Indonesian antenatal nutrition education: A qualitative study of healthcare professional views.

BACKGROUND: Early lifestyle intervention, including antenatal nutrition education, is required to reduce the triple burden of malnutrition. Understanding healthcare professionals' views and experiences is essential for improving future nutrition education programmes for Indonesian pregnant women. This study aimed to investigate the views of Indonesian antenatal healthcare professionals regarding nutrition education for pregnant women and the improvements required to provide more effective antenatal nutrition education. METHODS: A descriptive qualitative study involved semi-structured interviews was conducted with 24 healthcare professionals, including nutritionists (n = 10), midwives (n = 9) and obstetricians (n = 5) in Malang, Indonesia, between December 2018 and January 2019. Data were analysed using thematic analysis. RESULTS: The study identified four main themes. First, healthcare professionals were aware of the importance of providing antenatal nutrition education, which included supporting its targeted delivery. Second, there were differing views on who should provide nutrition education. Most midwives and obstetricians viewed nutritionists as the prime nutrition education provider. Nutritionists were confident in their capability to provide nutrition education. However, some nutritionists reported that only a few women visited primary health centres and received nutrition counselling via this pathway. Third, healthcare professionals revealed some barriers in providing education for women. These barriers included a limited number of nutritionists, lack of consistent guidelines, lack of healthcare professionals' nutrition knowledge and lack of time during antenatal care services. Fourth, participants expressed the need to strengthen some system elements, including reinforcing collaboration, developing guidelines, and enhancing capacity building to improve future antenatal nutrition education. CONCLUSIONS: Healthcare professionals play a central role in the provision of antenatal nutrition education. This study highlighted the importance of educational models that incorporate various antenatal nutrition education delivery strategies. These methods include maximizing referral systems and optimizing education through multiple delivery methods, from digital modes to traditional face-to-face nutrition education in pregnancy classes and community-based health services.

Examining the correlates of meal skipping in Australian young adults.

BACKGROUND: Meal skipping is associated with diet-related chronic disease risk and is highly prevalent in young adults. Despite this, the correlates of meal skipping in this population group are unknown. Therefore, the aim of this study was to examine the prevalence and correlates of meal skipping in young adults. METHODS: Young adults aged 18-30 years (n = 578) (24% male, 76% female) used 'FoodNow', a purpose designed real-time smartphone application to record food and beverage consumption over four non-consecutive days. The day following each reporting day, participants were asked about their previous day's eating occasions; if any eating occasions were not reported or if any were skipped. These data were used to categorise participants into specific meal skippers (breakfast, lunch and/or dinner skipper). Participants also completed an online questionnaire, which contained measures of correlates from the social-ecological framework across the individual, social-environmental and physical-environment domains. Logistic regression analyses were used to examine associations between specific meal skipping behaviours and measured correlates. RESULTS: Individual domain correlates (education status, smoking status and time scarcity) were associated with varying meal skipping behaviours, while no correlates from the social-environmental or physical-environmental domains of the social-ecological framework were associated with any meal skipping behaviours. Participants with a university education were less likely to be a meal skipper (any meal) (OR = 0.46; 95%CI: 0.22, 0.95; p = 0.035), while those who previously or currently smoked cigarettes were more likely to be breakfast skippers (OR = 1.10; 95%CI: 1.15, 3.86; p = 0.016) compared to those who had never smoked before. Those who are time scarce were more likely to be either breakfast (OR = 1.12; 95%CI: 1.00, 1.26; p = 0.036) or lunch skippers (OR = 1.11; 95% CI: 1.01, 1.23; p = 0.033). No variables were significantly associated with dinner skipping. CONCLUSIONS: The findings suggest that the correlates of meal skipping vary according to the specific meal skipped. University education status needs to be considered when designing interventions aimed at the reduction of meal skipping among young adults, while correlates such as time management and smoking status may offer potential behaviour change targets within these interventions.

Senior Secondary School Food Literacy Education: Importance, Challenges, and Ways of Improving.

