Burden and trend of diet-related non-communicable diseases in Australia and comparison with 34 OECD countries, 1990-2015: findings from the Global Burden of Disease Study 2015.

BACKGROUND: Diet is a major determining factor for many non-communicable chronic diseases (NCDs). However, evidence on diet-related NCD burden remains limited. We assessed the trends in diet-related NCDs in Australia from 1990 to 2015 and compared the results with other countries of the Organization for Economic Co-operation and Development (OECD). METHODS: We used data and methods from the Global Burden of Disease (GBD) 2015 study to estimate the NCD mortality and disability-adjusted life years (DALYs) attributable to 14 dietary risk factors in Australia and 34 OECD nations. Countries were further ranked from the lowest (first) to highest (35th) burden using an age-standardized population attributable fraction (PAF). RESULTS: In 2015, the estimated number of deaths attributable to dietary risks was 29,414 deaths [95% uncertainty interval (UI) 24,697 - 34,058 or 19.7% of NCD deaths] and 443,385 DALYs (95% UI 377,680-511,388 or 9.5% of NCD DALYs) in Australia. Young (25-49 years) and middle-age (50-69 years) male adults had a higher PAF of diet-related NCD deaths and DALYs than their female counterparts. Diets low in fruits, vegetables, nuts and seeds and whole grains, but high in sodium, were the major contributors to both NCD deaths and DALYs. Overall, 42.3% of cardiovascular deaths were attributable to dietary risk factors. The age-standardized PAF of diet-related NCD mortality and DALYs decreased over the study period by 28.2% (from 27.0% in 1990 to 19.4% in 2015) and 41.0% (from 14.3% in 1990 to 8.4% in 2015), respectively. In 2015, Australia ranked 12th of 35 examined countries in diet-related mortality. A small improvement of rank was recorded compared to the previous 25 years. CONCLUSIONS: Despite a reduction in diet-related NCD burden over 25 years, dietary risks are still the major contributors to a high burden of NCDs in Australia. Interventions targeting NCDs should focus on dietary behaviours of individuals and population groups.

Association between dietary zinc intake and mortality among Chinese adults: findings from 10-year follow-up in the Jiangsu Nutrition Study.

PURPOSE: Population studies of the association between zinc intake and mortality yield inconsistent findings. Using data from Jiangsu Nutrition Study, we aimed to assess the association between zinc intake and mortality among Chinese adults. METHODS: We prospectively studied 2832 adults aged 20 years and older with a mean follow-up of 9.8 years. At baseline, food intake was measured by 3-day weighed food record (WFR) between September and December in 2002. Death occurrence was assessed in 2012 during a household visit as well as by data linkage with the regional death registry. Hazard ratios (HRs) and 95% CI were calculated using competing risks regression (CVD and cancer mortality) and Cox proportional hazards analysis (all-cause mortality). RESULTS: During 27,742 person-years of follow-up, there were 184 deaths [63 cancer deaths and 70 cardiovascular disease (CVD) deaths]. Dietary zinc to energy ratio was positively associated with cancer and all-cause mortality. Across quartiles of the zinc to energy ratio from low to high, the HR (95% CI) for all-cause mortality was 1.00, 1.80 (95% CI 1.10-2.95), 1.55 (95% CI 0.96-2.50), and 1.85 (95% CI 1.11-3.07), respectively. Comparing the extreme quartiles of the zinc to energy ratio, the HR for cancer mortality was 2.28 (95% CI 1.03-5.04). CONCLUSION: Zinc intake was positively related to all-cause mortality and cancer mortality.

Meal-specific food patterns and the incidence of hyperglycemia in a Chinese adult population.

This study aimed to examine the association between meal-specific food patterns and incident hyperglycaemia in a Chinese adult population. Adults aged 20 years and older (n 1056) were followed from 2002 to 2007. Dietary data were collected using a 3-d food record and meal-specific (breakfast, lunch and dinner) food patterns were independently described by factor analysis based on the consumption of thirty-five food groups at each eating occasion. Each food pattern score was recoded as quartiles. Hyperglycaemia was defined as fasting plasma glucose >5·6 mmol/l at baseline and follow-up. The associated between food patterns and incident hyperglycaemia was assessed by logistic regression. During the follow-up, 125 new cases of hyperglycaemia were identified. Traditional (wheat) breakfast was inversely associated with incident hyperglycaemia, whereas traditional (rice, vegetable and pork) lunch and dinner were positively associated with the risk of incident hyperglycaemia, even after adjustment for a number of covariates including glycaemic load, carbohydrate intake and BMI. Incident hyperglycaemia occurred in 15·9, 13·6, 11·7, 6·1 % across quartiles of traditional breakfast; and 5·3, 9·1, 15·9, 17·1 % of the quartiles of traditional lunch pattern. The adjusted OR for hyperglycaemia was 0·67 (95 % CI 0·48, 0·92), 1·83 (95 % CI 1·32, 2·53) and 1·39 (95 % CI 1·04, 1·86) for 1 sd increase of traditional breakfast, lunch and dinner pattern factor score, respectively. A traditional wheat-based breakfast is associated with a decreased risk of hyperglycaemia. A rice-based traditional lunch and dinner is associated with an increased risk of hyperglycaemia in Chinese adults.

