Cardiometabolic diseases, including type 2 diabetes (T2DM) and cardiovascular disease (CVD), are common. Approximately one in three deaths annually are caused by CVD in Aotearoa New Zealand (AoNZ)(1). The Mediterranean dietary pattern is associated with a reduced risk of cardiometabolic disease in epidemiological and interventional studies(2,3). However, implementing the Mediterranean diet into non-Mediterranean populations can be challenging(4). Some of these challeanges include facilitating consumption of unfamiliar foods and the cultural and social context of food consumption. AoNZ produces a rich source of high-quality foods consistent with a Mediterranean dietary pattern. He Rourou Whai Painga is collaborative project combining contributions from food industry partners into a Mediterranean Diet pattern and providing foods, recipes and other support to whole household/whānau. The aim was to test if a New Zealand food-based Mediterranean diet (NZMedDiet) with behavioural intervention improves cardiometabolic health and wellbeing in individuals at risk. This presentation will review the background to the research, the process of forming a collaboration between researchers and the food industry, the design and implementation of a complex study design (see protocol paper)(5), with results from the initial randomised controlled trial. We conducted several pilot studies(6,7,8) to inform the final design of the research, which was a combination of two randomised controlled trials (RCT 1 and 2) and a longitudinal cohort study. RCT-1 compared 12-weeks of the NZMedDiet to usual diet in participants with increased cardiometabolic risk (metabolic syndrome severity score (MetSSS) >0.35). The intervention group were provided with food and recipes to meet 75% of their energy requirements, supported by a behavioural intervention to improve adherence. The primary outcome measure was MetSSS after 12 weeks. Two hundred individuals with mean (SD) age 49.9 (10.9)yrs with 62% women were enrolled with their household/whānau. After 12 weeks, the mean (SD) MetSSS was 1.0 (0.7) in the control (n = 98) and 0.8 (0.5) in the intervention (n = 102) group; estimated difference (95% CI) of -0.05 (-0.16 to 0.06), p=0.35. A Mediterranean diet score (PyrMDS) was greater in the intervention group 1.6 (1.1 to 2.1), p<0.001, consistent with a change to a more Mediterranean dietary pattern. Weight reduced in the NZMedDiet group compared with control (-1.9 kg (-2.0 to -0.34)), p=0.006 and wellbeing, assessed by the SF-36 quality of life questionnaire, improved across all domains p<0.001. In participants with increased cardiometabolic risk, food provision with a Mediterranean dietary pattern and a behavioural intervention did not improve a metabolic risk score but was associated with reduced weight and improved quality of life.

‘I just don’t know what to eat!’ is a frequent statement from people seeking nutrition support. With a magnitude of information available, confusion and limited confidence is a common complaint. People face myriad challenges in their attempts to have a healthy diet, including cost and time constraints, challenging food environments, and limited knowledge and skills(1). Challenges about eating well are often raised, yet enablers to eating well are not as readily discussed. Intention for healthy behaviours, self-efficacy and social support are examples of favourable elements which support healthy diets(1,2). As such, existing knowledge, skills, and positive influences should also be considered. As part of a wider qualitative study, and using an interpretive description approach, we sought to identify enablers to healthy eating perceived by people engaged with Green Prescription (GRx) and Active Families programmes. Nineteen clients aged 18 years and over, engaged with six GRx services were interviewed between May and October 2023. Eighteen whānau (family) members, (19-53 years) attending Active Families sessions facilitated in the Waitematā area participated in focus group discussions during May-August 2024. Participants were asked in these discussions (kōrero) to share what helps them and their whānau to eat well. Braun and Clarke’s(3) thematic analysis approach was used to analyse responses from these kōrero through data familiarisation, coding, and cyclical review of thematic relationships. Several themes were identified in this analysis: ‘confidence in personal skills,’ ‘supportive environments’, and ‘being open and willing’. Personal skills such as planning meals, managing household budget and efforts to procure ‘good’ food were identified as strengths. These wider food skills have been suggested as potentially more important to enhancing dietary behaviours than cooking skills(4). Participants relayed experiences of developing skills that improved their confidence in eating well including growing, gathering and preserving food, experimenting with recipes, and knowing where to find affordable, nutritious food. Environments where people learned food and cooking skills and household members supported their endeavours to eat well were described as influential to encourage people in their efforts. Participants also expressed that being open to trying new foods and ways of eating led to inspiration and new knowledge. This attitude resulted in increased variety in the diet and further enhanced confidence to seek recipes and food information and spurred on efforts to make changes. People who have sought nutrition advice have often expressed challenges and uncertainty impacting their efforts to eat well. Nevertheless, there are also strengths which have meaningful impact on their eating. In nutrition advice provision, it would be beneficial to thoroughly explore the strengths people exhibit to support healthy eating. Identifying these insights may powerfully effect people’s confidence to eat well and identify more effective support and information provision.

