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.

Nutritional requirements of individuals vary across the lifecycle, according to activity, age and gender. To optimize human health, consideration of nutritional priorities at each stage is needed. This conference brought together multidisciplinary experts in maternal and child nutrition and health, cardiometabolic and plant-based nutrition and dietitians involved in the care of vulnerable populations, plus nutritional metabolism, health and ageing. The presentations highlighted the most important nutrition research in these areas, updating knowledge and suggesting how dietary advice and policy could be adapted to incorporate research findings. With the global increase in non-communicable disease (NCD) and nutrition being considered as a key modifiable risk factor for the prevention and management of NCD, this conference was much needed.

Chronic constipation is a prevalent disorder representing a significant public health problem. The management of chronic constipation remains challenging, with people reporting dissatisfaction with available treatment options (1). Current clinical guidelines offer limited dietary recommendations only, and there is a lack of comprehensive evidence-based guidelines for the dietary management of chronic constipation. The aim of this project was to develop the first comprehensive evidence-based dietary guidelines for the management of chronic constipation in adults via a systematic literature review and a Delphi consensus process among an expert steering committee.

The scope of the guidelines included dietary supplements, foods and drinks, and whole diets in adults with chronic constipation. Four systematic reviews and meta-analyses were performed to identify eligible randomised controlled trials (RCTs)(2-5). The findings generated from the meta-analysis of RCTs were then used to develop guideline statements using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and a Delphi consensus survey among a multi-disciplinary expert steering committee. Recommendation statements were produced for treatment response, stool output, gut symptoms, adverse events, and quality of life. Statements were generated based on the findings only where ≥2 RCTs contributed to the meta-analysis (2-5). The “strength of recommendation” was assessed using the GRADE approach. Once statements were generated, they underwent consensus voting amongst the expert steering committee using a modified Delphi survey approach. Recommendation statements with ≥85% agreement were accepted.

The four systematic reviews included a total of 75 RCTs (2-5). Based upon these, 59 dietary recommendation statements were generated and accepted through the Delphi survey. In terms of dietary supplements, 15 recommendation statements related to fibre supplements (overall and specific types), 20 related to probiotics (overall and specific species or strains), 2 to synbiotics (overall), 5 to magnesium oxide, 2 to senna, and 3 to kiwifruit supplements. In terms of foods, 3 recommendation statements related to kiwifruits, 2 to prunes, and 2 to rye bread. In terms of drinks, 5 recommendation statements related to high mineral-containing water. No recommendations were made for whole diet approaches due to lack of evidence. Ten statements had a very low level of evidence, 41 had low level of evidence, and 8 had moderate evidence. Twenty-seven statements were strong recommendations and 32 were qualified recommendations.

These are the first ever comprehensive evidence-based dietary guidelines for the management of constipation. Recommendations were made for several dietary supplements, foods and drinks that have never been previously included in clinical guidelines. These guidelines offer new evidence-based dietary recommendations that can be rapidly implemented into clinical practice, thereby improving clinical care and patient outcomes.

