The effect of oral synbiotics on the gut microbiota and inflammatory biomarkers in healthy adults: a systematic review and meta-analysis.

CONTEXT: Prior research has explored the effect of synbiotics, the combination of probiotics and prebiotics, on the gut microbiota in clinical populations. However, evidence related to the effect of synbiotics on the gut microbiota in healthy adults has not been reviewed to date. OBJECTIVE: A systematic review and meta-analysis was conducted to comprehensively investigate the effect of synbiotics on the gut microbiota and inflammatory markers in populations of healthy adults. DATA SOURCES: Scopus, PubMed, Web of Science, ScienceDirect, MEDLINE, CINAHL, and The Cochrane Library were systematically searched to retrieve randomized controlled trials examining the primary outcome of gut microbiota or intestinal permeability changes after synbiotic consumption in healthy adults. Secondary outcomes of interest were short-chain fatty acids, inflammatory biomarkers, and gut microbiota diversity. DATA EXTRACTION: Weighted (WMD) or standardized mean difference (SMD) outcome data were pooled in restricted maximum likelihood models using random effects. Twenty-seven articles reporting on 26 studies met the eligibility criteria (n = 1319). DATA ANALYSIS: Meta-analyses of 16 studies showed synbiotics resulted in a significant increase in Lactobacillus cell count (SMD, 0.74; 95% confidence interval [CI], 0.15, 1.33; P = 0.01) and propionate concentration (SMD, 0.22; 95% CI, 0.02, 0.43; P = 0.03) compared with controls. A trend for an increase in Bifidobacterium relative abundance (WMD, 0.97; 95% CI, 0.42, 2.52; P = 0.10) and cell count (SMD, 0.82; 95% CI, 0.13, 1.88; P = 0.06) was seen. No significant differences in α-diversity, acetate, butyrate, zonulin, IL-6, CRP, or endotoxins were observed. CONCLUSION: This review demonstrates that synbiotics modulate the gut microbiota by increasing Lactobacillus and propionate across various healthy adult populations, and may result in increased Bifidobacterium. Significant variations in synbiotic type, dose, and duration should be considered as limitations when applying findings to clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO no. CRD42021284033.

Metabolisable energy from nuts and patterns of nut consumption in the Australian population: a secondary analysis of the 2011-12 National Nutrition and Physical Activity Survey.

BACKGROUND: Nut intake is not associated with increased body weight, which may be explained by their metabolisable energy, among other factors. Therefore, total energy intake may be overestimated among nut consumers. This study aimed to describe the metabolisable energy from nuts and nut consumption patterns in the Australian population. METHODS: A nut-specific database was expanded to include metabolisable energy of nuts (based on nut type and form) and applied to the 2011-12 National Nutrition and Physical Activity Survey (NNPAS). Participants were Australians aged 2 years and older from the 2011-12 NNPAS (n = 12,153, with n = 4,765 nut consumers). Mean metabolisable energy intake was compared with mean energy intake using Atwater factors in nut consumers. Additionally, nut consumption patterns were explored, including the proportion of nuts consumed at meals and snacks. RESULTS: Among nut consumers, mean metabolisable energy from nuts based only on nut type was 241.2 (95% confidence interval [CI]: 232.0, 250.5) kJ/day and mean metabolisable energy considering both nut type and form was 260.7 (95% CI: 250.2, 271.2) kJ/day. Energy intake from nuts using Atwater factors was 317.6 (95% CI: 304.8, 330.3) kJ/day. Nuts were more likely to be consumed at snack occasions, with approximately 63% of nut intake occurring as a snack. CONCLUSION: Application of metabolisable energy to the 2011-12 NNPAS has a significant impact on calculation of energy intake from nuts. Nut consumption patterns identified a majority of nut consumption occurring as snacks. These findings may inform strategies to support nut consumption in Australia.

Consumer perceptions of nutrient content claims in Australia: A qualitative study.

