Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory, Australia

Food Choices, Sustainability and Australian Native Foods: Perceptions among University Students

(1) Background: Urgent changes in our food choices are needed for more sustainable, resilient and equitable food systems. Australian native plant-based foods have both environmental and health benefits. Including these foods in our diet may reduce both the risk of chronic diseases and the impact of climate change. This study explored the perceptions and attitudes towards food choices, sustainability and Australian native plant-based food among university students. (2) Methods: A cross-sectional online survey was completed by 212 university students in Australia from October to December 2022. Questions included information about sociodemographic characteristics, food choices, Australian native foods and the impact on sustainability. Logistic regression was used for analyses. (3) Results: Most participants recognised the impact of food choices on sustainability. There was a significant association between recognition of the impact of food choices on sustainability and the environmental and nutritional benefits of Australian native foods (OR = 2.89, 95% CI 1.29, 6.46, p = 0.010). Students who were familiar with or had tried Australian native plant-based foods were significantly more likely to recognise their environmental and nutritional benefits (p < 0.001). (4) Conclusions: Students who recognise the impact of food choices on sustainability and the benefits of Australian native foods are more likely to include native foods in their diet. More studies are needed to investigate the specific native foods consumed and the barriers and facilitators to the intake of these foods.

Using photovoice to generate solutions to improve food security among families living in remote Aboriginal and/or Torres Strait Islander communities in Australia

The right to food security has been recognised internationally, and nationally in Australia by Aboriginal Community Controlled Health Organisations. This study aims to explore food (in)security and solutions for improvement of food security in remote Aboriginal and/or Torres Strait Islander communities in Australia, from the perspective of caregivers of children within the context of the family using photovoice. Participants took part in workshops discussing participant photographs of food (in)security, including solutions. Themes and sub-themes with associated solutions included traditional food use, sharing as a part of culture, the cost of healthy food, energy and transport, and housing and income. Community leaders used these data in setting priorities for advocacy to improve food security in their communities.

A Review of Phytochemicals and Bioactive Properties in the Proteaceae Family: A Promising Source of Functional Food

In recent decades, natural plant-based foods have been increasingly used to improve human health due to unhealthy modern dietary patterns, such as the consumption of foods high in sugar and fat. Many indigenous species have been used by Aboriginal peoples for their food and therapeutic properties. Thus, it is important to understand the health-enhancing bioactive profile of Australian indigenous species. The Proteaceae family, such as the genera of Protea, Macadamia, and Grevillea, have been commercially used in the horticulture and food industries. Researchers have reported some findings about Persoonia species, one of the genera in the Proteaceae family. The aim of this review was to provide an overview of the family Proteaceae and the genus Persoonia, including distribution, traditional and commercial uses, phytochemicals, bioactive properties, potential opportunities, and challenges. In this review, bioactive compounds and their properties related to the health benefits of the Proteaceae family, particularly the Persoonia genus, were reviewed for potential applications in the food industry.

Knowledge, Perception and Consumption of Indigenous Foods in Gauteng Region, South Africa

Urbanisation in South Africa has led to a nutritional transition from traditional diets (mainly based on indigenous foods) to a Western diet. Currently, the country is one of the most concerned about the prevalence of associated malnutrition and non-communicable diseases. One should, therefore, question the position of indigenous foods (IFs) in the population's eating habits since their nutritional and health value is known. This study aimed to collect updated data on South Africans' true awareness and consumption of indigenous foods, especially in the Gauteng region (the most urbanised province of the country). A quantitative cross-sectional research survey was conducted (n = 746). Among a list of 18 IFs, grain sorghum 32.4% (n = 242), marula 32% (n = 239), pearl millet 21.7% (n = 162), amadumbe 19.3% (n = 144) and cowpea 18.6% (n = 139) were the best known. However, the study noticed a maximum consumption of 19.3% (grain sorghum). Overall, this consumption was seasonal, and its level was significantly defined by race (p < 0.05). Black people consume more IFs compared to coloured people, Indian people and white people. Participants mostly consumed these foods for nutritional and health reasons and pointed out the problem of availability. "Poor image" was rated the lowest by all races (black 5.8%, coloured 4.2%, Indian 7.0% and white 4.1%) regarding the reasons for no or low consumption of IFs. Whatever the race, the desire to increase IF consumption was positive. The promotion of their integration into South African diets should, therefore, be considered as an intervention strategy.

