Regulatory requirements for infant formula in the Australia New Zealand Food Standards Code (the Code) have been reviewed and revised for the first time in 20 years(1). The review aimed to ensure infant formula products remain safe and suitable, while accounting for the latest scientific evidence, market developments, changes in the international regulatory context, and updated Australian and New Zealand policy guidance. A multi-disciplinary team assessed and considered the best available evidence on every aspect of infant formula product regulation. This included scientific risk assessments, independent consumer evidence and testing, economic analysis and market surveys. The assessment focused on requirements for the regulatory framework, product category definitions, composition, sale and labelling. In addition, Food Standard Australia New Zealand held seven rounds of public consultation to ensure a transparent and comprehensive review was undertaken. While breastfeeding is the recommended way to feed infants, a safe and nutritious substitute for breast milk is needed for infants who are not breastfed. The regulatory changes ensure products continue to provide formula-fed infants with optimal nutrition for growth and development. The changes also give parents and caregivers important information to make informed choices, and support manufacturers with better alignment with international standards. The review has resulted in amendments to five standards and eight schedules in the Code. Key amendments include:

• • compositional requirements that align with the latest scientific evidence, breast milk concentrations, Australian and New Zealand nutrient requirements and recently updated international regulations

• • mandated presentation of nutrition information that allows comparison across products and better supports caregivers in making informed choices

• • restrictions on the sale of special medical purpose products to healthcare professionals, direct source and pharmacies

• • clarification of existing Code requirements which will continue to prohibit health, nutrition content and ingredient claims on infant formula products

• • new requirements for products to be differentiated using text, imagery and/or colour

• • a prohibition on cross-promotion of infant formula products.

Infant formula product regulations are the most prescriptive of any food as the requirements need to cover every aspect of nutrition to support the normal growth and development of infants from birth to 12 months. The updated regulations will continue to protect the health and safety of infants and ensure appropriate information is provided to parents, carers and health professionals to enable informed choice.

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.

Healthy eating patterns from sustainable food systems are crucial for population and planetary health(1). Primary schools are opportune settings for teaching children about food, nutrition and sustainability(2) (FNS), though little is known about the delivery of FNS education in this sector. This study aimed to analyse current approaches to FNS education in Australian primary schools. A cross-sectional online survey (open from August 2022–October 2023) with closed- and open-ended questions collected data about (i) teacher perceptions/attributes regarding FNS education (e.g., importance, understanding, knowledge/skills, training); (ii) FNS teaching practices (e.g., frequency, teaching approaches); and (iii) factors influencing FNS education (e.g., funding, policies). Statistical analyses were conducted using STATA. Descriptive statistics were generated for all categorical data. Chi-square tests and post hoc analyses using contingency tables and adjusted standardised residuals analysed associations between frequency of FNS education and teaching approaches (cross-curricular subject vs stand-alone subjects vs both) and presence of FNS-related policies, access to funding and teacher training. Statistical significance was set at p < 0.05. Qualitative content and thematic analyses of open-ended questions were conducted using NVivo 14. Participants were 413 Australian primary school teachers recruited via social media, organisational mailing lists and departmental school listings. Most teachers reported it is extremely/very important to teach students about nutrition (83.8%), food skills (69.7%) and food sustainability (74.1%), and these topics were considered equally important to most mandatory curriculum subjects. FNS was generally taught only 1–2 times per term (29.9%) or 1–2 times per year (31.6%), and 44.1% of teachers taught this as both a stand-alone and cross-curriculum subject. Teachers reported high levels of understanding (89.3%/92.5%/78.7%) and knowledge/skills (70.5%/75.5%/62.5%) to teach students about food, nutrition and sustainability respectively. Less than a third were trained in food (22.8%), nutrition (29.5%) or sustainability (24.5%) education. Less than a third of teachers had access to funding for FNS activities (29.8%) or training (19.9%) or were from schools with policies about including FNS education in the curriculum (28.5%). There was a significant association between frequency of FNS education and teacher training, access to funding and presence of FNS curriculum policies (all p < 0.001). Teachers who were trained to teach nutrition, food skills or food sustainability were more likely to teach this as both a stand-alone and cross-curricular subject (all p < 0.05). Within open-ended responses, teachers described personal factors (e.g., workload) that influenced their FNS teaching practices, as well as factors related to students’ families (e.g., family food practices), the curriculum (e.g., overcrowding) and the school environment (e.g., time, funding, training). Strengthening FNS education in the Australian primary school sector is an important next step for public health. Researchers and policy makers should explore opportunities for training, funding and policies to prioritise FNS within the curriculum.