Food literacy education at senior secondary school can provide both immediate and long-term benefits for adolescents. The exploration of multiple stakeholder groups' opinions regarding the importance, roles, and challenges of school food literacy education, and their suggestions for its improvement, will help the design and execution of future food literacy-related curricula and programmes. This study explored a broad range of Australian and international food, health, and education professionals' opinions regarding senior secondary school food literacy education through an online survey. One hundred and fifty-five food, health, and education professionals completed this survey between April and October 2017. Overall, the respondents strongly supported the need for food literacy education for senior secondary school students. Their suggestions for improving this form of education included: incorporation of relevant and up-to-date content, the presence of strong practical components, offering food literacy as compulsory subjects or the incorporation of food literacy concepts into compulsory core subjects. Moreover, they proposed the active contribution of both internal and external stakeholders in the planning and delivery of this education to upgrade its quality and relevance. Overall, the findings suggest that a wide range of food, health, and education professionals are highly supportive of senior secondary school food literacy education and their constructive suggestions should be considered in school food literacy education enhancement efforts. Education authorities should seek ways of involving different stakeholders, including food-related professionals, in the design and delivery of food literacy education, and future studies should explore the best mechanisms for such involvement.

What Should Be Taught in Secondary Schools' Nutrition and Food Systems Education? Views from Prominent Food-Related Professionals in Australia.

Education can help young people to attain the knowledge and the skills that they need to make proper food choices and develop lifelong healthy eating patterns. This study explored the perspectives of prominent food-related professionals in Australia regarding essential nutrition and food systems (N&FS) education programs for adolescents during formal education. Semi-structured interviews were conducted with 21 prominent food-related professionals in Australia. Interview transcripts were analysed thematically. Four essential areas for N&FS education programs were identified. (1) Key nutrition messages to a healthy lifestyle; (2) Skill development programs to enhance health and wellbeing; (3) Ethical food-related lessons to support environmental sustainability, farm animal welfare, local producers, and food security; and, (4) Introductory lessons about foods from farm to plate to facilitate more informed food choices. Findings of this study may provide new insights for curriculum developers in Australia for further assessment of the current gaps in N&FS components of secondary school curriculum. Integration of these four areas into secondary school curricula has the potential to enhance adolescents' knowledge of important scientific and ethical issues in a range of N&FS fields, and enable them to develop fundamental food-related life skills that are supportive of health and wellbeing.

Adolescent women as a key target population for community nutrition education programs in Indonesia.

BACKGROUND AND OBJECTIVES: Adolescence is a critical life-stage that sets the foundation for health in adulthood. Adolescent women are a unique population and should be targeted as such for nutrition promotion activities. Using Indonesia as a case study, this qualitative study aimed to identify existing nutrition promotion programs aimed at adolescent girls, how best to target this population and effective recommendations to inform nutrition education program design for this important group. METHODS AND STUDY DESIGN: Semi-structured interviews and questionnaires were conducted with ten key informants working in public health in Indonesia. Interview transcripts were analysed and coded to identify key themes. RESULTS: No existing nutrition education programs targeting adolescent women in Indonesia were identified. Several strategies apply to nutrition programs for adolescent girls: 1) nutrition promotion messages that are relevant to the lifestyles and interests of adolescent women; 2) technology-based interventions show promise, however, they need to be appropriately targeted to sub-groups; 3) school remains an important setting; and 4) early marriage is an important issue affecting nutritional status and engagement of adolescent girls. The informants recommended that: 1) more research is needed about the underlying motivations for behaviour change among adolescent women and ways to effectively implement the identified engagement strategies; 2) adolescent girls should be included in program design to improve its suitability and uptake; and 3) government budget and policy support is crucial to success. CONCLUSIONS: Adolescent women are an important population group and more research is required to identify the optimal forms of engagement to improve nutrition programs for them.

Opportunities and barriers to public health nutrition education in Vietnamese universities.

BACKGROUND AND OBJECTIVES: A core challenge for low- and middle-income countries (LMICs) in combating the negative effects of the nutrition transition is to implement appropriate prevention strategies to halt the increasing prevalence of obesity and non-communicable diseases (NCDs), against a background of prevailing under nutrition. There have been several proposals for the enhancement of university nutrition education for future health and related professionals who are expected to communicate knowledge of health risks to the broad community. However, little is known about university nutrition education in LMICs. The present study aimed to investigate professional development opportunities and barriers for university nutrition lecturers to teach public health nutrition (PHN). METHODS AND STUDY DESIGN: An online survey was conducted among 242 Vietnamese health and education professionals and university nutrition lecturers across Vietnam. Purposive sampling was used to recruit participants. Comparisons of between the groups' responses were examined via SPSS Crosstabs. The structures of the perceived barriers and desired PHN training topics were examined via factor analyses. Multiple linear regression examined the influences on lecturers' learning interests in nutrition areas. RESULTS: The lecturers' learning interests spanned four areas: basic nutrition, basic food, food policy and 'new' trends (e.g. food policy, marketing). Major impediments to nutrition teaching in universities divided into two groups: resource limitations and professional constraints (e.g. lack of relevant training opportunities). The lecturers' perceptions of professional constraints influenced their interest in learning about 'new' trends. CONCLUSIONS: The results highlighted the need and opportunities to enhance PHN professional development for nutrition lecturers in Vietnam.

