if they assessed plant-based diets in adults, using an a priori methodology with food-based components. Studies conducted among pregnant/lactating people were excluded. Thirty-five unique plant-based diet quality indices were identified in 137 included articles published between 2007 and 2022. Indices were developed to reflect epidemiological evidence for associations between foods and health outcomes (n = 16 indices), previous diet quality indices (n = 16), country-specific dietary guidelines (n = 9), or foods from traditional dietary patterns (n = 6). Indices included 4 to 33 food groups, with fruits (n = 32), vegetables (n = 32), and grains (n = 30) the most common. Index scoring comprised of population-specific percentile cutoffs (n = 18) and normative cutoffs (n = 13). Twenty indices differentiated between healthy and less healthy plant-based foods when scoring intakes. Validation methods included construct validity (n = 26), reliability (n = 20), and criterion validity (n = 5). This review highlights that most plant-based diet quality indices were derived from epidemiological research, the majority of indices differentially scored healthy and unhealthy plant and animal foods, and indices were most often evaluated for construct validity and reliability. To ensure best practice use and reporting of plant-based dietary patterns, researchers should consider the basis for development, methodology, and validation when identifying appropriate plant-based diet quality indices for use in research contexts.

Sharing the load: A qualitative exploration of what mothers and fathers believe the father's role should be in food provisioning.

The father's role in household responsibilities has shifted over the past fifty years. In particular, fathers are now expected to be more involved in the family food provisioning but are often still positioned in a role that is supplementary to the mother's role. Previous literature has explored contemporary perceptions of the father's role in this domain, however research on the expectations both parents have for the father's role is limited. This qualitative study therefore seeks to understand what mothers and fathers believe the father's role in family food provisioning should be or what they would like it to be. Semi-structured interviews were used to explore the beliefs, expectations and lived experiences of heterosexual couples (N = 8) with at least one child aged between 5 and 12 years old. A thematic analysis informed by principles of constructivist grounded theory revealed that while the fathers placed importance on equally sharing the food provisioning role, a discrepancy is acknowledged between their attitudes and behaviours. The majority of the mothers desired a more equal share of the food provisioning role. However, such aspirations did not necessarily translate into real-world expectations of the father as they were deemed unlikely to be met. Parents recognised that the birth of children worked to increase the mother's load, and further reinforced the parent's roles moving forward. Constraints to change were heavily impacted by the socialisation of both gender and culture. The current study expands the existing literature by highlighting the need to focus on structural mechanisms that inform cultural and social change, in order to enable a more equal division of food provisioning.

The association between dietary intake and cardiometabolic risk factors among obese adolescents in Indonesia.

BACKGROUND AND OBJECTIVE: Poor diets, characterized by excess fat, sugar and sodium intakes, are considered to be one of the most important modifiable risk factors for cardiovascular disease. Diet patterns and intakes during adolescence may persist into adulthood and impact on risk for chronic disease later in life. We aimed to evaluate the dietary intake of obese adolescents and its relationship to cardiometabolic health including lipid status and glycemic control. METHODS AND STUDY DESIGN: This was a cross-sectional study of obese children aged 15 to < 18 years in Yogyakarta, Indonesia. All children had a medical history performed including a physical examination and fasting blood sample. Dietary intake was assessed using a semi-quantitative recall food frequency questionnaire. Multivariable linear regression model was performed to determine the relationship between dietary intakes and cardiovascular disease risks and to adjust for potential confounders. RESULTS: Of 179 adolescents, 101 (57.4%) were male and median age was 16.4 (15.0-17.9) years. The majority of adolescents (98%) had inadequate intake of fibre and exceeded intakes of total fat (65%) and total sugar (36%). There was statistically significant correlation found in the multivariable linear regression analysis between fibre intake and HDL cholesterol after adjusting for potential confounders (ß = 0.165; p = 0.033). CONCLUSIONS: This study demonstrates that there is a high proportion of obese Indonesian adolescents with poor dietary intakes. There was relationship observed between intake of nutrients of concern (fibre) and cardiometabolic risk factor among this sample of obese adolescents. Future research should examine overall dietary patterns in more detail among this population to elucidate the role of poor diet intakes in development of cardiovascular disease risk factors in young people transitioning into adulthood.