Chinese immigrants living in Western countries are at a higher risk of developing chronic diseases compared to those in China, due to the development of unhealthy dietary patterns during the process of acculturation(1). Australia, with 2.3% of its population being Chinese-born(2), serves as a representative country to explore Chinese immigrants’ food choice determinants. Food choice determinants have been widely researched, with numerous factors identified such as affordability, taste preferences and hunger/satiety. Contento (2018) developed a comprehensive framework which identified and categorised over 30 determinants into four socio-ecological groups(3). Therefore, the focus of current research is not the identification of food choice determinants but to explore the interactions among these determinants. Understanding the cultural influence on food choice is vital for target groups with a shared ethnic background. This study aimed to qualitatively explore the similarities and differences in food choice determinants between Chinese people in mainland China and those living in Australia. Ethical approval for this study was obtained from Monash University Human Research Ethics Committee. Eighteen participants were recruited for semi structured in-depth interviews from June 2021 to March 2022, with eight from Australia and ten from mainland China. Convenience and snowball sampling methods were employed to ensure a diverse sample regarding socio-economic background, occupation, health status, age, and education level. Interviews were conducted in Mandarin via in-person or video/voice calls and were audio-recorded and transcribed verbatim. Thematic analysis and investigator triangulation were used for data analysis. Four themes were identified. (a) Food choice determinants were influenced by nutrition perceptions and personal food philosophy. Chinese Australian immigrants were influenced by Western nutrition beliefs to a greater extent than their counterparts living in mainland China. Non-scientific or controversial nutrition beliefs were common. Personal food philosophy (e.g., eating food is for survival only, or for enjoyment, or for health) profoundly influences food choices. (b) Chinese people adjusted their dietary habits in response to clinical symptoms or self-observed physiological changes, such as, gaining weight or digestive issues. (c) Convenience was a predominant food choice determinant due to factors like long working hours, lack of motivation to cook, lack of cooking skills, time restrictions, and viewing cooking as a chore. (d) Different food environments in China and Australia lead to distinctive food choices. Chinese Australians were more price-sensitive, had more food safety concerns, and cooked more frequently at home than mainland Chinese, due to differences in food affordability, accessibility and information exposure between these two countries. Importantly, nostalgia for childhood foods had a unique influence on certain food choice behaviours in Chinese Australians. These cultural characteristics in food choice determinants should be considered by health educators, nutrition professionals, and policymakers when developing culturally appropriate health interventions for Chinese people.

Oceania is currently facing a substantial challenge: to provide sustainable and ethical food systems that support nutrition and health across land and water. The Nutrition Society of Australia and the Nutrition Society of New Zealand held a joint 2023 Annual Scientific Meeting on ‘Nutrition and Wellbeing in Oceania’ attended by 408 delegates. This was a timely conference focussing on nutrition challenges across the Pacific, emphasising the importance of nutrition across land and water, education settings, women’s health and gut health. Cutting-edge, multi-disciplinary and collaborative research was presented in a 4-day programme of keynote presentations, workshops, oral and poster sessions, breakfast and lunch symposiums and early career researcher sessions. The conference highlighted the importance of collaboration between nations to address the challenge facing nutrition and wellbeing across Oceania. A systems approach of collaboration among scientists, industry and government is vital for finding solutions to this challenge.

The impact of Human Milk (HM) bioactive compounds and microbiota on infant health is crucial yet complex. Current research highlights their role in immune system development and disease prevention (1-6). This review aims to synthesize existing literature on the role of HM’s bioactive compounds in the onset of diagnosed allergies, immunological diseases, and responses to infectious diseases in infants, along with related biomarkers.

The systematic review adhered to Synthesis without Meta-Analysis (SWiM), focusing on clinically defined allergies and immunological conditions, and responses to infectious diseases by infants and children up to 18 years. Studies analyzing HM microbiota and bioactive compounds of mothers in mother-infant pairs have been included. A comprehensive search strategy was employed across PubMed, Web of Science, SCOPUS, Scientific Electronic Library Online (SciELO), Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), and LIVIVO. Quality assessment utilized Joanna Briggs Institute checklists for various study designs.

The systematic review encompassed 32 studies ranging from 1983 to 2023, representing a total of 7,888 mother-infant dyads focusing on HM bioactive compounds and microbiota’s impact on clinically defined immunological conditions in infants. More than 90% of the literature had been conducted in upper-middle- and high-income countries. In low- and middle-income countries, including Gambia, Bangladesh, and Nicaragua, only 3 studies were conducted. We identified that allergic and autoimmune conditions, investigated in 25 articles, particularly food allergy, sensitization, and atopic dermatitis, were inversely associated with HM linolenic and linoleic acid. Furthermore, infectious and immunological conditions, primarily diarrhea and Group B Streptococcus (GBS) infections, investigated in 7 studies, revealed significant inverse associations with human milk oligosaccharides (HMOs) (2'-fucosyllactose (2′-FL), lacto-N-difucohexaose I (LDFH-I)) and immunoglobulins (Anti-GBS secretory immunoglobulin A (SIgA), Anti-lipopolysaccharide immunoglobulin A (Anti-LPS IgA), Anti-cholera toxin immunoglobulin A (Anti-cholera toxin IgA)), respectively. Upper and lower respiratory tract infections, otitis media, and dental caries were inversely associated with galectins and galectin-3, lacto-N-tetraose (LNT), 2′-FL, and Haemophilus influenzae, suggesting potential protective effects of HM bioactive compounds.

