Changes in Food Intake in Australia: Comparing the 1995 and 2011 National Nutrition Survey Results Disaggregated into Basic Foods

The burden of cardiovascular disease attributable to dietary risk factors in Australia between 1990 and 2019

Unhealthy diet is associated with increased risk of cardiovascular diseases (CVD). However, there are no studies reporting the impact and trends of dietary risk factors on CVD in Australia. This study aimed to determine the burden of CVDs attributable to dietary risk factors in Australia between 1990 and 2019. We used data from the Global Burden of Diseases (GBD) study and quantified the rate (per 100,000) of deaths, disability-adjusted life years (DALYs), years lived with a disability (YLDs), and years of life lost (YLLs) for 21 CVDs attributable to 13 dietary risk factors (eight food groups and five nutrients) in Australia by sex and age groups (≥25 years and over). In 2019, the age-standardised rates of deaths, YLDs, YLLs, and DALYs attributable to dietary risk factors attributable to CVDs in the Australian population were 26.5, 60.8, 349.9, and 410.8 per 100,000 in women and 46.1, 62.6, 807.0, and 869.6 in men. Between 1990 and 2019, YLLs consistently contributed more towards the rates of DALYs than YLDs. Over the 30-year period, CVD deaths, YLLs, and DALYs attributable to dietary risk factors declined in both women and men. The leading dietary risk factors for CVD deaths and DALYs were a diet high in red meat (6.1 deaths per 100,000 [3.6, 8.7] and 115.6 DALYs per 100,000 [79.7, 151.6]) in women and a diet low in wholegrains (11.3 deaths [4.4, 15.1] and 220.3 DALYs [86.4, 291.8]) in men. Sex differences were observed in the contribution of dietary risk factors to CVD over time such that the lowest rate of decrease in deaths and DALYs occurred with diets high in sodium in women and diets high in processed meat in men. Although the burden of diet-related CVD has decreased significantly in the Australian population over the past 30 years, diets low in wholegrains and high in red meat continue to contribute significantly to the overall CVD burden. Future nutrition programs and policies should target these dietary risk factors.

The Diet Quality of Australian Stroke Survivors in a Community Setting

INTRODUCTION

Diet quality is a marker of how closely eating patterns reflect dietary guidelines. The highest tertile for diet quality scores is associated with 40% lower odds of first stroke compared with the lowest tertile. Little is known about the diet of stroke survivors. We aimed to assess dietary intake and quality of Australian stroke survivors.

METHODS

Stroke survivors enrolled in the ENAbLE pilot trial (2019/ETH11533, ACTRN12620000189921) and Food Choices after Stroke study (2020ETH/02264) completed the Australian Eating Survey Food Frequency Questionnaire (AES), a 120-item, semiquantitative questionnaire of habitual food intake over the previous 3-6 months. Diet quality was determined by calculating the Australian Recommended Food Score (ARFS): a higher score indicates higher diet quality.

RESULTS

Eighty-nine adult, stroke survivors (female: n = 45, 51%) of mean age 59.5 years (±9.9) had a mean ARFS of 30.5 (±9.9) (low diet quality). Mean energy intake was similar to the Australian population: 34.1% from noncore (energy-dense/nutrient-poor) and 65.9% from core (healthy) foods. However, participants in the lowest tertile for diet quality (n = 31) had significantly lower intake of core (60.0%) and higher intake from noncore foods (40.0%). Most participants did not meet daily requirements for fiber, potassium, or omega 3 fatty acids (2%, 15%, and 18%), nutrients important to reduce stroke risk.

CONCLUSION

The diet quality of stroke survivors was poor, with inadequate intake of nutrients important for reducing recurrent stroke risk. Further research is needed to develop effective interventions to improve diet quality.

The burden of type 2 diabetes in Australia during the period 1990-2019: Findings from the global burden of disease study

AIMS

To describe morbidity and mortality trends of type 2 diabetes in Australia, from 1990 to 2019, compared with similar sociodemographic index (SDI) countries.

METHODS

Australia-specific Global Burden of Diseases data were used to estimate age-standardised, age-specific, and sex-specific rates for prevalence, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life years (DALYs), and deaths due to type 2 diabetes between 1990 and 2019. Australian data were compared with 14 similar SDI countries.