New Zealand and Australian governments rely heavily on voluntary industry initiatives to improve population nutrition, such as voluntary front-of-pack nutrition labelling (Health Star Rating [HSR]), industry-led food advertising standards, and optional food reformulation programmes. Research in both countries has shown that food companies vary considerably in their policies and practices on nutrition(1). We aimed to determine if a tailored nutrition support programme for food companies improved their nutrition policies and practices compared with control companies who were not offered the programme. REFORM was a 24-month, two-country, cluster-randomised controlled trial. 132 major packaged food/drink manufacturers (n=96) and fast-food companies (n=36) were randomly assigned (2:1 ratio) to receive a 12-month tailored support programme or to the control group (no intervention). The intervention group was offered a programme designed and delivered by public health academics comprising regular meetings, tailored company reports, and recommendations and resources to improve product composition (e.g., reducing nutrients of concern through reformulation), nutrition labelling (e.g., adoption of HSR labels), marketing to children (reducing the exposure of children to unhealthy products and brands) and improved nutrition policy and corporate sustainability reporting. The primary outcome was the nutrient profile (measured using HSR) of company food and drink products at 24 months. Secondary outcomes were the nutrient content (energy, sodium, total sugar, and saturated fat) of company products, display of HSR labels on packaged products, company nutrition-related policies and commitments, and engagement with the intervention. Eighty-eight eligible intervention companies (9,235 products at baseline) were invited to participate, of whom 21 accepted and were enrolled in the REFORM programme (delivered between September 2021 and December 2022). Forty-four companies (3,551 products at baseline) were randomised to the control arm. At 24 months, the model-adjusted mean HSR of intervention company products was 2.58 compared to 2.68 for control companies, with no significant difference between groups (mean difference -0.10, 95% CI -0.40 to 0.21, p-value 0.53). A per protocol analysis of intervention companies who enrolled in the programme compared to control companies with no major protocol violation also found no significant difference (2.93 vs 2.64, mean difference 0.29, 95% CI -0.13 to 0.72, p-value 0.18). We found no significant differences between the intervention and control groups in any secondary outcome, except in total sugar (g/100g) where the sugar content of intervention company products was higher than that of control companies (12.32 vs 6.98, mean difference 5.34, 95% CI 1.73 to 8.96, p-value 0.004). The per-protocol analysis for sugar did not show a significant difference (10.47 vs 7.44, mean difference 3.03, 95% CI -0.48 to 6.53, p-value 0.09).In conclusion, a 12-month tailored nutrition support for food companies did not improve the nutrient profile of company products.

Sustainability in Aotearoa New Zealand’s food system is essential for environmental health (taiao ora) and human well-being (tangata ora). However, achieving resilience in our food system faces significant cross-sector challenges, requiring a national food strategy that addresses environmental, economic, and social pressures(1). This work aims to develop the first national computational model of Aotearoa New Zealand’s food system, integrating key factors into a decision support tool. The model aims to support food system resilience by offering an accessible platform that could help inform decisions to strengthen preparedness for shocks, while also providing insights to enhance everyday food security. The Kai Anamata mō Aotearoa (KAMA) model leverages new data and indigenous crop trials to combine work across agriculture, environment, and human wellbeing, forming a comprehensive tool to examine food system resilience. This model will capture the resources required, outputs produced, and wellbeing outcomes of our food system. The KAMA model was built using a flow-state modelling approach, which allows for flexible configuration of land uses and ensures that the model can adapt to future technologies and climate change scenarios. The preliminary development the KAMA model was used to demonstrate the current production system and applied to a regional case study from Te Tauihu, integrating region-specific food production data, including apples, kiwifruit, mussels, wine, and hops production. Outputs included labour, carbon dioxide emissions and mass of production. Beyond food production, this model will enable users to explore the impacts of land use for commodity production, the effects of trade, nutrient supply, and the broader implications for well-being. model will be made publicly accessible online to allow any interested individual to explore the future of the national food system.

Gut health is a 50-billion-dollar (US) industry that is forecast to continue growing. This growth is attributed to our increased understanding and interest in the gut microbiome and its association with many chronic diseases, mental health and gut and autoimmune disorders. In 2024, “dysbiosis”, “gut microbiome” and “gut probiotics” were some of the most commonly google searched words but, what constitutes “good gut health”? There is no exact definition but in clinical practice we may use symptoms as a proxy for gut health, for example normal gastrointestinal function and the absence of chronic gastrointestinal symptoms that negatively impact on our quality of life. Consumer research found that consumers regard gut health as well-being and are interested in latest science but that does not inform their purchasing behaviours(1). Interestingly, symptoms of suboptimal gut health, which may include abdominal bloating, diarrhoea, constipation, excessive flatulence, were most likely to influence consumer behaviours.1 In this presentation, I review the latest scientific evidence about foods and dietary patterns that are associated with markers of gut health. I also provide examples of how we can practically educate and advise New Zealanders on implementation of dietary changes that may support sustainable gut health.

