1
|
Mauch CE, Golley RK, Hendrie GA. Variety Predicts Discretionary Food and Beverage Intake of Australian Adults: A Cross-Sectional Analysis of an Online Food Intake Survey. J Acad Nutr Diet 2024; 124:509-520. [PMID: 37499867 DOI: 10.1016/j.jand.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/15/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Variety has been used as a strategy for increasing intakes of healthy foods, but has not been well explored with respect to discretionary food/beverages. The diverse sensory properties of these foods suggests that variety could play an important role in total intake. OBJECTIVE This study explored variety as a predictor of intake of discretionary food/beverages, and described the variety of these items consumed by Australian adults. DESIGN Secondary analyses of cross-sectional data from a validated, online survey that assesses participants' dietary intake using frequency and portion-based questions. Discretionary food/beverages are grouped into 11 categories. PARTICIPANTS/SETTING Participants included 235,203 Australian adults, aged 18 years or older, who provided data from May 2015 to November 2020. OUTCOME MEASURES Variety was the number of categories of discretionary food/beverages consumed. Servings were estimated from usual intake questions, and percent contribution summarized by category. Consumption prevalence was the proportion of the sample/subgroup consuming each category. Consumption was calculated as the mean of the sample and per capita in servings. STATISTICAL ANALYSES PERFORMED Descriptive statistics were used to present variety and percent contribution to total intake across the sample and subgroups, and multiple regression was used to examine whether or not variety predicted intake of discretionary food/beverages. RESULTS Participants consumed a median of 8 categories of discretionary food/beverages, with every additional category associated wit h an increase in intake of half a serving of discretionary food/beverages per day (B = 0.48; P < 0.001). Alcohol, cakes and cookies, takeaway, and confectionary collectively contributed around two-thirds of total daily intake of discretionary food/beverages, with alcohol contributing the largest proportion (28.3% of total daily intake). CONCLUSIONS Variety is related to total intake of discretionary food/beverages. Intervention approaches targeting a reduction in variety, as an alternative to a focus on portion size or frequency of intake, would be a novel way of addressing overconsumption of discretionary food/beverages in future research.
Collapse
Affiliation(s)
- Chelsea E Mauch
- Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Rebecca K Golley
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Gilly A Hendrie
- Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia.
| |
Collapse
|
2
|
James-Martin G, Brooker PG, Hendrie GA, Stonehouse W. Avocado Consumption and Cardiometabolic Health: A Systematic Review and Meta-Analysis. J Acad Nutr Diet 2024; 124:233-248.e4. [PMID: 36565850 DOI: 10.1016/j.jand.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Avocados are a rich source of unsaturated fats and bioactives, however, their role in altering cardiometabolic risk factors is unclear. OBJECTIVE The aim was to review the effects of consuming diets containing avocado compared with control diets containing no or low amounts of avocado on cardiometabolic risk factors in adults who were healthy, had clinical cardiovascular disease, or were at increased risk of cardiovascular disease. METHODS Five electronic databases were searched (PubMed, Web of Science, Scopus, ProQuest, and a Clinical Trials Registry) along with Google Scholar to identify studies published between January 1990 and November 10, 2021. Randomized controlled trials ≥3 weeks and prospective cohort studies were included. Ten studies-9 randomized controlled trials (n = 503 participants) and 1 prospective observational study (n = 55,407)-met the inclusion criteria. Outcomes assessed by means of meta-analysis were low-density lipoprotein cholesterol (LDL-C) (primary), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides. Outcomes assessed by narrative review were TC to HDL-C ratio, non-HDL-C, apolipoprotein B, blood pressure, body weight, body mass index (calculated as kg/m2), waist circumference, waist-to-hip ratio, body composition, and blood glucose and insulin concentrations. Risk of bias was assessed using the Cochrane Risk of Bias tool, version 2.0 and Newcastle-Ottawa Scale; quality of evidence was examined using the Grading of Recommendations, Assessment, Development and Evaluation method. Random-effects models meta-analyses were performed when there were ≥3 studies of the same design (ie, randomized controlled trial) and reporting the same outcome. Statistical heterogeneity was assessed by calculating χ2 and I2 statistics and publication bias was assessed by funnel plots. RESULTS Overall, there was a small, significant reduction in TC (-5.08 mg/dL [to convert to mmol/L, divide by 38.67]; 95% CI -9.29 to -0.87 mg/dL; P = .02) in avocado vs the control groups and no significant difference in LDL-C, HDL-C, or triglycerides. Subgroup analysis demonstrated significant reductions in LDL-C (-9.4 mg/dL [to convert to mmol/L, divide by 38.67]; 95% CI -10.84 to -7.95 mg/dL; P < .00001) and TC (-7.54 mg/dL; 95% CI -9.40 to -5.68 mg/dL; P < .00001) in avocado vs control groups in hypercholesterolemic populations, and no differences were seen in normocholesterolemic populations. However, the certainty in the findings was graded as low to very low. Body weight and composition were not negatively affected by avocado consumption. CONCLUSIONS Avocado consumption may reduce TC and LDL-C in people with hypercholesterolemia. Avocado consumption does not negatively impact body weight. Larger, well-conducted studies are needed to have greater confidence in the role of avocado consumption on cardiovascular disease risk factors.