RESULTS

Type 2 diabetes increased in Australia between 1990 and 2019. The age-standardised prevalence increased from 1,985 [95% Confidence Interval (CI): 1,786.7-2195.3] per 100,000 population, to 3,429 [95% CI 3,053.3-3,853.7]. Cases tripled, from 379,532 [342,465-419,475] to 1,307,261 [1,165,522-1,461,180]. The age-standardised death rates doubled, from 2,098 [1,953-2,203] per 100,000, to 4,122 [3,617-4,512]. DALYs doubled, from 70,348 [59,187-83,500] to 169,763 [129,792-216,150], with increases seen in YLDs and YLLs. Men displayed higher rates. Compared to similar SDI countries, Australia ranked 4th in terms of burden for type 2 diabetes.

CONCLUSIONS

The burden of type 2 diabetes in Australia has increased considerably over three decades. There is an urgent need to prioritise resource allocation for prevention programs, screening initiatives to facilitate early detection, and effective and accessible management strategies for the large proportion of the population impacted by type 2 diabetes.

Food and nutrient intakes and compliance with recommendations in school-aged children in Ireland: findings from the National Children’s Food Survey II (2017–2018) and changes since 2003–2004

The childhood years represent a period of increased nutrient requirements during which a balanced diet is important to ensure optimal growth and development. The aim of this study was to examine food and nutrient intakes and compliance with recommendations in school-aged children in Ireland and to examine changes over time. Analyses were based on two National Children’s Food Surveys; NCFS (2003–2004) (n 594) and NCFS II (2017–2018) (n 600) which estimated food and nutrient intakes in nationally representative samples of children (5–12 years) using weighed food records (NCFS: 7-d; NCFS II: 4-d). This study found that nutrient intakes among school-aged children in Ireland are generally in compliance with recommendations; however, this population group have higher intakes of saturated fat, free sugars and salt, and lower intakes of dietary fibre than recommended. Furthermore, significant proportions have inadequate intakes of vitamin D, Ca, Fe and folate. Some of the key dietary changes that have occurred since the NCFS (2003–2004) include decreased intakes of sugar-sweetened beverages, fruit juice, milk and potatoes, and increased intakes of wholemeal/brown bread, high-fibre ready-to-eat breakfast cereals, porridge, pasta and whole fruit. Future strategies to address the nutrient gaps identified among this population group could include the continued promotion of healthy food choices (including education around ‘healthy’ lifestyles and food marketing restrictions), improvements of the food supply through reformulation (fat, sugar, salt, dietary fibre), food fortification for micronutrients of concern (voluntary or mandatory) and/or nutritional supplement recommendations (for nutrients unlikely to be sufficient from food intake alone).

Underinvestment in nutrition research for at-risk populations: An analysis of research funding awarded in Australia from 2014 to 2021

AIM

To determine the proportion of research projects funded by the National Health and Medical Research Council and Australian Research Council research funding from 2014 to 2021 that aimed to understand or improve dietary behaviours for at-risk populations in Australia and estimate the proportion of total funding allocated during this period.

METHODS

Retrospective analysis of the publicly available National Health and Medical Research Council and Australian Research Council funding grants over the 8 years from 2014 to 2021 (n = 18 098). At-risk dietary populations included people living in rural and remote Australia, Aboriginal and Torres Strait Islander people, or people living in socioeconomically disadvantaged areas. Descriptive analysis was undertaken.

RESULTS

In total, 144 out of 18 098 (0.8%) individual grants totalling $96.8 million were identified relating to nutrition research from 2014 to 2021. Out of the 144, only 21 ($19.6 million; 0.1%) of all National Health and Medical Research Council grants were identified for nutritionally at-risk populations, with the majority focused on Aboriginal and Torres Strait Islander people (15/21). The National Health and Medical Research Council and Australian Research Council grants that aimed to improve human dietary behaviours increased by 0.66% and 0.58%, respectively, from 2014 to 2021. However, the National Health and Medical Research Council grants aiming to improve nutritional behaviours in at-risk populations decreased by 0.04% over the 8 years.

CONCLUSIONS

Despite slight increases in the proportions of funding to improve dietary behaviours over the past decade, nutrition research specifically targeting at-risk groups is scarce and appears to have decreased over time. Insufficient investment in research for these groups presents a risk for widening health disparities now and into the future. As such, they must be further supported and considered in the design of future funding schemes.