Irritable bowel syndrome (IBS) is a chronic and painful gastrointestinal disorder associated with significantly worse physical functioning (abnormal physiology, visceral hypersensitivity, inflammation, immune dysregulation, microbiome, and malabsorption issues). IBS isinfluenced by genetic disposition, psychological factors and diet, significantly and adversely affects quality of life(1). Internationally IBS is a common disorder in primary and speciality care affecting 13 to 20% of people(2). IBS imposes a significant economic burden to health systems(2). The prevalence and economic results of IBS make it a major public health concern. Existing interventions revolve separately around diet (particularly the low FODMAP diet) and stress management. The goal of this project was to create a multimodal lifestyle intervention explicitly designed to enhance the health-related quality of life in women treated for IBS in Aotearoa with the imperative to minimise the risk of IBS recurrence and to reduce the burden of the long-term physical and psychological symptoms. This IBS programme builds on the well-established Women’s Wellness Programs (WWP) based at the Health Faculty, University of Technology, Sydney. These are robust and systematic programmes developed within the WWP team which comprises international experts in women’s health and chronic conditions, of cancer, diabetes, cardiovascular disease and stroke. All WWP employ individually tailored strategies to instil positive behavioural change. They are also designed for virtual delivery through participants’ mobile computing devices to ensure regional and rural access. This presentation explains the ‘The Aotearoa Women’s Wellness Program for IBS’ prototype that has been developed. This programme is designed based on the results of a study where IBS participants (n=15) and separately health professionals or researchers (n=15) working in the field of IBS in New Zealand were all asked the same questions about the IBS journey, including diagnosis and treatment. Their responses detailed how IBS adversely affected all aspects of quality of life, raised issues with diagnosis and treatment and articulated desired support approaches. When given information about the WWP and asked to provide feedback on it, all 30 interviewed participants agreed that a WWP health promotion approach for IBS was feasible, relevant, and warranted. Through this feedback the programme was developed. Participants work through the content to address issues such as nutrition, stress management, and physical activity, guided by a health professional with expertise in gut health. Various activities and opportunities to reflect are distributed throughout the programme to identify goals to help participants make and embed appropriate changes in their lifestyles. This new, evidence-based programme for IBS is now available to health professionals working in clinical situations related to gut health in Aotearoa. It gives them the opportunity to redesign care, irrespective of where care is delivered, in a way that is responsive to the needs of people with IBS.

The transition from breastmilk to solid foods (weaning) is a critical stage in infant development and plays a decisive role in the maturation of the complex microbial community inhabiting the human colon. Diet is a major factor shaping the colonic microbiota, which ferments nutrients reaching the colon unabsorbed by the host to produce a variety of microbial metabolites influencing host physiology(1). Therefore, making adequate dietary choices during weaning can positively modulate the colonic microbiota, ultimately contributing to health in infancy and later life(2). However, our understanding of how complementary foods impact the colonic microbiota of weaning infants is limited. To address this knowledge gap, we employed a metagenome-scale modelling approach to simulate the impact of complementary foods, either combined with breastmilk or with breastmilk and other foods, on the production of organic acids by colonic microbes of weaning infants(3). Complementary foods and combinations of foods with the greatest impact on the in silico microbial production of organic acids were identified. These foods and food combinations were further tested in vitro, individually or in combination with infant formula. Fifty-three food samples were digested using a protocol adapted from INFOGEST to mimic infant digestion and then fermented with faecal inoculum from 6 New Zealand infants (5-11 months old). After 24h of fermentation, the production of organic acids was measured by gas chromatography. Differences in organic acid production between samples were determined using the Tukey Honestly Significant Difference test to account for multiple comparisons. The microbial composition was characterised by amplicon sequencing of the V3-V4 regions of the 16S bacterial gene. Taxonomy was assigned using the DADA2 pipeline and the SILVA database (version 138.1). Bioinformatic and statistical analyses were conducted using the R packages phyloseq and ANCOM-BC2, with the Holm-Bonferroni adjustment to account for false discovery rates in differential abundance testing. Blackcurrant and raspberries increased the production of acetate and propionate (Tukey’s test, p<0.05) and the relative abundance of the genus Parabacteroides (Dunnett’s test, adjusted p<0.05) compared to other foods. Raspberries also increased the abundance of the genus Eubacterium (Dunnett’s test, adjusted p<0.05). When combined with infant formula, black beans stood out for increasing the production of butyrate (Tukey’s test, p<0.05) and the relative abundance of the genus Clostridium (Dunnett’s test, adjusted p<0.05). In conclusion, this study provides new evidence on how complementary foods, both individually or in combination with other dietary compounds, influence the colonic microbiota of weaning infants in vitro. Insights generated by this research can help design future clinical trials, ultimately enhancing our understanding of the relationship between human nutrition and colonic microbiota composition and function in post-weaning life.

