The Relationship between Dietary Macronutrient Composition and Telomere Length Among US Adults

The role of dietary macronutrients and energy intake in the aging process has been well-established. However, previous research has mainly focused on the association between leukocyte telomere length (LTL) and individual macronutrients, while the effects of macronutrient composition on LTL remain unclear. This cross-sectional analysis involved 4130 US adults (44.8 ± 17.0 years; 51% female) from the National Health and Nutrition Examination Survey during 1999-2002. A single 24-h dietary recall is used to collect dietary data. The relationship between dietary macronutrient composition and LTL is examined using three-dimensional generalized additive models. After adjustment for age, sex, ethnicity, education, physical activity, BMI, and dietary quality, a three-dimensional association of macronutrient composition with LTL (P = 0.02) is revealed. Diets lower in protein (5-10%), higher in carbohydrates (75%), and lower in fat (15-20%) are associated with the longest LTL corresponding to 7.7 years of slower biological aging. Diets lowest in protein (5%) and carbohydrate (40%), while highest in dietary fat (55%) are associated with the shortest LTL, corresponding to accelerated biological aging of 4.4 years. The associations appeared magnified with higher energy intake. These findings support a complex relationship between dietary macronutrients and biological aging independent of diet quality.

Nutritional, environmental and economic impacts of ultra-processed food consumption in Australia

OBJECTIVE

To quantify the full life cycle impacts of ultra-processed foods (UPF) for key environmental, economic and nutritional indicators to identify trade-offs between UPF contribution to broad-scope sustainability.

DESIGN

Using 24-h dietary recalls along with an input-output database for the Australian economy, dietary environmental and economic impacts were quantified in this national representative cross-sectional analysis. Food items were classified into non-UPF and UPF using the NOVA system, and dietary energy contribution from non-UPF and UPF fractions in diets was estimated. Thereafter, associations between nutritional, environmental and economic impacts of non-UPF and UPF fractions of diets were examined using a multi-dimensional nutritional geometry representation.

SETTING

National Nutrition and Physical Activity Survey 2011-2012 of Australia.

PARTICIPANTS

Respondents (n 5344) aged > 18 years with 1 d of 24-h dietary recall data excluding respondents with missing values and outlier data points and under reporters.

RESULTS

Australian diets rich in UPF were associated with reduced nutritional quality, high greenhouse gas emissions, energy use, and increased employment and income associated with the food supply chains. The environmental and economic impacts associated with the UPF portion of diets become more distinct when the diets are standardised to average protein recommendation.

CONCLUSION

Increased consumption of UPF has socio-economic benefits, but this comes with adverse effects on the environment and public health. Consideration of such trade-offs is important in identifying policy and other mechanisms regarding UPF for establishing healthy and sustainable food systems.

Vegetative fragment production as a means of propagule dispersal for tropical seagrass meadows

BACKGROUND AND AIMS

Long distance dispersal (LDD) contributes to the replenishment and recovery of tropical seagrass habitats exposed to disturbance, such as cyclones and infrastructure development. However, our current knowledge regarding the physical attributes of seagrass fragments that influence LDD predominantly stems from temperate species and regions. The goal of this paper is to measure seagrass fragment density and viability in two tropical species, assessing various factors influencing their distribution.

METHODS

We measured the density and viability of floating seagrass fragments for two tropical seagrass species (Zostera muelleri and Halodule uninervis) in two coastal seagrass meadows in the central Great Barrier Reef World Heritage Area, Australia. We assessed the effect of wind speed, wind direction, seagrass growing/senescent season, seagrass meadow density, meadow location and dugong foraging intensity on fragment density. We also measured seagrass fragment structure and fragment viability; i.e., potential to establish into a new plant.

KEY RESULTS

We found that seagrass meadow density, season, wind direction and wind speed influenced total fragment density, while season and wind speed influenced the density of viable fragments. Dugong foraging intensity did not influence fragment density. Our results indicate that wave action from winds combined with high seagrass meadow density increases seagrass fragment creation, and that more fragments are produced during the growing than the senescent season. Seagrass fragments classified as viable for Z. muelleri and H. uninervis had significantly more shoots and leaves than non-viable fragments. We collected 0.63 (±0.08 SE) floating viable fragments 100 m-2 in the growing season, and 0.13 (±0.03 SE) viable fragments 100 m-2 in the senescent season. Over a third (38%) of all fragments collected were viable.

CONCLUSION

There is likely to be a large number of viable seagrass fragments available for long distance dispersal. This study's outputs can inform dispersal and connectivity models that are used to direct seagrass ecosystem management and conservation strategies.

How the EAT-Lancet Commission on food in the Anthropocene influenced discourse and research on food systems: a systematic review covering the first 2 years post-publication

In 2019, the EAT-Lancet Commission's report on food in the Anthropocene presented a planetary heath diet to improve health while reducing the environmental effect of food systems globally. We assessed EAT-Lancet's immediate influence on academic research and debate by conducting a systematic review of articles citing the Commission and others published from January, 2019, to April, 2021. The Commission influenced methods, results, or discourse for 192 (7·5%) of 2560 citing articles, stimulating cross-disciplinary research and debate across life sciences (47%), health and medical sciences (42%), and social sciences (11%). Sentiment analysis of 76 critiquing articles indicated that opinions were, on average, more positive than negative. Positive sentiments centred on benefits for informing policy, public health, and raising public awareness. Negative sentiments included insufficient attention to socioeconomic dimensions, feasibility, and environmental effects other than emissions. Empirical articles predominantly evaluated the effects of changed diets or food production on the environment and wellbeing (29%), compared current diets with EAT-Lancet recommendations (12%), or informed future policy and research agendas (20%). Despite limitations in EAT-Lancet's method, scope, and implementation feasibility, the academic community supported these recommendations. A broad suite of research needs was identified focusing on the effects of food processing, socioeconomic and political drivers of diet and health, and optimising consumption or production for environment and health.