BACKGROUND: Nutrition and health claims influence consumer purchasing. Claims include content claims, which refer to the amount of a nutrient contained in a product, and health claims, which refer to health benefits of foods or nutrients in a product. Products that display a health claim must meet the Nutrient Profiling Scoring Criterion (NPSC). The present study aimed to explore consumer perceptions of content claims used on food and beverage labelling and advertisements. METHODS: Semi-structured focus groups were conducted with Australian consumers. Analysis involved an inductive, reflexive approach to thematic analysis. RESULTS: Six focus groups involving 26 participants were conducted. Four main interconnected themes were generated: (1) complex factors influence food choice; (2) content claim scepticism; (3) the difference between content and health claims is unclear; and (4) the regulation of content claims is not common knowledge. Content claims were used, although generally viewed through a lens of scepticism and mistrust, and seen as a promotional tool for the food industry. Product complexity appeared to increase content claim use as a result of consumer uncertainty of the content of complex products, such as ultraprocessed foods. Most participants were aware that content and health claims were in some way regulated. Overall, they did not know further detail, including the relevant regulatory body. CONCLUSIONS: For content claims to support the consumer they need to be accurate and their use limited to healthier foods. This can be achieved by requiring products with content claims to meet NPSC thresholds, as required for products making health claims.

Investigating the Prevalence of Copper and Zinc Abnormalities in Patients Pre and Post bariatric Surgery-an Australian Experience.

INTRODUCTION: Bariatric surgery predisposes patients to nutritional deficiencies. There are limited studies on zinc and copper abnormalities in this cohort. PURPOSE: The aim of this study was to identify the prevalence of these abnormalities in a cohort of Australian bariatric patients. Inflammatory markers, adherence to multivitamin supplementation (MVS) and the presence of gastrointestinal (GI) symptoms were also investigated. MATERIAL AND METHODS: Data was collected on all patients who attended a single clinic in Sydney, Australia, from August 2020 to August 2021. RESULTS: The study cohort consisted of 231 patients (76.2% female; mean pre-operative body mass index of 43.4 ± 7.1 kg/m2), most of whom underwent sleeve gastrectomy (78.8%). Data were collected preoperatively and then at ≤ 6 months, 1 and > 2 years postoperatively. Prior to surgery, low levels of zinc (2.1%) and copper (0.7%) were rare, but elevated copper levels were common (16.7%) and potentially related to an elevated C-reactive protein (CRP) (47.7%). Following surgery at > 2 years, the mean total weight loss (TWL) was 33.5 ± 12.4. CRP levels improved over time. Post operatively, low zinc (2.7-3.6%) and copper (1.5%) levels were rare. Patients with low levels in zinc and copper were a higher-risk group and generally exhibited GI symptoms, despite taking MVS. CONCLUSION: In the initial post-operative stages and with good adherence to MVS containing copper and zinc, abnormalities may not be a concern. Patients with GI symptoms appear to be at higher risk of abnormalities; increasing awareness, thorough screening, and more comprehensive supplementation are recommended.

Lifestyle Interventions, Kidney Disease Progression, and Quality of Life: A Systematic Review and Meta-analysis.