Collapse
Affiliation(s)
- Genevieve James-Martin
- Human Health, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia.
| | - Paige G Brooker
- Human Health, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Gilly A Hendrie
- Human Health, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Welma Stonehouse
- Human Health, Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| |
Collapse
|
3
|
Livingstone KM, Rawstorn JC, Partridge SR, Zhang Y, O E, Godrich SL, McNaughton SA, Hendrie GA, Dullaghan K, Abbott G, Blekkenhorst LC, Maddison R, Barnett S, Mathers JC, Alston L. Determining the feasibility of a codesigned and personalised intervention (Veg4Me) to improve vegetable intake in young adults living in rural Australian communities: protocol for a randomised controlled trial. BMJ Open 2024; 14:e078001. [PMID: 38216197 PMCID: PMC10806619 DOI: 10.1136/bmjopen-2023-078001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Diets low in vegetables are a main contributor to the health burden experienced by young adults in rural communities. Digital health interventions provide an accessible delivery model that can be personalised to meet the diverse preferences of young adults. A personalisable digital vegetable intake intervention (Veg4Me) was codesigned to meet the needs of young adults living in rural communities. This study will determine the feasibility of delivering a personalised Veg4Me programme and compare preliminary effects with a non-personalised Veg4Me (control). METHODS AND ANALYSIS A 12-week assessor-blinded, two-arm, parallel randomised controlled trial will be undertaken from August 2023 until April 2024. A total of 150 eligible and consenting young adults (18-35 years; eat<5 serves of vegetables/day; have an internet connected mobile device/computer) living in Loddon Campaspe or Colac Otway Shire in Victoria, Australia, will be randomised to receive 12 weeks of personalised (intervention) or non-personalised (control) support to increase vegetable intake via a free web application (app; Veg4Me). The primary outcome is feasibility (recruitment, participation and retention rates). Secondary outcomes are user engagement, usability and experience, as well as vegetable intake, eating habits and digital health equity. Process evaluation will be conducted in a subsample of participants using semistructured interviews. Descriptive statistics will be presented for the personalised and non-personalised groups at baseline and 12 weeks. Generalised linear models will be used to evaluate group differences in outcomes. Interviews will be transcribed and analysed thematically. ETHICS AND DISSEMINATION All procedures involving human subjects were approved by Deakin University's Human Ethics Advisory Group-Health (HEAG-H 06_2023) on 6 March 2023. Dissemination events will be held in the City of Greater Bendigo and the Colac Otway Shire. Summaries of the results will be disseminated to participants via email. Results will be disseminated to the scientific community through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trials Registry, ACTRN12623000179639p, prospectively registered on 21 February 2023, according to the World Health Organizational Trial Registration Data Set. Universal Trial Number U1111-1284-9027.
