Associations between the nutritional quality of snacks, overall diet quality and adiposity: findings from a nationally representative study of Australian adolescents.

The primary aim of this study was to examine the association between snack nutritional quality, overall diet quality and adiposity among Australian adolescents. The secondary aim was to assess the distribution of discretionary foods (i.e. energy-dense and nutrient-poor foods and beverages) and intakes from the five food groups at different levels of snack nutritional quality. Dietary data collected from nationally representative adolescents (12-18 years old) during a 24-h dietary recall in the National Nutrition and Physical Activity Survey were analysed (n 784). Snacks were defined based on participant-identified eating occasions. Snack nutritional quality was assessed using the Nutrient Profiling Scoring Criterion (NPSC), whereas diet quality was evaluated using the Dietary Guideline Index for Children and Adolescents. Adiposity was assessed through BMI Z-score waist circumference and waist:height ratio (WHtR). Higher nutritional quality of snacks, as assessed by the NPSC, has been associated with higher diet quality among both boys and girls (P < 0·001). However, there is no association between snacks nutritional quality with BMI Z-score, waist circumference and WHtR. Among both boys and girls, the consumption of fruits, vegetables and legumes/beans at snacks increased with improvement in snack nutritional quality. Conversely, the consumption of discretionary foods at snack decreased with improvement in snack nutritional quality. In conclusion, improved snack quality was associated with better diet quality in adolescents. However, there was no association between snack nutritional quality and adiposity. Future, snack nutrition quality indices should consider optimum snack characteristics related with adiposity and diet quality.

Advances in methods for characterizing dietary patterns: A scoping review.

There is a growing focus on better understanding the complexity of dietary patterns and how they relate to health and other factors. Approaches that have not traditionally been applied to characterize dietary patterns, such as machine learning algorithms and latent class analysis methods, may offer opportunities to measure and characterize dietary patterns in greater depth than previously considered. However, there has not been a formal examination of how this wide range of approaches has been applied to characterize dietary patterns. This scoping review synthesized literature from 2005-2022 applying methods not traditionally used to characterize dietary patterns, referred to as novel methods. MEDLINE, CINAHL, and Scopus were searched using keywords including machine learning, latent class analysis, and least absolute shrinkage and selection operator (LASSO). Of 5274 records identified, 24 met the inclusion criteria. Twelve of 24 articles were published since 2020. Studies were conducted across 17 countries. Nine studies used approaches that have applications in machine learning to identify dietary patterns. Fourteen studies assessed associations between dietary patterns that were characterized using novel methods and health outcomes, including cancer, cardiovascular disease, and asthma. There was wide variation in the methods applied to characterize dietary patterns and in how these methods were described. The extension of reporting guidelines and quality appraisal tools relevant to nutrition research to consider specific features of novel methods may facilitate complete and consistent reporting and enable evidence synthesis to inform policies and programs aimed at supporting healthy dietary patterns.

Analytic Methods for Understanding the Temporal Patterning of Dietary and 24-H Movement Behaviors: A Scoping Review.

Dietary and movement behaviors [physical activity (PA), sedentary behavior (SED), and sleep] occur throughout a 24-h day and involve multiple contexts. Understanding the temporal patterning of these 24-h behaviors and their contextual determinants is key to determining their combined effect on health. A scoping review was conducted to identify novel analytic methods for determining temporal behavior patterns and their contextual correlates. We searched Embase, ProQuest, and EBSCOhost databases in July 2022 to identify studies published between 1997 and 2022 on temporal patterns and their contextual correlates (e.g., locational, social, environmental, personal). We included 14 studies after title and abstract (n = 33,292) and full-text (n = 135) screening, of which 11 were published after 2018. Most studies (n = 4 in adults; n = 5 in children and adolescents), examined waking behavior patterns (i.e., both PA and SED) of which 3 also included sleep and 6 included contextual correlates. PA and diet were examined together in only 1 study of adults. Contextual correlates of dietary, PA, and sleep temporal behavior patterns were also examined. Machine learning with various clustering algorithms and model-based clustering techniques were most used to determine 24-h temporal behavior patterns. Although the included studies used a diverse range of methods, behavioral variables, and assessment periods, results showed that temporal patterns characterized by high SED and low PA were linked to poorer health outcomes, than those with low SED and high PA. This review identified temporal behavior patterns, and their contextual correlates, which were associated with adiposity and cardiometabolic disease risk, suggesting these methods hold promise for the discovery of holistic lifestyle exposures important to health. Standardized reporting of methods and patterns and multidisciplinary collaboration among nutrition, PA, and sleep researchers; statisticians; and computer scientists were identified as key pathways to advance future research on temporal behavior patterns in relation to health.

