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Bell LK, Leemaqz S, Devenish-Coleman G, Do LG, Ha D, Scott JA, Golley RK. Development and internal validation of the SMILE-FSS: a Free Sugars Screener for Australian children aged 2 and 5 years. Public Health Nutr 2023; 26:2691-2703. [PMID: 37905405 PMCID: PMC10755434 DOI: 10.1017/s1368980023002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To develop and internally validate a Free Sugars Screener (FSS) for Australian children aged 2 and 5 years. DESIGN Using data collected from a ninety-nine-item (2-year-olds) and ninety-eight-item (5-year-olds) FFQ in the Study of Mothers' and Infants' Life Events affecting oral health (SMILE-FFQ), a regression-based prediction modelling approach was employed to identify a subset of items that accurately estimate total free sugars intake (FSI). The predictors were grams of free sugars (FSg) for individual items in the SMILE-FFQ and child's age and sex. The outcome variable was total FSI per person. To internally validate the SMILE-FSS items, the estimated FSg was converted to percent energy from free sugars (%EFS) for comparison to the WHO free sugars guideline categories (< 5 %, 5-< 10 % and ≥ 10 %EFS) using cross-classification analysis. SETTING Australia. PARTICIPANTS 858 and 652 2- and 5-year-old children, respectively, with complete dietary (< 5 % missing) and sociodemographic data. RESULTS Twenty-two and twenty-six items were important in predicting FSI at 2 and 5 years, respectively. Items were similar between ages with more discretionary beverage items (e.g. sugar-sweetened beverages) at 5 years. %EFS was overestimated by 4·4 % and 2·6 %. Most children (75 % and 82 %) were categorised into the same WHO free sugars category with most (87 % and 95 %) correctly identified as having < 10 %EFS in line with the WHO recommendation. CONCLUSIONS The SMILE-FSS has good internal validity and can be used in research and practice to estimate young Australian children's FSI and compare to the WHO free sugars guidelines to identify those 'at risk'.
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Affiliation(s)
- Lucinda K Bell
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide5001, Australia
| | - Shalem Leemaqz
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | - Loc G Do
- School of Dentistry, The University of Queensland, Brisbane, QLD, 4072Australia
| | - Diep Ha
- School of Dentistry, The University of Queensland, Brisbane, QLD, 4072Australia
| | - Jane A Scott
- School of Population Health, Curtin University, Perth, WA6102, Australia
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide5001, Australia
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Brooker PG, Rebuli MA, Williams G, Muhlhausler BS. Effect of Fortified Formula on Growth and Nutritional Status in Young Children: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:5060. [PMID: 36501090 PMCID: PMC9737957 DOI: 10.3390/nu14235060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/19/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022] Open
Abstract
Previous reviews of the effect of young child formulas on health outcomes in infants and toddlers have been inconclusive. In this study, we undertook a contemporary synthesis of studies investigating the effects of consuming fortified milk beverages (compared to cow’s milk or unfortified comparator formula) on growth and/or nutritional status in children 1−3 years of age. Five electronic databases were searched (PubMed, Web of Science, Scopus, ProQuest, and Cochrane Library) for randomised controlled trials comparing fortified milk against control milk in young children (9−48 months), published between January 1990 and June 2022. Outcomes were growth, body composition, biochemical markers, and/or nutritional status. Mean differences (MD) were pooled using random-effects meta-analysis where there were ≥3 studies. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Nineteen articles (12 studies; n = 4795) met the inclusion criteria. Heterogeneity was substantial, likely attributable to considerable variation in study characteristics. Fortified milk was associated with increased weight gain (MD = 0.14 kg [95% CI 0.06, 021], p = 0.0003) compared with control milk. Subgroup analyses demonstrated increases in weight in lower-income countries, and in studies with intervention periods > 6 months. There were no effects of fortified milks on other anthropometric measures. Haemoglobin (MD = 3.76 g/L [95% CI 0.17, 7.34], p = 0.04) and ferritin (MD = 0.01 nmol/L [95% CI 0.00, 0.02], p = 0.02) concentrations were increased in infants consuming fortified milks. Fortified milk beverages appear to offer a safe and acceptable source of complementary nutrition as a short-term strategy for addressing nutritional deficits and may modestly promote weight gain in vulnerable populations when provided for periods > 6 months. This study was prospectively registered with PROSPERO (CRD42022339920) and funded by the Infant Nutrition Council.
