The burden of cardiovascular disease attributable to dietary risk factors in Australia between 1990 and 2019.

Unhealthy diet is associated with increased risk of cardiovascular diseases (CVD). However, there are no studies reporting the impact and trends of dietary risk factors on CVD in Australia. This study aimed to determine the burden of CVDs attributable to dietary risk factors in Australia between 1990 and 2019. We used data from the Global Burden of Diseases (GBD) study and quantified the rate (per 100,000) of deaths, disability-adjusted life years (DALYs), years lived with a disability (YLDs), and years of life lost (YLLs) for 21 CVDs attributable to 13 dietary risk factors (eight food groups and five nutrients) in Australia by sex and age groups (≥25 years and over). In 2019, the age-standardised rates of deaths, YLDs, YLLs, and DALYs attributable to dietary risk factors attributable to CVDs in the Australian population were 26.5, 60.8, 349.9, and 410.8 per 100,000 in women and 46.1, 62.6, 807.0, and 869.6 in men. Between 1990 and 2019, YLLs consistently contributed more towards the rates of DALYs than YLDs. Over the 30-year period, CVD deaths, YLLs, and DALYs attributable to dietary risk factors declined in both women and men. The leading dietary risk factors for CVD deaths and DALYs were a diet high in red meat (6.1 deaths per 100,000 [3.6, 8.7] and 115.6 DALYs per 100,000 [79.7, 151.6]) in women and a diet low in wholegrains (11.3 deaths [4.4, 15.1] and 220.3 DALYs [86.4, 291.8]) in men. Sex differences were observed in the contribution of dietary risk factors to CVD over time such that the lowest rate of decrease in deaths and DALYs occurred with diets high in sodium in women and diets high in processed meat in men. Although the burden of diet-related CVD has decreased significantly in the Australian population over the past 30 years, diets low in wholegrains and high in red meat continue to contribute significantly to the overall CVD burden. Future nutrition programs and policies should target these dietary risk factors.

Determining the feasibility of a codesigned and personalised intervention (Veg4Me) to improve vegetable intake in young adults living in rural Australian communities: protocol for a randomised controlled trial.

INTRODUCTION: Diets low in vegetables are a main contributor to the health burden experienced by young adults in rural communities. Digital health interventions provide an accessible delivery model that can be personalised to meet the diverse preferences of young adults. A personalisable digital vegetable intake intervention (Veg4Me) was codesigned to meet the needs of young adults living in rural communities. This study will determine the feasibility of delivering a personalised Veg4Me programme and compare preliminary effects with a non-personalised Veg4Me (control). METHODS AND ANALYSIS: A 12-week assessor-blinded, two-arm, parallel randomised controlled trial will be undertaken from August 2023 until April 2024. A total of 150 eligible and consenting young adults (18-35 years; eat<5 serves of vegetables/day; have an internet connected mobile device/computer) living in Loddon Campaspe or Colac Otway Shire in Victoria, Australia, will be randomised to receive 12 weeks of personalised (intervention) or non-personalised (control) support to increase vegetable intake via a free web application (app; Veg4Me). The primary outcome is feasibility (recruitment, participation and retention rates). Secondary outcomes are user engagement, usability and experience, as well as vegetable intake, eating habits and digital health equity. Process evaluation will be conducted in a subsample of participants using semistructured interviews. Descriptive statistics will be presented for the personalised and non-personalised groups at baseline and 12 weeks. Generalised linear models will be used to evaluate group differences in outcomes. Interviews will be transcribed and analysed thematically. ETHICS AND DISSEMINATION: All procedures involving human subjects were approved by Deakin University's Human Ethics Advisory Group-Health (HEAG-H 06_2023) on 6 March 2023. Dissemination events will be held in the City of Greater Bendigo and the Colac Otway Shire. Summaries of the results will be disseminated to participants via email. Results will be disseminated to the scientific community through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: Australia New Zealand Clinical Trials Registry, ACTRN12623000179639p, prospectively registered on 21 February 2023, according to the World Health Organizational Trial Registration Data Set. Universal Trial Number U1111-1284-9027.