The objective of the food safety system is to provide safe and suitable food in New Zealand(1). This is of particular importance for our youngest members– infants and young children. During the first 2000 days of life, food and nutrition have crucial roles. Nutrient requirements are high, and children often have an increased vulnerability to hazards associated with chemical and microbiological contamination. Foods targeted to this age group typically have strict regulations, as the quality and safety of foods for infants and young children is of great concern to caregivers, public health authorities and regulatory bodies worldwide. The recent First Foods New Zealand Study (FFNZ) and Young Foods New Zealand (YFNZ) Study have provided important data into what, and how, we feed our infants and young children under four years of age(2). Insights from the dietary intakes and health of 925 infants and young children from these studies are being used by NZFS to inform its work on food monitoring surveillance and food policy. Currently New Zealand Food Safety (NZFS) is conducting the 2024 New Zealand Total Diet Study (NZTDS) (Infants and Toddlers)(3). The NZTDS is a food monitoring and surveillance programme which aims to evaluate the risk to New Zealanders from exposure to certain chemicals such as agricultural chemicals, contaminants (including from food packaging), and nutrients. The 2024 NZTDS will, for the first time, focus exclusively on infants and young children. The FFNZ and YFNZ studies informed the selection of 117 foods to be tested from four New Zealand regions throughout 2024/2025. The dietary intake data will then be used to estimate the dietary exposure to each of the 362 chemicals analysed. This monitoring programme informs policy decision-making and food standard setting and provides assurance on the safety of our food supply. Concerns around the nutrient quality and labelling of some commercial products for infants and young children have been identified in Australia and New Zealand. Within the joint food regulatory system, consultation is underway to consider regulatory and non-regulatory options for improving commercial foods for infants and young children(4). This presentation will discuss NZFS’s role in monitoring foods and diets of infants and young children in Aotearoa New Zealand, the importance of, and application of evidence to inform policy, food safety, and potential regulatory and non-regulatory options to ensure that the food safety system continues to deliver safe and suitable food in New Zealand.

Poor iron status is one of the most prevalent problems facing infants worldwide, in both developing and developed countries(1). A complex interplay of both dietary and non-dietary factors affects iron intake, absorption, and requirements, and subsequently iron status(2). We aimed to describe iron status in an ethnically diverse cohort of urban-dwelling infants. Data were collected from 364 infants aged 7.0 to 10.0 months living in two main urban centres in New Zealand (Auckland and Dunedin) between July 2020 and February 2022. Participants were grouped by total ethnicity, with any participants who did not identify as either Māori or Pacific categorised into a single ‘others’ group. Haemoglobin, plasma ferritin, soluble transferrin receptor (sTfR), C-Reactive protein, and alpha-1-acid-glycoprotein were obtained from a non-fasting venous blood sample. Inflammation was adjusted for using the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) method(3). Body iron concentration (mg/kg body weight) was calculated using the ratio of sTfR and ferritin. A total of 96.3% of Pacific infants were iron sufficient, defined as body iron ≥0 mg/kg body weight and haemoglobin (Hb) ≥105 g/L, compared to 82.3% of Māori and 76.0% of ‘other’ (i.e. neither Māori nor Pacific) infants. ‘Other’ infants had the highest prevalence of iron deficiency overall, with 2.8% categorised with iron-deficiency anaemia (IDA) (body iron <0 mg/kg, haemoglobin <105 g/L), 11.8% with early ‘functional’ iron deficiency (body iron <0 mg/kg, haemoglobin ≥105 g/L), and 9.4% with iron depletion (ferritin <15 µg/L, in the absence of early ‘functional’ iron deficiency and iron deficiency anaemia). For Māori infants, 3.2% and 6.5% had IDA and early ‘functional’ iron deficiency respectively, and 8.1% were iron depleted. One (3.7%) Pacific infant was iron depleted, and the remainder were iron sufficient. Plasma ferritin and body iron concentration were, on average, higher in Pacific compared to non-Pacific infants. These findings give an up-to-date and robust understanding of the iron status of infants by ethnicity, highlighting an unexpected finding that infants who are neither Māori nor Pacific may be at higher risk of poor iron status in NZ.

Optimal early childhood nutrition is central to healthy growth, wellbeing and development. The World Health Organisation (WHO) Regional Office for Europe Nutrient and Promotion Profile Model (NPPM)(1) recommends that commercial infant and toddler foods do not carry compositional, nutrition, health or marketing claims. The Food Regulation Standing Committee of Australia and New Zealand (NZ) has identified labelling of these foods as a current area of concern(2). This study aims to identify on-pack labelling and marketing claims on commercial packaged foods aimed at infants and toddlers in NZ. Relevant infant and toddler products available in NZ supermarkets were identified through Nutritrack(3), a packaged food database managed by the University of Auckland. Information was collected from four major NZ supermarket chains in Auckland. Photographs of packaged foods and beverages were taken and names, brands, labelling, ingredients and NIP information identified. Data were collected between April and July 2023. In January 2024, online supermarket websites were checked for additional products. Infant products were those intended for ages up to 11 months as indicated on the package, and toddler products for ages 12 months to 36 months. Claims on each side of the package were coded using a pre-existing coding structure according to the three main categories identified in the WHO NPPM, composition and nutrition claims, health claims, and marketing claims, The absence or presence of the type of claim was noted. Descriptive statistics were conducted using Microsoft Excel to analyse frequency of types of claims. Two hundred and ten products were identified, 167 infant and 43 toddler products. All products had some type of claim on the package. On average, there were 7 unique types of claims per product (range 3-14) for both infant and toddler foods. The most common type of claims were composition and nutrition claims, with a mean of 4.0 types per product, followed by 3.3 types of marketing claims and 0.16 health claims. The most prevalent composition and nutrition claims were ‘free from’ claims relating to the absence of ingredients generally perceived to be harmful, most commonly flavours (on 72% of packages), colours (71%), added sugar (53%), preservatives (43%) and salt (33%). Two-thirds of packages (68%) carried statements on the natural or healthy nature of the ingredients mentioning words like organic/fresh/real or natural on-pack. All infant and toddler products carried some type of claim with the most common being about the composition or nutrition of the product, particularly the absence of additives, sugar and salt. Regulation is needed to ensure that parents and caregivers receive accurate information, preventing them from being misled when making purchasing decisions for their children.