Graduates from life sciences, including nutrition, will be at the forefront of promoting environmental, social, and food systems sustainability. The requisite competencies for their future roles include systems thinking, interdisciplinary collaboration, and effective communication, which are essential to navigating the complex interrelationship between human health and the environment [1,2]. To address this need, a 'Living Laboratory’ (LL) within a higher education (HE) food service setting could enrich the traditional laboratory experience, allowing students to cultivate these skills through experiential learning. This project aimed to i) scope the published literature to characterise LL examples within a HE food environment and ii) explore the understanding and perceptions of a LL concept in a food service setting for final year student research projects among students and academics at King’s College London.

A systematic scoping review was conducted in accordance with PRISMA-ScR guidelines (Registration OSF:d7y96). Two databases were searched (PubMed/Medline, Web of Science) from January 2010 to July 2024 to identify articles reporting the design, implementation or evaluation of LL in HE food service settings. A narrative synthesis was performed, and the resulting themes were used to inform focus groups (KCL Ethics:LRM-23/24-42657) with academic staff (two groups, nine participants) and students (four groups, seven postgraduate and nine undergraduate participants). Focus group discussions were audio-recorded and transcribed verbatim. Data were analysed using an inductive thematic approach [3].

Twenty-one articles were included in the scoping review. Common terms used to describe the LL concept included ‘innovation’, ‘collaboration’, ‘diverse stakeholders’, ‘enabling students’ and ‘practical learning experiences’. Recommendations for implementing LLs were provided in six articles and included engagement and outreach with stakeholders; managing conflicts; assessing impact; and establishing ethical and governance frameworks. The focus group findings indicated that both students and academics view the LL concept as a dynamic, real-world setting, emphasizing engagement and collaboration with internal and external stakeholders. Academics perceived the educational benefits of LLs as fostering experiential learning and perceived the barriers to implementation as including a lack of resources, scheduling conflicts, insufficient stakeholder engagement and unclear governance frameworks. Students highlighted the importance of aligning projects with taught programme content. and identified challenges such as limited awareness, unequal engagement across disciplines, time constraints, and concerns about inclusivity and equity across campuses. Students agreed that the LL provided opportunities to develop skills and knowledge in sustainability, science communication and real-world evidence studies, opening new career options after graduation. Lastly, altruism to improve food environments for peers and future students was a significant driving factor in student engagement.

Implementing LLs in HE food service settings requires input from multiple stakeholders. This scoping project identified key considerations from both academic staff and students to inform the co-design of a LL in a HE food service setting.

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.

Dietary intake modulates the gut microbiota by providing fermentation substrates. Both microbiota-accessible nutrients and digestible food components have been shown to modulate microbial abundance and function(1). A range of dietary assessment methods are used to investigate diet-microbe interactions, with two commonly used methods being food frequency questionnaires (FFQ) to assess ‘habitual’ dietary intake and food recalls which measure recent intake proximal to sampling of microbiota. This study aimed to compare diet-microbiome associations identified from habitual and proximal dietary intake aligned with stool microbiota sampling in a healthy adult cohort. Military trainees (n = 35), and non-military personnel (junior doctors during hospital placement; n = 21) self-reported proximal dietary intake using digital (Easy Diet Diary) or paper-based 24-hr recalls. Habitual intake was assessed using the Comprehensive Nutrition Assessment Questionnaire (CNAQ)(2) FFQ. Both measures were assessed at baseline and study completion. Diet recalls matched to the same week of FFQ were analysed using Foodworks 10(3). Stool samples were collected for metagenomic shotgun sequencing and annotated against the Microba Life Sciences platform. MaAsLin2 identified linear associations between nutrients and microbe abundance, controlling for total energy intake and individual variation with repeated measures. Thirty dietary variables common to both dietary assessment methods were used in analysis. Mean daily intakes for total energy and macronutrients were not significantly different between habitual and proximal data. Nutrients that differed between methods were polyols (p < 0.001), sugar (p = 0.006), sodium (p = 0.03), alcohol (p < 0.001), vitamin A equivalents (p < 0.001), b-carotene equivalents (p < 0.001) and dietary fibre (p = 0.01). Associations between nutrient intake and microbes also differed between dietary collection methods. Most significant associations were found with nutrients measured by 24-hr recall. Mean (M) proximal intake of polyols (M = 0.9 g, standard deviation (SD) = 1.8 g) was significantly associated with increased relative abundance of Akkermansia spp. and CAG460 spp. but not with habitual intake (M = 3.4 g, SD = 3.2 g). Proximal alcohol intake (M = 2.5 g, SD = 8.8 g) was associated with CAG1427 spp. and Collinsella spp., which was not identified with habitual intake (M = 4.4 g, SD = 6.7 g). In contrast, habitual sugar intake (M = 149 g, SD = 103 g) was associated with Bacteroides spp. and Blautia spp. This association was not evident for proximal intake (M = 112 g, SD = 68 g), suggesting that some diet-microbiota associations may depend on the dietary assessment method used. These findings demonstrate the relevance of considering both habitual diet and proximal intake when conducting diet-microbiome research. Further analysis will investigate the role of these microbes and further associations between these nutrients and the functional capacity of the microbiota.