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

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

Associations between childhood to adulthood socio-economic mobility and adult diet quality.

The impact of change in socio-economic status (SES) from childhood to adulthood (SES mobility) on adult diet is not well understood. This study examined associations between three SES mobility variables (area disadvantage, education, occupation) and adult diet quality. 1482 Australian participants reported childhood area-level SES in 1985 (aged 10-15 years) and retrospectively reported highest parental education and main occupation (until participant age 12) and own area-level SES, education, occupation and dietary intake in 2004-2006 (aged 26-36 years). A Dietary Guidelines Index (DGI) was calculated from food frequency and habit questionnaires. A higher score (range 0-100) indicated better diet quality. Sex-stratified linear regression models adjusted for confounders. Area-level SES mobility was not associated with diet quality. Compared with stable high (university) education, stable low (school only) was associated with lower DGI scores (males: ß = -5·5, 95 % CI: -8·9, -2·1; females: ß = -6·3, 95 % CI: -9·3, -3·4), as was downward educational mobility (participant's education lower than their parents) (males: ß = -5·3, 95 % CI: -8·5, -2·0; females: ß = -4·5, 95 % CI: -7·2, -1·7) and stable intermediate (vocational) education among males (ß = -3·9, 95 % CI: -7·0, -0·7). Compared with stable high (professional/managerial) occupation, stable low (manual/out of workforce) males (ß = -4·9, 95 % CI: -7·6, -2·2), and participants with downward occupation mobility (males: ß = -3·2, 95 % CI: -5·3, -1·1; females: ß = -2·8, 95 % CI: -4·8, -0·8) had lower DGI scores. In this cohort, intergenerational low education and occupation, and downward educational and occupational mobility, were associated with poor adult diet quality.

Dietary Intake, Cost, and Affordability by Socioeconomic Group in Australia.

Few Australians consume diets consistent with the Australian Dietary Guidelines. A major problem is high intake of discretionary food and drinks (those not needed for health and high in saturated fat, added sugar, salt and/or alcohol). Low socioeconomic groups (SEGs) suffer particularly poor diet-related health. Surprisingly, detailed quantitative dietary data across SEGs was lacking. Analysis of the most recent national nutrition survey data produced habitual intakes of a reference household (two adults and two children) in SEG quintiles of household income. Cost and affordability of habitual and recommended diets for the reference household were determined using methods based on the Healthy Diets Australian Standardised Affordability and Pricing protocol. Low SEGs reported significantly lower intakes of healthy food and drinks yet similarly high intakes of discretionary choices to high SEGs (435 serves/fortnight). Total habitual diets of low SEGs cost significantly less than those of high SEGs (AU$751/fortnight to AU$853/fortnight). Results confirmed low SEGs cannot afford a healthy diet. Lower intakes of healthy choices in low SEGs may help explain their higher rates of diet-related disease compared to higher SEGs. The findings can inform potential policy actions to improve affordability of healthy foods and help drive healthier diets for all Australians.

Cost and Affordability of Healthy, Equitable and Sustainable Diets in Low Socioeconomic Groups in Australia.

Few Australians consume a healthy, equitable and more sustainable diet consistent with the Australian Dietary Guidelines (ADGs). Low socioeconomic groups (SEGs) suffer particularly poor diet-related health problems. However, granular information on dietary intakes and affordability of recommended diets was lacking for low SEGs. The Healthy Diets Australian Standardised Affordability and Pricing protocol was modified for low SEGs to align with relevant dietary intakes reported in the National Nutrition Survey 2011-2012(which included less healthy and more discretionary options than the broader population), household structures, food purchasing habits, and incomes. Cost and affordability of habitual and recommended diets of low SEGs were calculated using prices of 'standard brands' and 'cheapest options'. With 'standard brands', recommended diets cost less than habitual diets, but were unaffordable for low SEGs. With 'cheapest options', both diets were more affordable, but recommended diets cost more than habitual diets for some low SEGs, potentially contributing to perceptions that healthy food is unaffordable. The study confirms the need for an equity lens to better target dietary guidelines for low SEGs. It also highlights urgent policy action is needed to help improve affordability of recommended diets.