The estimated global preterm birth rate in 2020(1) was more than 10% of livebirths or 13.4 million infants. Despite the importance of neonatal nutrition in optimising growth, neurodevelopment, and later metabolic disease risk, there is inconsistency in nutrition recommendations for preterm infants(2). Incomplete or inconsistent reporting of outcomes in nutrition intervention studies is part of the reason for the lack of consensus on optimal nutrition. To reduce uncertainty in measuring or reporting nutritional intake and growth outcomes in preterm studies, a consensus process is needed to identify relevant measures for patients, parents/caregivers, researchers, and health professionals. We aimed to develop a minimum reporting set (MRS) for measures of nutritional intake and growth in preterm nutrition studies. We collaborated with a group of international researchers from 13 countries and registered this study at the COMET initiative (registration number 3185). The target population was individuals born preterm at any gestational age and study location whose nutritional intake was assessed before first hospital discharge and whose growth was assessed at any age. Measures reported in preterm nutrition studies were systematically reviewed and used to develop the real-time Delphi survey(3) using Surveylet (Calibrum) software, including 13 questions about nutritional intake and 14 about growth outcomes. We used a snowball process to recruit participants from the consumer, healthcare provider, and researcher stakeholder groups with expertise in preterm infants, nutrition, and growth to rate the importance of each measure on a 9-point Likert scale. Participants initially rated the survey items without seeing other participants’ responses, saved and refreshed the page to see the anonymous responses of other participants, and had the option to change their rating and provide reasons for their answers. Participants’ final scores for each item will be used to identify the consensus criteria for that item(3). To date, we have recruited 246 participants from 31 countries across 5 continents, including 58 (24%) consumers, 156 (63%) healthcare professionals, and 26 (11%) researchers. Preliminary findings indicate that 12 measures of nutritional intake and 4 of growth have met the criteria for inclusion in the MRS. However, participant recruitment and survey responses are ongoing. A final consensus meeting is planned for November 2024 to confirm the MRS.

The nutrition workforce plays a vital role in disease prevention and health promotion, with expanding job opportunities shaped by factors like aging populations, climate change, global food systems, and advancing technologies(1,2). Preparing students for careers that require adaptability involves understanding the valuable skills they possess and identifying any gaps. This research aimed to identify the skills and knowledge valued by students who had recently completed work-based placements, and explore recent graduates’ experiences, challenges, and preparedness for employment. At the end of their work-based placements students give presentations sharing their experiences and learning. Permission was sought from ten students to analyse the recordings of these presentations. The presentations were selected to include a range of nutrition fields, including sports nutrition, public health, community nutrition, dietary counselling, food and industry, and nutrition communication. Additionally, a list of graduates (within four years of graduation) from various fields (as above) was compiled and they were invited to participate. Semi-structured interviews (n=10) were conducted online via Zoom and recorded. The interview guide included open-ended questions on employment experiences, challenges, preparedness, and required skills. The interviews, transcription and analyses were completed by two student researchers between November 2023 and February 2024. Thematic analysis using NVivo software was used to identify themes. The themes developed included the importance of skills relating to; i) communicating complex nutrition concepts to the public, ii) collaborating within diverse teams, iii) identifying and filling personal knowledge gaps. In addition Graduates felt practical experience from their University study boosted their preparedness for the workforce, though many struggled to apply their skills in non-traditional roles and expand their career scope. In summary, ongoing focus on team-based projects, communication with non-science audiences, and strategies for continuous learning using evidence-based sources are crucial for both undergraduate and postgraduate education.

Malnutrition from poor diet is a persistent issue in Sri Lanka, especially among women and children. High rates of undernutrition and micronutrient deficiencies are documented among rural poor communities(1). Household food production may enhance maternal and child nutrition directly by increasing access to diverse foods and indirectly by providing income to diversify diets(2). This study explores the cross-sectional relationship between household food production and individual dietary diversity among women aged 18-45 years and children aged 2-5 years in Batticaloa district, Sri Lanka. We randomly selected 450 low-income mother-child pairs receiving a Samurdhi subsidiary, having a home garden. Through face-to-face interview, we gathered information on the types of crops grown and livestock reared in the preceding 12 months. Production quantity and utilization were also detailed. Additionally, socio-demographic information and market access were obtained. To measure women’s dietary diversity (DD), we used a scale based on 10-food groups and a 7-food group scale for children. Women who consumed five or more food groups were defined as meeting the Minimum Dietary Diversity of Women (MDD-W), whereas children who consumed of four or more food groups met the minimum standards. Multiple linear regression and binary logistic regression were used to identify the factors predicting individual DD. Complete data for 411 pairs were analysed. The results showed, only 15.3% of the women met MDD-W, with a mean DDS of 3.3 (SD = 1.2). Children had a mean DDS of 3.3 (SD = 1.2), and 41.1% of them met the minimum diversity. Regression analysis indicated that growing leafy vegetables was positively associated with increased dietary diversity of women (β = 0.337; 95% CI: 0.13, 0.54; p = 0.001) and children (β = 0.234; 95% CI: 0.05, 0.42; p = 0.013) but not with meeting the minimum diversity. Moreover, monthly income above 35,000 LKR, higher education level, a secondary income source andfood security were also positively associated with women’s DD. Conversely, living further away from the main road reduced the women’s DD. Interestingly, livestock ownership was only associated with women meeting the MDD-W, but not for children. For children, monthly income was a strong predictor of DD and meeting minimum diversity. Surprisingly, living far from the market was associated with increased DD in children (β = 0.018; 95% CI: 0.01, 0.03; p = 0.013), while distance to main road had a similar effect as in women. Notably, selling their produce at the market contributed to meeting the minimum dietary diversity in children (β = 0.573; 95% CI: 0.14, 1.02; p = 0.013). These findings suggest that enhancing household food production could play a crucial role in improving dietary diversity and addressing malnutrition, particularly in rural Sri Lankan communities, and potentially in other similar settings.