Rationale & Objective: Poor dietary patterns and low physical activity levels are important lifestyle-related factors that contribute to negative health outcomes in individuals with chronic kidney disease (CKD). Previous systematic reviews have not explicitly focused on these lifestyle factors, nor undertaken meta-analyses of any effects. We aimed to evaluate the effect of lifestyle interventions (such as diet, exercise, and other lifestyle-related interventions) on the risk factors for and progression of CKD and the quality of life. Study Design: Systematic review and meta-analysis. Setting & Study Populations: Individuals aged 16 years or older with CKD stages 1 to 5 not requiring kidney replacement therapy. Selection Criteria for Studies: Randomized controlled trials of interventions. Data Extraction: Kidney function, albuminuria, creatinine, systolic blood pressure, diastolic blood pressure, body weight, glucose control, and quality of life. Analytical Approach: A random-effects meta-analysis with evidence certainty assessed using GRADE. Results: Seventy-eight records describing 68 studies were included. Twenty-four studies (35%) were dietary interventions, 23 (34%) exercise, 9 (13%) behavioral, 1 (2%) hydration, and 11 (16%) multiple component. Lifestyle interventions resulted in significant improvements in creatinine (weighted mean difference [WMD], -0.43 mg/dL; 95% CI, -0.74 to -0.11; P = 0.008); 24-hour albuminuria (WMD, -53 mg/24 h; 95% CI, -56 to -50; P < 0.001); systolic blood pressure (WMD, -4.5 mm Hg; 95% CI, -6.7 to -2.4; P < 0.001); diastolic blood pressure (WMD, -2.2 mm Hg; 95% CI, -3.7 to -0.8; P = 0.003); and body weight (WMD, -1.1 kg; 95% CI, -2.0 to -0.1; P = 0.025). Lifestyle interventions did not result in significant changes in the estimated glomerular filtration rate (0.9 mL/min/1.73 m2; 95% CI, -0.6 to 2.3; P = 0.251). However, narrative synthesis indicated that lifestyle intervention resulted in improvements in the quality of life. Limitations: Certainty of the evidence was rated very low for most outcomes, primarily owing to the risk of bias and inconsistency. No meta-analysis was possible for quality-of-life outcomes because of variations in measurement tools. Conclusions: Lifestyle interventions seem to positively affect some risk factors for progression of CKD and quality of life.

Tree Nut and Peanut Consumption and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Cardiovascular disease (CVD) is the leading cause of death globally. Habitual consumption of tree nuts and peanuts is associated with cardioprotective benefits. Food-based dietary guidelines globally recommend nuts as a key component of a healthy diet. This systematic review and meta-analysis were conducted to examine the relationship between tree nut and peanut consumption and risk factors for CVD in randomized controlled trials (RCTs) (PROSPERO: CRD42022309156). MEDLINE, PubMed, CINAHL, and Cochrane Central databases were searched up to 26 September, 2021. All RCT studies that assessed the effects of tree nut or peanut consumption of any dose on CVD risk factors were included. Review Manager software was used to conduct a random effect meta-analysis for CVD outcomes from RCTs. Forest plots were generated for each outcome, between-study heterogeneity was estimated using the I2 test statistic and funnel plots and Egger's test for outcomes with ≥10 strata. The quality assessment used the Health Canada Quality Appraisal Tool, and the certainty of the evidence was assessed using grading of recommendations assessment, development, and evaluation (GRADE). A total of 153 articles describing 139 studies (81 parallel design and 58 cross-over design) were included in the systematic review, with 129 studies in the meta-analysis. The meta-analysis showed a significant decrease for low-density lipoprotein (LDL) cholesterol, total cholesterol (TC), triglycerides (TG), TC:high-density lipoprotein (HDL) cholesterol, LDL cholesterol:HDL cholesterol, and apolipoprotein B (apoB) following nut consumption. However, the quality of evidence was "low" for only 18 intervention studies. The certainty of the body of evidence for TC:HDL cholesterol, LDL cholesterol:HDL cholesterol, and apoB were "moderate" because of inconsistency, for TG were "low," and for LDL cholesterol and TC were "very low" because of inconsistency and the likelihood of publication bias. The findings of this review provide evidence of a combined effect of tree nuts and peanuts on a range of biomarkers to create an overall CVD risk reduction.

The Effect of Non-Oil Seed Legume Intake on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Hypertension is a primary modifiable risk factor for CVD, whereby even small reductions in blood pressure (BP) can decrease risk for CVD events. Modification of dietary patterns is an established, nonpharmacologic approach for the prevention and management of hypertension. Legumes are a prevailing component of dietary patterns associated with lower BP in observational research, but there is a need to understand the effects of legume consumption on BP. This study aimed to synthesize evidence from randomized controlled trials (RCTs) for the effects of non-oil seed legume consumption on systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PROSPERO registration: CRD42021237732). We searched CINAHL, Cochrane, Medline, and PubMed scientific databases from inception through November 2022. A random-effects meta-analysis was conducted to assess the mean differences (MDs) for each outcome variable between legume-based and comparator diets. This review included 16 RCTs and 1092 participants. Studies ranged in duration (4-52 wk), participant age (17-75 y), and weekly legume dose (450-3150 g) in whole or powdered form. No significant overall effect between legume consumption and BP amelioration was observed in the meta-analysis (SBP-MD: -1.06 mm Hg; 95% CI: -2.57, 0.4410 mm Hg; I2 = 45%; DBP-MD: -0.48 mm Hg; 95% CI: -1.06, 0.10 mm Hg; I2 = 0%). The certainty of evidence was determined as low for SBP and DBP. Significant subgroup differences in SBP were found when studies were grouped according to participant BMI, with SBP reduction found for participants with overweight/obese BMI (MD -2.79 mm Hg, 95% CI: -4.68, -0.90 mm Hg). There is a need for large, high-quality trials to clearly define the benefits and mechanisms of legume consumption in BP management. Consideration of the relevance in individuals with obesity, overweight, and hypertension may also be warranted. This trial was registered at PROSPERO as CRD42021237732.