Identifying the barriers and facilitators to fruit and vegetable consumption in rural Australian adults: a mixed methods analysis.

BACKGROUND: Low fruit and vegetable consumption is a leading contributor to non-communicable disease risk. However, understanding of barriers and facilitators to fruit and vegetable intake in rural settings is limited. This study used a mixed methods approach to determine the barriers and facilitators to increasing fruit and vegetable intake in rural Australian adults and to identify if these varied by gender. METHODS: Quantitative and qualitative data were used from the 2019 Active Living Census, completed by adults living in north-west Victoria, Australia. Data were collected on fruit and vegetable intakes and barriers and facilitators to meeting fruit and vegetable recommendations. Multivariate logistic regression analyses were used to investigate the association between facilitators, classified using the socio-ecological framework, and meeting recommendations. Machine learning was used to automate content analysis of open ended information on barriers. RESULTS: A total of 13,464 adults were included in the quantitative analysis (51% female; mean age 48 [SE 0.17] years) with 48% and 19% of participants consuming the recommended two serves of fruit and five serves of vegetables daily, respectively. Strongest facilitators to fruit consumption were at the individual level: never smoked (OR: 2.12 95% CI: 1.83-2.45) and not drinking alcohol (OR: 1.47 95% CI: 1.31-1.64). Strongest facilitators for vegetable consumption were found at all levels; i.e., individual level: used to smoke (OR: 1.48 95% CI: 1.21-1.80), social-environmental level: living with three or more people (OR: 1.41 95% CI: 1.22-1.63), and physical-environmental level: use community gardens (OR: 1.20 95% CI: 1.07-1.34). Qualitative analyses (fruit n = 5,919; vegetable n = 9,601) showed that barriers to fruit consumption included a preference for other snacks and desire to limit sugar content, whilst lack of time and unachievable guidelines were barriers for vegetables. Barriers and facilitators differed by gender; females experienced barriers due to having a more varied diet while males reported a dislike of the taste. CONCLUSIONS: Barriers and facilitators to fruit and vegetable consumption among rural Australian adults were identified across all levels of the socio-ecological framework and varied between fruit and vegetables and by gender. Strategies that address individual, social, and physical-level barriers are required to improve consumption.

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

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

Bioavailability of Australian pre-schooler iron intakes at specific eating occasions is low.

PURPOSE: Poor bioavailability may contribute to iron deficiency among children in high-resource countries, but iron bioavailability of Australian pre-schooler diets is unknown. This study aimed to estimate the bioavailability of Australian pre-schooler iron intakes across the day and by eating occasions to identify optimal timing for intervention, by using five previously developed algorithms, and to estimate the proportion of children with intakes of absorbable iron below the requirements. METHODS: Dietary data of children aged 2 to < 6 y (n = 812) from the 2011-12 National Nutrition and Physical Activity Survey were collected via two 24-h recalls. Usual food and nutrient intakes were estimated via Multiple Source Method. Phytate, polyphenol, and heme iron values were sourced from international databases or the literature. Five previously published algorithms were applied to observed dietary data to estimate iron bioavailability and calculate the prevalence of children with intakes of absorbable iron below requirements. RESULTS: Pre-schooler daily iron bioavailability was low (2.7-10.5%) and corresponded to intakes of 0.18-0.75 mg/d of absorbable iron. The proportion of children with inadequate intakes of absorbable iron ranged between 32 and 98%. For all eating occasions, dinner offered iron of the greatest bioavailability (4.2-16.4%), while iron consumed at breakfast was of the lowest bioavailability (1.2-5.6%). CONCLUSION: Future strategies are required to improve intakes of bioavailable iron for pre-schoolers to prevent the risk of deficiency. These strategies could include the encouragement of concomitant consumption of enhancers of iron absorption with iron-rich sources, particularly at breakfast.