Diet quality is associated with primary melanoma thickness

Background

Objective

Methods

Results

Conclusions

Diets with Higher Vegetable Intake and Lower Environmental Impact: Evidence from a Large Australian Population Health Survey

Increasing the consumption of vegetables is a public health nutrition priority in Australia. This must be achieved in the context of lowering dietary environmental impacts. In this study, a subgroup of 1700 Australian adult daily diets having a higher diet-quality score and a lower environmental impact score was isolated from Australian Health Survey data. These diets were primarily distinguished by their lower content of energy-dense/nutrient-poor discretionary foods. Among these diets, those with higher levels of vegetable intake were characterized by greater variety of vegetables eaten, lower intake of bread and cereal foods, and higher intake of red meat. These diets also had a greater likelihood of achieving recommended intakes for a range of vitamins and minerals. These findings highlighted the importance of considering the total diet in developing strategies to promote healthy and sustainable food consumption, as well as the need to understand the interrelationships between foods that exist in a local cultural context. As vegetables are usually eaten with other foods, higher vegetable consumption in Australia could be supported by encouraging more regular consumption of the types of meals that include larger quantities of vegetables. Our results showed that this was possible while also substantially lowering total dietary environmental impacts.

Nineteen-Year Associations between Three Diet Quality Indices and All-Cause and Cardiovascular Disease Mortality: The Australian Diabetes, Obesity, and Lifestyle Study

BACKGROUND

Examining a variety of diet quality methodologies will inform best practice use of diet quality indices for assessing all-cause and cardiovascular disease (CVD) mortality.

OBJECTIVES

To examine the association between 3 diet quality indices (Australian Dietary Guideline Index, DGI; Dietary Inflammatory Index, DII; Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay, MIND) and risk of all-cause mortality, CVD mortality, and nonfatal CVD events ≤19 y later.

METHODS

Data on 10,009 adults (mean age 51.8 y; 52% female) from the Australian Diabetes, Obesity, and Lifestyle study were used. An FFQ was used to calculate DGI, DII, and MIND at baseline. Cox proportional hazard models were used to estimate HRs and 95% CI of all-cause mortality, CVD mortality, and nonfatal CVD events (stroke; myocardial infarction) according to 1 SD increase in diet quality, adjusted for age, sex, education, smoking, physical activity, energy intake, history of stroke or heart attack, and diabetes and hypertension status.

RESULTS

Deaths due to all-cause (n = 1955) and CVD (n = 520), and nonfatal CVD events (n = 264) were identified during mean follow-ups of 17.7, 17.4, and 9.6 y, respectively. For all-cause mortality, HRs associated with higher DGI, DII, and MIND were 0.94 (95% CI: 0.89, 0.99), 1.08 (95% CI: 1.02, 1.15), and 0.93 (95% CI: 0.89, 0.98), respectively. For CVD mortality, HRs associated with higher DGI, DII, and MIND were 0.93 (95% CI: 0.85, 0.99), 1.10 (95% CI: 1.00, 1.24), and 0.90 (95% CI: 0.82, 0.98), respectively. There was limited evidence of associations between diet quality and nonfatal CVD events.

CONCLUSIONS

A better quality diet predicted lower risk of all-cause and CVD mortality in Australian adults, whereas a more inflammatory diet predicted higher mortality risk. These findings highlight the applicability of following Australian dietary guidelines, a Mediterranean-style diet, and a low-inflammatory diet for the reduction of all-cause and CVD mortality risk.

Lifestyle correlates of dietary patterns among young adults: evidence from an Australian birth cohort

OBJECTIVE

Previous studies of sociodemographic and lifestyle correlates of dietary patterns among young adults have primarily focused on physical activity and smoking, with inconclusive results. This study aims to examine the associations between a broader range of lifestyles of young adults and their patterns of food consumption.

DESIGN

Cross-sectional.

SETTING

Brisbane, Australia.

PARTICIPANTS

The data set are from a long running birth cohort study which commenced in 1981. Details of dietary intake and sociodemographic and lifestyle factors were from the 21-year follow-up of the Mater-University of Queensland Study of Pregnancy (MUSP) birth cohort. The effective cohort (n 2665, 57 % women) is of young adult offspring. Usual dietary intake was assessed using a Food Frequency Questionnaire (FFQ). Data on sociodemographic and lifestyle variables were obtained from self-reports.

RESULTS

Western and prudent dietary patterns were identified for the combined cohort of women and men using principal components analysis. Multivariable linear regression models were used to examine the associations between lifestyle variables and dietary patterns adjusting for potential confounders. Results from multivariable adjusted models showed that physical activity, watching TV and smoking were strongly associated with each dietary pattern; alcohol consumption and BMI showed weaker associations (P < 0·05 for all).