A comparison of diet quality and cardiovascular and inflammatory responses between aerobically trained male adults following either a long-term vegan or omnivorous dietary pattern.

Vegan dietary patterns are increasingly being adopted by endurance athletes, yet research examining the influence of this dietary pattern on exercise-related physiology is limited. This pilot study, therefore, aimed to explore nutrient status, diet quality and cardiovascular and inflammatory responses in aerobically trained adult males following vegan and omnivorous dietary patterns during aerobic exercise. An incremental ramp running test was used to assess peak oxygen consumption (VO2peak ) in males aged 18-55 years, engaging in >4 h training/week. Exercise testing was performed during walking and steady-state running conditions (60% and 90% of VO2peak ). Participants were grouped by dietary pattern type and were equivalent for age, training volume and VO2peak . When compared to the omnivorous group (n = 8, age 35.6 years, VO2peak 55.7 mL/kg/min), the vegan group (n = 12, age 33.4 years, VO2peak 56.4 m/kg/min) consumed more energy from carbohydrates (p = 0.007), and less energy from protein (p = 0.001) while exhibiting a higher overall diet quality score (p = 0.008). No differences in inflammatory biomarkers were observed before or after running. Total red blood cell count, haemoglobin and haematocrit levels were lower in the vegan dietary group. In summary, aerobically trained males, following a long-term vegan diet, can tolerate a short bout of running broadly comparatively to their omnivore counterparts. More arduous endurance exercise conditions should be explored to further uncover potential outcomes of consuming a vegan dietary pattern and exercise-related physiology.

The Metabolizable Energy and Lipid Bioaccessibility of Tree Nuts and Peanuts: A Systematic Review with Narrative Synthesis of Human and In Vitro Studies.

Nuts are an energy-dense food, yet regular consumption is not associated with weight gain. A proportion of the fats found within nuts remains encapsulated within cell walls and cannot be digested. Metabolizable energy (ME) can be explored by measuring fecal fat excretion in human studies and fat release among in vitro studies. This systematic review with narrative synthesis aimed to examine the ME of tree nuts and peanuts (PROSPERO CRD42021252287). PubMed, MEDLINE, CINAHL, Cochrane, and Embase databases were searched to June 2021. Both in vitro and human studies (adults ≥18 y) were included. Data was synthesized via narrative synthesis with results reported in summary tables and compared between form, processing, and dose of nuts, where available. Twenty-one studies were included. The ME of nuts was consistently lower than that predicted by Atwater factors for investigated nut types (almonds, cashews, hazelnuts, pistachios, walnuts, and peanuts). The mechanisms may relate to a lower fat release from nuts, hence higher fecal fat excretion; however, this review did not consider the digestibility of carbohydrates and protein, which should be considered when interpreting the outcomes. ME was influenced by nut type (ME = 22.6 kJ/g for pistachios; ME = 18.5 kJ/g for raw almonds), physical form (flour > chopped > whole nuts), heat processing (butter > roasted > raw) and dose of consumption. The lower-than-expected ME may explain a lack of association between nut intake and body weight observed in the literature and has implications for the development of food composition databases, food labeling, and informing dietary guidelines. However, the strength of the evidence base was reduced by the variation in methods used between studies, suggesting that further clinical trials are needed to determine the impact of the findings of this review for clinical dietetics.