Collapse
Affiliation(s)
- Katherine M Livingstone
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Stephanie R Partridge
- Engagement and Co-design Research Hub, The University of Sydney, Sydney, New South Wales, Australia
| | - Yuxin Zhang
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Eric O
- Digital Services, Deakin University, Geelong, Victoria, Australia
| | - Stephanie L Godrich
- Nutrition and Health Innovation Research Institute, Edith Cowan University, Bunbury, Australian Capital Territory, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Gilly A Hendrie
- Human Health Program, CSIRO, Adelaide, South Australia, Australia
| | - Kate Dullaghan
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Scott Barnett
- Applied Artificial Intelligence Institute, Deakin University, Geelong, Victoria, Australia
| | - John C Mathers
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Laura Alston
- Deakin Rural Health, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
4
|
Livingstone KM, Rawstorn JC, Alston L, Partridge SR, Bastian A, Dullaghan K, McNaughton SA, Hendrie GA, Blekkenhorst LC, Maddison R, Zhang Y, Barnett S, Mathers JC, Godrich SL. Co-design of a personalised digital intervention to improve vegetable intake in adults living in Australian rural communities. BMC Public Health 2024; 24:146. [PMID: 38200514 PMCID: PMC10782626 DOI: 10.1186/s12889-024-17641-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas. This paper describes the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. METHODS Active participants in the co-design process were adults ≥ 18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population. Eight online workshops and a community survey were conducted between July and December 2021. The MoSCoW prioritisation method was used to help participants identify the 'Must-have, Should-have, Could-have, and Won't-have or will not have right now' features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community. RESULTS Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on (i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, (ii) access to personalisation options and behaviour change support, and (iii) improving the community food environment by providing information on and access to local food initiatives. CONCLUSIONS Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This research will inform the development of the prototyping (evaluation phase) and feasibility testing (post-design phase) of this intervention.
Collapse
Affiliation(s)
- Katherine Mary Livingstone
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 3220, Geelong, Victoria, Australia.
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, 3125, Melbourne, Victoria, Australia.
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 3220, Geelong, Victoria, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Amber Bastian
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 3220, Geelong, Victoria, Australia
| | - Kate Dullaghan
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 3220, Geelong, Victoria, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 3220, Geelong, Victoria, Australia
| | - Gilly A Hendrie
- Human Health Program, Health & Biosecurity, CSIRO, 5000, Adelaide, SA, Australia
| | - Lauren C Blekkenhorst
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 3220, Geelong, Victoria, Australia
| | - Yuxin Zhang
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 3220, Geelong, Victoria, Australia
| | - Scott Barnett
- Applied Artificial Intelligence Institute (A²I²), Deakin University, Geelong, Australia
| | - John C Mathers
- Human Nutrition Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, NE2 4HH, Newcastle upon Tyne, UK
| | - Stephanie L Godrich
- School of Medical and Health Sciences, Edith Cowan University, 6230, Bunbury, WA, Australia
| |
Collapse
|
5
|
Anastasiou K, Ribeiro De Melo P, Slater S, Hendrie GA, Hadjikakou M, Baker PK, Lawrence MA. From harmful nutrients to ultra-processed foods: exploring shifts in 'foods to limit' terminology used in national food-based dietary guidelines. Public Health Nutr 2023; 26:2539-2550. [PMID: 36458692 DOI: 10.1017/s1368980022002580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The choice of terms used to describe 'foods to limit' (FTL) in food-based dietary guidelines (FBDG) can impact public understanding, policy translation and research applicability. The choice of terms in FBDG has been influenced by available science, values, beliefs and historical events. This study aimed to analyse the terms used and definitions given to FTL in FBDG around the world, including changes over time and regional differences. DESIGN A review of terms used to describe FTL and their definitions in all current and past FBDG for adults was conducted, using a search strategy informed by the FAO FBDG website. Data from 148 guidelines (96 countries) were extracted into a pre-defined table and terms were organised by the categories 'nutrient-based', 'food examples' or 'processing-related'. SETTING National FBDG from all world regions. PARTICIPANTS None. RESULTS Nutrient-based terms (e.g. high-fat foods) were the most frequently used type of term in both current and past dietary guidelines (91 %, 85 %, respectively). However, food examples (e.g. cakes) and processing-related terms (e.g. ultra-processed foods) have increased in use over the past 20 years and are now often used in conjunction with nutrient-based terms. Regional differences were only observed for processing-related terms. CONCLUSION Diverse, and often poorly defined, terms are used to describe FTL in FBDG. Policymakers should ensure that FTL terms have clear definitions and can be integrated with other disciplines and understood by consumers. This may facilitate the inclusion of the most contemporary and potentially impactful terminology in nutrition research and policies.