CONCLUSIONS

Our study describes a clustering of unhealthy lifestyles in young adults. Young adults with unhealthy lifestyles less often adhere to a healthy prudent dietary pattern and more often an unhealthy Western pattern. Dietary preferences are enmeshed in a lifestyle matrix which includes physical activity, sedentary activity, smoking and alcohol consumption of young adults.

Identification of Salty Dietary Patterns of the Japanese Macroregion

Objective

The traditional Japanese dietary pattern, “Washoku,” is considered to provide an ideal nutritional balance. However, it tends to have a high salt intake. To reduce population-level salt intake, it is important to review the overall dietary patterns over a wide area.

Methods

To identify dietary patterns with high salt intake, partial least squares regression analysis was conducted using population-based household survey data from 52 cities. Annual salt consumption was set as the target variable, and the annual purchase weight of 109 foods was set as the explanatory variable.

Result

At least three dietary patterns (traditional, urban, and local) accounted for more than 90% of the variation in salt consumption and 29% of the explanatory variables (food purchases). Traditional patterns explained the salt consumption and regional differences in energy and protein consumption; however, their relationship to fat consumption was weak. The results reconfirmed that “Washoku” has an ideal nutritional balance but has high salt intake. The distribution of scores for traditional Japanese food patterns was high in northeast Japan and low in southwest Japan, with a geographical gradient. This pattern is thought to have formed over a long period of time because of the influence of environmental factors, such as local climate.

Less Is Better: How Nutrition and Low-Carbon Labels Jointly Backfire on the Evaluation of Food Products

(1) Background: Labeling is one of the significant strategies to guide sustainable consumption behaviors. Nowadays, multi labels being displayed on the front-of-pack of food products is a common phenomenon. However, labels seldom operate solo, and competition or complement effects may be exerted on different labels. Therefore, the research objective is to explore the interaction effect when nutrition and low-carbon labels appear simultaneously; (2) Methods: Across four scenario-based experiments, including ice cream, yogurt, steak, and toast, this study manipulated the separate and joint occurrences of low-carbon and nutrition labels, the interaction effect of joint labels was tested, and the serial mediation model, which includes resource allocation and anticipated enjoyment of food consumption, was verified; (3) Results: Results show that people have a positive preference for the nutrition label and the carbon label, respectively, while these two labels working simultaneously attenuate the positive effect of the single label. When facing nutrition and carbon labels simultaneously, people would infer partial resources are allocated to healthy and environmental aspects so they have a lower anticipated enjoyment from food consumption. Thus, these two labels working simultaneously attenuate the positive effect of the single label, and consumers have a lower evaluation of food products. In addition, the joint backfire on the effect is only exerted on people with a higher level of zero-sum bias and only when joint labels have a high consistency of labels; (4) Conclusions: This study solved the contradictory problem of the joint effect of positive labels. The findings in this research contribute to promote sustainable food consumption. We suggest that similar labels should be avoided in the same front-of-pack of food, and manufacturers need to use ads to bring down consumers' zero-sum bias.

An Assessment of Three Carbohydrate Metrics of Nutritional Quality for Packaged Foods and Beverages in Australia and Southeast Asia

Carbohydrate quality is an aetiological factor of diet-related disease. Indices of carbohydrate quality featuring various ratios of carbohydrates-to-dietary fibre-to-sugar have been associated with improved product and/or diet quality in westernised countries. Carbohydrate intake is especially high in Asia Pacific. Thus, this study evaluated the ability of such carbohydrate metrics to discriminate the nutritional quality of carbohydrate-rich packaged foods and beverages in Australia, Malaysia, Singapore, Thailand and the Philippines, with an additional focus on beverages. This evaluation was conducted by comparing product nutritional composition and assessing products against three national nutrient profiling models. Results showed that Australia had the highest proportion of products meeting all metrics, compared to the Southeast Asian countries. Beverages had a low adherence to all metrics compared to solid foods. Across the five countries, both processed food and beverages meeting the metrics generally contained higher dietary fibre, protein, and certain vitamins and minerals whilst having lower energy, total sugars, free sugars, trans fat and cholesterol content compared to products not meeting the metrics. The metrics were also aligned with national nutrient profiling models to identify nutritious products. In conclusion, these metrics allowed us to discriminate product nutritional quality in the countries assessed and are applicable to beverages.

