Evidence of low vitamin D intakes in the Australian population points to a need for data-driven nutrition policy for improving population vitamin D status.

BACKGROUND: Nearly one in four Australian adults is vitamin D deficient (serum 25-hydroxyvitamin D concentrations [25(OH)D] < 50 nmol L-1 ) and current vitamin D intakes in the Australian population are unknown. Internationally, vitamin D intakes are commonly below recommendations, although estimates generally rely on food composition data that do not include 25(OH)D. We aimed to estimate usual vitamin D intakes in the Australian population. METHODS: Nationally representative food consumption data were collected for Australians aged ≥ 2 years (n = 12,153) as part of the cross-sectional 2011-2013 Australian Health Survey (AHS). New analytical vitamin D food composition data for vitamin D3 , 25(OH)D3 , vitamin D2 and 25(OH)D2 were mapped to foods and beverages that were commonly consumed by AHS participants. Usual vitamin D intakes (µg day-1 ) by sex and age group were estimated using the National Cancer Institute method. RESULTS: Assuming a 25(OH)D bioactivity factor of 1, mean daily intakes of vitamin D ranged between 1.84 and 3.25 µg day-1 . Compared to the estimated average requirement of 10 µg day-1 recommended by the Institute of Medicine, more than 95% of people had inadequate vitamin D intakes. We estimated that no participant exceeded the Institute of Medicine's Upper Level of Intake (63-100 µg day-1 , depending on age group). CONCLUSIONS: Usual vitamin D intakes in Australia are low. This evidence, paired with the high prevalence of vitamin D deficiency in Australia, suggests that data-driven nutrition policy is required to safely increase dietary intakes of vitamin D and improve vitamin D status at the population level.

The Contribution of Nutrients of Concern to the Diets of 18-to-30-Year-Old Australians from Food Prepared Outside Home Differs by Food Outlet Types: The MYMeals Cross-Sectional Study.

Young adults are frequent consumers of food prepared outside the home (FOH). In a cross-sectional survey, the MYMeals study, we showed FOH provided one-third of meals and snacks for young Australian adults, yet it contributed higher proportions of energy and nutrients of concern, such as saturated fat and sodium. This study aimed to determine the detailed proportional contribution of nutrients of concern from the nine food outlet types captured in the MYMeals study. Young adults residing in New South Wales (NSW), Australia, (n = 1001) used a validated smartphone app to report all types and amounts of food and beverages consumed for three consecutive days, as well as their preparation location. The proportions of daily energy, macronutrients, sodium, total sugars, and saturated fat were calculated for each of the nine following outlet types: bakeries or patisseries, coffee chains, cold-drink chains, fast-food chains, ice creamery or frozen yoghurt outlets, independent cafes or restaurants, pubs (hotels) and clubs, service stations or convenience stores, and others not fitting the above categories. Of all FOH outlet types, independent cafes or restaurants contributed the most energy (17.5%), sodium (20.0%) and saturated fat (17.8%) to the total diet, followed by fast-food chains (12.0% energy, 15.8% sodium, and 12.0% saturated fat) and other outlets, with smaller proportions. For males, the proportion of energy and nutrients contributed by fast-food outlets was higher than for females (14.8% versus 9.8% energy). Menu labelling at independent cafes and restaurants is recommended, comprising, in addition to the energy labels already in use in fast-food restaurants, the labelling of nutrients of concern. The feasibility of this recommendation warrants further exploration.

Vitamin D Fortification of Milk Would Increase Vitamin D Intakes in the Australian Population, but a More Comprehensive Strategy Is Required.

Low vitamin D status (serum 25-hydroxyvitamin D (25(OH)D) concentration < 50 nmol/L) is prevalent in Australia, ranging between 15% and 32% in the adolescent and adult populations. Vitamin D intakes are also low across the population and were recently estimated at 1.8−3.2 µg/day on average, assuming equal bioactivity of the D vitamers. In combination, these findings strongly suggest that data-driven nutrition policy is needed to increase vitamin D intake and improve status in the Australian population. Food fortification is a potential strategy. We used up-to-date vitamin D food composition data for vitamin D3, 25(OH)D3, vitamin D2, and 25(OH)D2, and nationally representative food and supplement consumption data from the 2011−2013 Australian Health Survey, to model a fortification scenario of 0.8 µg/100 mL vitamin D for fluid dairy milks and alternatives. Under the modelled fortification scenario, the mean vitamin D intake increased by ~2 µg/day from baseline to 4.9 µg/day from food only (7.2 µg/day including supplements). Almost all individual intakes remained substantially below 10 µg/day, which is the Estimated Average Requirement in North America. In conclusion, this modelling showed that fortification of fluid milks/alternatives with vitamin D at the current permitted level would produce a meaningful increase in vitamin D intake, which could be of potential benefit to those with a low vitamin D status. However, this initial step would be insufficient to ensure that most of the population achieves the North American EAR for vitamin D intake. This approach could be included as an effective component of a more comprehensive strategy that includes vitamin D fortification of a range of foods.