Collapse
Affiliation(s)
- Kim Anastasiou
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
| | - Patricia Ribeiro De Melo
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
| | - Scott Slater
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
| | | | - Michalis Hadjikakou
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Melbourne, VIC, Australia
| | - Phillip K Baker
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Mark Andrew Lawrence
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, Australia
| |
Collapse
|
6
|
Cox DN, Campbell KJ, Cobiac L, Gardner C, Hancock L, Hendrie GA, Kelaart A, Lausen M, Poelman AA, Sambell R, Tikellis KM, Wiggins B. Working together to increase Australian children's liking of vegetables: a position statement by the Vegetable Intake Strategic Alliance (VISA). Public Health Nutr 2023; 26:2271-2275. [PMID: 37519225 DOI: 10.1017/s1368980023001398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Children need to be repeatedly and consistently exposed to a variety of vegetables from an early age to achieve an increase in vegetable intake. A focus on enjoyment and learning to like eating vegetables at an early age is critical to forming favourable lifelong eating habits. Coordinated work is needed to ensure vegetables are available and promoted in a range of settings, using evidence-based initiatives, to create an environment that will support children’s acceptance of vegetables. This will help to facilitate increased intake and ultimately realise the associated health benefits. The challenges and evidence base for a new approach are described.
Collapse
Affiliation(s)
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC3000, Australia
| | - Lynne Cobiac
- CSIRO Health & Biosecurity, Adelaide, SA5000, Australia
| | - Claire Gardner
- Caring Futures Institute, Flinders University, Bedford Park, SA5042, Australia
| | - Lucinda Hancock
- Nutrition Australia (Vic, SA Tas, WA), Melbourne, VIC3000, Australia
| | | | - Amber Kelaart
- Nutrition Australia (Vic, SA Tas, WA), Melbourne, VIC3000, Australia
| | - Michelle Lausen
- Nutrition Australia (Vic, SA Tas, WA), Melbourne, VIC3000, Australia
| | | | - Ros Sambell
- Edith Cowan University, Joondalup, WA6027, Australia
| | | | | |
Collapse
|
7
|
Maher C, Ferguson T, Curtis R, Brown W, Dumuid D, Fraysse F, Hendrie GA, Singh B, Esterman A, Olds T. Weekly, Seasonal, and Festive Period Weight Gain Among Australian Adults. JAMA Netw Open 2023; 6:e2326038. [PMID: 37498598 PMCID: PMC10375309 DOI: 10.1001/jamanetworkopen.2023.26038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Importance Obesity is a major global health concern. A better understanding of temporal patterns of weight gain will enable the design and implementation of interventions with potential to alter obesity trajectories. Objective To describe changes in daily weight across 12 months among Australian adults. Design, Setting, and Participants This cohort study conducted between December 1, 2019, and December 31, 2021 in Adelaide, South Australia, involved 375 community-dwelling adults aged 18 to 65 years. Participants wore a fitness tracker and were encouraged to weigh themselves, preferably daily but at least weekly, using a body weight scale. Data were remotely gathered using custom-developed software. Exposure Time assessed weekly, seasonally, and at Christmas/New Year and Easter. Main Outcomes and Measures Data were visually inspected to assess the overall yearly pattern in weight change. Data were detrended (to remove systematic bias from intraindividual gradual increases or decreases in weight) by calculating a line of best fit for each individual's annual weight change relative to baseline and subtracting this from each participant's weight data. Multilevel mixed-effects linear regression analysis was used to compare weight across days of the week and seasons and at Christmas/New Year and Easter. Results Of 375 participants recruited, 368 (mean [SD] age, 40.2 [5.9] years; 209 [56.8%] female; mean [SD] baseline weight, 84.0 [20.5] kg) provided at least 7 days of weight data for inclusion in analyses. Across the 12-month period, participants gained a median of 0.26% body weight (218 g) (range, -29.4% to 24.0%). Weight fluctuated by approximately 0.3% (252 g) each week, with Mondays and Tuesdays being the heaviest days of the week. Relative to Monday, participants' weight gradually decreased from Tuesday, although not significantly so (mean [SE] weight change, 0.01% [0.03%]; P = .83), to Friday (mean [SE] weight change, -0.18% [0.03%]; P < .001) and increased across the weekend to Monday (mean [SE] weight change for Saturday, -0.16% [0.03%]; P < .001; mean [SE] weight change for Sunday, -0.10% [0.03%]; P < .001). Participants' weight increased sharply at Christmas/New Year (mean [SE] increase, 0.65% [0.03%]; z score, 25.30; P < .001) and Easter (mean [SE] weight change, 0.29% [0.02%], z score, 11.51; P < .001). Overall, participants were heaviest in summer (significantly heavier than in all other seasons), were lightest in autumn (mean [SE] weight change relative to summer, -0.47% [0.07%]; P < .001), regained some weight in winter (mean [SE] weight change relative to summer, -0.23% [0.07%]; P = .001), and became lighter in spring (mean [SE] weight change relative to summer, -0.27% [0.07%]; P < .001). Conclusions and Relevance In this cohort study of Australian adults with weekly and yearly patterns in weight gain observed across 12 months, high-risk times for weight gain were Christmas/New Year, weekends, and winter, suggesting that temporally targeted weight gain prevention interventions may be warranted.