The relationship between voluntary product (re) formulation commitments and changes in the nutritional quality of products offered by the top packaged food and beverage companies in Canada from 2013 to 2017.

BACKGROUND: Food companies shape Canada's food supply through voluntary actions and commitments concerning product (re)formulation; however, the extent that these initiatives translate into actual improvements in nutritional quality is unclear. This study examined changes in the nutritional quality of products offered by the top 22 packaged food and beverage companies in Canada from 2013 to 2017, in relation to the strength of their product (re) formulation actions and commitments. METHODS: The Food Company Reformulation (FCR) scoring tool was used to quantify the strength of companies' reported recent actions and commitments to reduce energy and nutrients of concern in their products, with higher scores signifying stronger voluntary actions/commitments. Nutritional information for products was sourced from the University of Toronto FLIP 2013 (n = 6490) and 2017 (n = 8277) databases (n = 4074 matched products). Changes in product healthfulness were assessed using the Health Star Rating (HSR) system (with higher HSRs denoting healthier products) and calories, sodium, saturated fat, trans fat, and total and free sugar levels per 100 g/mL. Generalized estimating equations examined changes in nutritional quality in relation to FCR scores. RESULTS: Overall, mean HSRs increased significantly for 5 companies' product portfolios and were reduced in 1 company's product portfolio. There were significant reductions in calories, sodium, saturated fat in 2 companies' portfolios and increases in 4, 3, and 8 companies' portfolios, respectively. Trans fats increased significantly in 2 companies' portfolios. Total and free sugars decreased significantly in 4 and 5 companies' portfolios, respectively, and increased in 1 company's portfolio. There was little change in the healthfulness of matched products. Higher FCR scores were not associated with greater increases in HSRs, or reductions in calories or nutrient amounts. FCR scores were negatively associated with HSRs and positively associated with total and free sugars. No relationship was observed between FCR scores and calories, sodium, saturated fat or trans fat. CONCLUSIONS: Reporting stronger voluntary product (re) formulation actions and commitments was not associated with greater improvements in the healthfulness of products offered by Canada's leading packaged food and beverage companies from 2013 to 2017, suggesting a need for stronger industry initiatives or mandatory government interventions to improve the healthfulness of the food supply.

Comparing how Canadian packaged food products align with the 2007 and 2019 versions of Canada's Food Guide.

In 2019, Canada's Food Guide (CFG) was updated from the 2007 version. This study developed a food-based nutrient profile model (NPM) to evaluate the alignment of packaged food and beverage products with CFG 2019 and compared it with CFG 2007. Packaged products from the University of Toronto's Food Label Information Program 2017 database were evaluated in terms of their alignment with CFG 2007 (using the Health Canada Surveillance Tool (HCST)) and CFG 2019 (using our newly developed CFG 2019 NPM). Agreement in alignment (e.g., products "in line" according to CFG 2019 NPM and in Tiers 1 or 2 according to the HCST) was calculated and differences in alignment and reasons for differences were quantified and described. Overall agreement in product alignment between CFG 2007 and 2019 was 81.9%, with fewer products aligned with CFG 2019: 16.4% vs. 31.8%, (χ2 = 189.12, p < 0.001). Differences in alignment varied across food categories (0.0-73.8%), explained by differences in CFG 2019, reflected in the CFG 2019 NPM (e.g., emphasis on avoiding processed foods, encouraging whole grains and low-fat dairy). This study presents a first step in assessing packaged foods' alignment with CFG 2019; future work is needed to evaluate broader dietary adherence to the updated recommendations. Novelty: A food-based nutrient profile model was developed based on the 2019 CFG and tested on packaged foods by comparing it with the nutrient-based HCST, based on CFG 2007. Most (82%) packaged products were "not in line" with either CFG version.

Are meal kits health promoting? Nutritional analysis of meals from an Australian meal kit service.