Various nutrient profile models (NPM) are used for food package labelling, such as Traffic Lights, Health Star Rating, Nutri-Score (1). However, these existing NPMs do not suit the context of mobile applications (app), where food is logged exclusively as consumed, not as sold. The inadequacy of existing NPMs for app use highlights a gap in accurately assessing the nutritional quality of foods as per real time consumption. This limitation underscores the need for developing a new model that takes into account highly variable portion sizes to ensure app users receive accurate nutritional feedback.

To fill this gap, the World Health Organization’s (WHO) Nutrient Profiling guidelines (2) were applied to develop a Nutrition Score (NS) within a weight loss (WL) coaching app as a NPM. The aim of this work is to study quantitative characteristics of the NS and its reception by the app users.

The eight-step procedure outlined in the 2010 WHO recommendations for developing NPMs (2) was followed to define the NS. 1) Purpose: To develop a system for providing non-judgmental feedback on digital food logs, accounting for portions; 2) To use an existing or develop a new model: Develop a new model specifically for in-app food feedback; 3) Scope of and exemptions to the model: For foods as they’re consumed; 4) Food categories: foods and drinks; 5) Nutrients included: Energy, protein, fibre, total sugar, saturated and unsaturated fats, sodium, calcium, vitamin C, alcohol; 6) Reference amount: Absolute values per given portion, “per 1000 kcal” and “per 100 g”; 7) Thresholds and/or scores: both; 8) Numbers for thresholds: European Reference Intakes(3,4) and FDA daily values(5) for primary thresholds (secondary are decided pragmatically).

To evaluate the NS, food logs recorded by eligible app users (18–70 years, 45–250 kg, 150–250 cm, meals recorded for at least 15 days in August 2024) were selected. Each log was scored (Optimal, Good, Fair or Low) and given a list of nutrient claims using the NS algorithm. From this we assessed the distribution of scores. Users acceptability of the NS was measured by calculating an average of 1–5 star ratings received.

During August 2024, 213,525 app users logged 5,593,617 meals each accompanied by a NS. Among those, 52,541 users logged meals for at least 15 days during August 2024: 3,650,833 meals in total. Median share (IQR) of Optimal, Good, Fair and Low meal scores was 14.5 (7.8–22.8)%, 48.7 (39.3–57.4)%, 19.2 (10.8–28.6)% and 2.6 (0.0–6.0)%. From 116,822 star ratings, the average rating was 4.5/5, and 67.3% of ratings scored 5/5.

WHO Nutrient Profiling was effectively used to develop a NS for an app, reflecting nutritional quality and receiving positive user acceptability. Further research is required to assess its association with WL and improvement in dietary adequacy.