Using Wearable Cameras to Assess Foods and Beverages Omitted in 24 Hour Dietary Recalls and a Text Entry Food Record App.

Technology-enhanced methods of dietary assessment may still face common limitations of self-report. This study aimed to assess foods and beverages omitted when both a 24 h recall and a smartphone app were used to assess dietary intake compared with camera images. For three consecutive days, young adults (18-30 years) wore an Autographer camera that took point-of-view images every 30 seconds. Over the same period, participants reported their diet in the app and completed daily 24 h recalls. Camera images were reviewed for food and beverages, then matched to the items reported in the 24 h recall and app. ANOVA (with post hoc analysis using Tukey Honest Significant Difference) and paired t-test were conducted. Discretionary snacks were frequently omitted by both methods (p < 0.001). Water was omitted more frequently in the app than in the camera images (p < 0.001) and 24 h recall (p < 0.001). Dairy and alternatives (p = 0.001), sugar-based products (p = 0.007), savoury sauces and condiments (p < 0.001), fats and oils (p < 0.001) and alcohol (p = 0.002) were more frequently omitted in the app than in the 24 h recall. The use of traditional self-report methods of assessing diet remains problematic even with the addition of technology and finding new objective methods that are not intrusive and are of low burden to participants remains a challenge.

Dietary or supplemental intake of antioxidants and the risk of mortality in older people: A systematic review.

PURPOSE: Antioxidants have a protective role in the prevention of cancer, cardiovascular disease and all-cause mortality. The association between dietary or supplemental intake of various antioxidants and all-cause mortality or cause-specific mortality among older populations is inconclusive. This systematic review aimed to systematically evaluate whether higher dietary or supplemental intake of antioxidants can lower the risk of all-cause mortality or cause-specific mortality in the older population. METHODS: Five electronic databases were searched to identify studies that evaluated the effects of dietary or supplemental intake of antioxidants on cause-specific or all-cause mortality in the older population aged ≥65 years. The overall quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Twenty-two longitudinal, prospective observational studies and randomised controlled trial (RCT) studies involving 1 090 844 cases of cause-specific and all-cause mortality were included. The overall quality of studies was high with a low risk of bias. RESULT: Of the 22 studies, 16 were observational studies and 6 were RCTs. The overall quality of evidence for observational studies and RCTs were rated down as low (due to very serious risk of bias and indirectness) and moderate (due to unable to rule out publication bias), respectively. Nine studies showed significant decreases, four found significant increases and nine reported no association between antioxidant intake and risk of mortality. CONCLUSION: There was inconclusive evidence on the associations between dietary or supplemental intake of antioxidants and mortality in the older population. More clinical trials are required to confirm the associations.

The Impact of Preoperative Immunonutrition and Standard Polymeric Supplements on Patient Outcomes After Pelvic Exenteration Surgery, Taking Compliance Into Consideration: A Randomized Controlled Trial.

BACKGROUND: The effect of immunonutrition vs standard polymeric nutrition in the preoperative phase on patient outcomes is still unclear, which could be due to contributing factors such as poorly reported compliance and unequal provision of protein, energy, and volume. The aim of this study was to examine the effects of preoperative immunonutrition compared with standard polymeric supplements matched for energy, protein, volume, length of stay, and postoperative complications in pelvic exenteration surgery, taking into consideration compliance. METHODS: This was a single-blinded, randomized, controlled trial in patients undergoing pelvic exenteration surgery. Fifty-two participants were randomly assigned to consume 3 immunonutrition supplements/d for 5 days preoperatively, and 56 participants were randomly assigned to consume 3 standard polymeric supplements/d for 5 days preoperatively. Primary and secondary outcome measures were assessed. Compliance with each nutrition regime was recorded during the intervention, and subanalysis was conducted. RESULTS: There was no significant difference between immunonutrition and standard polymeric supplements on length of stay (P = 0.988) or postoperative complications (P = 0.179) after pelvic exenteration surgery. Compliance with nutrition supplements was significantly less in malnourished (n = 33) compared with well-nourished participants (n = 74) (P = 0.016). Compliance varied between study groups, although not significant. CONCLUSION: Preoperative immunonutrition did not significantly impact length of stay or postoperative complications compared with standard polymeric supplements after pelvic exenteration surgery, despite controlling for protein, energy, and volume. Compliance, protein, and energy may considerably impact the effect of immunonutrition, particularly in malnourished patients.