Using Popular Foods Consumed to Inform Development of Digital Tools for Dietary Assessment and Monitoring

Knowing the type and quality of the most popular foods consumed by a population can be useful in the design of technologies for monitoring food intake and interventions. The aim of this research was to determine the most frequently consumed foods and beverages among the Australian population and provide recommendations for progressing the design of dietary assessment technologies. Analysis of the first 24 h recall of the most recent Australian National Nutrition and Physical Activity Survey was conducted. The most popular foods and beverages consumed by energy (kJ) and by frequency were calculated. There were 4515 separate foods and beverages reported by 12,153 people. Overall, the top 10 foods that contributed most energy included full fat milk, beer, white rice, white bread, red wine, cola soft drinks, bananas, red apples, wholewheat breakfast cereal and white sugar. The five most frequently reported foods and beverages were tap water, black tea, full fat milk, instant coffee, and sugar. Understanding the most popular foods and beverages consumed can support innovations in the design of digital tools for dietary surveillance and to reduce under-reporting and food omissions. These findings could also guide the development of more tailored and relevant food databases that underpin these technologies.

Macronutrient (im)balance drives energy intake in an obesogenic food environment: An ecological analysis

OBJECTIVE

The protein leverage hypothesis (PLH) postulates that strong regulation of protein intake drives energy overconsumption and obesity when human diets are diluted by fat and carbohydrates. The two predictions of the PLH are that humans (i) regulate intake to maintain protein within a narrow range and that (ii) energy intake is an inverse function of percentage energy from protein because absolute protein intake is maintained within narrow limits.

METHODS

Multidimensional nutritional geometry was used to test the predictions of the PLH using dietary data from the Australian National Nutrition and Physical Activity Survey.

RESULTS

Both predictions of the PLH were confirmed in a population setting: the mean protein intake was 18.4%, and energy intake decreased with increasing energy from protein (L = -0.18, p < 0.0001). It was demonstrated that highly processed discretionary foods are a significant diluent of protein and associated with increased energy but not increased protein intake.

CONCLUSIONS

These results support an integrated ecological and mechanistic explanation for obesity, in which low-protein highly processed foods lead to higher energy intake because of the biological response to macronutrient imbalance driven by a dominant appetite for protein. This study supports a central role for protein in the obesity epidemic, with significant implications for global health.

Associations of dietary macronutrient composition with cardiometabolic health: data from the National Health and Nutrition Examination Survey (NHANES) 1999–2014

Background

Human nutrition is a leading modifiable risk factor for the prevention of cardiometabolic diseases. However, most nutritional research focuses on the role of specific nutrients rather than compositional analysis of the diet.

Purpose

We aimed to assess the association of dietary macronutrient composition with various markers of cardiometabolic health.

Methods

This study was undertaken using 24-hour food recall data from the National Health and Nutrition Examination Survey from years 1999–2014 (n=36,637). Participants included both males and females ≥20 years of age (49.8±18.3 years; 53% Female). Caloric outliers for males (<800 kcal/day or >4200 kcal/day) and females (<600 kcal/day or >3500 kcal/day) were removed from the analysis (n=1844). Cardiometabolic health markers were collected via mobile examination center and included triglycerides (n=16,444), total cholesterol (n=31,155), LDL cholesterol (n=15,798), HDL cholesterol (n=33,435), blood pressure (n=34,121), body fat percentage (n=4269), body mass index (n=35,187), glucose (n=17,208), insulin (n=16,273), oral glucose tolerance test (n=8280), and HbA1c (n=27,288). Associations of dietary macronutrients with cardiometabolic health markers were assessed using 3-dimensional general additive models (Protein; Carbohydrate; Fat) with adjustment for age, sex, misreporting, ethnicity, education level, household income, physical activity, alcohol intake, and smoking. Response surfaces on right-angled mixture triangles were generated as predictions from absolute macronutrient intake at the 50th percentile of total energy intake. Macronutrient intakes were transformed to a percentage of energy to visualize and interpret associations compositionally.

Results

There was a complex 3-way interactive non-linear association of macronutrient composition with lipid profile (Figure A-D; all p<0.04), blood pressure (Figure E-F; all p<0.001), body fat percentage (Figure G; p<0.001), body mass index (Figure H; p<0.001), and all markers of glycemic control (Figure I-L; all p<0.001). Diets comprised of high protein coupled with low fat were associated with higher triglycerides but generally more favorable total cholesterol, blood pressure, and body fatness. Conversely, diets composed of high protein coupled with high fat were associated with higher HDL cholesterol but worse total cholesterol, body fatness, body mass index, and glycemic control.

Conclusions

These findings display a complex relationship between dietary macronutrient composition and cardiometabolic health. Future research is needed to evaluate how dietary source and quality may modify the observed associations.

Funding Acknowledgement

Type of funding sources: Private company.