The theory of Developmental Origins of Health and Disease (DOHaD) suggests that the foetal origins of adult diseases are determined by perinatal exposure. Therefore, dietary intake during pregnancy is an opportunistic time to influence future disease susceptibility in infants. ORIGINS is a longitudinal birth cohort study aimed to reduce the rising epidemic of non-communicable diseases through ‘a healthy start to life’(1). We aimed to describe the dietary intakes of pregnant women in this cohort in Western Australia and compare this to the Nutrient Reference Values (NRVs) and Australian Recommended Food Score (ARFS)(2). The dietary intakes of women were collected using the Australian Eating Survey (AES), a semi-quantitative Food Frequency Questionnaire (FFQ). A total of n = 374 women completed the AES FFQ(3) at both 18- and 36-weeks’ gestation between 2016 and 2023. A descriptive cross-sectional analysis using STATA, was used to explore the macronutrient, micronutrient and food group intake at the two time points. Participants had a mean age of 32 years, were of Caucasian background (82.6%), had a tertiary education (78.1%), and majority were in the normal (37.7%) or overweight (29.4%) BMI category. Overall, it was found that the energy contribution from carbohydrate was low as compared to the recommended range (44% vs 45–65%); however, total fat (37% vs 30–35%) and saturated fat was high (14% vs < 10%). Participants were below the NRVs for micronutrient intakes for: calcium (~17–21% below NRVs), iron (~52% below NRVs), iodine (~21–23% below NRVs) and folate (~40% below NRVs) at 18- or 36-weeks. Participants consumed double the sodium NRVs (~198–201% above NRVs), and had low diet quality scores for all food groups (score = 35/73) at both timepoints. These findings suggest that despite ongoing promotion of healthy eating during pregnancy, more dietary support and education may be required during pregnancy for both mother and the long-term health of their offspring

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.

Mental health disorders including depression and anxiety are major contributors to global disease burden. Evidence indicates that nutrition may play a role in supporting mental health, with most investigations centred on one-carbon metabolism related B-vitamins (1). Recently it has been reported that polyphenol supplementation, particularly those high in anthocyanins (such as blueberries) may improve mood states, including depressive symptoms and anxiety (2). This pilot study aimed to investigate the influence of a combined multivitamin and blueberry extract multinutrient (Vitals+, Heights, UK) on B-vitamin biomarkers and mental wellbeing in healthy adults.

14 healthy adults (8 males, mean age ±SD 38 ±10 yrs) were recruited. Exclusion criteria were: coeliac disease, mental health condition, pregnancy or breastfeeding or taking nutritional supplements in the past 3 months. Participants received an 8-month supplementation of Vitals+ once a day. The supplement contained, among other nutrients, thiamine (B1), riboflavin (B2) and vitamin B6 at a dose of 30mg each, 500μg of 5-Methyltetrahydrofolate (B9) and 25μg methylcobalamin (B12) alongside 80mg blueberry extract. B-vitamin biomarker status and mental state were assessed pre-post intervention.

Functional biomarkers of vitamin B1, B2 and B6 were measured using the Erythrocyte Transketolase (ETKac), Erythrocyte Glutathione Reductase (EGRac) and Erythrocyte Glutamic Oxaloacetic Trans-aminase (EGOTac) activation coefficient assays, respectively. Folate was measured in red blood cells (RBCF) and holotranscobalamin in serum was utilised for B12 assessment. Mental wellbeing was assessed using three validated questionnaires: the Profile of Mood States (POMS), Perceived Stress Scale (PSS) and the General Health Questionnaire-12 (GHQ-12). Differences in outcome measure were assessed pre-post intervention using paired samples t-tests (p<0.05 was considered significant).

At baseline 71% of participants had suboptimal/deficient thiamine status (ETKac ≤ 1.25) whereas 50% were riboflavin deficient (EGRac ≥1.40). Mean values ±SD for EGOTac, RBCF and holotranscobalamin were above the threshold for deficiencies, (1.37±0.12), (654±203 nmol/L) and (70±35 pmol/L) respectively, with no cases of deficiency for these nutrients. There was a significant improvement in thiamine (p=0.024), riboflavin (p<0.001), folate (p<0.001) and B12 (p=0.021) status post intervention but no change in vitamin B6 (p=0.167) biomarker status. For mental wellbeing outcomes, a trend towards significant improvement by 4-points was reported in the GHQ-12 (p=0.062), with a 30% reduction in participants fulfilling the criteria suggestive of psychological distress. There was no significant change in PSS (p=0.179) or total POMS (p=0.167). However, when subdomains of POMS were investigated, significant decreases in fatigue (p=0.028), confusion (p=0.017), self-esteem (p=0.022) and tension (p=0.047) were observed.