SUMMARY: Meal kits are popular for consumers seeking greater convenience in preparing meals at home. The market share for meal kit subscription services (MKSSs) is growing in developed nations including Australia, however, literature about their health promoting qualities, e.g. nutritional composition, is scarce. This study aimed to assess the characteristics and nutritional composition of meals offered from an MKSS over 12 months. Nutritional data were extracted from recipes available to order from HelloFresh in Australia from 1 July 2017 to 30 June 2018. In total, 346 (251 unique) recipes were retrieved. Per serve (median size 580 g), meals contained a median of 2840 kJ (678 kcal) of energy, 58 g carbohydrate (14 g sugar), 44 g protein, 28 g total fat (8 g saturated fat) and 839 mg sodium. Median energy from macronutrients was total fat (38%), carbohydrates (34%), protein (25%) and saturated fat (11%). This paper is the first to describe characteristics of recipes available from an MKSS over a 12-month period of time. With their growing popularity, meal kit delivery services have the capacity to influence consumer food behaviours, diets and subsequently population health. MKSSs may function to promote health though education, training, and enabling home cooking behaviours, and may be a powerful commitment device for home cooking behaviour change. However, it is important for health professionals, including dietitians and nutritionists, to understand the nutritional risks, benefits and suitability of this contemporary mealtime option before recommending them to clients and members of the public as part of health promotion. LAY SUMMARY: Meal kit delivery services are growing in popularity in developed countries, complementing busy lifestyles with pre-measured ingredients and recipe instructions delivered to the home. These meal kits have the ability to influence consumer diets and population health, and may support health promoting diet behaviours, e.g. eating vegetables, and enable home cooking. In this study, we reviewed a years' worth of recipes from a popular meal kit service. We report that a typical recipe contained approximately nine different ingredients, comprising three vegetables and required three ingredients from the home pantry. Meals took ∼35 min to prepare and were found to be relatively high in energy from fat and protein, and relatively low in energy from carbohydrates. The level of sodium varied widely and some meals exceeded the Australian Suggested Dietary Target for sodium (<2000 mg). Meal kit recipes were found to have health promoting qualities, frequently including vegetable ingredients, however, improvements to recipes would make these meal kits more health promoting. Current diet intakes and the nutritional composition of meal kits recipes should be reviewed before being recommended by health professionals.

Methodology for the Determination of Fruit, Vegetable, Nut and Legume Points for Food Supplies without Quantitative Ingredient Declarations and Its Application to a Large Canadian Packaged Food and Beverage Database.

Nutrient profiling (NP) models are useful tools for objectively and transparently quantifying the nutritional quality of packaged foods and beverages. Many NP models incorporate ingredients beneficial for health (e.g., fruits, vegetables, nuts, legumes (FVNL)) in addition to less healthful nutrients or components, assigning points based on the proportion of the product that contains FVNL ingredients. However, with food labelling in most countries lacking mandatory quantitative ingredient declarations (QUIDs), there is potential for the estimation of FVNL points to be ambiguous and inconsistent. The purpose of this article was to describe the development and application of methodology for estimating FVNL points for products without QUIDs, based on the position of FVNL components within the ingredients list. Using this method, FVNL points were calculated for packaged foods and beverages in the University of Toronto Food Label Information Program 2017 database (n = 17,337). Distributions of FVNL points were examined overall and by food category. This study provides evidence of the feasibility of this method in distinguishing between products with differing amounts of FVNL ingredients. This method will be valuable for researchers and policymakers in ensuring consistent, objective and reproducible estimations of FVNL points-and consequently, assessments of product healthfulness-for food supplies without QUIDs.

Cross-Sectional Analysis of Calories and Nutrients of Concern in Canadian Chain Restaurant Menu Items in 2016.