The role of dwelling type on food expenditure: a cross-sectional analysis of the 2015-2016 Australian Household Expenditure Survey

OBJECTIVE

To explore differences in proportion of food budget and total food expenditure by dwelling type.

DESIGN

A cross-sectional study using data from the Australian Bureau of Statistics 2015-2016 Household Expenditure Survey. Food expenditure was examined on multiple categories: fresh fruits, fresh vegetables, pre-prepared meals, meals in restaurants, hotels and clubs, and fast food and takeaway meals, using two-part models and zero-one inflated beta regression models. Dwelling types were categorised as separate house, semi-detached house, low-rise apartment and high-rise apartment.

SETTING

Australia, 2015-2016.

PARTICIPANTS

Seven thousand three hundred and fifty-eight households from greater capital city areas.

RESULTS

Households living in high-rise apartments were estimated to allocate a greater proportion of their food budget to meals in restaurants, hotels and clubs, and to spend more (actual dollars) on that category, compared with other dwelling types. No substantial differences were estimated in the proportion of food budget allocated to the other food categories across dwelling types.

CONCLUSIONS

The dwelling type households live in may play a role in their food budget. Households living in a high-rise apartment may potentially spend more on meals in restaurants, hotels and clubs than those living in other dwelling types. Given the growth in urban population and the changes in living arrangements, findings point to the critical need for a better understanding of the influence of dwelling types on food expenditure and call for research investigating the relationship between the two.

Do the Dietary Intakes of Pregnant Women Attending Public Hospital Antenatal Clinics Align with Australian Guide to Healthy Eating Recommendations?

The maternal diet influences the long-term health status of both mother and offspring. The current study aimed to compare dietary intakes of pregnant women compared to food and nutrient recommendations in the Australian Guide to Healthy Eating (AGHE) and Nutrient Reference Values (NRVs). Usual dietary intake was assessed in a sample of women in their 3rd trimester of pregnancy attending antenatal outpatient clinics at John Hunter Hospital, Newcastle, New South Wales (NSW). Dietary intake was measured using the Australian Eating Survey, a validated, semi-quantitative 120-item food frequency questionnaire. Daily food group servings and nutrient intakes were compared to AGHE and NRV targets. Of 534 women participating, none met the AGHE recommendations for all food groups. Highest adherence was for fruit serves (38%), and lowest for breads and cereals (0.6%). Only four women met the pregnancy NRVs for folate, iron, calcium, zinc and fibre from food alone. Current dietary intakes of Australian women during pregnancy do not align with national nutrition guidelines. This highlights the importance of routine vitamin and mineral supplementation during pregnancy, as intakes from diet alone may commonly be inadequate. Future revisions of dietary guidelines and pregnancy nutrition recommendations should consider current dietary patterns. Pregnant women currently need more support to optimise food and nutrient intakes.

Adherence to the Australian Dietary Guidelines Is Not Associated with Brain Structure or Cognitive Function in Older Adults

BACKGROUND

Cognitive dysfunction is common in older adults, particularly in those with type 2 diabetes (T2D). Higher adherence to the Dietary Guidelines for Americans is associated with better brain health. However, it is unclear if adherence to the Australian Dietary Guidelines (ADG) is associated with cognition or brain structure in older adults.

OBJECTIVE

The aims of this study were to 1) examine the relation between adherence to the ADG, cognition, and brain MRI and 2) determine whether T2D modifies any associations.

METHODS

The Cognition and Diabetes in Older Tasmanians Study is a cross-sectional study in 688 people (n = 343 with T2D) aged 55-90 y. A validated 80-item food-frequency questionnaire was used to assess dietary intake. Adherence to the 2013 ADG was estimated using the Dietary Guidelines Index (DGI). Cognitive function in multiple domains was assessed with a comprehensive battery of neuropsychological tests and brain structure with MRI. Multivariable linear models were used to assess the associations between DGI, cognitive z scores, and brain structure. Effect modification for T2D was examined with a DGI × T2D product term.

RESULTS

The mean age of the sample was 69.9 y (SD: 7.4 y), with 57.1% men. The mean DGI was 54.8 (SD: 10.7; range: 24.1-84.6). No associations were observed between the Australian DGI and cognition or brain MRI measures. T2D did not modify any associations (P > 0.05).