At baseline B6, folate and B12 status was adequate however thiamine and riboflavin deficiencies were prevalent. Vitals+ normalised thiamine and riboflavin status and further improved biomarker status of other one-carbon metabolism related B-vitamins. The multinutrient may present an easily accessible intervention to improve B-vitamin status and mental health and wellbeing in adults.

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.

The cortisol awakening response (CAR), the sharp rise in cortisol level upon awakening, represents a unique aspect of hypothalamic pituitary adrenal (HPA) axis activity, combining features of circadian regulation and reactivity to awakening. Studies highlight that the CAR is influenced by state-like factors (e.g., subjective stress and poor sleep) and relates to health and ageing(1). Fluid regulation and the CAR share a common pathway, whereby hydration directly influences the secretion of arginine-vasopressin (AVP), which in-turn modulates HPA-axis activity and cortisol release. Studies have observed higher circulating and saliva cortisol in healthy, low drinking adults presenting with suboptimal hydration (e.g., elevated urine osmolality, UOsm); however, cortisol was only assessed at a single timepoint(2, 3). The study aim was to assess the influence of a change in daily fluid intake on the dynamic CAR.

From a sample of 71 eligible healthy adults (25 females, 46 males), 16 low drinkers (1315 ± 401 ml/day) and 16 high drinkers (4372 ± 1220 ml/day) were identified by adopting daily fluid intake thresholds from a matched UK population (4). In pairs, comprising a low and high drinker, participants underwent a 7-day habitual phase followed by a 7-day intervention phase. During the intervention phase low drinkers increased (+1953 ± 430 ml/day) and high drinkers reduced daily fluid intake (-3168 ± 1379 ml/day), adjusting only water intake. Saliva samples were collected at 0, 15, 30, and 45 minutes after awakening on the last two mornings of each phase, with compliance to sample timing (± 5 minutes) monitored as recommended (1). Saliva cortisol was assessed by ELISA and the CAR was reported as the area under the curve with respect to increase (AUCI) (1). Urine samples were collected the day before and the day of CAR sample collection (16:00-20:00) to assess UOsm.

Linear mixed model revealed a group (low drinkers, high drinkers)*phase (habitual drinking, intervention drinking) interaction for hydration (P < 0.01), whereby UOsm changed significantly in both low drinkers (mean ± SD: 582 ± 213 to 363 ± 200 mOsm/kg) and high drinkers (265 ± 153 to 612 ± 189 mOsm/kg), indicating the success of the intervention. However, no group*phase interaction was observed for the CAR (P = 0.9). The CAR was similar before and after the intervention in both low (AUCI: 15 ± 15 vs. 16 ± 8) and high drinkers (AUCI: 11 ± 14 vs. 12 ± 11), indicating that changing fluid intake did not affect the CAR. These findings remained when observations were restricted to participants who accurately complied to the CAR sampling protocol (N = 19).

These results suggest that the cortisol awakening response, which combines elements of circadian regulation and reactivity to awakening, is not influenced by daily fluid intake.

Nearly half of all Australians (42.9%) will experience a mental health disorder during their lifetime(1). Preliminary research suggests an association between dietary and tissue advanced glycation end-products (AGEs) and mental health conditions, such as depression(2,3). However, more research is needed to determine the extent to which poor mental health is linked with AGEs(4). This study examined whether dietary consumption of the AGE carboxymethyl-lysine (CML), tissue accumulation of AGEs, or levels of circulating glycated haemoglobin (HbA1c) were associated with depression or anxiety. Fifty adults participated in a cross-sectional study. Depression and anxiety were assessed using the Centre for Epidemiologic Studies Depression Scale (CES-D) and Spielberger’s State-Trait Anxiety Inventory (STAI). Dietary CML intake was assessed from 3-day food records by matching food items to those in published, validated food AGE databases and adjusting for energy intake (CML/MJ). Tissue accumulation of AGEs was measured as skin autofluorescence (SAF) using an AGE Reader. HbA1c was measured in whole blood using a Capillary 3 HbA1c kit. Spearman’s rank correlations were performed to explore relationships between variables. Participants included 14 males and 36 females, aged (median (range)) 30.6 (18–72) years. Participants were predominantly healthy, with a BMI of 23.3 (18.5–31.1) kg/m2 and energy intake of 7889 (5452–12568) kJ/day. Depression scores were 8 (0–40) out of 60. State anxiety scores were 26 (20–53) and trait anxiety scores were 33.5 (20–66) out of 80, where higher scores indicated greater symptom severity. Daily intake of CML was 0.6 (0.2–1.9) mg/MJ/day. SAF was 1.8 (1.2–3.3) arbitrary units (AU), similar to previously reported normal reference values(5). Circulating HbA1c was 5.1% (4.4–6.2%), all within the healthy range(6). Spearman’s correlation tests indicated no significant associations between any of the independent variables (CML/MJ, SAF, HbA1c) and any of the dependent variables (CES-D, STAI) (all p > 0.05). In this population of predominantly of healthy individuals, there was no association between dietary CML intake, tissue AGE accumulation or circulating HbA1c and increased symptom severity for depression or anxiety. The next step of this research is to investigate metabolomic markers in this population and their association with depression and anxiety. In relatively healthy people, dietary metabolites may be more sensitive to uncover whether a relationship exists between AGEs and depression and anxiety.