INTRODUCTION: The nutritional quality of restaurant foods in Canada is not monitored by government and limited research has evaluated the nutrient content of these foods. Given the increasing proportion of foods consumed outside the home, this study aims to assess levels of nutrients of public health concern in Canadian fast-food and sit-down restaurant menu items. METHODS: Levels of calories, saturated fat, sodium, and sugar of 10,285 menu items from 90 national chain restaurants in Canada were assessed. Data were collected in 2016, extracted and analyzed between 2018 and 2020, and presented overall and by category. Levels in fast-food and sit-down restaurant establishments were compared. RESULTS: Overall mean levels of saturated fat, sodium, and sugar were high. Entrées contained on average 52% of the total daily value for sodium (1,256 mg/serving) and 45% of the daily value for saturated fat (8.9 g/serving). Beverages and desserts had high levels of total sugar (mean=44 g and 32 g/serving, respectively) but tended to be low in sodium. Sit-down restaurant items had significantly (p≤0.0001) higher levels of calories, saturated fat, and sodium overall, although fast-food restaurant items had higher average sugar levels because of the higher number of beverage and dessert items. CONCLUSIONS: Levels of nutrients of concern in Canadian menu items are excessive among most food categories. As the frequency of eating out in restaurants rises, government policies to promote reformulation and increase transparency of the nutritional content of these items are required to reduce their negative impact on public health.

A comparison of the nutritional quality of products offered by the top packaged food and beverage companies in Canada.

BACKGROUND: Canada's food supply is abundant in less healthy products, increasing Canadians' risk of obesity and non-communicable diseases. Food companies strongly influence the food supply; however, no studies have examined differences in the healthfulness of products offered by various companies in Canada. This study aimed to compare the nutritional quality of products offered by the top packaged food and beverage companies in Canada. METHODS: Twenty-two top packaged food and beverage manufacturing companies were selected, representing > 50% of the Canadian market share in 2018. Nutritional information for products (n = 8277) was sourced from the University of Toronto Food Label Information Program 2017 database. Descriptive analyses examined the nutritional quality of products based on: 1) the Health Star Rating (HSR) system; 2) calories, sodium, saturated fat and total sugars per 100 g (or mL) and per reference amounts (RAs) defined by Health Canada; and 3) "high in" thresholds for sodium, saturated fat and total sugars proposed by Health Canada for pending front-of-package labelling regulations. Kruskal-Wallis tests compared HSRs of products between companies. RESULTS: Mean HSRs of companies' total product offerings ranged from 1.9 to 3.6 (out of 5.0). Differences in HSRs of products between companies were significant overall and for 19 of 22 food categories (P < 0.05), particularly for fats/oils and beverages. Calories, sodium, saturated fat and total sugars contents varied widely between companies for several food categories, and depending on whether they were examined per 100 g (or mL) or RA. Additionally, 66.4% of all products exceeded ≥1 of Health Canada's "high in" thresholds for sodium (31.7%), saturated fat (28.3%) and/or sugars (28.4%). The proportion of products offered by a company that exceeded at least one of these thresholds ranged from 38.5 to 97.5%. CONCLUSIONS: The nutritional quality of products offered by leading packaged food and beverage manufacturers in Canada differs significantly overall and by food category, with many products considered less healthy according to multiple nutrient profiling methods. Variation within food categories illustrates the need and potential for companies to improve the healthfulness of their products. Identifying companies that offer less healthy products compared with others in Canada may help prompt reformulation.

Orthorexia nervosa: examining the Eating Habits Questionnaire's reliability and validity, and its links to dietary adequacy among adult women.

OBJECTIVE: There has been increasing interest in identifying individuals with pathological healthy eating behaviours, or orthorexia nervosa (ON). This study aimed to investigate the validity (construct- and criterion-related) and reliability (internal consistency) of the Eating Habits Questionnaire (EHQ) as a measure of ON. A secondary aim was to examine how the EHQ would predict a distinct feature of ON, adequate dietary intake. DESIGN: Cross-sectional online questionnaire incorporating existing measures of ON and dietary intake. SETTING: Participants were recruited online via social media and a university's research webpage. PARTICIPANTS: Women (n 286) ranging in age from 17 to 73 years. RESULTS: Exploratory factor analysis established that the EHQ represented four ON dimensions (Healthy Eating Cognitions, Dietary Restriction, Diet Superiority and Social Impairment), inconsistent with the scale's original three dimensions (Problems, Knowledge and Feelings). Cronbach's α coefficients ranged from 0·72 to 0·80 for the four subscales and was 0·89 for the total EHQ scale. Criterion-related validity revealed a significant moderate to strong correlation (r = -0·54, P < 0·001) between the EHQ and ORTO-10 (a ten-item version of ORTO-15). The EHQ, particularly the EHQ-Diet superiority subscale, was found to be predictive of better, as opposed to, poorer dietary adequacy. CONCLUSIONS: Findings suggest that improvements still need to be made to the EHQ for it to be a valid and reliable measure of ON. Ideally, new assessment tools based on established diagnostic criteria are needed to advance our understanding of ON.