Global efforts to combat micronutrient deficiencies have often focused on assessing nutrient intakes and supplies(1,2), yet no studies have explored the role of crop selection and land suitability to tackle these deficiencies. This study aims to bridge this gap using existing estimates of global prevalence of iron(3) and zinc(4) deficiencies to identify crops with the highest potential to mitigate these deficiencies. Using the USDA food composition database, we established nutrient profiles for 37 widely cultivated crops, focusing on their iron and zinc content per 100 grams. To evaluate these crops’ effectiveness to meet nutrient requirements, we compared compositions to Harmonized Average Requirements (H-ARs) for women of reproductive age (WRA), a group particularly vulnerable to micronutrient deficiencies. The H-ARs account for variations in nutrient absorption and bioavailability(5). For each crop, we calculated the percentage of the H-AR met by 100 grams of iron and zinc content. This percentage was adjusted for the global prevalence of iron and zinc deficiencies by introducing deficiency weighting—multiplying each crop’s nutrient contributions by the global prevalence of iron and zinc deficiencies. The result was a deficiency-weighted nutrient score for each crop. Soybeans scored highest at 61.67, followed by cowpeas (50.30), pearl millet (33.69), and Phaseolus beans (31.33), indicating their strong potential to address global iron and zinc deficiencies. Next, we integrated these nutrient scores with global land suitability and yield potential data from the Global Agro-Ecological Zones (GAEZ) database to map regions most suited for growing these nutrient-dense crops. On average, our findings show that Tonga is the most suitable country for soybean cultivation, with a potential yield of 3.77 tons per hectare (tons/ha), Uruguay for cowpeas (2.82 tons/ha), Lithuania for Phaseolus beans (3.93 tons/ha), and Guinea-Bissau for pearl millet (3.87 tons/ha). Through multivariate clustering, we linked global deficiency patterns with yield potential across various regions. Countries such as those in the Caribbean, Eastern, Western, and Middle Africa, and Southern and Southeastern Asia emerged as priority regions where the production of these crops would be most beneficial to combat iron and zinc deficiencies. The results provide valuable insights to align agricultural land use practice with nutritional requirements, particularly in regions with high iron and zinc deficiency prevalence.

Although current estimates suggest that global food production is enough to meet nutritional needs, there are still significant challenges with equitable distribution(1). Tackling these disparities is essential for achieving global nutrition security now and in the future. This study uses the DELTA Model® to analyse global nutrient supply dynamics at national resolution and address nutritional shortfalls in specific countries(2). By examining the distribution of food commodities and nutrients in 2020, we project the future food and nutrient production needs for 2050 to ensure adequate global supply. Our findings indicate that while some nutrients are sufficiently supplied on a global scale, many countries face significant national deficiencies in essential nutrients such as vitamins A, B12, B2, potassium, and iron. Addressing these gaps will require substantial increases in nutrient supply or redistribution. For example, a 1% increase in global protein, targeted at countries with insufficient protein, could close the 2020 gaps. However, if current consumption patterns persist, the global food system will need a 26% increase in production by 2050 to accommodate population growth and changing consumption patterns. Our study developed a framework for exploring future production scenarios. This involves reducing surplus national nutrient supply linearly over decades while simultaneously increasing production of undersupplied nutrients. This framework provides a more practical assessment of future needs, transitioning from idealized production scenarios to realistic projections. Our study investigated a potential future for nutrient supply to meet minimum requirements by 2050. Calcium and vitamin E are crucial, and production must be increased to address significant gaps, given their severe deficiencies in 2020. Energy and fibre production will be required to peak between 2030 and 2040 before stabilizing back near 2020 levels. Predicted changes in nutrient supply from 2020 to 2050 vary: while calcium and vitamin E will need to increase, phosphorus, thiamine and the indispensable amino acids can decrease without compromising global nutrition with only minor redistribution. These results are essential for determining the food supply required to achieve adequate global nutrient supply in the future. Incorporating these insights into global food balance models will provide key stakeholders with evidence, refine future projections, and inform policy decisions aimed at promoting sustainable healthy diets worldwide.