Data shows that HM bioactive compounds such as polyunsaturated fatty acids (PUFAs), HMOs, and a number of specific immunoglobulin A (IgA) antibodies, might be protective for infants, possibly preventing the onset of symptoms and helping to avoid bacterial and parasitic infections, respectively. In this review, we address the increase in mechanistic knowledge about the protective effects of breastfeeding.

Vegan and vegetarian dietary patterns are known to beneficially modulate risk factors for cardiovascular disease; however, the current literature does not differentiate between various plant-based diets(1). This study aimed to examine the association between various plant-based diets and plasma lipids and glycaemic indices compared to a regular meat-eating diet. A cross-sectional study of Australian adults (n = 230) aged 30–75yrs habitually consuming the following were recruited: vegan, lacto-vegetarian, pesco-vegetarian, semi-vegetarian, or regular meat-eater. Multivariable regression analyses was used to adjust for covariates. Compared to regular meat-eaters, vegans had significantly lower total cholesterol (−0.77 mmol/L, 95% CI −1.15, −0.39, p < 0.001), low-density lipoprotein cholesterol (LDL-C, −0.71 mmol/L, 95% CI −1.05, −0.38, p < 0.001), non-high-density lipoprotein cholesterol (non-HDL-C, −0.75 mmol/L, 95% CI −1.11, −0.39, p < 0.001), total cholesterol/HDL-C-ratio (−0.49 mmol/L, 95% CI −0.87, −0.11, p = 0.012), fasting blood glucose (FBG, −0.29 mmol/L, 95% CI −0.53, −0.06, p = 0.014), haemoglobin A1C (−1.85 mmol/mol, 95% CI −3.00, −0.71, p = 0.002) and insulin (−1.76 mU/L, 95% CI −3.26, −0.26, p = 0.021) concentrations. Semi-vegetarians had significantly lower LDL-C (−0.41 mmol/L, 95% CI −0.74, −0.08, p = 0.041) and non-HDL-C (−0.40 mmol/L, 95% CI −0.76, −0.05, p = 0.026) and lacto-ovo vegetarians had significantly lower FBG (−0.34 mmol/L, 95% CI −0.56, −0.11, p = 0.003) compared to regular meat-eaters. There were no differences in HDL-C and triglycerides between plant-based and regular-meat diets. Plasma lipaemic and glycaemic measures as a collective were more favourable among vegans, whereas among lacto-ovo vegetarians and semi-vegetarians, only some measures were favourable.

This review will provide an overview of the immune system and then describe the effects of frailty, obesity, specific micronutrients and the gut microbiota on immunity and susceptibility to infection including data from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic where relevant. A key role for the immune system is providing host defence against pathogens. Impaired immunity predisposes to infections and to more severe infections and weakens the response to vaccination. A range of nutrients, including many micronutrients, play important roles in supporting the immune system to function. The immune system can decline in later life and this is exaggerated by frailty. The immune system is also weakened with obesity, generalised undernutrition and micronutrient deficiencies, which all result in increased susceptibility to infection. Findings obtained during the SARS-CoV-2 pandemic support what was already known about the effects of ageing, frailty and obesity on immunity and susceptibility to infection. Observational studies conducted during the pandemic also support previous findings that multiple micronutrients including vitamins C, D and E, zinc and selenium and long-chain n-3 fatty acids are important for immune health, but whether these nutrients can be used to treat those already with coronavirus disease discovered in 2019 (COVID-19), particularly if already hospitalised, is uncertain from current inconsistent or scant evidence. There is gut dysbiosis in patients with COVID-19 and studies with probiotics report clinical improvements in such patients. There is an inverse association between adherence to a healthy diet and risk of SARS-CoV-2 infection and hospitalisation with COVID-19 which is consistent with the effects of individual nutrients and other dietary components. Addressing frailty, obesity and micronutrient insufficiency will be important to reduce the burden of future pandemics and nutritional considerations need to be a central part of the approach to preventing infections, optimising vaccine responses and promoting recovery from infection.