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.

Oh So Sweet: A Comparative Investigation of Retail Market Composition of Sweetened and Flavoured Beverages in Singapore and Australia.

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

Nutrient composition of milk and plant-based milk alternatives: A cross-sectional study of products sold in Australia and Singapore.

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

Dairy food intake of Australian children and adolescents 2-16 years of age: 2007 Australian National Children's Nutrition and Physical Activity Survey.

OBJECTIVE: Dairy food consumption is important for Australian children as it contributes key nutrients such as protein and Ca. The aim of the present paper is to describe dietary intake from dairy foods for Australian children aged 2-16 years in 2007. DESIGN: Secondary analysis of a quota-sampled survey using population-weighted, 1 d (24 h) dietary recall data. SETTING: Australian national survey conducted from February to August 2007. SUBJECTS: Children (n 4487) aged 2-16 years. RESULTS: Most Australian children consumed dairy foods (84-98 %), with the proportion consuming tending to decrease with age and males consuming significantly more than females from the age of 4 years. Milk was the most commonly consumed dairy food (58-88 %) and consumed in the greatest amount (243-384 g/d). Most children consumed regular-fat dairy products. The contribution of dairy foods to total energy intake decreased with age; from 22 % of total energy at age 2-3 years to 11 % at age 14-16 years. This trend was similar for all nutrients analysed. Dairy food intake peaked between 06.00 and 10.00 hours (typical breakfast hours) corresponding with the peak in dairy Ca intake. Australian children (older than 4 years) did not reach recommendations for dairy food intake, consuming ≤2 servings/d. CONCLUSIONS: The under-consumption of dairy foods by Australian children has important implications for intake of key nutrients and should be addressed by multiple strategies.

An extended theory of planned behavior intervention for older adults with type 2 diabetes and cardiovascular disease.

A randomized controlled trial evaluated the effectiveness of a 4-wk extended theory of planned behavior (TPB) intervention to promote regular physical activity and healthy eating among older adults diagnosed with Type 2 diabetes or cardiovascular disease (N = 183). Participants completed TPB measures of attitude, subjective norm, perceived behavioral control, and intention, as well as planning and behavior, at preintervention and 1 wk and 6 wk postintervention for each behavior. No significant time-by-condition effects emerged for healthy eating. For physical activity, significant time-by-condition effects were found for behavior, intention, planning, perceived behavioral control, and subjective norm. In particular, compared with control participants, the intervention group showed short-term improvements in physical activity and planning, with further analyses indicating that the effect of the intervention on behavior was mediated by planning. The results indicate that TPB-based interventions including planning strategies may encourage physical activity among older people with diabetes and cardiovascular disease.

Beverage Intake and Associated Nutrient Contribution for Aboriginal and Torres Strait Islander Australians: Secondary Analysis of a National Dietary Survey 2012-2013.

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

Environmental sustainability in national food-based dietary guidelines: a global review.

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

Growth of Ready Meals in Australian Supermarkets: Nutrient Composition, Price and Serving Size.

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

Adults with and without type 1 diabetes have similar energy and macronutrient intakes: an analysis from the Australian Health Survey 2011-2013.

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

Drink Choice is Important: Beverages Make a Substantial Contribution to Energy, Sugar, Calcium and Vitamin C Intake among Australians.

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

Reply to "Comments on the Editor Re: Shi, Zumin, et al. High Chili Intake and Cognitive Function among 4582 Adults: An Open Cohort Study over 15 Years. Nutrients 11.5 (2019): 1183."

We would like to thank Drs [...].

High Chili Intake and Cognitive Function among 4582 Adults: An Open Cohort Study over 15 Years.

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

Chilli intake is inversely associated with hypertension among adults.