Supports and Barriers to Lifestyle Interventions in Women with Gestational Diabetes Mellitus in Australia: A National Online Survey.

BACKGROUND: Gestational diabetes mellitus (GDM) affects approximately one in six pregnancies, causing a significant burden on maternal and infant health. Lifestyle interventions are first-line therapies to manage blood glucose levels (BGLs) and prevent future cardiometabolic complications. However, women with GDM experience considerable barriers to lifestyle interventions; thus, the aim of this study was to determine how women with GDM manage their condition and to identify the primary supports and barriers to lifestyle intervention participation. METHODS: An online cross-sectional survey of women in Australia with a history of GDM was conducted. Questions included participant demographics, strategies used to manage BGLs, physical activity and dietary habits, and barriers and supports to lifestyle interventions. RESULTS: A total of 665 individuals consented and responded to the advertisement, of which 564 were eligible and provided partial or complete responses to the survey questions. Most respondents were between 35 and 39 years of age (35.5%), not pregnant (75.4%), working part-time (26.7%), university-educated (58.0%), and had only one child (40.1%). Most respondents managed their BGLs through diet (88.3%), with "low-carbohydrate" diets being the most popular (72.3%), and 46.2% of respondents were undertaking insulin therapy. Only 42.2% and 19.8% of respondents reported meeting the aerobic and strengthening exercise recommendations, respectively. Women with one child or currently pregnant expecting their first child were 1.51 times more likely (95% CI, 1.02, 2.25) to meet the aerobic exercise recommendations than those with two or more children. The most common reported barriers to lifestyle intervention participation were "lack of time" (71.4%) and "childcare" commitments (57.7%). Lifestyle interventions delivered between 6 and 12 months postpartum (59.0%), involving an exercise program (82.6%), and delivered one-on-one were the most popular (64.9%). CONCLUSION: Most women report managing their GDM with lifestyle strategies. The most common strategies reported involve approaches not currently included in the clinical practice guidelines such as reducing carbohydrate consumption. Furthermore, despite being willing to participate in lifestyle interventions, respondents report significant barriers, including lack of time and childcare commitments, whereas mentioned supports included having an online format. Lifestyle interventions for women with a history of GDM should be designed in a manner that is both tailored to the individual and considerate of existing barriers and supports to participation.

The Effects of Tree Nut and Peanut Consumption on Energy Compensation and Energy Expenditure: A Systematic Review and Meta-Analysis.

Nut consumption is not associated with a higher body weight, and potential energy-regulating mechanisms may include a reduced subsequent energy intake and increased EE. The aim of this study was to examine the effect of tree nut and peanut consumption on energy intake, compensation, and expenditure. PubMed, MEDLINE, CINAHL, Cochrane, and Embase databases were searched from inception to June 2, 2021. Human studies with adults aged ≥18 y older were included. Energy intake and compensation studies were restricted to acute effects (intervention duration of ≤24 h), whereas intervention duration was not limited for EE studies. Random effects meta-analyses were conducted to explore weighted mean differences in REE. Twenty-eight articles from 27 studies (16 energy intake studies, 10 EE studies, and 1 study investigating both) with 1121 participants were included in this review, with a variety of nut types addressed (almonds, Brazil nuts, cashews, chestnuts, hazelnuts, peanuts, pistachios, walnuts, and mixed nuts). Energy compensation occurred after nut-containing loads (range: -280.5% to +176.4%) and the degree of compensation varied depending on the form (whole and chopped) and how they were consumed (alone and within a meal). The meta-analyses identified a nonsignificant increase in REE associated with nut consumption (weighted mean difference: 28.6 kcal/d; 95% CI: -10.7, 67.8 kcal/d). This study provided support for energy compensation as a potential mechanism for a lack of association between nut consumption and body weight, whereas no evidence was found for EE as an energy-regulating mechanism of nuts. This review was registered at PROSPERO as CRD42021252292.

Identifying usual food choices with avocados in a clinical trial cohort of overweight and obese adults in Australia.