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Affiliation(s)
- Paige G. Brooker
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, BC 5000, Australia
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Rousham EK, Goudet S, Markey O, Griffiths P, Boxer B, Carroll C, Petherick ES, Pradeilles R. Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis. Adv Nutr 2022; 13:1669-1696. [PMID: 35362512 PMCID: PMC9526862 DOI: 10.1093/advances/nmac032] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/25/2022] [Accepted: 03/25/2022] [Indexed: 01/28/2023] Open
Abstract
This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL, and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs), non-RCTs, cohort studies, and pre/post studies with control; 2) participants aged ≤10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages compared with no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I (risk of bias in nonrandomized studies of interventions version I) and RoB2 [Cochrane RoB (version 2)] tools for nonrandomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSBs) and unhealthy foods in childhood may increase BMI/BMI z-score, percentage body fat, or odds of overweight/obesity (low certainty of evidence). Artificially sweetened beverages and 100% fruit juice consumption make little/no difference to BMI, percentage body fat, or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and percentage body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109.
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Affiliation(s)
- E K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - S Goudet
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - O Markey
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - P Griffiths
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - B Boxer
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - C Carroll
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - E S Petherick
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, United Kingdom
| | - R Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Hasheminejad N, Malek Mohammadi T, Mahmoodi MR, Barkam M, Shahravan A. The association between beverage consumption pattern and dental problems in Iranian adolescents: a cross sectional study. BMC Oral Health 2020; 20:74. [PMID: 32183764 PMCID: PMC7079373 DOI: 10.1186/s12903-020-01065-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With regard to the increasing consumption rates of unhealthy beverages among adolescents, the main purpose of the present study was to determine the association between beverage intake pattern and dental caries and tooth erosion in this age group. METHODS A total sample of 600 adolescents was recruited in this study using a multistage cluster random sampling method in the city of Kerman, in the southeast of Iran, in 2017. Then, the Decayed, Missed and Filled Teeth (DMFT) index and the Tooth Wear Index (TWI) were registered for each participant. A Beverage Frequency Questionnaire was also employed to estimate typical beverage intake frequency. Correspondingly, negative binominal regression and logistic regression were performed to determine the independent variables associated with the DMFT index and the TWI. RESULTS The findings revealed that the highest consumed beverage in daily living was tea in both genders, followed by sweetened soft beverages, as well as milk and kefir/yogurt drink. The results of the DMFT index were also significantly different in participants that had never consumed milk compared with those who had used milk on a daily basis. Moreover, the DMFT index in participants who had never consumed sweetened soft beverages was 39%, less than those who had had a daily intake of such beverages. Also, the chance of tooth erosion for participants who had never used sweetened soft beverages was 94%, lower than that in daily consumers. CONCLUSIONS The results of this study revealed that adolescents had an unhealthy beverage intake pattern. Furthermore, milk consumption was beneficial to dental caries, whereas use of soft drinks associated with more dental caries and tooth erosion.
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Affiliation(s)
- Naimeh Hasheminejad
- Oral and Dental Disease Research Center and Kerman Social Determinants on Oral Health Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Tayebeh Malek Mohammadi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Department of Dental Public Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Mahmoodi
- Physiology Research Center, Institute of Basic and Clinical Physiology & Department of Nutrition, Faculty of Health, Kerman University of Medical Sciences, Haft Bagh-E-Alavi Highway, Kerman, 7635111167, Iran.