A systematic scoping review of the habitual dietary costs in low socioeconomic groups compared to high socioeconomic groups in Australia.

BACKGROUND: Low socioeconomic groups (SEGs) in Australia are less likely to consume diets consistent with the Australian Dietary Guidelines (ADGs) and suffer poorer health than the broader population. The unaffordability, or perceived high cost, of healthy diets may be a factor. Detailed data on the cost of habitually consumed diets is required in order to inform strategies to alleviate socioeconomic impacts on dietary intake. This systematic scoping review aims to identify the cost of the habitual dietary intake of low SEGs in Australia, in terms of the whole diet and its composite foods, in comparison to the cost in higher SEGs. METHODS: A systematic search of peer-reviewed literature since 2000 and key government and non-government organisation (NGO) websites was undertaken. Data were extracted, synthesised and analysed in relation to study populations, dietary cost assessment measures, socioeconomic measures, and dietary cost and affordability. RESULTS: The review identified four studies meeting inclusion criteria. Results confirmed that overall, low SEGs spend a lower amount, yet a higher proportion of household income, on food and drinks than higher SEGs. Quantitative comparison of the dietary costs between included studies was not possible due to difference in populations and study metrics. Costs of the habitual diet in these studies were not reported for ADG food groups, so did not allow for assessment of the healthfulness of the dietary intake or comparison with costs of recommended diets at food group level. CONCLUSIONS: Existing research does not provide sufficiently granular data of the costs of habitual diets of low SEGs in comparison to higher SEGs or data in a form that can inform strategies and interventions to improve dietary intake and diet-related health of low SEGs in Australia. Future empirical health research requires more granular measures of habitual spending on ADG food groups across SEGs.

Ranking of meal preferences and interactions with demographic characteristics: a discrete choice experiment in young adults.

BACKGROUND: The diet of young adults is poor, yet little is known about the relative importance of influences on healthy eating in a decision-making context. The aim of this exploratory study was to understand the relative ranking of influences on meal choices in young adults and to investigate interactions between meal preferences and demographic and health characteristics. METHODS: Adults aged 18-30 years (n = 92, mean age: 23.9 (SD 3.4) years) completed an online discrete choice experiment. Participants were presented with 12 choice sets reflecting a typical weekday meal and were asked to choose between four meal options. Each meal consisted of a combination of five meal attributes (preparation time, cost, taste, familiarity and nutrition content) that each had three attribute levels. Data were analysed using conditional logit models. Subgroup analyses were performed by sex, education, income, weight status and meeting fruit and vegetable recommendations. RESULTS: Comparing the highest and lowest attribute levels, meal preferences were higher for better taste (B = 0.38; 95% CI: 0.12, 0.63), familiarity (B = 0.37; 95% CI: 0.21, 0.54) and nutrition content (B = 1.11; 95% CI: 0.81, 1.41) and lower for increased preparation times (B = -0.33; 95% CI: - 0.53, - 0.12) and cost (B = -0.50; 95% CI: - 0.75, - 0.24). Nutrition content was the most important influence on meal choice. Cost was the second most important, followed by taste, familiarity and preparation time. Compared to males, females had a higher preference for better nutrition content, taste and familiarity and a lower preference for increased cost. Higher educated participants had a higher preference for better nutrition content, familiarity and taste compared to lower educated participants. Young adults who met recommendations for fruit and vegetable intake had a higher preference for better nutrition content compared to participants who did not meet recommendations. CONCLUSION: Nutrition content was the most important influence on young adults' meal choices, followed by cost, taste, familiarity and preparation time. Preferences varied by demographics and health characteristics, suggesting that the focus of dietary interventions may benefit from being tailored to specific young adult groups.