A Comparison of the Australian Dietary Guidelines to the NOVA Classification System in Classifying Foods to Predict Energy Intakes and Body Mass Index

NOVA classification distinguishes foods by level of processing, with evidence suggesting that a high intake of ultra-processed foods (UPFs, NOVA category 4) leads to obesity. The Australian Dietary Guidelines, in contrast, discourage excess consumption of “discretionary foods” (DFs), defined according to their composition. Here, we (i) compare the classification of Australian foods under the two systems, (ii) evaluate their performance in predicting energy intakes and body mass index (BMI) in free-living Australians, and (iii) relate these outcomes to the protein leverage hypothesis of obesity. Secondary analysis of the Australian National Nutrition and Physical Activity Survey was conducted. Non-protein energy intake increased by 2.1 MJ (p < 0.001) between lowest and highest tertiles of DF intake, which was significantly higher than UPF (0.6 MJ, p < 0.001). This demonstrates that, for Australia, the DF classification better distinguishes foods associated with high energy intakes than does the NOVA system. BMI was positively associated with both DFs (−1. 0, p = 0.0001) and UPFs (−1.1, p = 0.0001) consumption, with no difference in strength of association. For both classifications, macronutrient and energy intakes conformed closely to the predictions of protein leverage. We account for the similarities and differences in performance of the two systems in an analysis of Australian foods.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Quantifying the environmental impact of a major coal mine project on the adjacent Great Barrier Reef ecosystems

A major coal mine project in Queensland, Australia, is currently under review. It is planned to be located about 10 km away from the Great Barrier Reef World Heritage Area (GBRWHA). Sediment dispersal patterns and their impact on marine ecosystems have not been properly assessed yet. Here, we simulate the dispersal of different sediment types with a high-resolution ocean model, and derive their environmental footprint. We show that sediments finer than 32 μm could reach dense seagrass meadows and a dugong sanctuary within a few weeks. The intense tidal circulation leads to non-isotropic and long-distance sediment dispersal patterns along the coast. Our results suggest that the sediments released by this project will not be quickly mixed but rather be concentrated where the most valuable ecosystems are located. If accepted, this coal mine could therefore have a far-reaching impact on the GBRWHA and its iconic marine species.

Nutrient-sensitive approach for sustainability assessment of different dietary patterns in Australia

BACKGROUND

Understanding the relation between sustainability and nutrients is important in devising healthy and sustainable diets. However, there are no prevailing methodologies to assess sustainability at the nutrient level.

OBJECTIVES

The aim was to examine and demonstrate the potential of integrating input-output analysis with nutritional geometry to link environmental, economic, and health associations of dietary scenarios in Australia with macronutrients.

METHODS

One-day dietary recalls of 9341 adult respondents (age ≥18 y) of the latest available cross-sectional National Nutrition and Physical Activity Survey-2011/12 of Australia were integrated with the input-output data obtained from the Australian Industrial Ecology Virtual Laboratory to calculate the environmental and economic impacts of dietary intakes in Australia. Australian adults' dietary intakes were classified into 3 dietary scenarios: "vegan," "pescatarian," and "omnivorous." Then, the relations between nutritional, economic, and environmental characteristics of the 3 dietary scenarios were demonstrated with the diets' macronutrient composition in a multidimensional nutritional geometry representation to link the sustainability indicators with macronutrients.

RESULTS

Nutrient density and economic and environmental indicators increased as the percentage of energy from proteins increased and decreased as the percentage of energy from fats increased for the 3 dietary scenarios, except for the nutrient density and water use of the "vegan" dietary scenario. Energy density increased as the percentage of energy from fats increased and decreased as the percentage of energy from proteins increased for "pescatarian" and "omnivorous" dietary scenarios. In the "vegan" dietary scenario, nutrient density and water use increased as the percentage of energy from proteins increased; however, these decreased as the percentage of energy from carbohydrates increased, instead of fats.

CONCLUSIONS

The study presents a new approach to analyzing the relations between sustainability indicators, foods, and macronutrients and establishes that proteins, irrespective of the source of protein, are driving dietary environmental and economic impacts.

Enablers and barriers of harnessing food waste to address food insecurity: a scoping review

Despite producing sufficient food for the global population, the growing prevalence of food insecurity in developed countries is cause for concern. The millions of metric tons of food wasted each year could be used instead to drastically lower rates of food insecurity and address food sustainability. In this scoping review, we aimed to identify barriers to and enablers of harnessing food waste across food sectors, including food retail, households, and food rescue organizations, to address food insecurity in a developed country, Australia. The findings demonstrate that research on and responsibility for harnessing food waste for food insecurity has predominantly fallen on ill-equipped food rescue organizations. Three primary policy advancements paramount to harnessing food waste to address food insecurity include (1) improving partnerships and subsidies to minimize transportation costs for redistributing imperfect or surplus food from farmers and retailers to those who with food insecurity; (2) enhancing existing partnerships and subsidies to stably involve more nutrition experts in food rescue organizations to improve the quality of foods being redistributed to those facing food insecurity; and (3) initiating interventions and campaigns that combine the following 5 characteristics: free to the participants; address food literacy; use multiple mass-media tools; are age tailored; and frame messages within personal values.

Diet Quality following Total Meal Replacement Compared with Food-Based Weight-Loss Diets in Postmenopausal Women with Obesity: A Secondary Analysis of the TEMPO Diet Trial

BACKGROUND

Severely energy-restricted diets that utilize meal-replacement products are the most effective dietary treatment for obesity. However, there are concerns they may fail to educate individuals on how to adopt a healthy food-based diet after weight loss.

OBJECTIVES

The aim of this research was to compare changes in diet quality following total meal replacement compared with food-based weight-loss diets.

METHODS

In this secondary analysis of a randomized controlled trial, 79 postmenopausal women aged 45-65 y, with a BMI (in kg/m2) of 30-40, were randomly assigned to either a total meal-replacement diet (energy intake restricted by 65-75% relative to requirements) for 16 wks, followed by a food-based diet (energy intake restricted by 25-35% relative to requirements) until 52 wks, or the food-based diet for the entire 52-wk period. Diet quality was scored at baseline and 52 wks using the Healthy Eating Index for Australian Adults, with score changes compared between groups using an independent t test.