CONCLUSIONS

This is the first study to investigate associations between adherence to the ADG and brain health in the older adults with and without T2D. Future prospective studies are required to clarify if there are long-term associations.

Validation of a revised General Nutrition Knowledge Questionnaire for Australia

OBJECTIVE

This study aimed to validate a nutrition knowledge questionnaire appropriate for use in Australia.

DESIGN

Nutrition knowledge is essential in establishing and maintaining strategies that reduce the burden of disease and promote wellbeing. The General Nutrition Knowledge Questionnaire (GNKQ) was developed in the United Kingdom in 1999 and validated for Australia in 2008. Changes in national nutrition recommendations and food availability prompted the redevelopment and revalidation of the UK questionnaire in 2016. However, the Australian questionnaire had not been subsequently updated.

SETTING

Australia.

PARTICIPANTS

Content validity was determined using a sample of academic dietitians in Australia (n 8). Face validity was undertaken with retail employees (n 11) whose highest level of education was secondary school. Ninety-three undergraduate nutrition and engineering students at Queensland University of Technology completed the questionnaire for construct validity, and nineteen students were contacted a week later for test-retest reliability.

RESULTS

In the 117-scored questionnaire, nutrition students scored consistently higher in each of the four sections and overall (87 %, M 102, IQR 95, 107) compared with engineering students (77 %, M 82, IQR 76, 87·25, P < 0·01). Internal reliability of the questionnaire was high (α = 0·92) as was test-retest reliability (rs = 0·96, ICC2,1 = 0·99). AUS-R NKQ determined significant differences between individuals with known higher levels of nutrition knowledge and obtained high validity, reliability and consistency within an Australian sample.

CONCLUSIONS

AUS-R NKQ refined through this research is valid and would be an appropriate questionnaire for assessing the effectiveness of nutrition knowledge-based interventions for public health programmes, clinicians and researchers.

Cropland Footprints of Australian Dietary Choices

Food systems vitally depend on croplands, which are a scarce natural resource. Croplands are also heterogeneous, differing in productive capability and in environmental context. Some are in regions of high biodiversity conservation importance, others in regions vulnerable to food insecurity. In this study, life cycle assessment was used to quantify cropland scarcity footprints, cropland biodiversity footprints and cropland malnutrition footprints for 9341 individual Australian adult daily diets. Dietary cropland scarcity footprints averaged 7.1 m2yr-e person-1 day-1, exceeding a target of 6.1 m2yr-e person-1 day-1, consistent with the proposed global cropland planetary boundary of 15% of the ice-free land area. Discretionary foods, which are energy-dense and nutrient-poor foods high in saturated fat, added sugars and salt, and alcohol and are not essential to a healthy diet, made the largest contribution, followed by fresh meats and alternatives, breads and cereals, fruit, dairy and alternatives and vegetables. Around 45% of the variation in cropland footprint between individuals was explained by differences in total dietary energy intake. Diets characterised by higher diet quality and lower cropland scarcity footprint required only 4.2 m2yr-e person-1 day-1 and recommended diets based on the food choices of this subgroup required 5.9 m2yr-e person-1 day-1. Eating within the global cropland planetary boundary appears realistic if Australians greatly reduce their intake of discretionary foods and moderate their food choices within the "meat and alternatives" food group.

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birth-dose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region.

Diet Quality and Water Scarcity: Evidence from a Large Australian Population Health Survey

There is widespread interest in dietary strategies that lower environmental impacts. However, various forms of malnutrition are also widely prevalent. In a first study of its kind, we quantify the water-scarcity footprint and diet quality score of a large (>9000) population of self-selected adult daily diets. Here, we show that excessive consumption of discretionary foods—i.e., energy-dense and nutrient-poor foods high in saturated fat, added sugars and salt, and alcohol—contributes up to 36% of the water-scarcity impacts and is the primary factor differentiating healthier diets with lower water-scarcity footprint from poorer quality diets with higher water-scarcity footprint. For core food groups (fruits, vegetables, etc.), large differences in water-scarcity footprint existed between individual foods, making difficult the amendment of dietary guidelines for water-scarcity impact reduction. Very large reductions in dietary water-scarcity footprint are possible, but likely best achieved though technological change, product reformulation and procurement strategies in the agricultural and food industries.