Approaches to Defining Healthy Diets: A Background Paper for the International Expert Consultation on Sustainable Healthy Diets.

BACKGROUND: Healthy diets promote optimal growth and development and prevent malnutrition in all its forms, including undernutrition, obesity, and diet-related noncommunicable diseases (NCDs). OBJECTIVE: This background paper for the International Expert Consultation on Sustainable Healthy Diets characterizes healthy diets and their implications for food system sustainability. METHODS: Three complementary approaches to defining healthy diets are compared: World Health Organization (WHO) guidelines or recommendations developed between 1996 and 2019; 2017 Global Burden of Disease (GBD) risk factor study estimates of diet-related risk-outcome associations; and analyses associating indices of whole dietary patterns with health outcomes in population studies and clinical trials. RESULTS: World Health Organization dietary recommendations are global reference points for preventing undernutrition and reducing NCD risks; they emphasize increasing intakes of fruits, vegetables (excepting starchy root vegetables), legumes, nuts, and whole grains; limiting energy intake from free sugars and total fats; consuming unsaturated rather than saturated or trans fats; and limiting salt intake. Global Burden of Disease findings align well with WHO recommendations but include some additional risk factors such as high consumption of processed meat; this approach quantifies contributions of diet-related risks to the NCD burden. Evidence on whole dietary patterns supports WHO and GBD findings and raises concerns about potential adverse health effects of foods with high levels of industrial processing. CONCLUSIONS: Implied shifts toward plant foods and away from animal foods (excepting fish and seafood), and for changes in food production systems have direct relevance to the sustainability agenda.

The Role of a Food Literacy Intervention in Promoting Food Security and Food Literacy-OzHarvest's NEST Program.

Food literacy interventions are widely implemented to improve the food security and health of low-socioeconomic adults. The purpose of this study was to conduct an inquiry into the value of OzHarvest's six-week NEST (Nutrition Education and Skills Training) program in promoting food security and food literacy, and to identify the barriers and enablers that participants experienced in sustaining food security, and in utilising their food literacy skills beyond the program. A descriptive evaluation study with pre-post surveys (n = 21) and post-program interviews (n = 17) was conducted, with a convenience sample of NEST program participants living in Sydney, Newcastle, and Melbourne, Australia. Participants demonstrated improvements in food security status (p = 0.030), cooking confidence (p = 0.001), food preparation behaviours (p = 0.006), nutrition knowledge (p = 0.033), vegetable consumption (p = 0.043), and a reduction in intake of sugar-sweetened beverages (p = 0.017), and salty snack foods (p = 0.011). The interviews revealed that participants learned to stretch their food budgets and make meaningful changes to their food utilisation (a key dimension of food security). Interviews also identified enablers (e.g., social support) and barriers (e.g., health conditions) to achieving food security. Acknowledging the need for a multi-faceted approach that also addresses upstream determinants, interventions like NEST may play a role in promoting food security and food literacy.

Long-term outcomes (2 and 3.5 years post-intervention) of the INFANT early childhood intervention to improve health behaviors and reduce obesity: cluster randomised controlled trial follow-up.