‘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.

There is mounting interest in the dual health and environmental benefits of plant-based diets. Such diets prioritise whole foods of plant origin and moderate (though occasionally exclude) animal-sourced foods. However, the evidence base on plant-based diets and health outcomes in Australasia is limited and diverse, making it unsuitable for systematic review. This review aimed to assess the current state of play, identify research gaps and suggest good practice recommendations. The consulted evidence base included key studies on plant-based diets and cardiometabolic health or mortality outcomes in Australian and New Zealand adults. Most studies were observational, conducted in Australia, published within the last decade, and relied on a single dietary assessment about 10–30 years ago. Plant-based diets were often examined using categories of vegetarianism, intake of plant or animal protein, or dietary indices. Health outcomes included mortality, type 2 diabetes and insulin resistance, obesity, CVD and metabolic syndrome. While Australia has an emerging and generally favourable evidence base on plant-based diets and health outcomes, New Zealand’s evidence base is still nascent. The lack of similar studies hinders the ability to judge the overall certainty of evidence, which could otherwise inform public health policies and strategies without relying on international studies with unconfirmed applicability. The proportional role of plant- and animal-sourced foods in healthy, sustainable diets in Australasia is an underexplored research area with potentially far-reaching implications, especially concerning nutrient adequacy and the combined health and environmental impacts.

Globally, the burden of skin diseases is considerable, being the fourth largest cause of disability (1). Diet is a modifiable risk factor for many dermatological conditions and one of the mechanisms by which nutrition influences skin health is via the gut microbiome. Oral probiotics, prebiotics and synbiotics may have the potential to improve functional indicators of skin health and delay skin ageing (2).

This scoping review aimed to map the body of literature on the role of oral probiotics, prebiotics and synbiotics in maintaining and optimising skin health and function, and preventing and managing skin conditions, through the life course. The first stage of the scoping review, reported here, was the mapping of systematic reviews. The ongoing second stage involves the mapping of experimental and observational studies.

The scoping review was conducted in accordance with the JBI methodology for scoping reviews (3). Six electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus and Web of Science) were systematically searched without limits on language or date, along with sources of grey literature. All sources were considered for inclusion by two reviewers based on previously established criteria using the participants, concept and context framework.

The titles and abstracts of 8,972 studies were screened and subsequently 1,034 full texts were retrieved. Finally, 521 studies were included in the scoping review of which 72 were systematic reviews and are analysed here.

Most reviews analysed the efficacy of oral probiotics (93%), with 13% and 18% of reviews considering oral prebiotics and oral synbiotics respectively. These interventions were most reviewed in infants aged 0-12 months (78%), pregnant mothers (47%), and/or younger children (43%) inclusively. Only 28% and 19% of reviews considered adults up to, and above, 60 years respectively. Most systematic reviews included participants who were either diagnosed with (42%), or at risk of a skin disease (28%) with just 4% reviewing effects in primarily healthy populations (24% did not confirm the included populations).

Outcomes related to preventing and managing a skin condition were studied by 97% of reviews; just 2 reviews examined optimising skin health and function (namely skin hydration, and epidermal thickness) in healthy populations. Atopic dermatitis (AD) was the most studied skin disease; 33 of 36 meta-analyses indicated a positive effect on its prevention, compared to 19 of 26 meta-analyses on AD severity. The remaining reviews investigated psoriasis (n=2), urticaria (n=2), and acne (n=2).

This review has identified a plethora of evidence synthesis on oral probiotics, prebiotics and synbiotics in AD, particularly in infants and children, and a paucity of evidence synthesis in healthy populations. The second stage of the review considering the underlying experimental and observational evidence will determine the scope for further evidence synthesis or confirm gaps in the experimental data to inform future research.