Awareness of nutrition problems among Vietnamese health and education professionals.

Professionals who provide nutrition education and consulting to the public are encouraged to take into account the health, environmental and social contexts that influence health-related attitudes and behaviours in the population. This paper examined the awareness of shifts in population health outcomes associated with the nutrition transition in Vietnam among university nutrition lecturers, health professionals and school education professionals. Most of these professionals held accurate views of the current population health issues in Vietnam. However, they differed in their awareness of the seriousness of overweight and obesity. Although the majority indicated that the prevalence of obesity and non-communicable diseases (NCDs) had increased, nearly half believed that the government should complete its attempts to control undernutrition before trying to control obesity. More health professionals believed that food marketing was responsible for the growing prevalence of children's obesity, and more of them disapproved of the marketing of less healthy food to children. In contrast, the university nutrition lecturers were least aware of food marketing and the seriousness of obesity. Of the three groups, the university nutrition lecturers held less accurate perceptions of nutrition transition problems and their likely drivers. There is an urgent need for greater provision of public nutrition education for all three groups of professionals.

Correlates of meal skipping in young adults: a systematic review.

BACKGROUND: Meal skipping rates may be highest during young adulthood, a period of transition and development. Although these dietary behaviours may increase future risk of chronic disease, limited research has investigated correlates of meal skipping in young adults. METHODS: A systematic literature search was conducted to identify studies that investigated correlates of meal skipping behaviours in young adults (aged 18-30 years). EBSCO host, MEDLINE Complete, Global Health, Scopus, EMBASE, Web of Science and Informit platforms were searched for eligible articles. Correlates were defined as any factor that was either associated with meal skipping or was self-reported by the participant to have an influence on meal skipping. Randomised controlled trials, prospective cohort studies, case-control studies, nested case-control studies, cross-sectional studies, and longitudinal studies were eligible for inclusion. RESULTS: Three-hundred and thirty-one articles were identified, 141 full-text articles assessed for eligibility, resulting in 35 included studies. Multiple methodological and reporting weaknesses were apparent in the reviewed studies with 28 of the 35 studies scoring a negative rating in the risk of bias assessment. Meal skipping (any meal), defined as the skipping of any meal throughout the day, was reported in 12 studies with prevalence ranging between 5 and 83%. The remaining 25 studies identified specific meals and their skipping rates, with breakfast the most frequently skipped meal 14-88% compared to lunch 8-57% and dinner 4-57%. Lack of time was consistently reported as an important correlate of meal skipping, compared with correlates such as cost and weight control, while sex was the most commonly reported associated correlate. Breakfast skipping was more common among men while lunch or dinner skipping being more common among women. CONCLUSIONS: This review is the first to examine potential correlates of meal skipping in young adults. Future research would benefit from stronger design and reporting strategies, using a standardised approach for measuring and defining meal skipping.

Dietary Behaviours, Impulsivity and Food Involvement: Identification of Three Consumer Segments.

This study aims to (1) identify consumer segments based on consumers' impulsivity and level of food involvement, and (2) examine the dietary behaviours of each consumer segment. An Internet-based cross-sectional survey was conducted among 530 respondents. The mean age of the participants was 49.2 ± 16.6 years, and 27% were tertiary educated. Two-stage cluster analysis revealed three distinct segments; "impulsive, involved" (33.4%), "rational, health conscious" (39.2%), and "uninvolved" (27.4%). The "impulsive, involved" segment was characterised by higher levels of impulsivity and food involvement (importance of food) compared to the other two segments. This segment also reported significantly more frequent consumption of fast foods, takeaways, convenience meals, salted snacks and use of ready-made sauces and mixes in cooking compared to the "rational, health conscious" consumers. They also reported higher frequency of preparing meals at home, cooking from scratch, using ready-made sauces and mixes in cooking and higher vegetable consumption compared to the "uninvolved" consumers. The findings show the need for customised approaches to the communication and promotion of healthy eating habits.