Conceptualisation, experiences and suggestions for improvement of food security amongst Aboriginal and Torres Strait Islander parents and carers in remote Australian communities

This study aimed to determine perceptions of the lived experience of food insecurity and suggestions to improve food security in four remote Aboriginal communities in the Northern Territory, and Queensland. Participants were Aboriginal and/or Torres Strait Islander pregnant and breastfeeding women, and parents/carers of children aged six months to five years. Semi-structured interviews (n=17) were conducted between June-July 2021 and the data thematically analysed using a four stage process. No specific term was used by participants to describe being either food secure or insecure. Descriptions of food security were centred in food sharing, food sufficiency, and family activities. Elements describing food insecurity were physical pain and emotional stress, adults going without food, seeking family help and managing without food until payday. Factors contributing to food insecurity were reported to be: (i) Low income and unemployment, (ii) Cost of living remotely, (iii) Resource sharing, and (iv) Impact of spending on harmful commodities and activities. Three themes were conceptualised: (1) Cultural practices buffer food insecurity, (2) Coping with food insecurity, (3) People accept a degree of food insecurity as normal. Findings suggest Aboriginal and Torres Strait Islander cultural practices such as sharing food buffer episodic food insecurity and constitute 'cultural food security'. Despite use of cultural practices (e.g., procuring traditional food) and generic coping strategies, regular episodes of food insecurity often aligned with the off week of social assistance payments. Household energy (electricity) security was coupled to food security. Suggestions for improving food security included better transport and food access, extending electricity rebates, increases in the regularity of social assistance payments, and computer access and training in budgeting. Policies to advance food security should embody deeper Aboriginal and Torres Strait Islander descriptions and experiences. Community-derived policy suggestions which aim to increase access to adequate, regular, stable household income are likely to succeed.

Folate vitamers in the Australian green plum: Through growth and ripening and across locations

The green plum is a native fruit of Australia that grows on the tree Buchanania obovata. This study aimed to confirm the high level of folate in green plums by analyzing a large number of ripe samples from multiple locations and to understand how folate vitamers change as the fruit grows through maturity stages. This study analyzed green plums for five vitamers of folate, H4folate, 5-CH3-H4folate, 5-CHO-H4folate, 10-CHO-PteGlu, and PteGlu (folic acid) using a stable isotope dilution assay on a liquid chromatograph mass spectrometer (LC-MS). Green plums were tested from four locations, two harvests and five maturity stages. Another 11 ripe samples, each from different tree clumps from one location, were also tested as were ripe red-colored green plums. The results show the 5-CH3-H4folate in green plum increases and accumulates in the fruit through development, ripening and senescence. The ripe green plums contain between 82.4 ± 5.5 and 149.4 ± 10.7 μg/100 g Fresh Weight (FW). The red-colored green plums are even higher in folate, with total folate measured as 192.5 ± 7.0 and 293.7 ± 27.4 μg/100 g FW, and further analysis of them is suggested. There is some variation in amounts of folate between fruit from different locations and sets of trees, but all ripe green plums tested are considered good dietary sources of folate.

Developing culturally appropriate food literacy resources for Aboriginal children with Foodbank WA's Superhero Foods®

ISSUE ADDRESSED

In Australia, food sovereignty of traditional landowners has been marginalised by the globalisation of food systems and resulted in limited opportunities for children to experience familiar bush tucker foods as healthy choices, particularly in a school environment. Superhero Foods^® themed teaching resources focus on the development of nutrition education materials that included traditional Aboriginal foods together with contemporary foods readily available in regional/remote communities.

METHODS

Consultation with an Aboriginal expert and Aboriginal artist; local, regional/remote teachers and stakeholders informed the development of tailored resources including food cartoon characters, school lesson plans and a storybook. The latter was guided by a resource development model. Users of the resources were surveyed to ascertain the useability, alignment with the Australian Dietary Guidelines, cross-curricular learnings and cultural relevance.

RESULTS

Respondents across regional/remote and urban locations completed a lesson plan and food character (clipart) survey (N = 51) and storybook survey (N = 14). Respondents advised the resources were relevant, enjoyable, engaging and culturally appropriate for all students regardless of Aboriginality. The resources provided learning opportunities for all children to enhance knowledge about Aboriginal culture and bush foods. Independent evaluation has further indicated the translation of messaging into student's knowledge and learning.

CONCLUSIONS

Key enablers to the success of the resource included; free online access, the highly engaging nature of the resources and adaptability to be implemented across a number of Aboriginal language groups in WA. Ensuring visual representation of healthy choices was fundamental to reinforcing nutrition messaging. Superhero Foods resources are a positive and important inclusion in the health promotion toolbox for Aboriginal children. SO WHAT?: Superhero Foods are novel nutrition education resources depicting Aboriginal foods and Aboriginal children. These food literacy resources will engage children's understanding of Aboriginal culture, improve food literacy and strengthen equitable access for regional and remote communities.

Variations in limited resources allocation towards friends and strangers in children and adolescents from seven economically and culturally diverse societies

Humans are unique among primates in altruism and sharing limited recourses towards non-kin. Our study revealed the differences in proportions of individuals ready to share limited resources with virtual friend compared to virtual stranger in children and adolescents from seven ethnic groups, represented by four traditional rural African societies from Tanzania with different types of economy and three societies from Russia. The study was conducted between 2015 and 2020, and the data on 2253 individuals (1104 males and 1149 females) were obtained. Six economic games with limited resource allocations were conducted: Prosocial, Envy, and Sharing games with imagined friends and stranger partners accordingly. All players were later classified according to their decisions in all six games into four behavioral types: egoistic, egalitarian, altruistic, and mixed. The effects of population origin, gender, age, and stranger/friend type of interaction on the behavior were estimated by multinomial logistic regression. It was demonstrated that more respondents prefer altruistic and egalitarian behavior than egoistic and mixed in the whole sample. However, significant parochial effect was found. The study revealed significant main effects of ethnicity, age, and the interaction effects of ethnicity and parochial tendencies, and ethnicity and age on the behavior of players.