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.

Nutrition plays a key role in brain development in the first 1000–2000 days of life(1). Furthermore, fussy eating is broadly defined as the inconsistent rejection and acceptance of both familiar and unfamiliar foods(2). Fussy eating is reportedly found in 10–15% of 2–3-year-old children, although typically starts to decrease in prevalence by 4 years old(3). Despite this decrease in the general population, children with neurodevelopmental disabilities, such as autism spectrum disorder, can see a protracted continuation of fussy eating and reject approximately 30% more foods than typically developing children(4). Consequently, for some children with neurodevelopmental disabilities maintaining adequate nutritional intake can be a challenge. Key nutrients for optimal neurodevelopment include iron, omega-3, protein, zinc and folate(1), and underconsumption of these nutrients can lead to poorer developmental outcomes in some children(1). Limited empirical evidence has been published on fussy eating in children with neurodevelopmental disabilities and no studies has examined the effects of poor diet variety on their emotional regulation. This study aims to systematically review current evidence to determine the association between fussy eating, diet variety and experiences of emotional regulation in children with neurodevelopmental disability. The search strategy was designed with the use of database specific index phrasing and was modified and tested several times before the formal search day. The systematic literature review was conducted across Medline, Scopus, Embase, Cinahl and Google Scholar. Studies included were dated from 2014–2024 and must have included children with a diagnosed or suspected neurodevelopmental condition and be aged been 1 to 9 years. Articles were excluded if children were following diets restricted by caregivers such as vegetarianism or ketogenic diets. Studies which focused primarily on a psychological outcome were also excluded due to the scope of the research not being within a nutrition related field. All articles were stored in Endnote, with duplicates removed before screening. The search results yielded 500 articles, following screening 10 full text articles met all inclusion criteria. Following data extraction, results illustrated that children with neurodevelopmental disabilities and observed fussy eating behaviours can experience difficulties regulating emotions. Additionally, diet variety was found to be consisting primarily of processed grains and meats, with minimal wholegrain and vegetable intake. Further research is needed to understand the aetiology and causative pathways between fussy eating, diet variety and emotional regulation for children with neurodevelopmental disability to better inform potential dietary interventions in this population.

There is growing interest in analysing potential sustainability trade-offs and co-benefits when it comes to national dietary guidelines (1,2). However, biodiversity is one area that is often left out of these analyses. This scoping review explores the range of studies measuring potential land use impacts of aligning diets or food supply with national dietary guidelines, with a secondary aim to identify how often biodiversity is included.

Scopus, Food Science and Web of Science were searched for peer-reviewed articles which focused on dietary guidelines, land use and future scenarios or modelling, following the Joanna Briggs Institute scoping review method (3).The 1,481 papers retrieved were uploaded to EPPI Reviewer, and 191 duplicates were removed. After screening, a final set of 40 papers were included. Data on the methods used, dietary and environmental impacts, and policy recommendations were extracted. Due to the variation in how impacts were measured, it was not possible to carry out any statistical analysis.

The majority (75%) of papers were published in the last 5 years. In most studies aligning diets with dietary guidelines involved reducing meat (-7% to -74%) and sugar (-3% to -100%), and increasing fruit and vegetables (+17% to +207%), compared to current diets. Only one Australian study found an increase in meat (21%). Results for dairy were mixed with two papers identifying a reduction, based on diets in England and Wales, and Germany. Two papers indicated no change in dairy, while all other papers which included dairy indicated an increase, one with an increase of 500%.