BACKGROUND: Consumption of avocados has been suggested to be beneficial for weight control, however, limited research is available about the related food choices. Understanding the food choices associated with avocados at meal occasions may further aid behavioural strategies to lose weight. The present study used a systematic approach to develop an avocado-specific food database, with the aim to explore food choices related to avocados at meal occasions as reported by overweight and obese volunteers in weight loss clinical trials. METHODS: The avocado-specific database was based on AUSNUT 2011-13 food composition database structure and was developed via a systematic approach, which determined the avocado content of Australian foods and beverages. Baseline usual food intake data was retrospectively pooled from four food-based clinical trials (n = 758). The Apriori algorithm of association rules, a two-step descriptive method was used to identify food choices associated with avocados at different meal occasions using a nested hierarchical food group classification system. RESULTS: The avocado database identified 34 avocados and avocado-containing foods and beverages. The proportion of avocado consumers in the pooled cohort was 51.3% (n = 389), with an average avocado intake of 21.57 ± 36.75 grams per day. Avocados were found to be closely related to other food groups at all of the food group levels at main meal occasions. A total of 68 food items containing avocados were identified for avocado consumers at the breakfast, lunch and dinner meals. CONCLUSION: The avocado specific database provides a snapshot of the foods and beverages which contain avocados. Enumerating the full range of food choices in relation to avocado consumption should provide examples of food choices that people might consider in their efforts to increase their avocado consumption.

The effect of sorghum consumption on markers of chronic disease: A systematic review.

Sorghum requires fewer inputs for sustainable cultivation in harsh climates and has the potential to be utilized in modern food product innovations. Moreover, consumption of sorghum may elicit favorable health effects similar to other commonly consumed cereals, like wheat. Animal and human research exploring health effects of sorghum consumption indicates potential beneficial effects on blood glucose and lipid regulation, oxidative stress modulation, appetite regulation and weight management. However, a recent appraisal of the strength of evidence has not been conducted. Therefore, this study aims to evaluate the effects of sorghum consumption on metabolic indicators of chronic disease, including blood lipid and blood glucose levels, markers of oxidative stress, and factors associated with weight management. Using CINAHL, Cochrane Library, PubMed and MEDLINE databases, a systematic review of intervention studies published up to May 2020 was conducted and 16 interventional studies met the criteria for inclusion. Evidence for favorable effects of sorghum consumption on indicators of chronic disease, including blood glucose responses, markers of oxidative stress, satiety measures and weight management was demonstrated. Evidence from this systematic review may assist to promote sorghum's potential health benefits globally, including in food markets where it is underutilized, stimulating more sorghum-based food innovations in the future.

Examining dietary behaviours, diet quality, motives and supplementation use in physically active individuals following vegetarian-based eating patterns.

The adoption of vegetarian-based dietary patterns among athletes has been gaining popularity. However, limited research examines the dietary behaviours within this group. Therefore, the aim of this study was to examine self-reported dietary behaviours in a cohort of physically active individuals following vegetarian-based dietary patterns, recruited via social media. A 52-item online survey was created with questions related to demographics, physical activity, eating patterns and supplementation use. An external link to the Australian Automated Self-Administered 24-h (ASA24-AU) recall was included to examine nutrient intakes. Dietary quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Dietary Phytochemical Index (DPI) tools. A total of 781 (84.8%) respondents completed the survey in 2018. Principal motives for adhering to a vegetarian-based dietary pattern included animal rights (86.5%), environmental concerns (75.4%), health reasons (69.6%) and improving physical performance (24.1%). Vitamin B12 was the most commonly reported supplement (58.1%) followed by protein powder (36.3%) and vitamin D (35.9%). A total of 133 respondents completed the ASA24-AU dietary recall with generally adequate nutrient intakes and a high-quality diet as assessed by the AHEI-2010 and DPI. A significant minority of physically active individuals following vegetarian-based diets do so with the aspiration of improving their exercise performance. Dietary quality was considered high in this group for recreational physical activity, although intakes of vitamin B12 and LC n-3 PUFA were low.

Knowledge, Messaging, and Selection of Whole-Grain Foods: Consumer and Food Industry Perspectives.