A Socio-Cognitive Review of Healthy Eating Programs in Australian Indigenous Communities

Purpose: This paper aims to understand the challenges to healthy eating for Indigenous Australians using a Social Cognitive Theory lens. Understanding the environmental, cognitive, and behavioural barriers to healthy eating for Indigenous populations in Australia will help identify current gaps and highlight future actions needed in this area to close the gap for Indigenous Australians. Study design: Narrative review of interventions of healthy eating programs in Australian Indigenous communities sourced using a systematic search protocol to understand the environmental, cognitive, and behavioural barriers to healthy eating among Indigenous Australians and to identify gaps and future actions needed to address this from 2010–2020. Results: The search produced 486 records, after duplicates were removed and the inclusion and exclusion process were utilised, seven interventions were retained in nine studies. The seven interventions had multiple study designs, from randomised control trials to case studies. Conclusions: Further work needs to explore the long-term feasibility of providing fruit and vegetable discounts and the impact of remoteness for the delivery of healthy food. Dietary interventions need to be clearly described, and fidelity and process of the design and implementation process to help with replication of work.

Effects of Nutritional Interventions on Cardiovascular Disease Health Outcomes in Aboriginal and Torres Strait Islander Australians: A Scoping Review

Nutrition interventions can support Aboriginal and Torres Strait Islander peoples to reduce their risk of cardiovascular disease (CVD). This review examines nutritional interventions aiming to improve CVD outcomes and appraises peer-reviewed interventions using an Aboriginal and Torres Strait Islander Quality Appraisal Tool. Five electronic databases and grey literature were searched, applying no time limit. Two reviewers completed the screening, data extraction and quality assessment independently. The study quality was assessed using the South Australian Health and Medical Research Institute and the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT). Twenty-one nutrition programs were included in this review. Twelve reported on anthropometric measurements, ten on biochemical and/or hematological measurements and sixteen on other outcome domains. Most programs reported improvements in measurable CVD risk factors, including reduced body mass index (BMI), waist circumference (WC), weight, blood pressure and improved lipid profiles. Most programs performed well at community engagement and capacity strengthening, but many lacked the inclusion of Indigenous research paradigms, governance and strengths-based approaches. This review highlights the need for contemporary nutrition programs aimed at improving cardiovascular health outcomes to include additional key cultural components.

Oral health education and prevention strategies among remote Aboriginal communities: a qualitative study

BACKGROUND

The delivery of effective oral health promotion strategies is essential to improving oral health outcomes among remote Aboriginal communities. This study aimed to explore the perceptions and attitudes of Aboriginal Australians living in remote Kimberley communities towards oral health education and disease prevention.

METHODS

Semi-structured interviews and yarning circles were carried out following purposive sampling of Aboriginal adults living in the East Kimberley region of Western Australia.

RESULTS

A total of 80 community members participated in the yarning process. School-based oral health promotion and community-driven restrictions on the sale of sugary food and drink were seen as positive strategies in improving oral health. Lifestyle changes brought about by modernity, internet availability and fixed community stores were perceived to create new challenges and shift the priorities for those living in remote communities.

CONCLUSIONS

Community-based yarning may better inform future oral health strategies in the Kimberley. A neoliberal approach of shifting responsibility onto the individual ignores the complex social inequities faced by Aboriginal people living in remote communities where macro-level determinants such as remoteness, food security and education significantly influence decisions around diet and oral health.

Interventions to address food insecurity among Aboriginal and Torres Strait Islander people: a rapid review

Food insecurity disproportionately impacts Aboriginal and Torres Strait Islander Australians. This review sought to investigate research and evaluations of programs and interventions implemented to address food insecurity among Aboriginal and Torres Strait Islander communities. A rapid review was conducted to collate the available research from 6 databases. The search was conducted in May 2020. Search constructs related to food insecurity, Aboriginal and Torres Strait Islander people, and Australia. Twenty-five publications were included in this review, 24 reported on an intervention, while 9 were evaluations of an intervention. Interventions included behaviour change projects, including projects that sought to change purchasing and cooking behaviours, school-based education programs, and gardening programs. In general, the studies included in this sample were small and lacked a systematic consideration of the factors that shape the experience of food insecurity among Aboriginal and Torres Strait Islander people specifically. Based on the findings of this review, authors suggest greater consideration to the systematic determinants of food insecurity among Aboriginal and Torres Strait Islander communities to have lasting and sustainable impact on food insecurity. This review has been registered with the international prospective register of systematic reviews (PROSPERO: CRD42020183709). Novelty: Food insecurity among Aboriginal and Torres Strait Islander people poses significant risk to health and wellbeing. Small-scale food security interventions may not provide ongoing and sustained impact. Any intervention to promote food security will need to involve Aboriginal and Torres Strait Islander people and be sustained once external parties have left.