BACKGROUND: The few health behavior interventions commencing in infancy have shown promising effects. Greater insight into their longer-term benefits is required. This study aimed to assess post-intervention effects of the Melbourne INFANT Program to child age 5y on diet, movement and adiposity. METHODS: Two and 3.5y post-intervention follow-up (2011-13; analyses completed 2019) of participants retained in the Melbourne INFANT Program at its conclusion (child age ~ 19 m; 2008-10) was conducted. The Melbourne INFANT Program is a 15-month, six session program delivered within first-time parent groups in Melbourne, Australia, between child age 4-19 m. It involves strategies to help parents promote healthy diet, physical activity and reduced sedentary behavior in their infants. No intervention was delivered during the follow-up period reported in this paper. At all time points height, weight and waist circumference were measured by researchers, children wore Actigraph and activPAL accelerometers for 8-days, mothers reported children's television viewing and use of health services. Children's dietary intake was reported by mothers in three unscheduled telephone-administered 24-h recalls. RESULTS: Of those retained at program conclusion (child age 18 m, n = 480; 89%), 361 families (75% retention) participated in the first follow-up (2y post-intervention; age 3.6y) and 337 (70% retention) in the second follow-up (3.5y post-intervention; age 5y). At 3.6y children in the intervention group had higher fruit (adjusted mean difference [MD] = 25.34 g; CI95:1.68,48.99), vegetable (MD = 19.41; CI95:3.15,35.67) and water intake (MD = 113.33; CI95:40.42,186.25), than controls. At 5y they consumed less non-core drinks (MD = -27.60; CI95:-54.58,-0.62). Sweet snack intake was lower for intervention children at both 3.6y (MD = -5.70; CI95:-9.75,-1.65) and 5y (MD = -6.84; CI95:-12.47,-1.21). Intervention group children viewed approximately 10 min/day less television than controls at both follow-ups, although the confidence intervals spanned zero (MD = -9.63; CI95:-30.79,11.53; MD = -11.34; CI95:-25.02,2.34, respectively). There was no evidence for effect on zBMI, waist circumference z-score or physical activity. CONCLUSIONS: The impact of this low-dose intervention delivered during infancy was still evident up to school commencement age for several targeted health behaviors but not adiposity. Some of these effects were only observed after the conclusion of the intervention, demonstrating the importance of long-term follow-up of interventions delivered during early childhood. TRIAL REGISTRATION: ISRCTN Register ISRCTN81847050 , registered 7th November 2007.

Lifestyle Patterns Begin in Early Childhood, Persist and Are Socioeconomically Patterned, Confirming the Importance of Early Life Interventions.

Traditional approaches to understanding the behavioural determinants of adiposity have considered diet, physical activity and sedentary behaviour in isolation. Although integrative approaches have identified a variety of lifestyle patterns in children at preschool-age or older, along with some variability by socio-economic positions, this has rarely been examined in younger cohorts. We aimed to identify lifestyle patterns at 1.5, 3.5 and 5 years, including dietary intake, outdoor time and television viewing time, to assess associations with maternal education (as a proxy for socio-economic position), and to investigate their persistence between toddlerhood and preschool age. Participants were 417 and 293 children aged 1.5 y from the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) and InFANT Extend Programs, respectively. Data were collected using questionnaires at child ages 1.5, 3.5 and 5 y (InFANT); and 1.5 and 3.5 y (InFANT Extend). Principal component analysis was undertaken at each time point on the separate and pooled datasets. Associations between the lifestyle patterns scores and maternal education were assessed with multivariable regression analysis. Two lifestyle patterns ("Discretionary consumption and TV" and "Fruit, vegetables and outdoor") were identified as early as 1.5 y. They remained consistent across ages and were evident in both datasets. These patterns were inversely and positively associated with maternal education, respectively. Such early clustering of obesity related energy balance behaviours and tracking during early childhood suggests there may be shared antecedents common to the individual behaviours that could be targeted for intervention. Our findings provide support for interventions targeting multiple behaviours and tailored to the level of family socio-economic disadvantage.

Smartphone Cardiac Rehabilitation, Assisted Self-Management Versus Usual Care: Protocol for a Multicenter Randomized Controlled Trial to Compare Effects and Costs Among People With Coronary Heart Disease.