The relationship between food label use and dietary intake in adults: A systematic review.

Poor diet, resulting from high intake of ultra-processed packaged foods, is increasingly recognised as a key contributing factor to ill health. Food labels provide information on the nutritional content of packaged foods to consumers, which may influence consumption of nutrients such as energy, fat, saturated fat, trans-fats, sodium and added sugars. This review aims to summarise the current evidence for the association between use of food labels and dietary intake. The systematic search was conducted in August 2017 using six databases, with 6325 results. Twenty-six studies were included, including cross-sectional studies (n = 20), a cohort study (n = 1) and randomised controlled trials (n = 5). Studies were assessed using the American Dietetic Association Quality Criteria Checklist. Results were inconsistent in reporting a relationship between diet and food label use but indicated that reading the nutrition facts label is associated with healthier diets, measured by food frequency questionnaires and 24 h recalls. However, there is insufficient research on the association between dietary consumption and use of ingredients lists, serving size information and front-of-pack labels. Using health-related claims may be associated with poor diets, however evidence is inconclusive. Apart from health-related claims, using food labels is associated with healthier diets and should continue to be promoted through policies and education programs. Further research in this area is warranted to provide additional information on the impact of ingredients lists, serving sizes, front-of-pack labels and health-related claims on dietary intake.

Are Clean Eating Blogs a Source of Healthy Recipes? A Comparative Study of the Nutrient Composition of Foods with and without Clean Eating Claims.

Food blogs are an increasingly popular source of information about food and nutrition. There is a perception that foods published on clean eating blogs, which promote unprocessed foods, are healthier than comparable foods without these claims. However, foods with these claims and their nutrient composition have not previously been evaluated. The purpose of the study was to describe the nutritional content of clean eating recipes compared to recipes without clean eating claims and the nutritional guidelines published by the World Health Organisation (WHO). Clean eating recipes were systematically selected from 13 popular clean eating blogs and were described and compared with control recipes without clean eating claims. The nutrient profiles from the included recipes were summarised and evaluated against criteria from WHO recommendations for chronic disease prevention and criteria from the U.K. Food Standards Agency. Data for 86 clean eating recipes were extracted that represented five food categories: breakfast, snacks, treats, desserts, and smoothies. These were matched with 86 control recipes without clean eating claims. The clean eating recipes, per portion, provide the equivalent of 15% of daily energy intake. The average serving sizes were not significantly different between clean eating and control recipes. Overall, the clean eating recipes contained significantly more protein (8.1 ± 7.3 g vs. 5.7 ± 4.1 g, p = 0.01), fat (15.8 ± 10.6 g vs. 12.4 ± 9.3 g, p = 0.03), and fibre (5.0 ± 4.3 g vs. 2.8 ± 2.9 g, p < 0.01) per serving than control recipes. There were no significant differences between clean eating and control recipes with respect to the energy (1280 ± 714 kJ vs. 1137 ± 600 kJ, p = 0.16), carbohydrate (31.5 ± 27.3 g vs. 33.9 ± 19.4 g, p = 0.51), sugar (21.1 ± 20.9 g vs. 23.2 ± 14.9 g, p = 0.46), and sodium content (196.7 ± 269 vs. 155.8 ± 160.8, p = 0.23). Less than 10% of clean eating and control recipes met the WHO constraints for proportions of energy from fat and sugar intake. A simulated nutrient profile of an average clean and control recipe shows that nutrients for both are similarly classified as moderate to high in fat, saturated fat, salt, and sugar. Foods with clean eating claims contained the same amount of energy, sugar, and sodium as foods without those claims. Clean eating claims are potentially misleading for consumers who may believe these foods are healthy alternatives, potentially undermining people's efforts to eat a healthy diet.

The Dirt on Clean Eating: A Cross Sectional Analysis of Dietary Intake, Restrained Eating and Opinions about Clean Eating among Women.