RESULTS

Diet quality improved from baseline in both groups, but less so in the total meal-replacement group, with a mean (SD) increase of 3.6 (10.8) points compared with 11.8 (13.9) points in the food-based group, resulting in a mean between-group difference of -8.2 (P = 0.004; 95% CI: -13.8, -2.7) points. This improvement in diet quality within both groups was mostly driven by a reduction in the intake of discretionary foods. Intake remained below the recommendations at 52 wks for 4 of the 5 food groups in both dietary interventions.

CONCLUSIONS

In postmenopausal women with obesity, weight-loss interventions that involve either a total meal-replacement diet or a food-based diet both improve diet quality, however, not sufficiently to meet recommendations. This highlights the importance of addressing diet quality as a part of all dietary weight-loss interventions. This trial is registered with the Australia and New Zealand Clinical Trials Registry as 12612000651886.

Trends in Sales and Industry Perspectives of Package Sizes of Carbonates and Confectionery Products

Discretionary food package sizes are an important environmental cue that can affect the amount of food consumed. The aim of this study was to determine sales trends and reported food industry perspectives for changing food package sizes of carbonates and confectionery between 2005 and 2019. Changes in package sizes of carbonates and confectionery were investigated in Australia, the USA, Canada, and the UK. Sales data (units per capita and compound annual growth rate between 2005 and 2019) were extracted from the Euromonitor database. Qualitative data (market research reports) on industry perspectives on package size changes were extracted from industry and marketing databases. Carbonate sales data showed increased growth of smaller package sizes (<300 mL) and a decrease in sales of larger package sizes (≥2000 mL) in all four countries. In contrast, confectionery sales data showed no consistent trends across the selected countries. No growth was observed for smaller confectionery package sizes but an increase in growth of larger package sizes (50–99 g, >100 g), including share packages, was observed in Australia. Qualitative data (n = 92 articles) revealed key reasons identified by industry for changes in package size related to consumer health awareness, portion size control, convenience, market growth, and government or industry initiatives. Monitoring of discretionary food package sizes provides additional insights into consumers’ food environment.

Lithium monitoring in clinical practice

Introduction

Lithium is widely used for the treatment of bipolar disorder. Owing to its narrow therapeutic index and side-effect profile, regular monitoring is recommended by all major guidelines on lithium use.

Objectives

The aim of this study was to determine whether routine lithium monitoring practice at the local mental hospital in Malta reaches the standard set by the most recent NICE guidelines (NICE, 2014a).

Methods

All patients on lithium maintenance treatment for bipolar disorder at the local Mental Hospital were included. Blood tests within the last one year were collected using iSOFT clinical manager (iCM). After the first audit cycle, a lithium monitoring sheet was created in accordance with the NICE guideline and after 6 months of implementation, the second audit cycle was conducuted.

Results

In the first cycle, 28 patients met the NICE criteria for increased risk of toxicity and have a recommended testing frequency for lithium levels of every 3 months. However, only 1 patient was observed to meet this criteria. When assessing the last lithium level only 35.7% were within 0.4-0.8 mmol/L. In the second audit cycle, 28 patients met the NICE criteria for increased risk of toxicity and have a recommended testing frequency for lithium levels of every 3 months. Almost half of the patients (12 patients, 42%) were to observed to meet this criteria. When assessing the last lithium level, 50% were within 0.4-0.8 mmol/L

Conclusions

After the introduction of the lithium monitoring sheet, monitoring improved substantially especially in high risk patients. Moreover, the majority of test results for lithium levels were within the therapeutic range.

Did social media interaction replace quantitatively and qualitatively social face to face interaction during first months of COVID-19 pandemic ?

Introduction

COVID-19 has changed entire lives. Lockdowns all over the world have resulted in social isolation and whole populations started to live a new social norm.

Objectives

In this presentation I will discuss the role social media has played in social interactions during lockdown. Mainly if social media use has replaced social face to face interactions. This both in terms of quantity and emotional quality of interactions. I will be using a study we conducted in Malta in this regard.

Methods

It seems that social media use has increased during lockdown. To analyse this in Malta we studied a dataset comprising more than 50,000 comments and more than 150,000 interactions that has been extracted from Facebook covering a time span of four months. These months were the first wave of COVID- 19 cases in Malta. We conducted a quantitative and qualitative data analysis to establish the social polarity of the content.

Results

I will discuss how social media has in part replaced the social face to face interactions during COVID- 19 pandemic initial months, and use the results of the study we conducted in Malta as an example.

Conclusions

It would be useful to analyse further the use of social media in the new social norm caused by COVID- 19. Most importantly how it could be used to decrease social isolation effectively and increase psychological wellbeing.

A scoping review of policies promoting and supporting sustainable food systems in the university setting

BACKGROUND

Transitioning towards sustainable food systems for the health of the population and planet will require governments and institutions to develop effective governance to support the adoption of sustainable food practices. The aim of the paper is to describe current governance within Australian and New Zealand universities designed to support sustainable food systems.

METHODS

A systematic search of governance documents to support sustainable food systems within Australian and New Zealand universities was conducted. Data were obtained from 1) targeted websites 2) internet search engines and 3) expert consultations. Inclusion criteria consisted of university governance documents including by-laws, policies, guidelines, frameworks, and procedures that support sustainable food systems.