Current levels of salt knowledge: a review of the literature.

High salt intake increases the risk of hypertension and cardiovascular diseases. Given the role of knowledge as a determinant of food intake, this paper aims to review the current levels of salt knowledge and the association between salt knowledge and dietary salt intake and salt-related dietary practices in the general population. Twenty two studies were included in the review. In general, the studies showed consumers were able to identify the health risks associated with high salt intake. However, knowledge of recommended daily intakes, understanding of the relationships between salt and sodium and foods that contribute most salt to the diet were poor. Four of the five studies which examined the relationships between salt knowledge and salt-related dietary practices reported significant associations. Two important gaps in the current literature were identified. First, there is a need for a robustly validated tool to examine salt knowledge and its impact on salt intake. Second, a comprehensive salt knowledge assessment should include assessment of procedural, as well as declarative, knowledge.

Does personality affect dietary intake?

The purpose of this review is to evaluate the evidence for an association between the Big Five dimensions of personality, dietary intake, and compliance to dietary recommendations. Poor diet is a known risk factor for overweight and obesity and associated chronic lifestyle diseases and it has been proposed that personality may be linked to dietary choices. Findings from cross-sectional surveys from different countries and cultures show a positive association between Openness and consumption of fruits and vegetables and between Conscientiousness and healthy eating. Although no evidence has been found that personality dimensions are associated with adherence to dietary recommendations over time, Conscientiousness is associated with a number of prosocial and health-promoting behaviors that include avoiding alcohol-related harm, binge-drinking, and smoking, and adherence to medication regimens. With emerging evidence of an association between higher Conscientiousness and lower obesity risk, the hypothesis that higher Conscientiousness may predict adoption of healthy dietary and other lifestyle recommendations appears to be supported.

An examination of the mediating role of salt knowledge and beliefs on the relationship between socio-demographic factors and discretionary salt use: a cross-sectional study.

BACKGROUND: Discretionary salt use varies according to socio-demographic factors. However, it is unknown whether salt knowledge and beliefs mediate this relationship. This study examined the direct and indirect effect of socio-demographic factors on salt knowledge and discretionary salt use in a sample of 530 Australian adults. METHODS: An internet based cross-sectional survey was used to collect data for this study. Participants completed an online questionnaire which assessed their salt knowledge, beliefs and salt use behaviour. Mplus was used to conduct structural equation modelling to estimate direct and indirect effects. RESULTS: The mean age of the participants was 49.2 years, and about a third had tertiary education. Discretionary salt use was inversely related to age (r=-0.11; p<0.05), and declarative salt knowledge (knowledge of factual information) scores (r = -0.17; p<0.01), but was positively correlated with misconceptions about salt (r = 0.09; p<0.05) and beliefs about the taste of salt (r = 0.51; p<0.001). Structural equation modelling showed age, education and gender were indirectly associated with the use of discretionary salt through three mediating pathways; declarative salt knowledge, misconceptions about salt and salt taste beliefs. CONCLUSIONS: Inequalities observed between socio-demographic groups in their use of discretionary salt use can potentially be reduced through targeted salt knowledge and awareness campaigns.

Similar but different. Health behaviour pathways differ between men and women.

The purpose of the study was to examine middle to older aged Australians' healthy eating, eating out, and physical activity behaviours and to investigate their relationships with likely antecedents such as demographics, personal values, health background, and attention to weight and health habits. A mail survey was conducted among a random sample of men and women aged between 38 and 79 years; 1105 usable questionnaires were obtained. Structural equation modelling was used to examine relationships between the variables. The results showed that there were distinct relationships between predictive variables and behavioural and BMI outcomes for men and women. For example, healthy eating, eating out behaviours were positively associated with body weight for women but not men while attention to weight and health habits was positively related to hedonism values for women but not for men. The interrelationships among the predictors and the outcome variables appear to be more complex for women than men. The implications of the findings for nutrition communication are discussed.

The relationships between eating habits, smoking and alcohol consumption, and body mass index among baby boomers.