Concerns and priorities of Aboriginal and Torres Strait Islander peoples regarding food and nutrition: a systematic review of qualitative evidence

BACKGROUND

Aboriginal and Torres Strait Islander Australians experience persistent health and social inequities. Chronic conditions, many of which are diet-related, are leading contributors to the burden of disease and health inequity in Australia. First Nations Peoples have the right to be involved in all policy decisions affecting them. This review aimed to synthesise Aboriginal and Torres Strait Islander Peoples' concerns and priorities about food and nutrition in order to inform policies to improve health equity.

METHODS

MEDLINE, CINAHL, Informit and Google Scholar were systematically searched to identify qualitative studies-published from January 2008-that included data from Aboriginal and/or Torres Strait Islander Peoples about their concerns and priorities related to food and nutrition. Data were extracted from included studies using a pre-determined template and study quality was assessed using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. Qualitative findings were synthesised using inductive thematic analysis and categorised based on an ecological model of health.

RESULTS

Twenty-one studies were included. Key factors influencing food and nutrition were identified across all levels of the ecological framework. These included interpersonal and institutional racism, junk food availability and marketing, food accessibility and affordability, housing conditions, food knowledge and cooking skills, and connection to family and culture.

CONCLUSIONS

Documenting Aboriginal and Torres Strait Islander Peoples' lived experiences of the colonised food system is one step necessary for informing policy to tackle food and nutrition inequities. Based on existing qualitative research, food and nutrition policymakers should prioritise building a supportive food environment by focusing on self-determination; ensuring access to healthy, affordable food and safe housing; and by eliminating systemic racism.

Antioxidant biomarkers and cardiometabolic risk markers in an Aboriginal community in remote Australia: a cross-sectional study

OBJECTIVE

High-quality diets, characterised by nutrient-rich foods, are one of the foundations for health and well-being. Indicators of diet quality, antioxidants, are associated with protection against cardiometabolic diseases. The current study explores relationships between plasma antioxidants and cardiometabolic risk among Aboriginal people in Australia.

DESIGN

As part of a community-driven health promotion programme, we conducted a cross-sectional study including a health-behaviour questionnaire, plasma antioxidants and cardiometabolic risk markers (anthropometric, blood pressure measurements, fasting glucose, glycated Hb (HbA1c), lipids, C-reactive protein and albumin-creatinine-ratio) continuous and categorised into population-specific cut-offs. Antioxidants (β-carotene, β-cryptoxanthin, lycopene, lutein-zeaxanthin, retinol and α-tocopherol measured using HPLC) were applied to a principal component analysis, which aggregated these into a single component. Linear regression models were applied to investigate associations between the antioxidant component and cardiometabolic risk markers.

SETTING

Community in a remote area in Northern Territory, Australia.

PARTICIPANTS

A total of 324 Aboriginal people, mean age 35·5 (range 15-75) years.

RESULTS

Antioxidant component levels were higher among individuals with higher self-reported vegetable intake (P < 0·01), higher among individuals with higher self-reported fruit intake (P = 0·05) and lower among current smokers (P = 0·06). Linear regression revealed an inverse association between the antioxidant component and C-reactive protein (β = -0·01, P < 0·01) after adjusting for confounders.

CONCLUSION

Higher plasma antioxidant levels, indicators of diet quality, were associated with lower levels of high-sensitivity C-reactive protein in this Aboriginal population in remote Australia. This association suggests plasma antioxidants may be protective against inflammation; however, longitudinal studies are needed to examine this potentially protective relationship.

The iron content of healthy diets for one day for breastfed babies and young children

AIMS

Early childhood anaemia due to iron deficiency is widespread in remote communities across northern Australia. Current recommendations for healthy food to complement breastfeeding at age 6 to 23 months include iron-rich and iron-enriched foods. An electronic nutrient analysis was undertaken to assess the iron content of hypothetical healthy diets for breastfed babies and young children aged 6 to 23 months in Australia, in comparison with their estimated requirements.

METHODS

Hypothetical diets for 1 day were developed that were consistent with the Foundation Diets for breastfed infants 6 to 12 months and for toddlers 13 to 23 months. Nutrient content was derived using the Australian Food Composition database in FoodWorks 10. The iron content of these two diets were compared with Estimated Average Requirements (EARs) and Recommended Dietary Intakes (RDIs) for iron for infants aged 7 to 12 months and children aged 1 to 3 years.

RESULTS

The iron content of the hypothetical diet for breastfed infants aged 6 to 12 months (5.8 mg) was less than the EAR (7 mg, 83%) and the RDI (11 mg, 53%). For young breastfed children aged 13 to 23 months, the iron content of the hypothetical diet was 4.4 mg; above the EAR (4 mg, 110%) but less than RDI (9 mg, 49%).

CONCLUSIONS

Breastfeeding has health and neurodevelopmental benefits for infants and young children that are particularly important in remote Australia where food insecurity and poor nutrition compromise health and wellbeing. Adequate iron intake is also important for neurodevelopment in early life but healthy diets for breastfed babies and young children may have insufficient iron content to meet requirements. The upcoming revision of the Australian Dietary Guidelines provides an opportunity to consider this issue.