RESULTS

Twenty-nine governance documents across nineteen Australian and New Zealand universities were included for synthesis, including waste management policies (n = 3), fair-trade/procurement policies (n = 6), catering and or event guidelines (n = 7) and catering policies (n = 2), and environmental management plans (n = 11). The main strategies adopted by universities were sustainable waste management and prevention (e.g. reducing landfill, reducing wasted food, (27%)), ethical procurement practices (i.e. fair-trade (27%)) and environmentally sustainable food consumption (e.g. local, seasonal, organic, vegetarian food supply (14.5%)). Only 12.5% of universities addressed all three of the main strategies identified.

CONCLUSIONS

This study indicates that while sustainable food systems are considered in some university governance documents, efforts are predominantly focused on aspects such as waste management or procurement of fair-trade items which as stand-alone practices are likely to have minimal impact. This review highlights the scope of universities to provide strong leadership in promoting and supporting sustainable food systems through holistic institutional policies and governance mechanisms.

Dietary patterns and cardiovascular disease in Australian adults: Findings from the 2011-12 Australian Health Survey

BACKGROUND AND AIMS

Great discrepancies exist in results from studies examining the association between dietary patterns and cardiovascular disease (CVD) in different populations. The aim of this study is to examine the relationship between the Australian Dietary Guidelines (ADG) 2013, Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND), Paleolithic and Okinawan dietary patterns and CVD respectively.

METHODS AND RESULTS

In this cross-sectional secondary analysis of the 2011-12 Australian Health Survey, adults who self-reported physician-diagnosed CVD, completed two multiple-pass 24 h recalls and had no missing data on all confounders were analysed (weighted n = 5376; 295 CVD cases). Dietary intake was transformed to represent usual intake by the multiple source method. The score of Healthy Eating Index for Australian Adults (HEIFA-2013) was adopted for ADG 2013, while the scores of MIND, Paleolithic and Okinawan dietary patterns were constructed by separating the intake of each predefined food and nutrient into quintiles. The associations between the dietary patterns (as tertiles of scores) and CVD were examined using binary logistic regression adjusted for significant cardiovascular risk factors. Higher adherence to the Okinawan diet pattern was significantly associated with a reduced prevalence of ischemic heart disease (IHD) (OR per unit increase in dietary pattern score: 0.94, 95%CI: 0.90-0.98). Comparing its extreme tertiles, the OR was 0.49 (95%CI: 0.29-0.82; p_trend < 0.01). The associations between HEIFA-2013, MIND and Paleolithic diet patterns and CVD were insignificant.

CONCLUSION

The findings suggested an inverse association between adherence to Okinawan dietary pattern and prevalence of IHD in Australian adults.

Obstetric complications in patients with schizophrenia and their unaffected siblings

Objective

We sought to explore whether obstetric complications (OCs) are more likely to occur in the presence of familial/genetic susceptibility for schizophrenia or whether they themselves represent an independent environmental risk factor for schizophrenia.

Methods

The presence of OCs was assessed through maternal interview on 216 subjects, comprising 36 patients with schizophrenia from multiply affected families, 38 of their unaffected siblings, 31 schizophrenic patients with no family history of psychosis, 51 of their unaffected siblings and 60 normal comparison subjects. We examined the familiality of OCs and whether OCs were commoner in the patient and sibling groups than in the control group.

Results

OCs tended to cluster within families, especially in multiply affected families. Patients with schizophrenia, especially those from multiply affected families, had a significantly higher rate of OCs compared to normal comparison subjects, but there was no evidence for an elevated rate of OCs in unaffected siblings.

Conclusion

Our data provides little evidence for a link between OCs and genetic susceptibility to schizophrenia. If high rates of OCs are related to schizophrenia genes, this relationship is weak and will only be detected by very large sample sizes.

Breakfast size is associated with daily energy intake and diet quality

OBJECTIVES

The aim of this study was to investigate the role of breakfast consumption and breakfast size on daily energy, nutrient intakes, and diet quality.

METHODS

One-day 24-h recall data from the 2011 to 2012 National Nutrition and Physical Activity Survey (n = 9341, adults ≥ 19 y) were analyzed, and respondents were classified into breakfast consumers or skippers. Breakfast consumers were further classified into quartile of breakfast size (energy intake [EI] from breakfast × 100%/daily EI). Diet quality was assessed using the Healthy Eating Index for Australian Adults. General linear modeling was undertaken to compare groups, adjusting for potential confounders.

RESULTS

Overall, 85.9% of adults consumed breakfast, contributing a mean of 19.9 ± 10.9% of daily EI for consumers. Among breakfast consumers, obtaining a higher proportion of daily EI from breakfast was associated with lower daily intakes of energy, added sugars, saturated fat, and alcohol (%E); higher intakes of dietary fiber (%E) and most micronutrients (per 1000 kJ); and better Healthy Eating Index for Australian Adults scores (P_trend < 0.0001). Additionally, those in the highest quartile of breakfast size (>25.5% EI) had higher diet quality scores (P < 0.001) but similar daily EI (P = 0.751) compared with breakfast skippers.

CONCLUSIONS

These findings indicate that obtaining a higher proportion of daily EI from breakfast may result in more favorable dietary profiles and lower daily EI. Further research is needed to confirm this.