Low calcium intakes among Australian adolescents and young adults are associated with higher consumption of discretionary foods and beverages.

OBJECTIVES: Calcium is an essential nutrient required for peak bone mass growth during adolescence and into young adulthood. The aim of this study was to examine the calcium intake of Australian adolescents and young adults from both food sources and supplements; and the relationship between calcium intake and intake of food groups. METHODS: Dietary data from 770 adolescents (14-18 y of age) and 774 young adults (19-25 y of age) from the 2011 to 12 National Nutrition and Physical Activity Survey were used. Analysis of covariances were conducted to identify associations between calcium intake and consumption of food groups. RESULTS: For adolescents, 83% of males and 95% of females did not meet the Estimated Average Requirement (EAR); whereas for young adults, 69% of males and 83% of females failed to meet the EAR. Food sources contributing to calcium intake were similar across age groups and sex. The largest contributors included regular milk (15-24%), cheese (10-12%), refined low-fiber bread (10%), and low-fat milk (7-9%). For both age groups, the lowest consumers of calcium were the poorest consumers of dairy products and the highest consumers of discretionary food choices and alcoholic beverages. A higher consumption of calcium was associated with a higher intake of dairy products and lower intakes of meat and alternatives and all discretionary choices. CONCLUSIONS: Calcium intake among Australian adolescents and young adults remains below recommendations, particularly in females. A higher intake of calcium was associated with a better dietary pattern. Further investment in interventions is indicated.

Discrepancy in socioeconomic status does not fully explain the variation in diet quality between consumers of different coffee types.

PURPOSE: Habitual consumers of different coffee types may vary in socioeconomic status (SES), which is an important determinant of diet quality. Nonetheless, research on diet quality among coffee consumers was scarce. We aimed to compare the diet quality of coffee consumers with different preferences towards coffee type and additive usage. METHODS: In this cross-sectional analysis, intake data of food, coffee, and additive usage from the adult respondents of the 2011-2012 Australian Health Survey were used. Participants were grouped according to the type of coffee (espresso and ground coffee, E&G; coffee made from coffee mixes and instant coffee, M&I; non-consumers, NC) and additives (milk, sugar, and intense sweetener) consumed. Adjusted food group intake was compared between consumption groups using general linear model. RESULTS: E&G drinkers had better SES than M&I and NC. After adjusting for covariates, the mean dairy intake of E&G drinkers was 22.2% higher than M&I drinkers (p < 0.001) and 33.1% higher than NC (p < 0.001). Mean discretionary food intake of E&G drinkers was 12.1% lower than M&I (p = 0.003) and 12.3% lower than NC (p = 0.001). In terms of additive usage, non-users of coffee additive had the lowest dairy food intake and the highest discretionary food intake. CONCLUSIONS: Coffee consumers' different preferences towards coffee type and additive usages reflected significant variations in their diet quality, even after adjustment of SES. Therefore, future epidemiological studies should consider separating coffee drinkers according to their habitual consumption of different types of coffee.

A modeling study of beverage substitution and obesity outcomes among Australian adults.

OBJECTIVE: The aim of this study was to investigate the cross-sectional associations among sugar-sweetened beverage (SSB) consumption, its substitution with beverage alternatives, and obesity outcomes in an Australian population. METHODS: We used data from 9341 adults ages ≥19 y from the 2011-2012 Australian National Nutrition and Physical Activity Survey. Multivariate linear regression with adjustment for covariates was used to examine the associations between SSB consumption and body mass index (BMI) and waist circumference (WC). Substitution modeling was used to simulate the effect of replacing SSB with water, coffee/tea, fruit juice, and milk. RESULTS: SSB intake (100 g/d) was associated with higher BMI (ß = 0.06 kg/m2; P = 0.001) and WC (ß = 0.19 cm; P < 0.001). A linear trend with BMI and WC also was seen when SSB intake was examined as categories of servings per day (Ptrend ≤ 0.001). Replacing SSB with water, coffee/tea, or milk was inversely associated with BMI (ß = -0.07 to -0.09 kg/m2; P < 0.001) and WC (ß = -0.25 to -0.28 cm; P < 0.001). CONCLUSIONS: The results of the present study suggested that SSB intake is associated with obesity and that coffee/tea, water, and milk may be good alternatives for SSB. Further longitudinal and intervention studies are warranted to examine the effects of beverage substitution on obesity.