The Retail Food Sector and Indigenous Peoples in High-Income Countries: A Systematic Scoping Review

Indigenous Peoples in high-income countries experience higher burdens of food insecurity, obesity, and diet-related health conditions compared to national averages. The objective of this systematic scoping review is to synthesize information from the published literature on the methods/approaches, findings, and scope for research and interventions on the retail food sector servicing Indigenous Peoples in high-income countries. A structured literature search in two major international databases yielded 139 relevant peer-reviewed articles from nine countries. Most research was conducted in Oceania and North America, and in rural and remote regions. Several convergent issues were identified across global regions including limited grocery store availability/access, heightened exposure to unhealthy food environments, inadequate market food supplies (i.e., high prices, limited availability, and poor quality), and common underlying structural factors including socio-economic inequality and colonialism. A list of actions that can modify the nature and structure of retailing systems to enhance the availability, accessibility, and quality of healthful foods is identified. While continuing to (re)align research with community priorities, international collaboration may foster enhanced opportunities to strengthen the evidence base for policy and practice and contribute to the amelioration of diet quality and health at the population level.

Traditional Food Energy Intake among Indigenous Populations in Select High-Income Settler-Colonized Countries: A Systematic Literature Review

The traditional diets of Indigenous Peoples globally have undergone a major transition due to settler colonialism. This systematic review aims to provide a perspective of traditional food intake of Indigenous populations in high-income settler-colonized countries. For inclusion, studies reported the primary outcome of interest-traditional food contribution to total energy intake (% of energy)-and occurred in Canada, the United States (including Hawaii and Alaska), New Zealand, Australia, and/or Scandinavian countries. Primary outcome data were reported and organized by date of data collection by country. Forty-nine articles published between 1987 and 2019 were identified. Wide variation in contribution of traditional food to energy was reported. A trend for decreasing traditional food energy intake over time was apparent; however, heterogeneity in study populations and dietary assessment methods limited conclusive evaluation of this. This review may inform cross-sectoral policy to protect the sustainable utilization of traditional food for Indigenous Peoples.

Prevalence and Socio-Demographic Predictors of Food Insecurity in Australia during the COVID-19 Pandemic

The COVID-19 pandemic has exacerbated economic vulnerabilities and disrupted the Australian food supply, with potential implications for food insecurity. This study aims to describe the prevalence and socio-demographic associations of food insecurity in Tasmania, Australia, during the COVID-19 pandemic. A cross-sectional survey (deployed late May to early June 2020) incorporated the U.S. Household Food Security Survey Module: Six-Item Short Form, and fifteen demographic and COVID-related income questions. Survey data (n = 1170) were analyzed using univariate and multivariate binary logistic regression. The prevalence of food insecurity was 26%. The adjusted odds of food insecurity were higher among respondents with a disability, from a rural area, and living with dependents. Increasing age, a university education, and income above $80,000/year were protective against food insecurity. Food insecurity more than doubled with a loss of household income above 25% (Adjusted Odds Ratio (AOR): 2.02; 95% CI: 1.11, 3.71; p = 0.022), and the odds further increased with loss of income above 75% (AOR: 7.14; 95% CI: 2.01, 24.83; p = 0.002). Our results suggest that the prevalence of food insecurity may have increased during the COVID-19 pandemic, particularly among economically vulnerable households and people who lost income. Policies that support disadvantaged households and ensure adequate employment opportunities are important to support Australians throughout and post the COVID-19 pandemic.

Diabetes during pregnancy and birthweight trends among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years

Background

Early-life risk factors, including maternal hyperglycaemia and birthweight, are thought to contribute to the high burden of cardiometabolic disease experienced by Indigenous populations. We examined rates of pre-existing diabetes in pregnancy, gestational diabetes mellitus (GDM) and extremes of birthweight over three decades in the Northern Territory (NT) of Australia.

Methods

We performed a retrospective cohort analysis of the NT Perinatal Data Collection from 1987 to 2016, including all births >20 weeks gestation, stratified by maternal Aboriginal identification. Key outcomes were annual rates of pre-existing diabetes, GDM, small-for-gestational-age, large-for-gestational-age, low birthweight (<2500 g), and high birthweight (>4000 g). Logistic regression was used to assess trends and interactions.

Findings

109 349 babies were born to 64 877 mothers, 36% of whom identified as Aboriginal ethnicity. Among Aboriginal women, rates of GDM and pre-existing diabetes, respectively, were 3 · 4% and 0 · 6% in 1987 and rose to 13% and 5 · 7% in 2016 (both trends p<0 · 001). Among non-Aboriginal women, rates of GDM increased from 1 · 9% in 1987 to 11% in 2016 (p<0 · 001), while pre-existing diabetes was uncommon (≤0 · 7% throughout). Rates of small-for-gestational-age decreased, while rates of large-for-gestational-age and high birthweight increased in both groups (all trends p<0 · 001). Multivariable modelling suggests that hyperglycaemia was largely responsible for the growing rate of large-for-gestational-age births among Aboriginal women.