The Relationship between Vegetable Intake and Weight Outcomes: A Systematic Review of Cohort Studies

The relationship between vegetable consumption and measures of adiposity was assessed in cohort studies. Seven databases were searched from inception until February 2018. The quality of individual studies was assessed using the Joanna Briggs Institute Critical Appraisal of Cohort Studies tool. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was applied to determine the quality of the body of evidence. Ten studies were included. Six measured change in vegetable intake over time. Two showed that increasing vegetable consumption resulted in weight loss of 0.09⁻0.1 kg over four years (p < 0.001). Increased vegetable intake was also associated with a reduced risk of weight gain and overweight or obesity (Odds ratios (ORs) ranged from 0.18 to 0.88) in other studies. Four studies measured vegetable intake at the baseline only. One showed that intakes >4 servings/day reduced the risk of weight gain (OR 0.27 (95% confidence interval (CI) 0.08⁻0.99) and another found an inverse association with waist circumference in women (-0.36 cm per vegetable serving/day). This review provides moderate quality evidence for an inverse association between vegetable intake and weight-related outcomes in adults. When these findings are coupled with no apparent harm from vegetable consumption, the evidence-base can be used with acceptable confidence to guide practice and policy.

Macronutrient Composition of the Australian Population's Diet; Trends from Three National Nutrition Surveys 1983, 1995 and 2012

Although the role of individual macronutrients in the development of obesity remains controversial, changes in macronutrient composition of the diet may have played a causal role in the obesity epidemic. The aim of this analysis was to determine the percentage energy (%E) for protein, carbohydrate and fat of Australian adults' diets over time. Cross-sectional, national nutrition surveys from 1983, 1995 and 2012 assessed diet using one 24 h recall. The prevalence of obesity increased between each survey, from 9.6% to 19.7% and 27.7%. Protein (%E) differed between each survey and contributed 17.7%, 16.8% and 18.3% energy in 1983, 1995 and 2012, respectively (p < 0.001). Carbohydrate (%E) increased from 40.0% in 1983 to 44.9% in 1995 (p < 0.001), with no change in dietary fibre but declined in 2012 to 43.1%. Fat (%E) declined between each survey from 35.3%, 31.9%, to 30.9%, respectively (p < 0.001). Alcohol (%E) has declined for younger adults and men but intake increased for women aged >45 years. Prospective cohort studies with comprehensive assessment of foods consumed, together with measurements of weight and height, will advance the understanding of the relationship between macronutrients and changes in body weight and obesity.

Effectiveness of lifestyle interventions for preventing harmful weight gain among young adults from lower socioeconomic status and ethnically diverse backgrounds: a systematic review

The incidence of overweight and obesity are increasing with each successive generation of young adults. Associated co-morbidities will emerge at an earlier age unless weight gain is prevented. Evidence has demonstrated young adults (aged 18-35 years) from low socioeconomic and ethnically diverse backgrounds are at greater risk of overweight or obesity, yet it is unclear how to effectively intervene in this population. This systematic review aimed to assess the effectiveness of lifestyle interventions conducted in this population. Thirty studies reporting on lifestyle interventions for prevention of weight gain were identified from eight electronic databases searched. Six interventions included subgroup analyses to determine if ethnicity moderated weight change, and two included subgroup analyses to determine if socioeconomic status had an effect on change in weight. Five of these six studies were effective in preventing weight gain, and subgroup analyses showed no differences in effect by ethnicity. Of these five studies, two included a subgroup analysis that showed socioeconomic status to have no effect on weight outcome. Despite the promising results from these five lifestyle interventions utilizing online and mobile components to effectively reach and prevent weight gain in this priority population, the evidence base of high quality trials is limited.

Assessing the efficacy and external validity of interventions promoting calcium or dairy intake in young adults: A systematic review with meta-analysis

Calcium and dairy products have a role in the prevention of chronic diseases and attainment of peak bone mass, during adolescence to young adulthood. However, intakes are often suboptimal and interventions to improve consumption of food sources are needed. This systematic review aimed to investigate the efficacy and external validity of interventions promoting calcium or dairy foods among young adults. Eight databases were searched from inception to identify relevant studies. Inclusion criteria included those aged 18 to 35 years in an intervention promoting calcium or dairy food intake. The mean age of the participants was 19.9 ± 1.4 years. Of the 16 studies that met the selection criteria, five studies were included in the meta-analyses for calcium (pooled effect size 0.35, 95% CI 0.04 to 0.67) and three studies for dairy (pooled effect size 0.31, 95% CI 0.11 to 0.50). The quality of the body of evidence was determined using the GRADE system, and was of overall low quality with high risk of bias. Our review suggests young adults respond favorably to interventions but the effect size is small.

Increases in Alcohol Intakes Are Concurrent with Higher Energy Intakes: Trends in Alcohol Consumption in Australian National Surveys from 1983, 1995 and 2012

This research aimed to provide the first assessment of the contribution of alcohol to Australian adults' diets over time and determine if people reporting alcohol had higher total dietary energy intakes. Secondary analyses of cross-sectional national nutrition surveys from 1983, 1995, and 2011/12 for adults 18 years (n = 26,675) and over were conducted. Alcoholic beverage intake and diet were assessed using 24-h recalls. The proportion of participants reporting alcohol consumption declined over time and in 1983, 1995, and 2011/12 was 52.0%, 44.2%, and 39.8%, respectively, for men (p < 0.001) and 31.6%, 25.7%, and 25.7%, respectively, for women (p < 0.001). A decline in alcohol intake was seen between 1983 and 2012 for all subpopulations, except for women aged over 45 years, for whom alcohol intake increased. Energy intake was higher for participants reporting alcohol intake and the mean difference (SD) in energy intake for those reporting alcohol versus non-consumers was +1514 kJ (462) for men and +1227 kJ (424) for women. Consistent with apparent consumption data, reported alcohol intake for the total population decreased over time. As those reporting alcohol had much higher energy intakes than non-consumers, promoting alcohol intakes consistent with national recommendations may have important implications for the prevention of obesity, particularly for middle-aged women.