Sleep Quality and the Mediating Role of Stress Management on Eating by Nursing Personnel

(1) Background: The work schedule of nursing personnel often involves double or continuous shifts and sources of stress derived from the work context, making it necessary to ensure their rest and eating habits contribute to a healthy lifestyle. The objective of this study was to analyze the mediating role of stress management on the effect that sleep quality has on uncontrolled and emotional eating by nursing professionals. The Three-Factor Eating Questionnaire-R18 was applied to measure uncontrolled and emotional eating, the Pittsburgh Sleep Quality Index as a measure of sleep quality, and the EQ-i-20M for the stress management component of emotional intelligence. (2) Methods: A sample of 1073 nurses aged 22 to 57 years was selected for this purpose. (3) Results: The main result of this study was that stress management was a mediator in the effect of sleep quality on uncontrolled and emotional eating. Furthermore, low scores for sleeping problems correlated with high scores for stress management. The results also revealed a strong negative association between stress management and uncontrolled and emotional eating. (4) Conclusions: The results are discussed from the perspective of promoting health at work as well as improving the psychosocial wellbeing of nursing professionals and increasing the quality of patient care.

Physiological risk factors for cardiovascular disease in middle-aged (40-60 year) adults and their association with dietary intake, Northern Iran

Background

Considering the importance of healthy diet in the protection of cardiovascular diseases (CVD), this research aimed to assess the physiological risk factors for CVD in middle-aged adults and their association with dietary intake in the north of Iran.

Methods

In this cross-sectional study conducted in the years 2016-2017 among the adults aged 40-60 years living in Amirkola, Babol, the participants´ physical activity, dietary intake, body mass index, fat mass, blood pressure, fasting blood glucose and serum lipid profile were reported. The International Physical Activity Questionnaire was used to assess physical activity and a structured 24-hour food-recall questionnaire was used to assess the participants´ dietary intake. Consumed foods and beverages on two separate days were analyzed and transcribed in 10 food groups (gram).

Results

Two hundred and ninety-one persons (96.7%) had complete participation, 96.2% with at least one CVD risk factor and 75.9% had overweight or obesity; 33% with hypertension; 6.2% had high fasting blood glucose; 64.6% with hypercholesterolemia, 47.8% had hypertriglyceridemia, and 8.9% with low HDL. Mean daily intake values of carbohydrate, protein and fat were all higher than dietary reference intakes for adults. Physical activity less than 1500 MET-minutes per week was significantly associated with having three or more physiological risk factors for CVD [adjusted odds ratio: 2.04 (1.08-3.85)] (P=0.029).

Conclusion

Most of the middle-aged adults in this region had at least one of the physiological risk factors for CVD and daily intakes of carbohydrate and protein were higher than dietary reference intakes (DRIs) for adults.

Adequacy of iron intakes and socio-demographic factors associated with iron intakes of Australian pre-schoolers

PURPOSE

To estimate the prevalence of inadequate iron intakes and identify socio-demographic factors associated with iron intakes of Australian children aged 2-5 years.

METHODS

Data from the 2011-2012 National Nutrition and Physical Activity Survey component of the Australian Health Survey were analysed (n = 783, 2-5 years old). Dietary intake was assessed via two non-consecutive 24-h recalls. Prevalence of inadequate iron intake was estimated using the full probability approach after estimating the distribution of usual intakes with PC-SIDE. Associations between potential socio-demographic factors and energy-adjusted iron intakes were assessed via linear regression accounting for the complex survey design.

RESULTS

Mean (SD) iron intakes for pre-schoolers were 7.9 (1.9) mg/day and the prevalence of inadequate iron intake was 10.1% (95% CI 7.9%, 12.1%). Male sex (mean difference between boys and girls: - 0.22 (95% CI - 0.03, - 0.41) mg/day; p = 0.022) and age (each additional year was associated with 0.11 (95% CI - 0.22, - 0.00) mg/day lower iron intake; p = 0.048) were negatively associated with pre-schooler iron intakes.

CONCLUSIONS

This study provides current data relating to the iron nutrition of Australian pre-schoolers. Poor iron intakes continue to be a problem for 10% of Australian children beyond the second year of life, with iron intakes being lower for boys compared to girls and declining with age. Future research should examine strategies to improve iron intakes of young children, with a focus on promoting iron-rich food sources.