Greenhouse gas emissions were the most common additional environmental factor included (n=30), followed by water (n=19), fertiliser (n=9) energy (n=7) eutrophication (n=3). Biodiversity was featured in only three papers, two of which found both reductions and increases in threats to biodiversity. The third study found most dietary guidelines are incompatible with Aichi biodiversity target to limit rate of cropland change.

Twenty-four authors made the following policy recommendations; incorporate environmental sustainability into dietary guidelines (n=8), having holistic and coherent food systems approaches (n=5), implement policies to change food production and promote sustainability (n=5), combine supply and demand side approaches (n=4), consider socioeconomic factors of food-environment nexus and related policies (n=3), use regional approaches to develop food policy (n=2), and implement measures to encourage dietary change (n=2).

Dietary results were relatively consistent across studies and regions, with most suggesting increasing fruit and vegetables, and reducing meat and sugar. Mixed environmental impacts highlight the need to include multiple environmental factors in diet and land use modelling, for a broader picture of potential trade-offs or co-benefits. Considering the importance of biodiversity to the food system, it is essential that it is included in more studies modelling the land use impacts of dietary guidelines.

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.

Sustainable food based dietary guidelines could be leveraged by national governments to lead transitions to more sustainable food systems. Many countries are in the process of updating their national dietary guidelines to incorporate sustainability (1). In 2021 during the preparations for the United Nations Food Systems Summit, the Irish government announced their aim to become a world leader in sustainable food systems(2).To achieve this, a coherent food system approach is needed, which involves updating the dietary guidelines in line with this goal. To help inform future updates of dietary guidelines in Ireland, this study aimed to identify the sustainability gaps in current Irish dietary guidelines, and barriers to making them more sustainable.

The sustainability gaps in the guidelines and barriers to addressing them were identified by combining a content analysis of the Irish dietary guidelines and supporting documents to evaluate their sustainability, with semi-structured stakeholder interviews to identify barriers to sustainable dietary guidelines. The guidelines were evaluated using an integrated framework by Ahmed and colleagues (3) covering four dimensions of sustainability; ‘health’, ‘economic’, ‘ecological’ and ‘socio-cultural and political’. Semi-structured interviews were held with eight key stakeholders in research, food industry and governance in the Irish food system. Transcripts from interviews were analysed using NVivo 12. A thematic analysis was carried out based on Clarke and Braun’s method(4).

Across the four dimensions of sustainability, the Irish dietary guidelines scored highest in the ‘human health’ (6/8). Food safety and the nutrition aspects of food security were the two aspects of the human health dimension which were not incorporated in the dietary guidelines. However, scores were universally low in the other dimensions, scoring 1/8 in both the ‘socio-cultural and political’ and ‘economic’ dimensions, and 0/8 in the ‘ecological’ dimension. Key barriers to closing these gaps, identified by interviewees included: a siloed approach toward food policy in Ireland; lack of evidence of long-term nutritional impacts of shifting towards sustainable diets; knowledge and behaviours of consumers; no agreed framework defining and monitoring progress towards sustainability; the social and economic importance of animal sourced foods in Ireland and the affordability of sustainable diets.

Future versions of the dietary guidelines need to address the gaps identified in this study to incorporate multiple dimensions of sustainability. While doing so, the government will also need to tackle the barriers to closing these gaps highlighted by stakeholders, if they are to fulfil the ambition to be a world leader in sustainable food systems.

It would also be worthwhile carrying out research on barriers and enablers to compliance with dietary guidelines to improve uptake. An integrated food systems approach including larger sample a range of stakeholders, including consumers, is recommended when updating future dietary guidelines.