OBJECTIVE: To explore whole-grain food definitions in labeling and relevance to consumers and the food industry. DESIGN: Semistructured focus groups and interviews. SETTING: Online. PARTICIPANTS: Consumers (n = 43) aged ≥ 18 years currently purchasing/consuming grain foods. Food industry participants (n = 17) currently/recently employed within grain food companies. PHENOMENON OF INTEREST: Impact of using whole-grain food definitions in labeling. ANALYSIS: Inductive thematic analysis. RESULTS: Six major themes included: consumer knowledge and understanding of whole-grain foods; factors affecting consumer grain food choices; consumer skepticism of labeling; consumer preferences toward whole-grain labeling; acceptability and feasibility of whole-grain food definitions in the food industry; and food innovation/reformulation. For the food industry, definitions impact feasibility, food innovation, and reformulation. Skepticism affected consumer knowledge and understanding, impacting grain food choice and their preference regarding whole-grain labeling. Consumers preferred whole grain in the name of a food and placing the percent of whole grain on the front-of-pack. CONCLUSIONS AND IMPLICATIONS: Our findings suggest that definitions and regulations, consumer education, and strategies addressing factors influencing consumer choice are needed to improve population whole-grain intakes. Future research may consider formal regulation and implementation of standardized whole-grain food definitions in labeling and explore the subsequent impact on consumer choice and whole-grain intake.

Systematic literature review: should a bedtime snack be used to treat hyperglycemia in type 2 diabetes?

BACKGROUND: Consuming a bedtime snack is often recommended for people with type 2 diabetes. OBJECTIVE: This systematic review aims to evaluate the evidence from intervention studies to determine whether consuming a bedtime snack improves fasting hyperglycemia and/or overall glycemic control in individuals with type 2 diabetes. METHODS: PubMed, Medline (EBSCO), Cochrane Library, and CINAHL Plus (EBSCO) databases were searched until 20 July, 2022. We included prospective studies in people with type 2 diabetes or prediabetes that included the intervention of a bedtime snack, consumed >30 min after dinner and <2 h before bed and reported glycemic outcomes. RESULTS: The systematic review included 16 studies. There was no consistent relationship between consumption of a bedtime snack and improved glycemic control, especially when a no-snack control was included. Of the 4 studies that included the use of corn starch, a low dose seemed to have benefits over high-dose corn starch in terms of improved nocturnal and fasting glucose concentrations. CONCLUSIONS: Current advice to consume a bedtime snack is based on a limited number of intervention studies that often do not include a no-snack control, nor have used a feasible bedtime snack option that could be translated into everyday clinical practice. Further research is needed in type 2 diabetes patients treated with or without insulin. This review was registered at the Prospective Register of Systematic Reviews (PROSPERO) as CRD42020182523.

Nutrition and Health Claims: Consumer Use and Evolving Regulation.

PURPOSE OF REVIEW: The value of nutrition and health claims (N&HC) depends on how consumers use them and the regulatory framework that enables them. This paper aims to explore the impact of claims on consumer behaviour and identify evolving regulatory challenges, using the Australian experience as a reference point. RECENT FINDINGS: N&HC can influence consumer food purchasing and consumption, but how consumers interpret and act on specific claims is less well understood, and regulatory frameworks are evolving. In the last 10 years, changes to the Australian regulatory framework have exposed greater opportunities for promoting foods, albeit with challenges regarding self-substantiation of claims. N&HC can play a significant role in driving consumer choices towards a healthier food supply. The Australian experience demonstrates how N&HC can continue to evolve, reflecting developments in methodologies and a fundamental appreciation of the relationship between food and health.

Perceptions of Nut Consumption amongst Australian Nutrition and Health Professionals: An Online Survey.