Micronutrient deficiencies (MND) are a significant global health issue, particularly affecting children’s growth and cognitive potential and predisposing to adverse health outcomes for women of reproductive age (WRA).(1) Over half of global MND cases occur in Sub-Saharan Africa (SSA), with 80% of women estimated to be deficient in at least one of three micronutrients(2). Large-scale food fortification is a cost-effective strategy recommended for combatting widespread MND and has been effectively implemented in many developed countries(3). In developing countries such as SSA, socio-economic barriers and a fragmented food processing industry hinders effective implementation of food fortification(4). As a result, countries with fortification programmes face significant challenges, including low coverage of fortified food in the population and poor compliance with fortification standards by food producers(5) The contribution of food fortification to nutrient intakes of WRA in SSA have yet to be fully assessed. This study sought to evaluate mandatory food fortification programmes in SSA and estimate the contribution of fortified food consumption to micronutrient intakes and requirements of WRA. We utilised multi-national fortification data from the global fortification data exchange, which includes data on country fortification standards and the estimated level of compliance to fortification requirements. Data on the supply and consumption of fortifiable food was also included from the FAO. We calculated the potential nutrient intake from fortified food consumption for each nutrient using country fortification standards and food availability. We adjusted the estimated intake for each nutrient by multiplying with the estimated compliance percentage. We also assessed what proportion of women’s requirements for essential micronutrients, folate, iron, iodine, vitamin A, and zinc, are met through fortified food consumption using RNI values from WHO/FAO for WRA. Between 2019 and 2021, we estimated that mandatory fortification of wheat and maize flour, oil and salt in SSA contributes a median of 138µgDFE of folic acid, 217µg of iodine, 43µg RAE of vitamin A and 2.1mg and 2.0mg of iron and zinc respectively to the intakes of WRA daily. These intakes represent 12.8% (0.0-49.2) of iron, 27.5% (0.0-83.2) of zinc, 55.0% (0.0-245.0) of folate, 8.8% (0.0-37.2) of vitamin A and 228.2% (98.2-358.6) of iodine requirements respectively, taking into consideration the lower bioavailability of iron and zinc from cereal-based diets of SSA populations. In reality, compliance with fortification requirements in SSA is low, estimated at a median of 22% (0.0 - 83.4) for maize flour, 44% (0.0 - 72.0) for vegetable oil and 83% (0.0 - 100.0) for wheat flour fortification and is a major factor limiting the overall contribution of fortification to micronutrient intakes. Inadequate regulatory monitoring to ensure compliance with fortification requirements in SSA have resulted in lower-quality fortified foods, limiting women’s potential to achieve adequate micronutrient intake through fortified food consumption.

Natural disasters, exacerbated by climate change, pose significant threats worldwide. Each year, there are hundreds natural disasters (emergencies) globally that cripple economics, destroy crops, and shift millions. Immediately after a natural disaster, preliminary aid is food, water, sanitation, and shelter(1). New Zealand typically faces natural disaster risks such as earthquakes, floods, tsunamis, and even volcanoes to consider. According to the World Health Organisation (WHO) guidelines, ‘food supply should be adequate to cover the overall nutritional needs of all population groups in terms of quantity, quality, and safety. In an emergency, an adequate food ration meets the population’s minimum energy, protein and fat requirement for survival and light physical activity. An adequate food ration is also nutritionally balanced, diversified, culturally acceptable, fit for human consumption and suitable for all sub-groups of the population’(2,3). In the initial research, we could not find any market available emergency food that is based on nutrient-rich milk powder. In addition, though emergency food is called survival food, the taste and nutritional profile could be improved. The aim of the study was to develop prototypes that meet the criteria of the WHO guidelines for food and nutrition in emergencies, taste acceptable and cost effective, have good nutrient profiling score and 10+ years shelf-life; in partnership with GMP Dairy Ltd. Using mainly New Zealand ingredients (e.g. oatmeal, cornflour maize, cranberries) including milk powder (whole- and skim- milk powder content was approximately 27%), formulas were computed with different combination and composition with potential ingredients. Nutritional analysis was conducted referring to the Concise New Zealand Food Composition Tables to ensure essential nutrient provision in the formulas. Three powder-form prototypes were developed based on the WHO guidelines in terms of energy, protein, fat, and vitamins. The bench trials were conducted to check the uniformity when adding water, and the taste acceptability. Of each prototype (oatmeal-wheat, chickpea-wheat, chickpea-maize), energy intake was 2124 kcal, 2118 kcal, 2103 kcal per person/day; in which energy from protein (in g and in % kcal) was (61g, 11.5%), (63g, 12%), (62.9g, 12%); energy from fat (in g and in % kcal) was (41g, 17%), (40g, 17%), (39g, 17%); respectively. Vitamins were added to the formulas (VA: VB1: VB2: VB3: VC: VD ≈ 500μg: 0.9mg: 1.4mg: 12mg: 28mg: 3.8μg). The prototypes were acceptable in taste and had a nutritional health star rating of 3.5 (on a scale of 0.5 to 5). The further work is a refinement of the ration to meet specific considerations for vulnerable persons, and handling large-scale production, packaging for 10+ years shelf-life, and distribution of emergency food products. The successful outcomes of the research will have considerable potential in production. It is beneficial for the population.

Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease globally(1) whereby there is a loss of dopaminergic neurons in the brain and a deficiency of dopamine. PD is characterised by dyskinesia, rigidity, tremor and postural instability, and non-motor symptoms which include neuropsychiatric, sleep and autonomic dysfunction which often occur before motor symptoms(2). Several of these motor and non-motor symptoms can adversely affect nutritional status(3) and a significant number of people with PD are at risk of malnutrition(4). Observational studies have examined the relationship between dietary intake, symptoms and disease progression yet there is a lack of randomised controlled trials of dietary interventions. This presentation will examine the evidence base and suggest future directions for nutrition research in this important area.

Nourishing kai supports behaviour and concentration, tamariki learn well when food secure and eat regularly(1). Early food experiences influence our relationship with food as adults(2) and that tamariki health and wellbeing are shaped by education environments(3). WAVE (Well-being and Vitality in Education) has enduring partnerships with all preschools, kindergartens, playcentres, primary and secondary schools in our South Canterbury rohe(3), supporting healthy education environments with the goal of reducing inequities in health and education outcomes. Despite concerns about food security and processed foods, health promotion advisors note kaiako reluctance to promote nutrition using a whole-setting approach. The whole school approach(4) includes policies and procedures for kai (food) and wai (water), nutrition education within teaching and learning and nutrition messages promoted to whānau through enrolment information, learning stories/newsletters and displays, and in conversations with whānau. We describe an increase in kaiako acceptability occurring with the move from discussing nutrition as ‘healthy eating’ to using language of ‘supporting positive kai environments’. We include examples of mahi that the education settings put in place in this process. Between October 2023 and June 2024, WAVE provided internal professional development for health promotion kaimahi, focusing on supporting positive kai environments. Resources were redeveloped to align with messages about fostering positive relationships with kai and encouraging tamariki to be food explorers(5). The updated approach was widely communicated through newsletters and meetings with kaiako, alongside sharing relevant webinar and article resources from the Education Hub and Heart Foundation to support kaiako professional development. Health promotion advisors working with early childhood education and primary schools discussed nutrition within the broader context of positive kai and wai environments, aiming to develop positive relationships with food. These discussions took place through a combination of one-on-one meetings with lead kaiako each term and staff team meetings. Interview questions were sent to priority education (n=10) settings in September 2024 to gather feedback on barriers to promoting nutrition, how the change to ‘positive kai and supporting kai explorers’ has made a difference, and to hear the settings’ plans for current and future action in their setting. Responses from 8 ECE indicated that WAVE PD workshops using Heart Foundation resources were the resources they found most useful in enabling them to support tamariki as kai explorers. The shift to ‘positive kai environments’ has given kaiako consistent positive language around food, created space for tamariki to be self-directing with food, and has been mana-enhancing for tamariki and whānau. Kaiako stated that this evidence-based approach has taken the pressure off food, and kaiako are more responsive to tamariki needs. Kaiako are more willing to approach nutrition messages in a holistic manner to support tamariki.

The Tohu Manawa Ora | Healthy Heart Award programme helps early learning services across Aotearoa create an environment that promotes nutritional health and physical activity. It achieves a sustainable change to the environment by using a ‘whole-service’ approach, through governance and management, learning and teaching, collaboration and professional development. The programme aims to foster happy tamariki with awareness of how to have hearts fit for life, ensuring healthier futures for whānau across Aotearoa New Zealand. To evaluate and understand the impact and social value of the Tohu Manawa Ora | Healthy Heart Award programme on fostering healthy habits and creating supportive environments in early learning settings across Aotearoa New Zealand the Heart Foundation undertook this evaluation with ImpactLab. Two hundred and fifteen early learning services and 33,717 tamariki across Aotearoa New Zealand, who were enrolled in or had achieved a Tohu Manawa Ora | Healthy Heart Award, were used to determine the impact and social value of the programme. This was achieved through using a social value calculation which integrates multiple data sources and analytical methods. Firstly, impact values derived from the programme were combined with evidence from global literature on the effectiveness of similar health promotion programmes. Secondly, the size of the opportunity for participants—early learning services across Aotearoa New Zealand—to achieve more positive health outcomes was assessed. Thirdly, the number of people supported by the programme was considered. Every year, the Tohu Manawa Ora | Healthy Heart Award programme delivers $6,163,581 of measurable good to society in New Zealand. Outcomes for tamariki of improved oral health, physical activity and reduced diabetes and improved physical activity for whānau directly contribute to the social value. Improved health equity, nutrition, increased food exposure and physical activity, promotion of lifelong wellbeing and positive health behaviours, reduced cardiovascular disease and sugar consumption indirectly contributed to the social value. This means that every dollar invested in the Tohu Manawa Ora | Healthy Heart Award programme delivers $4.50 of measurable good to New Zealand. The Tohu Manawa Ora | Healthy Heart Award programme delivers significant measurable social value to Aotearoa New Zealand. Growth, development and continued funding of the programme should continue to further positively impact the future of tamariki and their whānau in Aotearoa New Zealand.