#Fail: the quality and accuracy of nutrition-related information by influential Australian Instagram accounts.

BACKGROUND: Social media is a popular source of information about food and nutrition. There is a high degree of inaccurate and poor-quality nutrition-related information present online. The aim of this study was to evaluate the quality and accuracy of nutrition-related information posted by popular Australian Instagram accounts and examine trends in quality and accuracy based on author, topic, post engagement, account verification and number of followers. METHODS: A sample of posts by Australian Instagram accounts with ≥ 100,000 followers who primarily posted about nutrition was collected between September 2020 and September 2021. Posts containing nutrition-related information were evaluated to determine the quality and accuracy of the information. Quality was assessed using the Principles for Health-Related Information on Social Media tool and accuracy was assessed against information contained in the Australian Dietary Guidelines, Practice-based Evidence in Nutrition database, Nutrient Reference Values and Metafact. RESULTS: A total of 676 posts were evaluated for quality and 510 posts for accuracy, originating from 47 Instagram accounts. Overall, 34.8% of posts were classified as being of poor quality, 59.2% mediocre, 6.1% good and no posts were of excellent quality. A total of 44.7% of posts contained inaccuracies. Posts authored by nutritionists or dietitians were associated with higher quality scores (ß, 17.8, CI 13.94-21.65; P < 0.001) and higher accuracy scores (OR 4.69, CI 1.81-12.14, P = 0.001) compared to brands and other accounts. Information about supplements was of lower accuracy (OR 0.23, CI 0.10-0.51, P < 0.001) compared to information about weight loss and other nutrition topics. Engagement tended to be higher for posts of lower quality (ß -0.59, P = 0.012), as did engagement rate (ß -0.57, P = 0.016). There was no relationship between followers or account verification and information quality or accuracy and no relationship between engagement and accuracy. CONCLUSIONS: Nutrition-related information published by influential Australian Instagram accounts is often inaccurate and of suboptimal quality. Information about supplements and posts by brand accounts is of the lowest quality and accuracy and information posted by nutritionists and dietitians is of a higher standard. Instagram users are at risk of being misinformed when engaging with Australian Instagram content for information about nutrition.

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.

Associations of adherence to the DASH diet and Mediterranean diet with maternal c-reactive protein levels during pregnancy.

BACKGROUND AND AIMS: Elevated C-reactive protein (CRP) during pregnancy, a marker of inflammation, is associated with adverse outcomes. Better understanding the relationship between CRP and modifiable factors, including diet, is essential to assist early pregnancy lifestyle interventions. The aim of this study was to assess the relationship between adherence to the Dietary Approaches to Stop Hypertension diet (DASH-diet) and the Mediterranean diet (MED-diet) during pregnancy with maternal plasma CRP in early and late pregnancy. METHODS AND RESULTS: Secondary analysis of the Creatine and Pregnancy Outcomes (CPO) study was undertaken. Women (n = 215) attending antenatal clinics through Monash Health, Melbourne were recruited at 10-20 weeks gestation. Medical history and blood samples were collected at 5 antenatal visits. Adapted DASH-diet and MED-diet scores were calculated from Food Frequency Questionnaires completed at early ([mean ± SD]) (15 ± 3 weeks) and late (36 ± 1 week) pregnancy. CRP was measured in maternal plasma samples collected at the same time points. Adjusted linear regression models assessed associations of early-pregnancy DASH and MED-diet scores with early and late pregnancy plasma CRP. There were no statistically significant changes in DASH-diet score from early (23.5 ± 4.8) to late (23.5 ± 5.2) pregnancy (p = 0.97) or MED-diet score from early (3.99 ± 1.6) to late pregnancy (4.08 ± 1.8) (p = 0.41). At early-pregnancy, there was an inverse relationship between DASH-diet scores and MED-diet scores with plasma CRP; (ß = -0.04 [95%CI = -0.07, -0.00], p = 0.044), (ß = -0.12 [95%CI = -0.21, -0.02], p = 0.023). CONCLUSION: Adherence to the DASH-diet and MED-diet during early pregnancy may be beneficial in reducing inflammation. Assessment of maternal dietary patterns may assist development of preventive strategies, including dietary modification, to optimise maternal cardiometabolic health in pregnancy.