Collapse
Affiliation(s)
- Carol Maher
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Ty Ferguson
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Rachel Curtis
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Wendy Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Brisbane, Australia
| | - Dorothea Dumuid
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Francois Fraysse
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Gilly A Hendrie
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Ben Singh
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Adrian Esterman
- UniSA Clinical and Health Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Timothy Olds
- UniSA Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
8
|
Brankovic A, Hendrie GA, Baird DL, Khanna S. Predicting Disengagement to Better Support Outcomes in a Web-Based Weight Loss Program Using Machine Learning Models: Cross-Sectional Study. J Med Internet Res 2023; 25:e43633. [PMID: 37358890 DOI: 10.2196/43633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/21/2023] [Accepted: 04/16/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Engagement is key to interventions that achieve successful behavior change and improvements in health. There is limited literature on the application of predictive machine learning (ML) models to data from commercially available weight loss programs to predict disengagement. Such data could help participants achieve their goals. OBJECTIVE This study aimed to use explainable ML to predict the risk of member disengagement week by week over 12 weeks on a commercially available web-based weight loss program. METHODS Data were available from 59,686 adults who participated in the weight loss program between October 2014 and September 2019. Data included year of birth, sex, height, weight, motivation to join the program, use statistics (eg, weight entries, entries into the food diary, views of the menu, and program content), program type, and weight loss. Random forest, extreme gradient boosting, and logistic regression with L1 regularization models were developed and validated using a 10-fold cross-validation approach. In addition, temporal validation was performed on a test cohort of 16,947 members who participated in the program between April 2018 and September 2019, and the remaining data were used for model development. Shapley values were used to identify globally relevant features and explain individual predictions. RESULTS The average age of the participants was 49.60 (SD 12.54) years, the average starting BMI was 32.43 (SD 6.19), and 81.46% (39,594/48,604) of the participants were female. The class distributions (active and inactive members) changed from 39,369 and 9235 in week 2 to 31,602 and 17,002 in week 12, respectively. With 10-fold-cross-validation, extreme gradient boosting models had the best predictive performance, which ranged from 0.85 (95% CI 0.84-0.85) to 0.93 (95% CI 0.93-0.93) for area under the receiver operating characteristic curve and from 0.57 (95% CI 0.56-0.58) to 0.95 (95% CI 0.95-0.96) for area under the precision-recall curve (across 12 weeks of the program). They also presented a good calibration. Results obtained with temporal validation ranged from 0.51 to 0.95 for area under a precision-recall curve and 0.84 to 0.93 for area under the receiver operating characteristic curve across the 12 weeks. There was a considerable improvement in area under a precision-recall curve of 20% in week 3 of the program. On the basis of the computed Shapley values, the most important features for predicting disengagement in the following week were those related to the total activity on the platform and entering a weight in the previous weeks. CONCLUSIONS This study showed the potential of applying ML predictive algorithms to help predict and understand participants' disengagement with a web-based weight loss program. Given the association between engagement and health outcomes, these findings can prove valuable in providing better support to individuals to enhance their engagement and potentially achieve greater weight loss.