The study was to examine the eating habits of baby boomers and to investigate the relationship of these and other lifestyle habits on their reported body mass indices (BMI). A questionnaire was administered by mail to a random sample of people aged 40 years and above, drawn from the Electoral Rolls in Victoria, Australia. Part of the questionnaire contained questions about the respondents' eating habits, smoking status and alcohol use, as well as self reported heights and weights and demographic characteristics. Eight hundred and forty-four people (out of 1470) returned usable questionnaires. Statistically significant differences were found between the eating habits of men and women. Generally, more women snacked on high energy dense foods (e.g., confectionery). More men took larger mouthfuls than women. The eating habits of women appeared to be more formal than men's. Four constructs named: unconstrained eating, traditional eating style, gulping, and chocolate and junk food were derived from the eating behaviour literature. Structural equation modelling showed that eating behaviour was associated with BMI along with current smoking, ex-smoking status, alcohol consumption, and demographics. Eating habits and other lifestyle behaviours appear to be associated with BMI though in different pathways for men and women.

Investigation of population heterogeneity of diet use among middle-aged Australians.

The purpose of the study was to determine patterns of diet use among middle-aged Australian men and women and the relationships between these different usage patterns and demographic characteristics, health status and health habits. A cross-sectional mail survey was conducted among a random sample of 2975 people aged 40-71 years in Victoria, Australia. A total of 1031 usable questionnaires were obtained which included information about the use of diets (e.g. low-fat and low-salt) during the past 3 months along with demographic information, health status and health habits. Based on the responses about the use of thirteen diets for both sexes, latent class analysis was employed to identify the optimal number of use of diets and the assignment of participants to particular groups. Three types of diet uses were identified and provisionally named: diet use, selected diet use and non-diet use. This classification was associated with demographics, health status and health habits, and these associations differed between men and women. The findings suggest that nutrition education programmes should be tailored to the different needs of the diet use groups.

Trends in BMI, diet and lifestyle between 1976 and 2005 in North Sydney.

Although the prevalence of overweight and obesity in Australia has increased during the past 30 years, little is known about the dietary and behavioural antecedents of body mass index (BMI). We examined changes in mean BMI, diet, and other lifestyle behaviours between 1976 and 2005 and described the cross-sectional associations between these factors and BMI. A series of biennial biomedical surveys by Sydney Adventist Hospital from 1976 to 2005 allowed examination of BMI trends, while the selection of three surveys enabled detailed examination of likely dietary and lifestyle associations. Subjects included in this study were: 384 men and 338 women in 1976; 160 men and 146 women in 1978; 166 men and 141 women in 1980; 164 men and 142 women in 1982; 177 men and 13 women in 1984; 239 men and 227 women in 1986; 210 men and 225 women in 1988; 165 men and 148 women in 1990; 138 men and 167 women in 1992 and 270 men and 62 women in 2005. Height and weight were measured by hospital staff. Mean BMI increased in the early 1990s. Salt, coffee, cola, alcohol and meat consumption, dieting to lose weight and eating between meals were positively associated with BMI while physical activity, food variety, large breakfasts and consumption of spreads were negatively associated. Food consumption and daily activities have important associations with BMI, though their specific associations differ by sex. "Affluent" lifestyle patterns appear to contribute to higher BMI, while a more "prudent" lifestyle seems to protect from such increases.

Does the prescriptive lifestyle of Seventh-day Adventists provide 'immunity' from the secular effects of changes in BMI?

OBJECTIVE: To examine the effect of Seventh-day Adventist (SDA) membership on 'immunity' to the secular effects of changes in BMI. DESIGN: Three independent, cross-sectional, screening surveys conducted by Sydney Adventist Hospital in 1976, 1986 and 1988 and a survey conducted among residents of Melbourne in 2006. SUBJECTS: Two hundred and fifty-two SDA and 464 non-SDA in 1976; 166 SDA and 291 non-SDA in 1986; 120 SDA and 300-non SDA in 1988; and 251 SDA and 294 non-SDA in 2006. MEASUREMENTS: Height and weight measured by hospital staff in 1976, 1986 and 1988; self-reported by respondents in 2006. RESULTS: The mean BMI of non-SDA men increased between 1986 and 2006 (P < 0.001) but did not change for SDA men or non-SDA women. Despite small increases in SDA women's mean BMI (P = 0.030) between 1988 and 2006, this was no different to that of SDA men and non-SDA women in 2006. The diet and eating patterns of SDA men and women were more 'prudent' than those of non-SDA men and women, including more fruit, vegetables, grains, nuts and legumes, and less alcohol, meat, sweetened drinks and coffee. Many of these factors were found to be predictors of lower BMI. CONCLUSION: The 'prudent' dietary and lifestyle prescriptions of SDA men appear to have 'immunised' them to the secular effects of changes that occurred among non-SDA men's BMI. The dietary and lifestyle trends of SDA women did not reflect the increase in their BMI observed in 2006.