Clean eating is understood in broad terms to be an approach to eating which promotes the exclusion of processed foods. Social media and websites which promote clean eating are becoming increasingly popular as sources of nutrition information. Currently, there is a lack of knowledge regarding women's opinions about clean eating sites and their influence on eating behaviour. The aim of the present study was to investigate differences in dietary intake, dietary restraint and opinions about clean eating between women who had, and women who had never adhered to dietary advice from clean eating sites. Using a cross-sectional survey design, women (n = 762) ranging in age from 17⁻55 completed a self-report questionnaire on eating behaviour and beliefs about clean eating. Findings showed that 25.5% of the sample adhered to dietary advice from a clean eating site sometimes, often or very often. A significantly higher proportion of women who had adhered to dietary advice from clean eating sites met dietary guidelines for the consumption of fruit, meats and alternatives compared to women who had seldom or never adhered. Adherers also had significantly higher levels of restrained eating and were more positive about clean eating in general in comparison to those who seldom or never adhered. Results provide new information about exposure to clean eating sites and how they may influence women's eating practices. These preliminary findings suggest additional studies are required to better understand the influence of clean eating sites, particularly with regard to whether the information on such sites are from reputable sources and to what degree their recommendations may be problematic for individuals with eating concerns.

Comparison of nutrient profiling models for assessing the nutritional quality of foods: a validation study.

Nutrient profiling (NP) is a method for evaluating the healthfulness of foods. Although many NP models exist, most have not been validated. This study aimed to examine the content and construct/convergent validity of five models from different regions: Australia/New Zealand (FSANZ), France (Nutri-Score), Canada (HCST), Europe (EURO) and Americas (PAHO). Using data from the 2013 UofT Food Label Information Program (n15342 foods/beverages), construct/convergent validity was assessed by comparing the classifications of foods determined by each model to a previously validated model, which served as the reference (Ofcom). The parameters assessed included associations (Cochran-Armitage trend test), agreement (κ statistic) and discordant classifications (McNemar's test). Analyses were conducted across all foods and by food category. On the basis of the nutrients/components considered by each model, all models exhibited moderate content validity. Although positive associations were observed between each model and Ofcom (all P trend<0·001), agreement with Ofcom was 'near perfect' for FSANZ (κ=0·89) and Nutri-Score (κ=0·83), 'moderate' for EURO (κ=0·54) and 'fair' for PAHO (κ=0·28) and HCST (κ=0·26). There were discordant classifications with Ofcom for 5·3 % (FSANZ), 8·3 % (Nutri-Score), 22·0 % (EURO), 33·4 % (PAHO) and 37·0 % (HCST) of foods (all P<0·001). Construct/convergent validity was confirmed between FSANZ and Nutri-Score v. Ofcom, and to a lesser extent between EURO v. Ofcom. Numerous incongruencies with Ofcom were identified for HCST and PAHO, which highlights the importance of examining classifications across food categories, the level at which differences between models become apparent. These results may be informative for regulators seeking to adapt and validate existing models for use in country-specific applications.

Eating occasions and the contribution of foods to sodium and potassium intakes in adults.

OBJECTIVE: To examine dietary Na and K intake at eating occasions in Australian adults and identify the contribution of major food sources to Na and K at different eating occasions. DESIGN: Secondary analysis of 24 h recall diet data from the Australian Health Survey (2011-2013). SETTING: Nationally representative survey in Australia. SUBJECTS: Male and female Australians aged 18-84 years (n 7818). RESULTS: Dinner contributed the greatest proportion to total daily Na intake (33 %) and K intake (35 %). Na density was highest at lunch (380 mg/MJ) and K density highest at between-meal time eating occasions (401 mg/MJ). Between-meal time eating occasions provided 20 % of daily Na intake and 26 % of daily K intake. The major food group sources of Na were different at meal times (breads and mixed dishes) compared with between-meal times (cakes, muffins, scones, cake-type desserts). The top food group sources of K at meal times were potatoes and unprocessed meat products and dishes. CONCLUSIONS: Foods which contributed to Na and K intake differed according to eating occasion. Major food sources of Na were bread and processed foods. Major food sources of K were potatoes and meat products and dishes. Public health messages that emphasise meal-based advice and diet patterns high in vegetables, fruits and unprocessed foods may also aid reduction in dietary Na intake and increase in dietary K intake.