Interpretation

The burden of hyperglycaemia in pregnancy has grown substantially in the NT over three decades and is impacting birthweight trends. The prevalence of pre-gestational diabetes in Aboriginal women is among the highest in the world.

Funding

Diabetes Australia Research Program.

Sociodemographic factors associated with food insecurity: data from the 2003-2014 New South Wales Population Health Survey

OBJECTIVE

To determine the prevalence and sociodemographic factors associated with food insecurity in the state of New South Wales (NSW), Australia.

DESIGN

Cross-sectional analysis of food insecurity data collected by the NSW Population Health Survey between 2003 and 2014. Multiple logistic regression was used to examine associations with key sociodemographic variables.

SETTING

NSW, Australia.

PARTICIPANTS

212 608 survey participants responded to the food insecurity survey question between 2003 and 2014. 150 767 of them were aged ≥16 years. The survey sample was randomly selected and weighted to be representative of the NSW population.

RESULTS

On average 6 % of adults aged ≥16 years experienced food insecurity in NSW. The odds of food insecurity appeared to increase from one survey year to the next by a factor of 1·05. Food insecurity was found to be independently associated with age, sex, marital status, household size, education, employment status, household income, smoking status, alcohol intake and self-rated health. The association with income, smoking status and self-rated health appeared to be the strongest among all covariates and showed a gradient effect. Food insecurity appeared to increase significantly between the age of 16 and 19 years.

CONCLUSIONS

The prevalence of food insecurity appears to be rising over time. Given the negative health consequences of food insecurity, more rigorous measurement and monitoring of food insecurity in NSW and nationally is strongly recommended. The findings provide support for interventions targeting low-income and younger population groups.

Resetting the Narrative in Australian Aboriginal and Torres Strait Islander Nutrition Research

As the oldest continuous living civilizations in the world, Aboriginal and Torres Strait Islander peoples have strength, tenacity, and resilience. Initial colonization of the landscape included violent dispossession and removal of people from Country to expand European land tenure and production systems, loss of knowledge holders through frontier violence, and formal government policies of segregation and assimilation designed to destroy ontological relationships with Country and kin. The ongoing manifestations of colonialism continue to affect food systems and food knowledges of Aboriginal peoples, and have led to severe health inequities and disproportionate rates of nutrition-related health conditions. There is an urgent need to collaborate with Aboriginal and Torres Strait Islander peoples to address nutrition and its underlying determinants in a way that integrates Aboriginal and Torres Strait Islander peoples' understandings of food and food systems, health, healing, and well-being. We use the existing literature to discuss current ways that Australian Aboriginal and Torres Strait Islander peoples are portrayed in the literature in relation to nutrition, identify knowledge gaps that require further research, and propose a new way forward.

A Qualitative Analysis of the Accessibility and Connection to Traditional Food for Aboriginal Chronic Maintenance Hemodialysis Patients

BACKGROUND

Due to the lack of resources in remote Aboriginal communities within the Northern Territory of Australia, Aboriginal people requiring chronic maintenance hemodialysis often must relocate from their home communities to Darwin city permanently to receive ongoing care. This phenomenon can cause distressing isolation from important traditional food, land, and family.

OBJECTIVE

The aim was to identify the relation to traditional food from an Aboriginal perspective and the enablers and barriers to accessing traditional food post-relocation from remote regions of the Northern Territory, Australia, to the urban city of Darwin.

METHODS

This was a qualitative study design with a total of 12 Aboriginal participants (4 males, 8 females) receiving ongoing hemodialysis at the Nightcliff Renal Unit. Participants had all relocated from a remote region to Darwin. Interviews were conducted between July and September 2018 in Darwin, Australia. Data interpretation was conducted by an Aboriginal researcher and co-authors with a combined 30 y of experience conducting research with Aboriginal people in a health context. Data analysis comprised an inductive thematic analysis approach with an indigenist knowledge interpretation lens to construct, reaffirm, and protect Indigenous views.

RESULTS

Traditional food was an important part of participants' identity and strongly connected to social, emotional, spiritual and physical health, and well-being. Access to traditional food post-relocation is associated with enablers and barriers including mobility, local knowledge, social support networks, commercial access, and economics.

CONCLUSIONS

Dialysis patients who are dislocated from remote Aboriginal communities to Darwin experience clear disruption to traditional food access, consumption, availability, and knowledge dissemination to the younger generations.

Socioeconomic status, remoteness and tracking of nutritional status from childhood to adulthood in an Australian Aboriginal Birth Cohort: the ABC study

OBJECTIVES

To determine prevalences of underweight and overweight as well as low and high waist-to-height ratio (WHtR) in three prospective follow-ups and to explore tracking of these measures of nutritional status from childhood to adolescence and adulthood. The influence of socioeconomic status, remoteness, maternal body mass index (BMI) and birth weight on weight status was assessed.

DESIGN

Longitudinal birth cohort study of Indigenous Australians.

SETTING

Data derived from three follow-ups of the Aboriginal Birth Cohort study with mean ages of 11.4, 18.2 and 25.4 years for the participants.