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.

Co-design of a personalised digital intervention to improve vegetable intake in adults living in Australian rural communities.

BACKGROUND: Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas. This paper describes the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. METHODS: Active participants in the co-design process were adults ≥ 18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population. Eight online workshops and a community survey were conducted between July and December 2021. The MoSCoW prioritisation method was used to help participants identify the 'Must-have, Should-have, Could-have, and Won't-have or will not have right now' features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community. RESULTS: Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on (i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, (ii) access to personalisation options and behaviour change support, and (iii) improving the community food environment by providing information on and access to local food initiatives. CONCLUSIONS: Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This research will inform the development of the prototyping (evaluation phase) and feasibility testing (post-design phase) of this intervention.

Achieving high diet quality at eating occasions: findings from a nationally representative study of Australian adults.

This study examined differences in food groups consumed at eating occasions by the level of adherence to dietary guidelines in Australian adults (≤19 years) and whether consumption differed with respect to age, sex and education levels. Secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey (n 9054) was performed, using one 24-h dietary recall with self-reported eating occasions. Dietary Guideline Index scores were used to assess adherence to the 2013 Australian Dietary Guidelines. Mean differences (95 % CI) in servings of the five food groups and discretionary foods at eating occasions were estimated for adults with higher and lower diet quality, stratified by sex, age group and education. Using survey-based t-tests, differences of at least half a serving with P values < 0·05 were considered meaningful. Compared with adults with lower diet quality, women and men aged 19-50 years with higher diet quality consumed more serves of vegetables at dinner (mean difference (95 % CI), women; 1·0; 95 % CI (0·7, 1·2); men: 0·9; 95 % CI (0·6, 1·3)) and fewer serves of discretionary foods at snacks (women: -0·7; 95 % CI (-0·9, -0·5); men: -1·0; 95 % CI (-1·4, -0·7). Other food groups, such as grains, dairy products and alternatives, meats and alternatives, were not significantly different between adults with lower and higher diet quality, across any eating occasions and age groups. Discretionary food intake at lunch, dinner and snacks was consistently greater among adults with lower diet quality, regardless of education level. Our findings identify dinner and snacks as opportunities to increase vegetable intake and reduce discretionary food intake, respectively.

Sociodemographic differences in dietary trends among Iranian adults: findings from the 2005-2016 Iran-WHO STEPS survey.

OBJECTIVE: To examine trends in the intake of key food groups among Iranian adults between 2005 and 2016, overall, and according to sociodemographic characteristics. DESIGN: Repeat cross-sectional data from the Iran-STEPwise approach to risk factor surveillance (Iran-WHO STEPS) 2005-2016 were analysed. Regression analyses were used to evaluate trends in the frequency of fruits, vegetables and fish intake and type of oil used over time. Interactions by sex, age and area of residence were examined. SETTING: Iran. PARTICIPANTS: 225 221 Iranian adults. RESULTS: The frequency of vegetables (ß: -0·03; 95 % CI (-0·06, -0·00); P-trend = 0·030) and fish (ß: -0·09; 95 % CI (-0·10, -0·08); P-trend < 0·001) intake and use of solid fat (OR: 0·70; 95 % CI (0·70, 0·72); P-trend < 0·001) declined, whilst the frequency of fruit intake (ß-Coeff: 0·03, 95 % CI (0·01, 0·05); P-trend = 0·014) and liquid oil use (OR: 1·40; 95 % CI (1·3, 1·4); P-trend<0·001) rose. Rising trends in fruit intake were larger in mid-aged (40-60 years) and older (>60 years) adults (P-interaction < 0·001), whilst declines in vegetable (P-interaction < 0·001) and fish intake (P-interaction = 0·001) were larger in older adults. The declining use of solid fat was strongest in middle-aged and older adults (P-interaction = 0·035), while the increasing use of liquid oil was strongest in rural areas (P-interaction = 0·011). CONCLUSIONS: During the nutrition transition, liquid oil use and the frequency of fruit intake rose, while the frequency of vegetables and fish intake declined. Nonetheless, the fatty acid composition and cooking methods are important considerations. The changes observed are concerning from a public health perspective and demonstrate the need for interventions and possible targets for tailored strategies.