BACKGROUND: Alternative evidence-based cardiac rehabilitation (CR) delivery models that overcome significant barriers to access and delivery are needed to address persistent low utilization. Models utilizing contemporary digital technologies could significantly improve reach and fidelity as complementary alternatives to traditional center-based programs. OBJECTIVE: The aim of this study is to compare the effects and costs of the innovative Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) intervention with usual care CR. METHODS: In this investigator-, assessor-, and statistician-blinded parallel 2-arm randomized controlled trial, 220 adults (18+ years) with coronary heart disease are being recruited from 3 hospitals in metropolitan and regional Victoria, Australia. Participants are randomized (1:1) to receive advice to engage with usual care CR or the SCRAM intervention. SCRAM is a 24-week dual-phase intervention that includes 12 weeks of real-time remote exercise supervision and coaching from exercise physiologists, which is followed by 12 weeks of data-driven nonreal-time remote coaching via telephone. Both intervention phases include evidence- and theory-based multifactorial behavior change support delivered via smartphone push notifications. Outcomes assessed at baseline, 12 weeks, and 24 weeks include maximal aerobic exercise capacity (primary outcome at 24 weeks), modifiable cardiovascular risk factors, exercise adherence, secondary prevention self-management behaviors, health-related quality of life, and adverse events. Economic and process evaluations will determine cost-effectiveness and participant perceptions of the treatment arms, respectively. RESULTS: The trial was funded in November 2017 and received ethical approval in June 2018. Recruitment began in November 2018. As of September 2019, 54 participants have been randomized into the trial. CONCLUSIONS: The innovative multiphase SCRAM intervention delivers real-time remote exercise supervision and evidence-based self-management behavioral support to participants, regardless of their geographic proximity to traditional center-based CR facilities. Our trial will provide unique and valuable information about effects of SCRAM on outcomes associated with cardiac and all-cause mortality, as well as acceptability and cost-effectiveness. These findings will be important to inform health care providers about the potential for innovative program delivery models, such as SCRAM, to be implemented at scale, as a complement to existing CR programs. The inclusion of a cohort comprising metropolitan-, regional-, and rural-dwelling participants will help to understand the role of this delivery model across health care contexts with diverse needs. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN): 12618001458224; anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374508. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15022.

Adequacy of iron intakes and socio-demographic factors associated with iron intakes of Australian pre-schoolers.

PURPOSE: To estimate the prevalence of inadequate iron intakes and identify socio-demographic factors associated with iron intakes of Australian children aged 2-5 years. METHODS: Data from the 2011-2012 National Nutrition and Physical Activity Survey component of the Australian Health Survey were analysed (n = 783, 2-5 years old). Dietary intake was assessed via two non-consecutive 24-h recalls. Prevalence of inadequate iron intake was estimated using the full probability approach after estimating the distribution of usual intakes with PC-SIDE. Associations between potential socio-demographic factors and energy-adjusted iron intakes were assessed via linear regression accounting for the complex survey design. RESULTS: Mean (SD) iron intakes for pre-schoolers were 7.9 (1.9) mg/day and the prevalence of inadequate iron intake was 10.1% (95% CI 7.9%, 12.1%). Male sex (mean difference between boys and girls: - 0.22 (95% CI - 0.03, - 0.41) mg/day; p = 0.022) and age (each additional year was associated with 0.11 (95% CI - 0.22, - 0.00) mg/day lower iron intake; p = 0.048) were negatively associated with pre-schooler iron intakes. CONCLUSIONS: This study provides current data relating to the iron nutrition of Australian pre-schoolers. Poor iron intakes continue to be a problem for 10% of Australian children beyond the second year of life, with iron intakes being lower for boys compared to girls and declining with age. Future research should examine strategies to improve iron intakes of young children, with a focus on promoting iron-rich food sources.

How and why does discretionary food consumption change when we promote fruit and vegetables? Results from the ShopSmart randomised controlled trial.