PARTICIPANTS

Of the 686 Indigenous babies recruited to the study between 1987 and 1990, 315 had anthropometric measurements for all three follow-ups and were included in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

BMI categories (underweight, normal weight, overweight and obesity),WHtR categories (low and high), sex, areal socioeconomic disadvantage as defined by the Indigenous Relative Socioeconomic Outcomes index, urban/remote residence, maternal BMI and birth weight. Logistic regression was used to calculate ORs for belonging to a certain BMI category in adolescence and adulthood according to BMI category in childhood and adolescence.

RESULTS

Underweight was common (38% in childhood and 24% in adulthood) and the prevalence of overweight/obesity increased with age (12% in childhood and 35% in adulthood). Both extremes of weight status as well as low and high WHtR tracked from childhood to adulthood. Underweight was more common and overweight was less common in remote and more disadvantaged areas. Birth weight and maternal BMI were associated with later weight status. There were significant sex differences for prevalences and tracking of WHtR but not for BMI.

CONCLUSIONS

Socioeconomic factors, remoteness and gender must be addressed when assessing nutrition-related issues in the Indigenous communities due to the variation in nutritional status and its behaviour over time within the Indigenous population.

Medicinal plant use in two Tiwi Island communities: a qualitative research study

BACKGROUND

Traditional medicinal plants are still used today in many Aboriginal communities across Australia. Our research focused on the contemporary use of such plants in the two communities within the Tiwi Islands, Wurrumiyanga and Pirlangimpi.

METHODS

This qualitative research project performed a video ethnography, community interviews, and a trial intervention to better understand the extent to which these plants are still used throughout the community and how they may be used more in the future.

RESULTS

We found that several plants are still used predominantly as medicinal washes to treat skin disorders and/or as a tea to treat congestion associated with cold and flu. Those plants that are commonly used are found near to the community in large amounts and are recognized as being both safe and effective.

CONCLUSIONS

Within the community, it is the elder women who remain most knowledgeable about these plants and continue to make them for their families. However, there are many families who no longer know how to make these traditional medicines though they express a desire to use them. Therefore, it would be beneficial to have a central location or method to produce traditional medicine for the community-a bush pharmacy.

A Pragmatic Review to Assist Planning and Practice in Delivering Nutrition Education to Indigenous Youth

Many health promotion campaigns have incorporated multi-component nutrition interventions to promote healthy diet-related behaviours among Indigenous communities, particularly children and adolescents. However, these campaigns show mixed results and while research often describes outcomes of approaches and interventions, it does not extensively describe implementation processes and best practices for nutrition education for Indigenous youth. To enhance knowledge and understanding of best processes in nutritional education approaches with Indigenous youth, we conducted a search using multiple databases including PubMed, Google Scholar, the Australian Indigenous HealthInfoNet and Australian government research databases to identify relevant peer-reviewed and grey literature as well as educational resources, such as websites and handbooks for teachers, parents, and students. We list and describe common features of successful nutritional interventions in Indigenous settings, steps for nutrition education targeting youth, school-based nutrition education for different ages, and general guidelines for teaching Indigenous students. Current best practice and knowledge gaps for the delivery of nutrition education to Indigenous youth are described.

Measuring and Understanding Food Insecurity in Australia: A Systematic Review

The number of Australians seeking food aid has increased in recent years; however, the current variability in the measurement of food insecurity means that the prevalence and severity of food insecurity in Australia is likely underreported. This is compounded by infrequent national health surveys that measure food insecurity, resulting in outdated population-level food insecurity data. This review sought to investigate the breadth of food insecurity research conducted in Australia to evaluate how this construct is being measured. A systematic review was conducted to collate the available Australian research. Fifty-seven publications were reviewed. Twenty-two used a single-item measure to examine food security status; 11 used the United States Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM); two used the Radimer/Cornell instrument; one used the Household Food and Nutrition Security Survey (HFNSS); while the remainder used a less rigorous or unidentified method. A wide range in prevalence and severity of food insecurity in the community was reported; food insecurity ranged from 2% to 90%, depending on the measurement tool and population under investigation. Based on the findings of this review, the authors suggest that there needs to be greater consistency in measuring food insecurity, and that work is needed to create a measure of food insecurity tailored for the Australian context. Such a tool will allow researchers to gain a clear understanding of the prevalence of food insecurity in Australia to create better policy and practice responses.

Health-Promoting Food Pricing Policies and Decision-Making in Very Remote Aboriginal and Torres Strait Islander Community Stores in Australia