BACKGROUND & AIMS: This study aimed to examine the association between chilli intake and the incidence of hypertension in a Chinese adult population. METHODS: Adults aged 20-75 years in the China Health and Nutrition Survey were followed from 1991 to 2011. Dietary data were collected during home visits using a 3-day food record in 1991, 1993, 1997, 2000, 2004, 2006, 2009 and 2011. Cox regression was used in the analysis. Blood pressure was measured at each data collection point. RESULTS: 13,670 adults were followed for a median of 9.0 years. During 132,089 person years of follow-up 4040 subjects developed hypertension. Chilli consumption was inversely associated with the incidence of hypertension. The incidence rate of hypertension was 30.5, 33.4, 31.9, and 24.0 per 1000 person years among those who consumed no chilli or 1-20, 20.1-50, ≥50.1 g/day respectively. Adjusting for age, gender, energy intake, sodium and fat intake, smoking, alcohol consumption and physical activity, those with increasing cumulative average chilli intake were less likely to develop hypertension: 0, 1-20, 20.1-50 and ≥50.1 g/day had a hazard ratio (HR) for hypertension of 1.00, 0.80 (95%CI 0.73-0.88), 0.81 (0.73-0.89) and 0.65 (0.57-0.75) (p for trend <0.001) respectively. The association was independent of overall dietary patterns and BMI. There was no significant interaction between chilli intake and gender, income, education and residence (urban/rural) in relation to the risk of hypertension. CONCLUSIONS: Chilli intake is inversely associated with the risk of developing hypertension in Chinese adults.

Differential Impact of Malnutrition on Health Outcomes Among Indigenous and Non-Indigenous Adults Admitted to Hospital in Regional Australia-A Prospective Cohort Study.

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

Association between dietary patterns, cadmium intake and chronic kidney disease among adults.

BACKGROUND & AIMS: Almost one in ten Chinese adults has chronic kidney disease (CKD). However, the link between dietary patterns, dietary cadmium intake and CKD has not been studied in China. METHOD: Adults (n = 8429) in the China Health and Nutrition Survey who had at least one 3-day 24 h food record in combination with household food inventory in 1991, 1993, 1997, 2000, 2004, 2006, and 2009 and estimated glomerular filtration rate (eGFR) measured in 2009. Dietary pattern was identified using factor analysis. CKD was defined as eGFR <60 mL/min/1.73 m2. RESULTS: There were 641 (7.6%) cases of CKD in the sample. After adjustment for demographic, lifestyle factors (i.e. smoking, alcohol drinking, physical activity) and chronic conditions, the odds ratio (OR) for CKD was 4.05 (95%CI 2.91-5.63, p for trend <0.001) for extreme quartiles of estimated cumulative cadmium intake. A traditional southern dietary pattern (high intake of rice, pork, and vegetables, and low intake of wheat) was associated with more than four times increased prevalence of CKD (comparing extreme quartiles, OR 4.56, 95%CI 3.18-6.56). A modern dietary pattern (high intake of fruit, soy milk, egg, milk and deep fried products) was inversely associated with CKD (for extreme quartiles, OR 0.5, 95%CI 0.36-0.71). The association between dietary patterns and CKD were attenuated by cadmium intake. CONCLUSION: Traditional southern dietary pattern is positively associated, and modern dietary pattern is inversely associated, with CKD among Chinese adults. However, these associations can be partly attributed to cadmium contamination in parts of the food supply.

The burden and nature of malnutrition among patients in regional hospital settings: A cross-sectional survey.

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

Individualized Fracture Risk Feedback and Long-term Benefits After 10 Years.

INTRODUCTION: This study aimed to determine if beneficial effects of individualized feedback of fracture risk on osteoporosis preventive behaviors and bone mineral density observed in a 2-year trial were sustained long-term. METHODS: This was a 10-year follow-up of a 2-year RCT in 470 premenopausal women aged 25-44 years, who were randomized to one of two educational interventions (the Osteoporosis Prevention and Self-Management Course [OPSMC] or an osteoporosis information leaflet) and received tailored feedback of their relative risk of fracture in later life (high versus normal risk groups). Bone mineral density of lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. Physical activity, dietary calcium intake, calcium and vitamin D supplements, and smoking status were measured by questionnaires. RESULTS: From 2 to 12 years, the high-risk group had a smaller decrease in femoral neck bone mineral density (ß=0.023, 95% CI=0.005, 0.041 g/cm2) but similar lumbar spine bone mineral density change as the normal-risk group. They were more likely to use calcium (relative risk=1.66, 95% CI=1.22, 2.24) and vitamin D supplements (1.99, 95% CI=1.27, 3.11). The OPSMC had no effects on bone mineral density change. Both high-risk (versus normal-risk) and the OPSMC groups (versus leaflet) had a more favorable pattern of smoking behavior change (relative risk=1.85, 95% CI=0.70, 4.89 and relative risk=2.27, 95% CI=0.86, 6.01 for smoking cessation; relative risk=0.33, 95% CI=0.13, 0.80 and relative risk=0.28, 95% CI=0.10, 0.79 for commenced or persistent smoking). CONCLUSIONS: Feedback of high fracture risk to younger women was associated with long-term improvements in osteoporosis preventive behaviors and attenuated femoral neck bone mineral density loss. Therefore, this could be considered as a strategy to prevent osteoporosis. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) NCT00273260.