Collapse
Affiliation(s)
- Aida Brankovic
- The Australian e-Health Research Centre, Health & Biosecurity, Commonwealth Scientific Industrial Research Organisation, Brisbane, Australia
| | - Gilly A Hendrie
- Human Health Program, Health & Biosecurity, Commonwealth Scientific Industrial Research Organisation, Adelaide, Australia
| | - Danielle L Baird
- Human Health Program, Health & Biosecurity, Commonwealth Scientific Industrial Research Organisation, Adelaide, Australia
| | - Sankalp Khanna
- The Australian e-Health Research Centre, Health & Biosecurity, Commonwealth Scientific Industrial Research Organisation, Brisbane, Australia
| |
Collapse
|
9
|
Livingstone KM, Rawstorn JC, Partridge SR, Godrich SL, McNaughton SA, Hendrie GA, Blekkenhorst LC, Maddison R, Zhang Y, Barnett S, Mathers JC, Packard M, Alston L. Digital behaviour change interventions to increase vegetable intake in adults: a systematic review. Int J Behav Nutr Phys Act 2023; 20:36. [PMID: 36973716 PMCID: PMC10042405 DOI: 10.1186/s12966-023-01439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Digital interventions may help address low vegetable intake in adults, however there is limited understanding of the features that make them effective. We systematically reviewed digital interventions to increase vegetable intake to 1) describe the effectiveness of the interventions; 2) examine links between effectiveness and use of co-design, personalisation, behavioural theories, and/or a policy framework; and 3) identify other features that contribute to effectiveness. METHODS A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Library, INFORMIT, IEEE Xplore and Clinical Trial Registries, published between January 2000 and August 2022. Digital interventions to increase vegetable intake were included, with effective interventions identified based on statistically significant improvement in vegetable intake. To identify policy-action gaps, studies were mapped across the three domains of the NOURISHING framework (i.e., behaviour change communication, food environment, and food system). Risk of bias was assessed using Cochrane tools for randomized, cluster randomized and non-randomized trials. RESULTS Of the 1,347 records identified, 30 studies were included. Risk of bias was high or serious in most studies (n = 25/30; 83%). Approximately one quarter of the included interventions (n = 8) were effective at improving vegetable intake. While the features of effective and ineffective interventions were similar, embedding of behaviour change theories (89% vs 61%) and inclusion of stakeholders in the design of the intervention (50% vs 38%) were more common among effective interventions. Only one (ineffective) intervention used true co-design. Although fewer effective interventions included personalisation (67% vs 81%), the degree of personalisation varied considerably between studies. All interventions mapped across the NOURISHING framework behaviour change communication domain, with one ineffective intervention also mapping across the food environment domain. CONCLUSION Few digital interventions identified in this review were effective for increasing vegetable intake. Embedding behaviour change theories and involving stakeholders in intervention design may increase the likelihood of success. The under-utilisation of comprehensive co-design methods presents an opportunity to ensure that personalisation approaches better meet the needs of target populations. Moreover, future digital interventions should address both behaviour change and food environment influences on vegetable intake.
Collapse
Affiliation(s)
- Katherine M Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, VIC, 3125, Melbourne, Australia.
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie L Godrich
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Bunbury, WA, 6230, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Gilly A Hendrie
- Human Health Program, Health & Biosecurity, CSIRO, Adelaide, SA, 5000, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Yuxin Zhang
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Scott Barnett
- Applied Artificial Intelligence Institute (A²I²), Deakin University, Geelong, Australia
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Maria Packard
- The National Heart Foundation of Australia, Melbourne, VIC, 3000, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Australia
- The Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| |
Collapse
|
10
|
Brooker PG, Hendrie GA, Anastasiou K, Woodhouse R, Pham T, Colgrave ML. Marketing strategies used for alternative protein products sold in Australian supermarkets in 2014, 2017, and 2021. Front Nutr 2022; 9:1087194. [PMID: 36618675 PMCID: PMC9815776 DOI: 10.3389/fnut.2022.1087194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Marketing plays an important role in consumers' perceptions and acceptance of new foods. The purpose of this study was to investigate the marketing strategies used for alternative protein products available in Australia in 2014, 2017, and 2021. Methods Product data were extracted from FoodTrack™, an established database of packaged supermarket products. Marketing strategies investigated included product format descriptors, front of pack (FOP) labeling claims, price, and in-store placement (2021 only). Results Data from 292 alternative protein products (n = 12 tofu-based products; n = 100 legume-based products; and n = 180 plant-based meats) were analyzed. Across the product range, "burgers" (n = 86), "strips and similar" (n = 51) and "sausages" (n = 42) were the most common product formats, accounting for ∼61% of the product range. Nutrient content claims featured on 273 (93%) products. "Positive" nutrient claims (those highlighting the presence of a nutrient) occurred on FOP labels four times more than "negative" nutrient claims (those highlighting the absence or low levels of a nutrient; 432 versus 101, respectively). Protein-related claims were the most common "positive" nutrient claim (n = 180, 62%). Health claims on FOP labels appeared on 10% of products. Most products (n = 265, 91%) mentioned a dietary pattern (such as "vegetarian" and "plant-based"), or a combination of dietary patterns on their FOP label. The price of alternative products increased over time; between 2014 and 2021, on average, the unit price increased (9% increase, p = 0.035) and the pack size decreased (14% decrease, p < 0.001). There was inconsistency in product placement across the eight stores visited. Occasionally (n = 3 of 13 locations), chilled alternative protein products were positioned near conventional meat products. More commonly, alternative protein products shared space with other vegetarian products (such as non-dairy cheeses and tofu blocks) or alongside convenience products, suggesting these products are promoted as convenience foods, or options for individuals with special dietary needs. Discussion This study provides a useful evidence base to understand the marketing strategies used for alternative protein products. It appears from this analysis that considerable effort has gone into providing consumers with a level of familiarity and comfort prior to purchasing these alternative protein products.