Aboriginal and Torres Strait Islander people living in remote communities in Australia experience a disproportionate burden of diet-related chronic disease. This occurs in an environment where the cost of store-purchased food is high and cash incomes are low, factors that affect both food insecurity and health outcomes. Aboriginal and Torres Strait Islander storeowners and the retailers who work with them implement local policies with the aim of improving food affordability and health outcomes. This paper describes health-promoting food pricing policies, their alignment with evidence, and the decision-making processes entailed in their development in community stores across very remote Australia. Semi-structured interviews were conducted with a purposive sample of retailers and health professionals identified through the snowball method, September 2015 to October 2016. Data were complemented through review of documents describing food pricing policies. A content analysis of the types and design of policies was undertaken, while the decision-making process was considered through a deductive, thematic analysis. Fifteen retailers and 32 health professionals providing services to stores participated. Subsidies and subsidy/price increase combinations dominated. Magnitude of price changes ranged from 5% to 25% on fruit, vegetables, bottled water, artificially sweetened and sugar sweetened carbonated beverages, and broadly used 'healthy/essential' and 'unhealthy' food classifications. Feasibility and sustainability were considered during policy development. Greater consideration of acceptability, importance, effectiveness and unintended consequences of policies guided by evidence were deemed important, as were increased involvement of Aboriginal and Torres Strait Islander storeowners and nutritionists in policy development. A range of locally developed health-promoting food pricing policies exist and partially align with research-evidence. The decision-making processes identified offer an opportunity to incorporate evidence, based on consideration of the local context.

The cost-effectiveness of a 20% price discount on fruit, vegetables, diet drinks and water, trialled in remote Australia to improve Indigenous health

This paper estimates the cost-effectiveness of a 20% price discount on healthy food and beverages with and without consumer nutrition education, as trialled in remote Northern Australia. Changes in actual store sales, from the pre-discount baseline period, were analysed for population impact on consumption of fruit and vegetables, water and artificially sweetened soft drinks, in addition with total dietary weight (grams), energy (Mega Joules), and sodium (milligrams). Disability Adjusted Life Years (DALYs), arising from changes in dietary risk factor prevalence in the population, were estimated as the primary health outcome in a multi health-state Markov model. The costs of the strategies were sourced from paid invoices and time estimates of staff providing store-based discount promotion and consumer education. The incremental cost-effectiveness ratio adopted a partial societal perspective, (including health and retail sector costs), as cost per DALY averted and was presented in 2011 Australian dollars. The price discount, helped address a gap in food price equity for residents of remote communities. However, the discount strategy, with or without consumer education led to a net loss of population health –36 95%CI (-47,-25) or -21(-28, -15) DALYs respectively, at increased cost to the retail and health sectors, of AUD860000 95%CI (710000, 1million) or AUD500000 (410000, 590000). The strategies trialled were thereby categorised as dominated by current practice while acknowledging considerable uncertainty surrounding the health outcome estimates. The 20% discount on limited targeted products appeared to need to be considered in conjunction with other marketing strategies to support healthy food choices, if remote Australian Indigenous population health is to be improved.

The significance of DOHaD for Small Island Developing States

Small Island Developing States (SIDS) are island nations that experience specific social, economic and environmental vulnerabilities associated with small populations, isolation and limited resources. Globally, SIDS exhibit exceptionally high rates of non-communicable disease (NCD) risk and incidence. Despite this, there is a lack of context-specific research within SIDS focused on life course approaches to NCD prevention, particularly the impact of the early-life environment on later disease risk as defined by the Developmental Origins of Health and Disease (DOHaD) framework. Given that globalization has contributed to significant nutritional transitions in these populations, the DOHaD paradigm is highly relevant. SIDS in the Pacific region have the highest rates of NCD risk and incidence globally. Transitions from traditional foods grown locally to reliance on importation of Western-style processed foods high in fat and sugar are common. The Cook Islands is one Pacific SIDS that reports this transition, alongside rising overweight/obesity rates, currently 91%/72%, in the adult population. However, research on early-life NCD prevention within this context, as in many low- and middle-income countries, is scarce. Although traditional research emphasizes the need for large sample sizes, this is rarely possible in the smaller SIDS. In these vulnerable, high priority countries, consideration should be given to utilizing 'small' sample sizes that encompass a high proportion of the total population. This may enable contextually relevant research, crucial to inform NCD prevention strategies that can contribute to improving health and well-being for these at-risk communities.

A comparison of dietary estimates from the National Aboriginal and Torres Strait Islander Health Survey to food and beverage purchase data

OBJECTIVE

We compared self-reported dietary intake from the very remote sample of the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (VR-NATSINPAS; n=1,363) to one year of food and beverage purchases from 20 very remote Indigenous Australian communities (servicing ∼8,500 individuals).

METHODS

Differences in food (% energy from food groups) and nutrients were analysed using t-test with unequal variance.

RESULTS

Per-capita energy estimates were not significantly different between the surveys (899 MJ/person/day [95% confidence interval -152,1950] p=0.094). Self-reported intakes of sugar, cereal products/dishes, beverages, fats/oils, milk products/dishes and confectionery were significantly lower than that purchased, while intakes of meat, vegetables, cereal-based dishes, fish, fruit and eggs were significantly higher (p<0.05).

CONCLUSION

Differences between methods are consistent with differential reporting bias seen in self-reported dietary data. Implications for public health: The NATSINPAS provides valuable, much-needed information about dietary intake; however, self-reported data is prone to energy under-reporting and reporting bias. Purchase data can be used to track population-level food and nutrient availability in this population longitudinally; however, further evidence is needed on approaches to estimate wastage and foods sourced outside the store. There is potential for these data to complement each other to inform nutrition policies and programs in this population.