The Decreasing Trend in Dietary Glycaemic Index and Glycaemic Load in Australian Children and Adolescents between 1995 and 2012

This study aims to examine whether there were changes between 1995⁻2012 in the dietary glycaemic index (dGI) and glycaemic load (dGL) in Australian children (<16 years) according to three national surveys in 1995 (1995NS), 2007 (2007NS), and 2011⁻2012 (2012NS). Glycaemic index (GI) values of foods were assigned using published methodology. Plausible 24-h recall data from the 1995NS, 2007NS and 2012NS (weighted n = 2475, 4373 and 1691 respectively) were compared for differences in dGI and dGL, and the contribution to dGL from different foods using one-way ANOVA with Bonferroni post hoc comparisons and linear regression. Decreasing trends across surveys were found in dGI and dGL (p < 0.001). Between 1995 and 2012, dGI and dGL per Megajoule (MJ) dropped by 2% and 6% respectively. The per capita dGL contribution from breads and bread rolls, fruit and vegetable juices, sweetened beverages and potatoes showed strong decreasing trends (R² > 0.7). Our findings suggest that dGI and dGL of Australian youths declined between 1995 to 2012, which may be due to increased awareness of the GI concept and healthy diet, widened food choices and immigrants with diverse dietary habits. This may lower the future risks of chronic degenerative diseases in Australian youths.

Lack of Reality: Positive Self-Perceptions of Health in the Presence of Disease

The aim of this study was to determine if adults in Central Queensland have accurate self-perceptions of health. Data were collected as part of the 2010 Central Queensland Social Survey (N = 1289). Overweight/obesity is considered a health disorder and was determined using body mass index. Disease states were determined by asking respondents if they have: heart disease, high/low blood pressure, high cholesterol, high triglycerides, thyroid disorder, diabetes, and osteopenia/osteoporosis. Self-perceptions of health were assessed by asking, “Would you say that in general your health is” poor, fair, good, very good, excellent, don’t know, and no response. An accurate health perception occurred if: (1) A respondent with a disease/health disorder reported that their health was poor/fair or (2) A respondent without a disease/health disorder reported that their health was good/very good/excellent. The proportions of people with an accurate health perception by disease/health disorder were compared using a χ² test. A proportion ratio (PR) with a 95% confidence interval (CI) was calculated for each disease/health disorder. A logistic regression analysis was performed to examine the association between each disease/health disorder and health perception using gender, age, education, physical activity level, and smoking status as covariates. More than 50% of residents with each disease/health disorder reported their health to be good/very good/excellent. Residents with each disease/health disorder were less likely to have an accurate health perception than those without the corresponding disease/health disorder prior to (p < 0.001) and following adjustment of the covariates (p < 0.001). Our results suggest that overweight/obesity and prevalence of disease are not being recognized as unhealthy, which contradicts established definitions of health.

Declining consumption of added sugars and sugar-sweetened beverages in Australia: a challenge for obesity prevention

Background: Reduced intakes of added sugars and sugar-sweetened beverages (SSBs) have been the main focus of efforts to stall obesity. Although obesity has risen steeply in Australia, some evidence suggests that added-sugars and SSB intakes have declined over the same time frame.Objective: We investigated recent trends in the availability of sugars and sweeteners and changes in intakes of total sugars, added sugars, and SSBs in Australia by using multiple, independent data sources.Design: The study was designed to compare relevant data published by the Food and Agriculture Organization of the United Nations [FAO Statistics Division Database (FAOSTAT)], the Australian government, academia, and the food industry.Results: With the use of the FAOSTAT food balance sheets for Australia, the per capita availability of added or refined sugars and sweeteners was shown to have fallen 16% from 152 g/d in 1980 to 127 g/d in 2011 (P-trend = 0.001). In national dietary surveys in 1995 and 2011-2012, added-sugars intake declined markedly in adult men (from 72 to 59 g/d; -18%) but not in women (44-42 g/d; NS). As a proportion of total energy, added-sugars intake fell 10% in adult men but nonsignificantly in adult women. Between 1995 and 2011-2012, the proportion of energy from SSBs (including 100% juice) declined 10% in adult men and 20% in women. More marked changes were observed in children aged 2-18 y. Data from national grocery sales indicated that per capita added-sugars intakes derived from carbonated soft drinks fell 26% between 1997 and 2011 (from 23 to 17 g/d) with similar trends for noncarbonated beverages.Conclusions: In Australia, 4 independent data sets confirmed shorter- and longer-term declines in the availability and intake of added sugars, including those contributed by SSBs. The findings challenge the widespread belief that energy from added sugars or sugars in solution are uniquely linked to the prevalence of obesity.