The food we eat has a critical impact on human and planetary health. Food systems are responsible for approximately a third of total global greenhouse gas emissions (GHGE). This review summarises studies that have measured dietary GHGE and assessed their associations with various demographic variables. Most studies report dietary emissions at the individual level, but some studies use households as the unit of analysis. Studies investigating individuals estimate dietary intakes using 24-hour dietary recalls, FFQ, diet history interviews, food diaries or other dietary records. Studies investigating households rely on food purchasing data and expenditure surveys. The majority of studies estimate dietary GHGE using process-based life cycle assessments. It is difficult to directly compare emissions estimates between studies at either the individual or household-level due to methodological differences. In general, there are mixed findings with regard to the relationships between various demographic variables and dietary emissions, although older adults generally had higher dietary GHGE than younger adults, and men typically had higher dietary GHGE than women, even when standardising for total energy intake. This review may be useful in informing and targeting policies and interventions to reduce GHGE of dietary intake.

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.

Maintaining a healthy weight during pregnancy is critical for both women's and children's health. Excessive gestational weight gain (GWG) can lead to complications such as gestational diabetes, hypertension and caesarean delivery. Insufficient GWG can cause fetal growth restriction and increase infant mortality risk. Additionally, postpartum weight retention raises risk of obesity, type 2 diabetes and other chronic diseases for both mother and child. This review seeks to identify current obstacles in weight management research during and after pregnancy and explore evidence-based strategies to overcome them. Pregnancy offers a window of opportunity for health behaviour changes as women are more receptive to education and have regular contact with health services. Staying within Institute of Medicine's recommended GWG ranges is associated with better maternal and fetal outcomes. Systematic review evidence supports structured diet and physical activity pregnancy interventions, leading to reduced GWG and fewer complications. Health economic evaluation indicates significant returns from implementation, surpassing investment costs due to decreased perinatal morbidity and adverse events. However, the most effective way to implement interventions within routine antenatal care remains unclear. Challenges increase in the postpartum period due to competing demands on women physically, mentally and socially, hindering intervention reach and retention. Flexible, technology-supported interventions are needed, requiring frameworks such as penetration-implementation-participation-effectiveness and template-for-intervention-description-and-replication for successful implementation. Greater research efforts are necessary to inform practice and investigate fidelity aspects through pragmatic implementation trials during the pregnancy and postpartum periods. Understanding the best ways to deliver interventions will empower women to maintain a healthy weight during their reproductive years.

Teacher food and nutrition (FN) practices influence their personal health and wellbeing outcomes, with implications for students. As educators, teachers role model FN practices to students and act as health promoters. Our team’s recent scoping review outlined the lack of standardised methods used to assess FN constructs in teachers, with limited validated and composite tools available that measure FN constructs, especially culinary factors, alongside measures of wellbeing(1). The importance of teacher FN education, to facilitate effective school health promotion, is highlighted by the World Health Organization and the United Nations Education Scientific and Cultural Organization. Therefore, understanding the scope of teacher FN practices in relation to teacher wellbeing is critical, yet limited evidence currently exists. This research aims to examine baseline data on teacher FN practices and potential FN predictors of teacher health and wellbeing from the Australian longitudinal teacher FN-related health and wellbeing study. The Teacher Food and Nutrition Questionnaire (TFNQ) consists of nine sub-scales and 21 single-item measures using pre-defined food, nutrition, and wellbeing constructs. This provides a composite evaluation tool to collate data on teacher FN practices for comparison with wellbeing outcomes, including stress and burnout. Descriptive statistics and Pearson correlation coefficient (r) were used to assess relationships between food, nutrition, and wellbeing constructs, and linear regression to determine slope of significant relationships using diet quality (i.e., the Fruit and Vegetable Variety index), wellbeing (i.e., burnout) and professional FN confidence as outcome variable(s) of interest. A total of n = 112 secondary teachers completed the baseline TFNQ (September 2023). Of these, the majority were female (87.5%), aged 31–45 years (52%), with 90% on full time contracts. Mean diet quality score was 92.0 (maximum score (MS) of 190), with sub-scale score for vegetable (63.2/122 MS) and fruit (28.9/68 MS) intake. Of the wellbeing measures, burnout (16.3/24 MS), stress (7.3/10 MS) and coping (6.2/10 MS) were measured alongside teacher food skills confidence (105.7/133 MS) and food agency (40.9/55 MS). Teacher FN confidence to role model healthy FN practices was moderately correlated to food agency r = −0.43 (p < 0.001), and personal subjective wellbeing ‘satisfied’ r = 0.41 (p < 0.001). A moderate correlation was observed between vegetable intake and food skills confidence r = 0.42 (p < 0.001), with a moderate negative correlation observed between food agency and teacher burnout r = −0.43 (p < 0.001). Overall, these baseline data confirm teacher diet quality is suboptimal, with teacher food agency and/or food skills confidence demonstrating moderate correlations with all three study outcomes of teacher wellbeing, diet quality and professional FN confidence. These data provide a snapshot of secondary teachers’ FN practices and wellbeing. Results inform development of professional development to support FN behaviours as a contributing factor for optimal teacher health and wellbeing.