Psychiatric hospitals may enhance holistic care by introducing medical and surgical liaison teams

Introduction

Patients with mental health problems (MHP) are known to have more physical comorbidities compared to the general population.

In Malta, Mount Carmel hospital (MCH) which is the main psychiatric hospital (consisting of both acute and chronic wards), is separate from Mater Dei hospital (MDH) which is the general hospital at which medical and surgical care is provided.

Such a division in healthcare may result in inadequate focus on physical health amongst patients of high demand in this regard. This subsequently puts an increased strain on the general hospital through repeated referrals.

Objectives

The purpose of this study is to show that inpatients with MHP have a significant number of comorbidities and require multiple referrals to a general hospital for medical and surgical attention.

Methods

Three hundred and ninety-three inpatients at acute and chronic wards of MCH (during the first week of December 2016) were enrolled in the study.

Treatment charts and iSOFT (healthcare IT software used in Malta) were used to determine patient's diagnosed comorbidities, number and type of referrals to MDH outpatient clinics (OPC), casualty and admissions at MDH over 1 year.

Results

Results of the audit indicate that a significant number of inpatients at MCH have medical comorbidities and the majority have been referred to MDH for OPC and casualty over the past year.

Conclusions

Having medical and surgical liaison teams in psychiatric hospitals may enhance patient care and reduce the pressure exerted on general hospitals.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Are products sold in university vending machines nutritionally poor? A food environment audit

AIM

(i) To audit the nutritional composition, promotion and cost of products available from vending machines available to young adults; and (ii) to examine the relationship between product availability and sales.

METHODS

A cross-sectional analysis of snacks and beverages available and purchased at a large urban university was conducted between March and September 2014. Sales were electronically tracked for nine months.

RESULTS

A total of 61 vending machines were identified; 95% (n = 864) of the available snacks and 49% of beverages (n = 455) were less-healthy items. The mean (SD) nutrient value of snacks sold was: energy 1173 kJ (437.5), saturated fat 5.36 g (3.6), sodium 251 mg (219), fibre 1.56 g (1.29) and energy density 20.16 kJ/g (2.34) per portion vended. There was a strong correlation between the availability of food and beverages and purchases (R² = 0.98, P < 0.001).

CONCLUSIONS

Vending machines market and sell less-healthy food and beverages to university students. Efforts to improve the nutritional quality are indicated and afford an opportunity to improve the diet quality of young adults, a group at risk of obesity.

‘Dar Kenn Ghal Sahhtek’ – An Effective Therapeutic Intervention

Introduction

‘Dar Kenn Ghal Sahhtek’ is a residential service for patients suffering from eating disorders, namely Bulimia Nervosa, Anorexia Nervosa and Obesity (Binge Eating and Non Binge Eating type). The focus will be made on the obesity services.

Objectives

1. To show that Dar Kenn Ghal Sahhtek has proved to be an effective therapeutic intervention towards obesity (with or without binge eating). 2. To show that from a recruitment of 30 obese subjects a substantial proportion met the DSM-5 criteria for Binge Eating Disorder.

Aims

1. To show that by means of questionnaires and physical testing a marked improvement was made following the therapeutic interventions offered at DKGS. 2. To highlight the high incidence of binge eating disorder in a sample of 30 obese subjects recruited via DKGS.

Methods

1. Interviewing the patient for the DSM-5 criteria of binge eating. 2. Comparing scores of questionnaires before admission and prior to discharge. 3. Evaluating the response to various treatment modalities.

Results

On interviewing the group of 30 patients, 47.6% of the patients were found to be the diagnostic criteria of Binge Eating Disorder according to DSM-5 (Table 1).

Conclusion

Firstly, a considerable proportions of obese subjects proved to meet the DSM-5 criteria for binge eating while Dar Kenn Ghall Sahhtek has proved to be an effective therapeutic intervention towards obesity (with and without binge eating).

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A systematic literature review of nutrition interventions in vending machines that encourage consumers to make healthier choices

Internationally, vending machines are scrutinized for selling energy-dense nutrient-poor foods and beverages, and the contribution to overconsumption and subsequent risk of obesity. The aim of this review is to determine the efficacy of nutrition interventions in vending machine in eliciting behaviour change to improve diet quality or weight status of consumers. Electronic databases Cochrane, EMBASE, CINAHL, Science Direct and PubMed were searched from inception.

INCLUSION CRITERIA

(i) populations that have access to vending machines; (ii) nutrition interventions; (iii) measured outcomes of behaviour change (e.g. sales data, dietary intake or weight change); and (iv) experimental trials where controls were not exposed to the intervention. Risk of bias was assessed independently by two researchers, and higher quality research formed the basis of this qualitative review. Twelve articles from 136 searched were included for synthesis. Intervention settings included schools, universities and workplaces. Reducing price or increasing the availability increased sales of healthier choices. The results of point-of-purchase nutrition information interventions were heterogeneous and when measured changes to purchases were small. This review offers evidence that pricing and availability strategies are effective at improving the nutritional quality foods and beverages purchased from vending machines. Evidence on how these interventions alter consumer's overall diet or body mass index is needed.