Maternal diet quality and associations with plasma lipid profiles and pregnancy-related cardiometabolic health.

PURPOSE: To assess the relationship of early pregnancy maternal diet quality (DQ) with maternal plasma lipids and indicators of cardiometabolic health, including blood pressure (BP), gestational diabetes mellitus (GDM) and gestational weight gain (GWG). METHODS: Women (n = 215) aged 18-40 years with singleton pregnancies were recruited at 10-20 weeks gestation. Diet quality was assessed by the Dietary Guideline Index, calculated at early ([mean ± SD]) (15 ± 3 weeks) and late (35 ± 2 weeks) pregnancy. Lipidomic analysis was performed, and 698 species across 37 lipid classes were measured from plasma blood samples collected at early (15 ± 3 weeks) and mid (27 ± 3 weeks)-pregnancy. Clinical measures (BP, GDM diagnosis, weight) and blood samples were collected across pregnancy. Multiple linear and logistic regression models assessed associations of early pregnancy DQ with plasma lipids at early and mid-pregnancy, BP at three antenatal visits, GDM diagnosis and total GWG. RESULTS: Maternal DQ scores ([mean ± SD]) decreased significantly from early (70.7 ± 11.4) to late pregnancy (66.5 ± 12.6) (p < 0.0005). At a false discovery rate of 0.2, early pregnancy DQ was significantly associated with 13 plasma lipids at mid-pregnancy, including negative associations with six triglycerides (TGs); TG(54:0)[NL-18:0] (neutral loss), TG(50:1)[NL-14:0], TG(48:0)[NL-18:0], TG(52:1)[NL-18:0], TG(54:1)[NL-18:1], TG(50:0)[NL-18:0]. No statistically significant associations were found between early pregnancy DQ and BP, GDM or GWG. CONCLUSION: Maternal diet did not adhere to Australian Dietary Guidelines. Diet quality was inversely associated with multiple plasma TGs. This study provides novel insights into the relationship between DQ, lipid biomarkers and cardiometabolic health during pregnancy.

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

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

Do food-related capabilities, opportunities and motivations of adolescents mediate the association between socioeconomic position in adolescence and diet quality in early adulthood?

BACKGROUND: Socio-economic position (SEP) in adolescence may influence diet quality over the life course. However, knowledge of whether individual and environmental determinants of diet quality mediate the longitudinal association between SEP and diet quality is limited. This study examined whether and to what extent food-related capabilities, opportunities and motivations of adolescents mediated the longitudinal association between SEP in adolescence and diet quality in early adulthood overall and by sex. METHODS: Longitudinal data (annual surveys) from 774 adolescents (16.9 years at baseline; 76% female) from ProjectADAPT (T1 (baseline), T2, T3) were used. SEP in adolescence (T1) was operationalized as highest level of parental education and area-level disadvantage (based on postcode). The Capabilities, Opportunities and Motivations for Behaviour (COM-B) model was used as a framework to inform the analysis. Determinants in adolescence (T2) included food-related activities and skills (Capability), home availability of fruit and vegetables (Opportunity) and self-efficacy (Motivation). Diet quality in early adulthood (T3) was calculated using a modified version of the Australian Dietary Guidelines Index based on brief dietary questions on intake of foods from eight food groups. Structural equation modelling was used to estimate the mediating effects of adolescents' COM-B in associations between adolescent SEP and diet quality in early adulthood overall and by sex. Standardized beta coefficients (ß) and robust 95% confidence intervals (CI) were generated, adjusted for confounders (T1 age, sex, diet quality, whether still at school, and living at home) and clustering by school. RESULTS: There was evidence of an indirect effect of area-level disadvantage on diet quality via Opportunity (ß: 0.021; 95% CI: 0.003 to 0.038), but limited evidence for parental education (ß: 0.018; 95% CI: -0.003 to 0.039). Opportunity mediated 60.9% of the association between area-level disadvantage and diet quality. There was no evidence of an indirect effect via Capability or Motivation for either area-level disadvantage or parental education, or in males and females separately. CONCLUSIONS: Using the COM-B model, the home availability of fruit and vegetables (Opportunity) of adolescents explained a large proportion of the association between area-level disadvantage in adolescence and diet quality in early adulthood. Interventions to address poor diet quality among adolescents with a lower SEP should prioritize environmental determinants of diet quality.