Non-alcoholic fatty liver disease (NAFLD) is associated with long-time exposure to obesity, physical inactivity, smoking, and Western diets high in saturated fats, refined sugar, and low in fibres.(1) It is one of the most common chronic liver disease globally with a prevalence of 32% in 2022,(1) and is associated with greater risk of cardiovascular diseases as well as non-alcoholic steatohepatitis (NASH).(1) Currently, there is no medical treatment against NAFLD, but high consumption of plant-based protein sourced foods appear beneficial.

Legumes are considered an environmentally friendly and healthy protein source, low in saturated fat and energy density, and rich in dietary fibre(2). However, the scientific evidence on the association between legume intake and NAFLD in humans is sparse.(2) This study evaluated substituting red and processed meat, poultry, or fish with legumes on the risk of developing NAFLD.

We analyzed data from 124,194 UK Biobank participants who completed two or more dietary assessments using a 24-hour dietary assessment tool, the Oxford WebQ, developed and validated within the cohort,(3) and provided comprehensive information on covariates. Participants were invited to complete up to five Oxford WebQs from 2009 to 2012.(3)Incident NAFLD cases were identified through linkage to National Health Service registries.

Multivariable adjusted Cox proportional hazards regression models were used to conduct equal mass food substitution analyses, estimating hazard ratios (HR) and 95% confidence intervals (CI) for NAFLD when replacing one 80g serving/week of i) red and processed meat, ii) poultry, iii) or fish with legumes.

Age was the underlying time scale in the analyses. Person-years at risk were calculated from the date of the last completed Oxford WebQ to the date of death, loss to follow-up, diagnosis of NAFLD or NASH, or right censoring, whichever occurred first.

All participants gave written informed consent to participate in the study. The UK Biobank was approved by the National Information Governance Board for Health and Social Care and the National Health Service North West Multicentre Research Ethics Committee (ref 21/NW/0157).

Over a median follow-up period of 10.49 years (IQR: 10.4-10.9 years), 1,201 NAFLD cases were documented. Replacing 80 g/week of red and processed meat or poultry with legumes resulted in 4% and 3% lower rates of NAFLD, respectively (Meat HR: 0.96, 95% CI: 0.94–0.98; Poultry HR: 0.97, 95% CI: 0.95; 0.99). However, replacing fish with legumes was not significantly associated with NAFLD risk (HR: 0.98, 95% CI: 0.96–1.01). These findings remained consistent after adjusting for BMI.

Replacing red and processed meat or poultry with legumes could modestly reduce the risk of NAFLD. No significant association was observed for replacing fish with legumes.