The relationship between education and food consumption in the 1995 Australian National Nutrition Survey.

OBJECTIVE: To assess the relationship between education and the intake of a variety of individual foods, as well as groups of foods, for Australian men and women in different age groups. DESIGN: Cross-sectional national survey of free-living men and women. SUBJECTS: A sample of 2501 men and 2739 women aged 18 years and over who completed the National Nutrition Survey (NNS) 1995. METHODS: Information about the frequency of consumption of 88 food items was obtained using a food-frequency questionnaire in a nation-wide nutrition survey. Irregular and regular consumers of foods were identified according to whether they consumed individual foods less than or more than once per month. The relationship between single foods and an index of education (no post-school qualifications, vocational, university) was analysed via contingency table chi-square statistics for men and women. Food group variety scores were derived by assigning individual foods to conventional food group taxonomies, and then summing the dichotomised intake scores for individual foods within each food group. Two-way analyses of variance (education by age groups) were performed on food variety scores for men and women, separately. RESULTS: While university-educated men and women consumed many individual foods more regularly than less-educated people, they were less likely to be regular consumers of several meat products. The relationship between education and food consumption was less apparent when individual food scores were aggregated into food group scores. University-educated men and women exhibited higher scores on total food group variety than the other educational groups. CONCLUSIONS: Higher education is associated with the regular consumption of a wider variety of foods. Aggregation of individual food consumption indices into food variety scores may mask the apparent effects of educational background on food consumption.

Dietary composition of pregnant women is related to size of the baby at birth.

The fetal origins theory of adult disease suggests that term infants who are small for their gestational age have an increased susceptibility to chronic disease in adulthood as a consequence of physiologic adaptations to undernutrition during fetal life. Consistent evidence for an influence of women's dietary composition during pregnancy on growth of their babies is lacking, despite robust effects in animal experiments. We undertook a prospective observational study of 557 women aged 18-41 y, living in Adelaide, South Australia. Diet was assessed in early and late pregnancy using an FFQ. In early pregnancy, medians for energy intake, the proportion of energy derived from protein and from carbohydrate were 9.0 MJ, 17 and 48%, respectively. In late pregnancy the corresponding medians were 9.2 MJ, 16 and 49%. In early pregnancy, the percentage of energy derived from protein was positively associated with birth weight (P = 0.02) and placental weight (P = 0.07), independently of energy intake and weight gain during pregnancy, and after adjustment for potential confounders, including maternal age, parity, and smoking. Effects were stronger among women (n = 429) who had reliable data, based on prespecified criteria including the plausibility of dietary data when referenced against estimated energy expenditure. In addition, for this subgroup, the percentage of energy from carbohydrate in early and late pregnancy was negatively associated with ponderal index of the baby, and a specific effect of protein from dairy sources was identified. These data support the proposition that maternal dietary composition has an effect on fetal growth. Maternal diet in Western societies may therefore be important for the long-term health of the child.

Characteristics of soy bread users and their beliefs about soy products.

A two-stage random telephone/mail survey was conducted during the last quarter of 1998 among Adelaide residents to determine consumers' use of soy bread and other soy products and their health expectations of soy products. One in five (21%) of 1477 telephone subscribers usually consumed soy bread and related soy products. Comparisons of soy bread consumers and non-consumers, based on the mail survey sample, showed that more soy bread consumers used dietary supplements and ate low fat and vegetarian diets, though their experiences of ill health were similar. Soy bread consumers held stronger universalism (pro-nature) values than non-consumers. They also held more positive expectations about the benefits of soy consumption, including reductions in menstrual and menopausal symptoms, increased bowel regularity and reductions in the risk of heart disease and cancer. The findings are discussed in relation to the psychology of dietary supplementation, values orientations and physiological plausibility. Further investigations are suggested.