Zinc supplement use and contribution to zinc intake in Australian children.

OBJECTIVE: The aims of the present study were to examine the Zn intake and characteristics of Zn supplement users and non-users and to survey Zn supplements that are commercially available. DESIGN: Cross-sectional national nutrition survey (2007 Australian Children's Nutrition and Physical Activity Survey) and a review of commercially available Zn supplements. SETTING: Australia. SUBJECTS: Children (n 4834) aged 2-16 years. RESULTS: Zn supplement use was associated with younger age, being female, having a lower BMI and consuming a vegetarian or modified diet. Supplement users had significantly higher intakes of Zn than non-users in all age and gender subgroups. Adolescent boys aged 14-16 years who did not use Zn supplements were at highest risk of inadequate Zn intake (15 % compared with 1 % of users). Conversely, children aged 2-3 years were at highest risk of exceeding the recommended upper limit of Zn intake (86-87 % of users and 64-71 % of non-users), followed by children aged 4-8 years (9-29 % of users and 3-12 % of non-users). The most common sources of Zn supplements consumed by children were multi-vitamin and mineral preparations (92 %), followed by Zn-only supplements (5 %) and Zn-containing cold and flu, or cold sore supplements (3 %). A survey of commercially available Zn supplements revealed that the median elemental Zn content was 2 and 25 mg for multi-vitamin and mineral preparations and Zn-only supplements, respectively. CONCLUSIONS: Based on these data, widespread Zn supplement use among young children is unlikely to be warranted. The impact of exceeding the upper limit of Zn intake on biomarkers of Zn toxicity requires further investigation.

Zinc intake and its dietary sources: results of the 2007 Australian National Children's Nutrition and Physical Activity Survey.

The current Australian Nutrient Reference Values (NRV) use different Estimated Average Requirements (EAR) for zinc for adolescent boys and girls compared to the previous recommendations. The adequacy of zinc intakes of 2-16 years old children (n = 4834) was examined in the 2007 Australian National Children's Nutrition and Physical Activity Survey. Zinc intakes were estimated from two 24-h recalls and compared with age- and gender-specific NRV. Food sources of zinc were assessed and compared with those of the 1995 National Nutrition Survey. The mean (SD) zinc intake was 10.2 (3.0) mg/day for all children. Nearly all children met the EAR for zinc except for 14-16 years old boys (29% did not meet EAR). Children (2-3 years) were at highest risk of excessive zinc intakes with 79% exceeding the Upper Level of Intake. Meat and poultry; milk products; and cereals and cereal products contributed 68% of total zinc intake. The contribution of cereals to total zinc intake has increased significantly since 1995, due to the greater market-availability of zinc-fortified breakfast cereals. We conclude that sub-groups of Australian children are at-risk of inadequate (boys 14-16 years) or excessive (children 2-3 years) zinc intakes, and monitoring of zinc status is required.

Oral nutritional supplementation increases caloric and protein intake in peritoneal dialysis patients.

BACKGROUND: Malnutrition is highly prevalent in peritoneal dialysis (PD) patients and is associated with a poor prognosis. Attempts to improve nutritional status with enteral supplements have yielded poor results. METHODS: We performed a crossover-design trial on 13 PD patients to investigate whether these patients reduce their food intake after drinking oral nutritional supplements. Patients attended three visits in which they were administered a standard oral nutritional supplement either 2 hours or 30 minutes before lunch or a placebo drink 30 minutes before lunch. Lunch was provided as a self-select buffet-style meal, and food intake was measured. Total intake was calculated by adding the nutritional content of the oral supplement. RESULTS: Patients showed poor food intake, with mean values equaling only 18% of the recommended daily intake for calories and 34% for protein. Drinking the supplement 2 hours before lunch resulted in a significant increase compared with the placebo visit in total caloric (430 to 843 kcal; P < 0.001) and protein intake (27.6 to 41.3 g; P = 0.006). No significant difference in total intake was detected between drinking the supplement 2 hours versus 30 minutes before lunch. CONCLUSION: These results indicate that oral nutritional supplements administered before a meal may significantly increase caloric and protein intakes of PD patients.