The dual burden of malnutrition is characterised by the coexistence of undernutrition alongside overweight/obesity and diet-related noncommunicable diseases. It is a paradox which disproportionately affects women and is applicable to those who become pregnant after weight loss surgery. Obesity before and during pregnancy is associated with increased risk of adverse perinatal outcomes in both mother and child. Overall lifestyle interventions targeting weight loss in the preconception period have not proven effective, with people, and women in particular, increasingly seeking weight loss surgery. In women with severe obesity, surgery may normalise hormonal abnormalities and improve fertility. In those who become pregnant after surgery, evidence suggests a better overall obstetric outcome compared to those with severe obesity managed conservatively; however, there is heightened risk of maternal nutritional deficiencies and infants born small for gestational age. Specifically, pregnancy soon after surgery, in the catabolic phase when rapid weight loss is occurring, has the potential for poor outcomes. Lifelong micronutrient supplementation is required, and there is considerable risk of malnutrition if nutritional aftercare guidelines are not adhered to. It is therefore recommended that pregnancy is delayed until a stable weight is achieved and is supported by individualised advice from a multidisciplinary team. Further research is required to better understand how weight loss surgery affects the chances of having a healthy pregnancy and to ultimately improve nutritional management and patient care. In this review, we aim to summarise the evidence and guidance around nutrition during pregnancy after weight loss surgery.

Despite the healthful nature of plant-based diets (PBDs) there is potential for nutrient inadequacies(1). This study aimed to compare dietary intakes and nutritional adequacy in Australians following plant-based diets compared a regular meat-eating diet (RME) in a cross-sectional study of adults (n = 240) aged 30–75yrs. Participants were habitually consuming dietary patterns for ≥ 6 months; vegan, lacto-vegetarian, pesco-vegetarian, semi-vegetarian or RME (n = 48 per group). Dietary intake was assessed using a validated food frequency questionnaire and dietitian-administered diet histories. Multivariable regression was used to adjust for potential lifestyle and demographic confounders. Compared to RMEs, vegans and lacto-ovo vegetarians had significantly lower dietary intakes of protein (percentage energy intake, EN%), saturated fat, trans fat, cholesterol, vitamin B12, iodine, riboflavin, niacin, sodium, and long chain omega-3 polyunsaturated fatty acids (LCn-3PUFA), and higher carbohydrate (EN%), dietary fibre, vitamin E, folate, magnesium, iron, and n-6PUFA, whereas, pesco-vegetarians and semi-vegetarians had intermediate intakes. Individuals adhering to PBD consumed significantly more vegetables, fruit (vegan only), legumes/nuts, and less discretionary choices compared to RMEs. All dietary patterns met adequate intake for protein, exceeded for fat, were below for carbohydrate (EN%) and had adequate serves of fruit and vegetables, but not grains. Including plant-based alternatives, vegans, lacto-ovo vegetarians, and semi-vegetarians had inadequate serves of ‘meat/poultry/eggs/beans/nuts’, and semi-vegetarians and RMEs had inadequate serves of dairy. Vegans and lacto-vegetarians had nutritional inadequacies in vitamin B12, LCn-3PUFA, iodine, and in addition calcium among vegans, pesco-vegetarians in iodine, and semi-vegetarians and RMEs in LCn-3PUFA. PBDs, specifically vegans and lacto-ovo vegetarians, while significantly higher in beneficial nutrients and wholefood groups than RMEs, may lead to nutritional inadequacies if not planned appropriately.

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.

The Pacific Islands region is home to a diversity of countries and territories, who are at the forefront of climate change and the triple burden of malnutrition. In recent years there has been increasing interest in schools as a setting for transforming food systems, improving nutrition and health outcomes, increasing educational outcomes, and enhancing livelihoods in the Pacific Islands. This review examines and describes current school food and nutrition initiatives within the literature that aim to promote healthier, sustainable diets within the Pacific Islands region. As there is a paucity of literature in this area of interest in the Pacific Islands, the review focuses on the policy landscape, the provision of food near, and in schools, nutrition education, and future opportunities. The available literature demonstrates that there is broad regional interest and momentum from numerous stakeholders to enhance SFNE in the Pacific Islands, with several opportunities for future activities. While there are frameworks to explore food environments available there is a need for a Pacific Islands school food environment conceptual framework that captures aspects, both within and around schools, that can guide research and assessment for robust comparable data collection. This may in turn support healthier SFNE and ultimately nutritious food choices for children and adolescents.