The various COVID-19 lockdowns and restriction periods significantly changed both food accessibility and availability, which considerably impacted food practices of Australians. Food insecurity prevalence increased in Tasmania(1), but data from elsewhere in Australia is scarce and other changes in food shopping habits have not been reported. We aimed to explore Australian adults’ self-reported experiences of running out of food, spending on food and food shopping habits during the COVID-19 restriction periods in 2020. An online survey of Australian adults was administered via Qualtrics. Chi-square tests examined bivariate associations between categorical variables (gender, age, change in employment status, education level, main language spoken at home and marital status), and responses to the main research questions. Respondents (n = 764) were predominantly female (86%), primarily from Victoria (48%), with the majority over 55 years of age (57%, mean age [SD] 53.4 [18.1] years). Additionally, half (51%) were not in paid employment. Overall, 11% reported running out of food and not being able to purchase more. There was an association between age and running out of food (4% of the 64–74 and 75+ year old age groups ran out of food compared to 23% of the 18–24 year olds, p < 0.001, chi square). The most reported reasons for running out of food, out of six provided options, were ‘lack of availability in the shops’ (74%) and ‘lack of money’ (34%). There was no association with gender, employment status change, education level, main language spoken at home, or marital status and running out of food. When asked how the amount of money spent on food changed during COVID-19, most respondents (n = 318, 42%) reported spending about the same amount of money as before the pandemic, 284 (37%) reported spending more and 162 (21%) reported spending less on food. About a third of respondents (38%, n = 293) reported buying more food than they needed since the start of COVID-19 and 9% (n = 66) reported wasting more food than usual. This did not differ with age, gender, employment status change, education level, main language spoken at home, or marital status. Nearly two-thirds (63%) reported that they had changed how they bought their food since the start of COVID-19.Of these 75% reported a change in frequency of food shopping and 45% reported a change in the amount of time spent food shopping. Just under half (44%) reported a change in the amount of money spent on food and 42% reported a change in the food bought. The COVID-19 pandemic restrictions caused significant changes to Australians’ food procurement and younger people appeared more at risk of food insecurity. Policies that support young people are important to ensure food security in the most vulnerable groups.

The food supply is known to have a substantial impact on greenhouse gas emissions. The Global Warming Potential Star (GWP*) refers to the amount of carbon dioxide equivalents produced by food items, and can be used to quantify the impact of the food supply on the environment. GWP* values are available for n = 232 Australian food products(1). In order to estimate the climate footprint of diets in Australia, GWP* values must be applied to all foods in AUSNUT 2011–13, the most current Australian food composition database. The aim of this study was to systematically apply GWP* values to foods in AUSNUT 2011–13, to facilitate calculation of the climate footprint of Australian dietary data. To create the GWP*-AUSNUT 2011–13 database, all n = 5740 food and beverage items in AUSNUT 2011–13 were reviewed, and GWP* values were applied via a systematic approach. Initially, GWP* values were matched to AUSNUT 2011–13 foods based on conceptual similarities, where an appropriate GWP* item existed (e.g., Beef, mince, < 5% fat, raw was matched to the GWP* item ‘Beef meat’, with a GWP* value of 16.68 CO2e/kg). For AUSNUT 2011–13 foods where there was not an appropriate GWP* item, for example composite foods with multiple ingredients, the AUSNUT 2011–13 Recipe File was used to determine constituent ingredients and match these to GWP* items (e.g., Beef, mince, < 5% fat, baked, roasted, fried or stir-fried, grilled or BBQ’d, canola oil was matched to the GWP* items ‘Beef meat’ and ‘Canola oil’ based on the ingredient proportions in the AUSNUT 2011–13 Recipe File). Where an AUSNUT 2011–13 recipe did not exist, these were determined based on ingredient descriptions in the AUSNUT 2011–13 database, or based on ingredient proportions from a sample of food labels (e.g., Peanut butter, smooth & crunchy, added sugar & salt). In the case of single ingredient foods without an appropriate GWP* item match, an average of GWP* values for similar foods (using the AUSNUT 2011–13 food classification categories) was calculated (for example as there was no GWP* item for Mulberry, raw, an average of all GWP* items aligning with foods in the AUSNUT 2011–13 minor food group ‘berry fruit’ was calculated). The systematic process of applying GWP* values to AUSNUT 2011–13 foods was conducted by two researchers independently, with any disagreements resolved via consensus and discussion with the research team. Through application of GWP* values to the AUSNUT 2011–13 food composition database via a systematic process, the GWP*-AUSNUT 2011–13 database was created. This database will allow for the estimation of the climate impact from dietary data collected in Australia, both retrospectively and in future studies, to identify the climate footprint of different dietary patterns or to provide insight into dietary changes required to decrease greenhouse gas emissions.