Does the presence of cardiovascular disease risk factors or established disease influence the dietary intake of affected adults and their children residing in the same household? A secondary analysis of the Australian Health Survey (2011-2013).

BACKGROUND: Diet is an important contributor to risk of cardiovascular disease (CVD) and integral in management and delaying progression. Little is known however about whether increased CVD risk or established CVD has any influence on dietary intakes of Australian adults or children residing in the same household. This study aimed to determine whether the presence of CVD or CVD risk factors influences dietary intake of Australian adults and if the presence of an adult with increased CVD risk influences the dietary intake of a child living in the same household. METHODS: Data were sourced from the 2011-2013 Australian Health Survey for: (1) adults ≥18 years with risk factors or established CVD and (2) children 2-17 years residing in the same household as adults with CVD risk factors or established CVD. Selected nutrient intakes (total fat, saturated fat plus trans fat, alpha-linolenic acid, total long chain omega 3 fatty acids, fibre and sodium) collected by repeated 24 h recalls were compared to national dietary recommendations and to the intakes of all other adults and children surveyed. Standard errors of the estimates were calculated using the replicate weights method, and an alpha value of <0.05 considered statistically significant. RESULTS: Six thousand two hundred sixty five of 9435 adults surveyed were identified as having CVD risk factors or established disease and of these 1609 had a child in the same household that also contributed data in this survey. No differences were observed in adjusted mean dietary intakes between those without risk factors or established CVD and those with, except for total energy and sodium which were significantly lower in the adults with CVD risk factors and/or established disease. However sodium intakes across both groups were higher than recommended targets. There were no differences for selected nutrients between children residing with affected adults and other children surveyed. CONCLUSIONS: While intakes of Australian adults with CVD risk factors or established disease were favourable for sodium, compared to unaffected adults, there is still scope for improvement as many Australian adults, despite CVD risk, are unable to achieve targets for selected nutrients. Effective dietary behaviour change strategies and resources are urgently needed.

The effect of dietary sodium modification on blood pressure in adults with systolic blood pressure less than 140 mmHg: a systematic review.

BACKGROUND: Modifying dietary sodium intake is a cornerstone of diet advice for lowering blood pressure (BP) under the assumption that it is protective against cardiovascular disease. Previous meta-analyses of normotensive participants have not excluded all studies that recruited participants with systolic blood pressure (SBP) > 140 mmHg, which greatly hinders generalization to the wider normotensive population. OBJECTIVES: The objective of this review was to identify the effectiveness of reducing or increasing sodium intake on BP in normotensive participants with SBP ≤ 140 mmHg. INCLUSION CRITERIA TYPES OF PARTICIPANTS: This review considered studies on adult participants (≥18 years) with SBP ≤ 140 mmHg. Studies on pregnant women or patients prescribed antihypertensive or vasoactive medications were excluded. TYPES OF INTERVENTIONS: Interventions that quantitatively evaluated dietary sodium intake for equal to or greater than four weeks duration were considered. Only studies that included two study arms comprising different levels of sodium intake were included. TYPES OF OUTCOMES: Studies that reported SBP, diastolic blood pressure (DBP), pulse wave velocity (PWV), pulse wave analysis or flow mediated dilatation were considered. TYPES OF STUDIES: Experimental study designs including randomized controlled trials and non-randomized controlled trials were considered. SEARCH STRATEGY: An initial search strategy was conducted on databases MEDLINE and CINAHL before an extensive search of all relevant published and gray literature databases, and clinical trial registries were searched. METHODOLOGICAL QUALITY: Potential papers were assessed for methodological validity using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION: Quantitative data were extracted from papers using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS: Quantitative data were pooled in statistical meta-analysis. Effect sizes were expressed as weighted mean differences and 95% confidence intervals. Meta-analysis was conducted using a random-effect model, and heterogeneity assessed statistically using the standard Chi-square test and the I index. A priori sub-group analysis was undertaken on studies achieving ≥40 mmol versus <40 mmol in urinary sodium excretion and post hoc on studies with a mean body mass index (BMI) ≥ 30 versus less than 30. RESULTS: Five trials were included with a total of 1214 participants. The overall reduction in SBP was -0.71 mmHg (95% CI: -2.62, 1.20, P = 0.47) and DBP -0.57 mmHg (95% CI: -1.26, 0.12, P = 0.10). There was no significant change in PWV following reduction of dietary sodium over a four to six-week period. Sub-group analysis did not find a significant effect of urinary sodium excretion or BMI on outcomes; however, a trend toward a greater reduction in BP was observed in those with a higher BMI (MD -2.41, 95% CI -5.72, +0.91, P = 0.16). CONCLUSION: Blood pressure in normotensive participants was not significantly affected by sodium modification and was controlled to within 1% of baseline values. Reducing dietary sodium in normotensive participants may still be of importance for cardiovascular risk management; however, good quality interventional research is limited.