OBJECTIVE: The present study aimed to identify whether discretionary food consumption declined in an intervention focused primarily on promoting fruit and vegetable consumption. We also aimed to identify potential mediators explaining intervention effects on discretionary food consumption. DESIGN: Secondary analysis of data from the ShopSmart study, a randomised controlled trial involving a 6-month intervention promoting fruit and vegetable consumption. Linear regression models examined intervention effects on discretionary food consumption at intervention completion (T2). A half-longitudinal mediator analyses was performed to examine the potential mediating effect of personal and environmental factors on the association between the intervention effects and discretionary food consumption. Indirect (mediated) effects were tested by the product of coefficients method with bootstrapped se using Andrew Hayes' PROCESS macro for SPSS. SETTING: Women were recruited via the Coles FlyBuys loyalty card database in socio-economically disadvantaged suburbs of Melbourne, Australia. PARTICIPANTS: Analyses included 225 women (116 intervention and 109 control). RESULTS: Compared with controls, intervention participants consumed fewer discretionary foods at T2, after adjusting for key confounders (B = -0·194, 95 % CI -0·378, -0·010 servings/d; P = 0·039). While some mediators were associated with the outcome (taste, outcome expectancies, self-efficacy, time constraints), there was no evidence that they mediated intervention effects. CONCLUSIONS: The study demonstrated that a behavioural intervention promoting fruit and vegetable consumption among socio-economically disadvantaged participants was effective in reducing discretionary food intake. Although specific mediators were not identified, researchers should continue searching for mechanisms by which interventions have an effect to guide future programme design.

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.

Are dietary inequalities among Australian adults changing? a nationally representative analysis of dietary change according to socioeconomic position between 1995 and 2011-13.

BACKGROUND: Increasing inequalities in rates of obesity and chronic disease may be partly fuelled by increasing dietary inequalities, however very few nationally representative analyses of socioeconomic trends in dietary inequalities exist. The release of the 2011-13 Australian National Nutrition and Physical Activity Survey data allows investigation of change in dietary intake according to socioeconomic position (SEP) in Australia using a large, nationally representative sample, compared to the previous national survey in 1995. This study examined change in dietary intakes of energy, macronutrients, fiber, fruits and vegetables among Australian adults between 1995 and 2011-13, according to SEP. METHODS: Cross-sectional data were obtained from the 1995 National Nutrition Survey, and the 2011-13 National Nutrition and Physical Activity Survey. Dietary intake data were collected via a 24-h dietary recall (n = 17,484 adults) and a dietary questionnaire (n = 15,287 adults). SEP was assessed according to educational level, equivalized household income, and area-level disadvantage. Survey-weighted linear and logistic regression models, adjusted for age, sex/gender and smoking status, examined change in dietary intakes over time. RESULTS: Dietary intakes remained poor across the SEP spectrum in both surveys, as evidenced by high consumption of saturated fat and total sugars, and low fiber, fruit and vegetable intakes. There was consistent evidence (i.e. according to ≥2 SEP measures) of more favorable changes in dietary intakes of carbohydrate, polyunsaturated and monounsaturated fat in higher, relative to lower SEP groups, particularly in women. Intakes of energy, total fat, saturated fat and fruit differed over time according to a single SEP measure (i.e. educational level, household income, or area-level disadvantage). There were no changes in intake of total sugars, protein, fiber or vegetables according to any SEP measures. CONCLUSIONS: There were few changes in dietary intakes of energy, most macronutrients, fiber, fruits and vegetables in Australian adults between 1995 and 2011-13 according to SEP. For carbohydrate, polyunsaturated and monounsaturated fat, more favorable changes in intakes occurred in higher SEP groups. Despite the persistence of suboptimal dietary intakes, limited evidence of widening dietary inequalities is positive from a public health perspective. TRIAL REGISTRATION: Clinical trials registration: ACTRN12617001045303 .

Early Childhood Vegetable, Fruit, and Discretionary Food Intakes Do Not Meet Dietary Guidelines, but Do Show Socioeconomic Differences and Tracking over Time.