| | - Moein Barkam
- Oral and Dental Disease Research Center and Kerman Social Determinants on Oral Health Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Arash Shahravan
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Sources and Determinants of Discretionary Food Intake in a Cohort of Australian Children Aged 12-14 Months. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010080. [PMID: 31861905 PMCID: PMC6981432 DOI: 10.3390/ijerph17010080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
Abstract
Despite recommendations to the contrary, consumption of discretionary (energy-dense, nutrient-poor) foods begins for some children early in the weaning period, and the proportion of children consuming discretionary foods increases markedly in the second year of life. The purpose of this study was to determine intake and sources of discretionary foods in a cohort of 828 Australian toddlers (mean age: 13.1mo), and to identify determinants of discretionary food intake. At approximately 12 months of age, 3 non-consecutive days of dietary intake data were collected using a 24-h recall and 2-day food record, and the percentage total energy derived from discretionary foods was estimated. Linear regression was used to identify associations between discretionary food intake and socio-demographic determinants (mother's age, level of education, country of birth, pre-pregnancy body mass index, socioeconomic position, parity, age of child when mother returned to work, and child's sex) and age at which complementary foods were introduced. The average energy intake of children in this cohort was 4040 (±954.7 SD) kJ with discretionary foods contributing an average of 11.2% of total energy. Sweet biscuits, and cakes, muffins, scones and cake-type desserts contributed 10.8% and 10.2% of energy intake from discretionary foods, respectively. Other key contributors to energy intake from discretionary foods included sausages, frankfurters and saveloys (8.3%), vegetable products and dishes where frying was the main cooking technique (8.6%), butter (7.3%), and finally manufactured infant sweet or savory snack foods (9.3%). Higher intakes of discretionary food were associated with children having two or more siblings (p = 0.002), and being born to younger mothers (<25 years) (p = 0.008) and mothers born in Australia or the United Kingdom (p < 0.001). Parents, in particular young mothers and those with larger families, need practical guidance on how much of, and how often, these foods should be eaten by their children.
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Devenish G, Golley R, Mukhtar A, Begley A, Ha D, Do L, Scott JA. Free Sugars Intake, Sources and Determinants of High Consumption among Australian 2-Year-Olds in the SMILE Cohort. Nutrients 2019; 11:E161. [PMID: 30642136 PMCID: PMC6356352 DOI: 10.3390/nu11010161] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 11/17/2022] Open
Abstract
In the first 2 years of life, it is important to limit exposure to foods high in free sugars, in order to lay foundations for lifelong eating patterns associated with a reduced risk of chronic disease. Intake data at this age is limited, so compliance with recommendations is not known. This analysis describes free sugars intakes, food sources and determinants of high consumption among Australian children at 2 years of age. Free sugars intakes were estimated using a customized Food Frequency Questionnaire, and median usual free sugars intake at 2 years was 22.5 (Interquartile Range (IQR) 12.8⁻37.7) g/day, contributing a median 8% of the estimated energy requirement (EER). Based on the EER, most children (71.1%) exceeded the World Health Organization recommendation that <5% of energy should come from free sugars, with 38% of participants exceeding the <10% recommendation. Children from households with the greatest socioeconomic disadvantage were more likely to exceed the 10% recommendation (Prevalence Ratio (PR) 1.44, 95% Confidence Interval (95% CI) 1.13⁻1.84), and be in the top tertile for free sugars intake (PR 1.58, 95% CI 1.19⁻2.10) than the least disadvantaged. Main sources of free sugars were non-core foods, such as fruit juice, biscuits, cakes, desserts and confectionery; with yogurt and non-dairy milk alternatives the two notable exceptions. Improved efforts to reduce free sugars are needed from the introduction of solid food, with a particular focus on fruit juice and non-core foods.
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Affiliation(s)
- Gemma Devenish
- School of Public Health, Curtin University, Perth 6102, Australia.
| | - Rebecca Golley
- College of Nursing and Health Sciences, Flinders University, Adelaide 5000, Australia.
| | - Aqif Mukhtar
- School of Public Health, Curtin University, Perth 6102, Australia.
| | - Andrea Begley
- School of Public Health, Curtin University, Perth 6102, Australia.
| | - Diep Ha
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide 5000, Australia.
| | - Loc Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide 5000, Australia.
| | - Jane A Scott
- School of Public Health, Curtin University, Perth 6102, Australia.