Guiding principles for the improved governance of port and shipping impacts in the Great Barrier Reef

The Great Barrier Reef (GBR) region of Queensland, Australia, encompasses a complex and diverse array of tropical marine ecosystems of global significance. The region is also a World Heritage Area and largely within one of the world's best managed marine protected areas. However, a recent World Heritage Committee report drew attention to serious governance problems associated with the management of ports and shipping. We review the impacts of ports and shipping on biodiversity in the GBR, and propose a series of guiding principles to improve the current governance arrangements. Implementing these principles will increase the capacity of decision makers to minimize the impacts of ports and shipping on biodiversity, and will provide certainty and clarity to port operators and developers. A 'business as usual' approach could lead to the GBR's inclusion on the List of World Heritage in Danger in 2014.

Rapid assessment of risks to a mobile marine mammal in an ecosystem-scale marine protected area

Ecosystem-scale networks of marine protected areas (MPAs) are important conservation tools, but their effectiveness is difficult to quantify in a time frame appropriate to species conservation because of uncertainties in the data available. The dugong (Dugong dugon) is a mobile marine species that occurs in shallow inshore waters of an ecosystem-scale network of MPAs (the Great Barrier Reef World Heritage Area [GBRWHA]). We developed a rapid approach to assess risk to dugongs in the region and evaluate options to ameliorate that risk. We used expert opinion and a Delphi technique to identify and rank 5 human factors with the potential to adversely affect dugongs and their sea grass habitats: netting, indigenous hunting, trawling, vessel traffic, and poor-quality terrestrial runoff. We then quantified and compared the distribution of these factors with a spatially explicit model of dugong distribution. We estimated that approximately 96% of habitat of high conservation value for dugongs in the GBRWHA is at low risk from human activities. Using a sensitivity analysis, we found that to decrease risk, commercial netting or indigenous hunting had to be reduced in remote areas and the effects of vessel traffic, terrestrial runoff, and commercial netting had to be reduced in urban areas. This approach enabled us to compare and rank risks so as to identify the most severe risks and locate specific sites that require further management attention.

Complete structural characterisation of the mammalian and Drosophila TRAF genes: implications for TRAF evolution and the role of RING finger splice variants

The complete murine TRAF2 gene was obtained using a lambda phage and PCR cloning strategy. The gene was found to consist of ten coding and one 5' non-coding exon spread over 28 kbp of DNA. We also report the basic structure of the human TRAF5 and TRAF6 genes obtained by analysis of the genomic DNA database. Comparison of these three gene structures, along with those previously described for TRAF1, TRAF3 and TRAF4, revealed the evolutionary relationship between the six known mammalian TRAFs. The TRAF1/TRAF2 and TRAF3/TRAF5 gene pairs were found to have arisen from recent independent gene duplications and to share a common ancestral gene. Specific TRAF4 and TRAF6 precursor genes were found to have arisen earlier during evolution, with the divergence of the TRAF6 precursor occuring earliest of all. The Drosophila genome was found to contain three TRAF family genes: dTRAF1, dTRAF6 (dTRAF2) and a previously undescribed member we have designated dTRAF3. TRAF-C domain homology indicated that dTRAF3 is likely to have derived from the common precursor for the TRAF 1, 2, 3 and 5 genes, whilst dTRAF1 and dTRAF6 have derived from the TRAF4 and TRAF6 precursor genes, respectively. The implication of these results for the functional evolution of TRAFs is discussed. Analysis is also presented of the conservation of the TRAF2A molecule, a TRAF2 alternate splice isoform with an extended RING finger domain previously described in mice. TRAF2A was not found to be encoded by the human or rat TRAF2 genes and no other murine TRAF gene was found to produce a similar alternate splice product. We also report that the sequence of murine C57BL/6 TRAF4 differs significantly from the published murine TRAF4 sequence, but appears to represent the actual TRAF4 sequence expressed in many mouse strains.

Maternal exposure to influenza and paranoid schizophrenia

Previous research has suggested that schizophrenics exposed to influenza in the second trimester have more delusions of jealousy, delusions of reference and suspiciousness. We therefore hypothesised that the risk-increasing effect of in utero exposure to influenza would be particularly demonstrable in paranoid schizophrenia. We studied patients with an ICD diagnosis of schizophrenia in England and Wales who were born each month between 1923 and 1965 (N = 17,247. Chi-square test for trend showed that an increase in influenza exposure level during the fifth month of gestation was accompanied by an increase in the proportion of patients with paranoid schizophrenia. However, logistic regression analysis including sex, seasonality and birth period in the model resulted in the loss of any significant association between in utero exposure to influenza and the development of paranoid schizophrenia, the loss of this significance being mainly accounted for by birth period. Therefore, the association in utero exposure to influenza and subsequent development of paranoid schizophrenia we hypothesised was not supported by our data.

Computerization of data: a person-based medical record system

The collection and evaluation of obstetric data is essential for assessing the effectiveness of the health and social services in a country. A computerized system in use on a national level is described. The person-based system aims to include all patients who encounter government medical services, including obstetric and infant data. The scope of the service is to make individual patient records easily available to the practitioner, but is designed to allow statistical analysis of the data.

Exposure to lead and cadmium of the general population of Malta

The blood levels of lead (PbB), cadmium (CdB), and zinc protoporphyrin (ZPP) were determined in 538 Maltese adult subjects. A relatively high level exposure to both metals was discovered. For lead, the median value is 274 micrograms/l with percentile 90 and 98 respectively 564 and 863 micrograms/l. These values are to be compared with the reference values proposed by a directive of the European Community, respectively 200, 300 and 350 micrograms/l. For cadmium, the median value is 2.2 micrograms/l with percentile 90 and 98 respectively 3.8 and 5.7 micrograms/l. These values are compared with those of a Belgian population which are respectively 1.7, 2.6 and 4.3 micrograms/l. The causes of this relatively high exposure are not known. A few tentative hypotheses, which are to be investigated, are made.