BACKGROUND: Dietary intakes of young children are likely to be important determinants of their short- and long-term health, yet there are few longitudinal dietary studies of this age group, and no previous assessments of diets before age 2 years compared with national dietary guidelines. OBJECTIVE: This study aimed to compare vegetable, fruit, and discretionary food intakes of children aged 9 months to 5 years to dietary guidelines, and to assess differences in intakes by socioeconomic status and tracking of intakes across early childhood. DESIGN: This study analyzed longitudinal data from the Melbourne Infant Feeding Activity and Nutrition Trial Program early childhood lifestyle intervention trial, and is the first study to compare diets of children younger than age 2 years to national dietary guidelines. PARTICIPANTS/SETTING: Participants were 467 children in Melbourne, Australia, aged 4 months at baseline (study conducted 2008-2015). MAIN OUTCOME MEASURES: Multiple 24-hour recalls with parents were conducted at child ages 9 months, 1.5 years, 3.5 years, and 5 years. STATISTICAL ANALYSES PERFORMED: Intakes of vegetables, fruits, and discretionary foods were compared with Australian Dietary Guidelines. Differences by socioeconomic status and tracking of intakes of each food group were assessed by multivariable linear regression. RESULTS: Few children (<10%) met guidelines for discretionary food intakes at any age. Most children (≥90%) met vegetable and fruit guidelines at 9 months, but thereafter rates of adequate intakes reduced substantially. Children of higher socioeconomic status consumed diets closer to guidelines for most food groups at most ages. Tracking of intakes was apparent across ages, with the strongest and most consistent tracking for discretionary foods. CONCLUSIONS: This study shows that diets of Australian children participating in this lifestyle intervention trial were suboptimal from early life. The evidence of differences by socioeconomic status and tracking from age 9 months, particularly for discretionary foods, highlights the importance of research and action to support appropriate introduction of complementary foods during the first year of life, and of focusing these efforts on disadvantaged groups.

Socioeconomic Inequities in Diet Quality and Nutrient Intakes among Australian Adults: Findings from a Nationally Representative Cross-Sectional Study.

Poor diet may represent one pathway through which lower socioeconomic position (SEP) leads to adverse health outcomes. This study examined the associations between SEP and diet quality, its components, energy, and nutrients in a nationally representative sample of Australians. Dietary data from two 24-h recalls collected during the cross-sectional Australian Health Survey 2011-13 (n = 4875; aged ≥ 19 years) were analysed. Diet quality was evaluated using the Dietary Guidelines Index (DGI). SEP was assessed by index of area-level socioeconomic disadvantage, education level, and household income. Linear regression analyses investigated the associations between measures of SEP and dietary intakes. Across all of the SEP indicators, compared with the least disadvantaged group, the most disadvantaged group had 2.5-4.5 units lower DGI. A greater area-level disadvantage was associated with higher carbohydrate and total sugars intake. Lower education was associated with higher trans fat, carbohydrate, and total sugars intake and lower poly-unsaturated fat and fibre intake. Lower income was associated with lower total energy and protein intake and higher carbohydrate and trans fat intake. Lower SEP was generally associated with poorer diet quality and nutrient intakes, highlighting dietary inequities among Australian adults, and a need to develop policy that addresses these inequities.

Skipping breakfast among Australian children and adolescents; findings from the 2011-12 National Nutrition and Physical Activity Survey.

OBJECTIVE: Skipping breakfast has been linked with poor diet quality, higher BMI and adverse cardiometabolic outcomes. This study aimed to determine the prevalence and correlates of skipping breakfast among Australian children and adolescents. METHODS: A total of 1,592 2-17-year-olds completed two 24-hour recalls, collected via face-to-face and telephone interview, in the 2011-12 National Nutrition and Physical Activity Survey. Breakfast was an eating occasion of ≥210kJ named as 'breakfast' by the participant. Child, household and adult correlates of skipping breakfast were reported. Odds ratios were calculated using ordinal regression. Linear regression was used to examine differences in dietary intake. Survey weights were applied to give nationally representative estimates. RESULTS: Most (86.8% of boys, 81.4% of girls) ate breakfast on both days, 11.8% of boys and 14.8% girls skipped on one day and 1.4% boys and 3.8% girls skipped on both days. Characteristics associated with skipping breakfast were being female, being older, being underweight or overweight/obese, poorer diet, lower physical activity, inadequate sleep, lower household income, greater socioeconomic disadvantage, and being from a single-parent home. CONCLUSION: Skipping breakfast was common among Australian adolescents but few consistently skipped. Implications for public health: Interventions to increase breakfast should target adolescents, particularly girls, and low SEP households.