Quality and accuracy of online nutrition-related information: a systematic review of content analysis studies.

OBJECTIVE: This systematic review aimed to summarise the level of quality and accuracy of nutrition-related information on websites and social media and determine if quality and accuracy varied between websites and social media or publishers of information. DESIGN: This systematic review was registered with PROSPERO (CRD42021224277). CINAHL, MEDLINE, Embase, Global Health and Academic Search Complete were systematically searched on 15 January 2021 to identify content analysis studies, published in English after 1989, that evaluated the quality and/or accuracy of nutrition-related information published on websites or social media. A coding framework was used to classify studies' findings about information quality and/or accuracy as poor, good, moderate or varied. The Academy of Nutrition and Dietetics Quality Criteria Checklist was used to assess the risk of bias. SETTING: N/A. PARTICIPANTS: N/A. RESULTS: From 10 482 articles retrieved, sixty-four were included. Most studies evaluated information from websites (n 53, 82·8 %). Similar numbers of studies assessed quality (n 41, 64·1 %) and accuracy (n 47, 73·4 %). Almost half of the studies reported that quality (n 20, 48·8 %) or accuracy (n 23, 48·9 %) was low. Quality and accuracy of information were similar on social media and websites, however, varied between information publishers. High risk of bias in sample selection and quality or accuracy evaluations was a common limitation. CONCLUSION: Online nutrition-related information is often inaccurate and of low quality. Consumers seeking information online are at risk of being misinformed. More action is needed to improve the public's eHealth and media literacy and the reliability of online nutrition-related information.

Dietary patterns derived using principal component analysis and associations with sociodemographic characteristics and overweight and obesity: A cross-sectional analysis of Iranian adults.

Introduction: This study examined the cross-sectional association between household dietary patterns and sociodemographic characteristics and BMI in a nationally representative sample of Iranian adults. Methods: Data on 6,833 households (n = 17,824 adults) from the National Comprehensive Study on Household Food Consumption Pattern and Nutritional Status 2001-2003 were used. Principal component analysis (PCA) was used to extract dietary patterns from three household 24-h dietary recalls. Linear regression analyses were used to examine associations between dietary patterns and sociodemographic characteristics and BMI. Results: Three dietary patterns were identified: the first was characterized by high citrus fruit intake, the second by high hydrogenated fats intake and the third by high non-leafy vegetables intake. The first and third patterns were associated with household heads with higher education and living in urban areas, while the second was associated with household heads with lower education and living in rural areas. All dietary patterns were positively associated with BMI. The strongest association was found with the first dietary pattern (ß: 0.49, 95% CI: 0.43, 0.55). Discussion: While all three dietary patterns were positively associated with BMI, the sociodemographic characteristics of Iranian adults who consumed them differed. These findings inform the design of population-level dietary interventions to address rising obesity rates in Iran.

Nutrition-Related Information on Instagram: A Content Analysis of Posts by Popular Australian Accounts.

Social media is a popular source of nutrition information and can influence food choice. Instagram is widely used in Australia, and nutrition is frequently discussed on Instagram. However, little is known about the content of nutrition information published on Instagram. The aim of this study was to examine the content of nutrition-related posts from popular Australian Instagram accounts. Australian Instagram accounts with ≥100,000 followers, that primarily posted about nutrition, were identified. All posts from included accounts, from September 2020 to September 2021, were extracted and posts about nutrition were included. Post captions were analysed using Leximancer, a content analysis software, to identify concepts and themes. Text from each theme was read to develop a description and select illustrative quotes. The final sample included 10,964 posts from 61 accounts. Five themes were identified: (1) recipes; (2) food and nutrition practices; (3) body goals; (4) food literacy and (5) cooking at home. Recipes and practical information about nutrition and food preparation are popular on Instagram. Content about weight loss and physique-related goals is also popular and nutrition-related Instagram posts frequently include marketing of supplements, food and online programs. The popularity of nutrition-related content indicates that Instagram may be a useful health-promotion setting.