Habitual nut consumption is associated with reduced risk of chronic diseases; however, consumption levels in Australia are below recommendations. This study examined perceptions and knowledge regarding nut consumption among Australian healthcare professionals and their provision of nut consumption recommendations. A cross-sectional online survey of Australian health professionals was conducted in February-April 2020. Questions in the survey included demographic details, participants' perceptions of nut consumption, and nut consumption recommendations they may make to clients and patients. A total of 204 health professionals completed the survey, of which 84% were dietitians or nutritionists. Health professionals demonstrated basic nutritional knowledge regarding nut consumption; however, non-dietitians/nutritionists lacked knowledge of long-term benefits of nut consumption. Dietitians/nutritionists were more likely to agree that nuts are healthy and do not cause weight gain when compared to non-dietitians/nutritionists (p = 0.021). A total of 63% of health professionals advised at least some of their clients to eat more nuts, and this was higher among dietitians/nutritionists (68%) than non-dietitians/nutritionists (31%). While basic nutritional knowledge regarding nut consumption was observed among all health professionals, there is scope for further education, particularly for non-dietitians/nutritionists, to ensure that nutrition information provided to patients and clients is accurate and reflects the current evidence base.

A Cross-Sectional Comparison of the Whole Blood Fatty Acid Profile and Omega-3 Index of Male Vegan and Omnivorous Endurance Athletes.

Background: Evaluation of the dietary fat consumption in athletes following vegan diets is scarce. The aim of this study was to explore the intakes, availability, and uptake of physiologically relevant fatty acids into whole blood, and consequently the Omega-3 Index (O3I) of endurance athletes following vegan and omnivorous dietary patterns.Materials: Males aged 18 to 55 years, engaging in ≥ four hours of training/week and following a vegan (>6 months) or omnivorous dietary pattern were eligible to participate. A 7-day food and training diary was collected and an incremental ramp running protocol used to determine peak aerobic capacity. A finger prick blood sample was collected to determine the whole blood fatty acid profile and O3I. Participants were grouped as following a vegan or omnivorous diet matched for age, training volume and peak aerobic capacity.Results: The vegan group (n = 12) consumed significantly less dietary total fat (122.2 g/day vs 84.1 g/day p = 0.007), saturated fat (43.74 g/day vs 18.42 g/day p < 0.0001), monounsaturated fat (49.6 g/day vs 35.64 g/day p = 0.039) and long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA) compared to the omnivorous group (n = 8). Between group differences in whole blood fatty acid concentrations were observed including; linoleic, eicosapentaenoic, docosahexaenoic, n-6:n-3 and AA:EPA ratios. O3I in both groups were suboptimal (vegan: 4.13%, omnivorous: 5.40%) in terms of cardiac risk.Conclusion: Male endurance athletes should ensure their dietary LC n-3 PUFA intakes, particularly EPA and DHA fatty acids are sufficient to optimize their O3I.

Consumption of avocado and associations with nutrient, food and anthropometric measures in a representative survey of Australians: a secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey.

Avocados are a rich source of nutrients including monounsaturated fats, dietary fibre, potassium and Mg, as well as phytochemicals. However, no epidemiological analysis for the associations between avocado consumption and participant anthropometric measures has been conducted in Australia. The present study aimed to perform a secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey (NNPAS) to quantify avocado consumption in the Australian population and explore the associations between avocado intakes, consumption of nutrients and food groups based on the Australian Dietary Guidelines and anthropometric measurements. Usual avocado consumption in the 2011-2012, NNPAS was determined using the multiple source method regression model. The relationship between avocado consumption and intakes of key nutrients and food groups and participant weight, BMI and waist circumference were examined using linear regression. Mean avocado intake was 2·56 (95 % CI: 2·37, 2·75) grams per day with 15·9 % of Australians considered to be 'avocado consumers' (n 21 526 456 population size; n 12 153 observations). Greater consumption (g) of avocados was associated with significantly higher consumption of monounsaturated fats, polyunsaturated fats, dietary fibre, vitamin E, Mg and potassium, as well as 'whole grains', 'vegetables', 'fruit' and 'meat and alternatives' food groups. Greater consumption (g) of avocados was associated with significantly lower consumption of carbohydrates and discretionary foods. When adjusted for covariates, greater consumption of avocados was significantly associated with a lower body weight (P = 0·034), BMI (P < 0·001) and waist circumference (P < 0·001). Avocados may be incorporated into an eating pattern and may be beneficial in weight management.