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Marakis G, Kontopoulou L, Garofalakis G, Vasara E, Vasiliadis G, Grammatikopoulou MG. Development and relative validity of a self-administered semi-quantitative drinks frequency questionnaire, validated in a population of university students. Nutr Diet 2018; 76:532-538. [PMID: 30353963 DOI: 10.1111/1747-0080.12494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/06/2018] [Accepted: 09/14/2018] [Indexed: 01/10/2023]
Abstract
AIM Drinks can contribute to energy as well as micro- and macro-nutrient intake. Drink-specific, validated, quick and easy to administer questionnaires are needed to monitor secular trends in beverage consumption for different populations. The aim of the present cross-sectional study was to develop and validate a drink-specific questionnaire for the Greek population. METHODS A 41-item semi-quantitative drinks frequency questionnaire (DFQ) was developed and validated against 7-day weighed food records, among young Greek adults. Wilcoxon ranks tests, Kendall tau-b correlations and Bland-Altman plot were used to compare the two methods. Fifty-nine Greek University students (28 males, 31 females) completed both methods. RESULTS No difference was observed in total drinks intake between the two methods. The Bland-Altman plot showed that the two methods are likely to agree concerning the total drinks intake. Wilcoxon's rank test showed no significant differences between the two methods, except for the 'whiskey/vodka/gin' intake (P < 0.001). 'Good' agreement (tau-b > 0.61) was observed for most DFQ items, including low-fat and chocolate milk, hot chocolate, Greek/espresso coffee, commercial tea, packaged fruit juices, wine, alcohol-free beer, light cola-type drinks and water (tap/bottled/sparkling). 'Low' agreement (<0.30) was noted for filtered/instant/iced coffee, freshly squeezed orange juice and some alcoholic drinks (beer/whiskey/vodka/gin). CONCLUSIONS The DFQ appears to be an overall valid means of estimating the habitual intake of drinks in large-scale epidemiological surveys. The study supports the use of DFQ for assessing drinks consumption patterns and secular trends.
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Affiliation(s)
- Georgios Marakis
- Nutrition Policy and Research Directorate, Hellenic Food Authority, Athens, Greece
| | - Lamprini Kontopoulou
- Department of Nutrition & Dietetics, Technological Educational Institute of Thessaly, Karditsa, Greece
| | - Gorgias Garofalakis
- Nutrition Policy and Research Directorate, Hellenic Food Authority, Athens, Greece
| | - Eleni Vasara
- Department of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Vasiliadis
- Department of Informatics Engineering, Technological Educational Institute of Western Macedonia, Kastoria, Greece
| | - Maria G Grammatikopoulou
- Department of Nutrition & Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece.,Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Devenish G, Ytterstad E, Begley A, Do L, Scott J. Intake, sources, and determinants of free sugars intake in Australian children aged 12-14 months. MATERNAL AND CHILD NUTRITION 2018; 15:e12692. [PMID: 30225982 DOI: 10.1111/mcn.12692] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/14/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
The consumption of free sugars is directly associated with adiposity and dental caries in early childhood; however, intake data in the first 2 years of life are limited. This cross-sectional analysis aims to identify major food sources of free sugars for Australian children aged 12-14 months and investigate factors associated with meeting the World Health Organisation (WHO) Guideline for sugars intake. Three days of nonconsecutive dietary data were collected via a 24-hr recall and 2-day food record for 828 participants. Usual intake of energy, total sugars, and free sugars were estimated, along with food group contributions to free sugars. Multiple logistic regression analysis was used to investigate factors associated with exceeding the WHO conservative recommendation that <5% of energy should come from free sugars. Mean free sugars intake was 8.8 (SD 7.7, IQR 3.7-11.6) g/day, contributing 3.6% (SD 2.8, IQR 1.6-4.8) of energy. Only 2.4% of participants exceeded the WHO recommendation that <10% of energy should come from free sugars, with 22.8% of participants exceeding the <5% recommendation. Children from households with greater socio-economic disadvantage (IRSAD <5, OR = 1.94) and in the lowest income bracket (OR = 2.10) were more likely to have intakes ≥5% of energy. Major food sources of free sugars were commercial infant foods (26.6%), cereal-based products (19.7%), namely, sweet biscuits (8.3%) and cakes (7.6%), followed by yoghurt (9.6%), and fruit and vegetable beverages (7.4%). These findings highlight the substantial contribution of infant foods to free sugars intakes and provide further evidence that dietary intakes are influenced by social determinants.
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Affiliation(s)
- Gemma Devenish
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Elinor Ytterstad
- Department of Mathematics and Statistics, UiT The Arctic University of Norway, Tromsø, Norway
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Loc Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jane Scott
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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Probst Y. Food matrix: The influence of tools, training and policies on our nutrition practice. Nutr Diet 2018; 75:139-141. [DOI: 10.1111/1747-0080.12417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yasmine Probst
- Senior Lecturer, School of Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong New South Wales Australia
- Research Fellow, Illawarra Health and Medical Research Institute; Illawarra New South Wales Australia
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