Dietary intake of working women with children does not appear to be influenced by hours of employment: A secondary analysis of the Australian Health Survey (2011-2013).

UNLABELLED: Women with children often fulfil multiple roles of running a household, raising a family and working outside the home. Good nutrition during this time is important to optimise their performance and prevent lifestyle diseases. Women also act as nutritional gatekeepers for their family. The dual burden of paid employment and unpaid family work may be associated with time scarcity in mothers which can impact food preparation and therefore nutritional adequacy. The aim of this study was to examine the diet of women who lived with children by comparison of hours worked. METHODS: This was a secondary analysis of the Australian National Nutrition and Physical Activity Survey 2011-12. Subjects were women aged 18-65 years who resided with ≥1 child (<18 years). Women were grouped according to hours of employment: not working; working <25 h a week; and working ≥25 hours a week. Data from two 24-h dietary recalls were used to compare differences between groups in nutrient intake and proportion of energy from discretionary foods. Covariates included were age, education, smoker status, Socio-Economic Indexes for Areas (SEIFA), number of persons in household, week or weekend day of the survey and the sequence of recalls. RESULTS: Analyses included 1869 women. Dietary intakes varied minimally between groups with intakes of fibre, vitamin C, and calcium lowest in the group not working. Overall diet quality was poor with >30% of energy coming from discretionary foods in all groups. CONCLUSIONS: Usual hours of employment per week have a minimal effect on diet quality in women with children. It is likely that different factors specific to each group contribute to the poor dietary intakes and should be further investigated.

Alcoholic beverage intake throughout the week and contribution to dietary energy intake in Australian adults.

OBJECTIVE: To assess alcoholic beverage intake among Australian adults and its contribution to dietary energy intake. DESIGN: Secondary analysis of a national dietary survey using 24 h dietary recall. SETTING: Australian National Nutrition and Physical Activity Survey (NNPAS) conducted from May 2011 to June 2012. SUBJECTS: Adults (n 9341) aged 19 years and over. RESULTS: On the day preceding the survey, 32·8% of Australian adults consumed one or more alcoholic drinks. The median contribution to total energy intake for consumers did not differ significantly between males and females (13·7% and 12·9%, respectively; P=0·10). The prevalence of consumption of alcoholic drinks on Friday, Saturday and Sunday was 38·8 (95% CI 37·1, 40·5)%, higher than the other days (28·6 (95% CI 27·5, 29·8)%). Consumers had a median daily intake of 4·0 standard drinks on the weekend compared with 3·0 standard drinks during the week (P<0·001). Beer was the most commonly consumed alcoholic beverage for men and white wine for women. The highest prevalence of alcoholic beverage intake occurred in the highest quintile of adjusted household income (42·7 (95% CI 40·4, 45·0)%) and the 'overweight' BMI category (40·3 (95% CI 38·5, 42·0)%). Alcoholic beverage intake among consumers was significantly different by household income quintile (median 3·84 (highest) v. 3·05 standard drinks (lowest); P<0·05) and by waist circumference category (median 4·09 standard drinks (highest)). CONCLUSIONS: Alcoholic drinks contribute substantially to the dietary energy intake of Australian adults. The type and pattern of consumption of alcoholic beverage intake should be considered in the development of strategies to improve dietary intake.