Collapse
Affiliation(s)
- Paige G. Brooker
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, SA, Australia
| | - Gilly A. Hendrie
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, SA, Australia
| | - Kim Anastasiou
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, SA, Australia
| | - Rachel Woodhouse
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, SA, Australia
- Department of Nutrition and Dietetics, Flinders University, Bedford Park, SA, Australia
| | - Theresa Pham
- Health Research and Innovation, The National Heart Foundation of Australia, Docklands, VIC, Australia
- Grains & Legumes Nutrition Council, North Sydney, NSW, Australia
| | - Michelle L. Colgrave
- Agriculture and Food, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Saint Lucia, QLD, Australia
| |
Collapse
|
11
|
James-Martin G, Baird DL, Hendrie GA, Bogard J, Anastasiou K, Brooker PG, Wiggins B, Williams G, Herrero M, Lawrence M, Lee AJ, Riley MD. Environmental sustainability in national food-based dietary guidelines: a global review. Lancet Planet Health 2022; 6:e977-e986. [PMID: 36495892 DOI: 10.1016/s2542-5196(22)00246-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 07/11/2022] [Accepted: 09/27/2022] [Indexed: 06/17/2023]
Abstract
Food-based dietary guidelines (FBDGs) provide country-specific guidance on what constitutes a healthy diet. With increasing evidence for the synergy between human and planetary health, FBDGs have started to consider the environmental sustainability of food choices. However, the number of countries that discuss environmental sustainability in their guidelines is unknown. The purpose of this Review was to identify countries with government-endorsed FBDGs that made explicit mention of environmental sustainability and to examine the breadth and depth of the inclusion of sustainability in FBDGs. The Food and Agriculture Organization of the UN identified 95 countries with FBDGs. We assessed 83 countries against our inclusion criteria, of which 37 mentioned environmental sustainability. Relevant content was assessed against a set of criteria based on the Food and Agriculture Organization's guiding principles for sustainable healthy diets. The depth to which environmental sustainability was discussed varied and it was often restricted to general explanations of what a sustainable diet is. Few FBDGs addressed why sustainability is important, how dietary changes can be made, or provided quantified advice for implementing sustainable diets.
Collapse
Affiliation(s)
- Genevieve James-Martin
- Commonwealth Scientific and Research Organisation, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
| | - Danielle L Baird
- Commonwealth Scientific and Research Organisation, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Gilly A Hendrie
- Commonwealth Scientific and Research Organisation, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Jessica Bogard
- Commonwealth Scientific and Research Organisation, St Lucia, QLD, Australia
| | - Kim Anastasiou
- Commonwealth Scientific and Research Organisation, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Paige G Brooker
- Commonwealth Scientific and Research Organisation, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Bonnie Wiggins
- Commonwealth Scientific and Research Organisation, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Gemma Williams
- Commonwealth Scientific and Research Organisation, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Mario Herrero
- Department of Global Development, College of Agriculture and Life Sciences, and Cornell Atkinson Center for Sustainability, Cornell University, New York, NY, USA
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Amanda J Lee
- The University of Queensland, Herston, QLD, Australia
| | - Malcolm D Riley
- Commonwealth Scientific and Research Organisation, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| |
Collapse
|
12
|
Hendrie GA, Rebuli MA, James-Martin G, Baird DL, Bogard JR, Lawrence AS, Ridoutt B. Towards healthier and more sustainable diets in the Australian context: comparison of current diets with the Australian Dietary Guidelines and the EAT-Lancet Planetary Health Diet. BMC Public Health 2022; 22:1939. [PMID: 36261800 PMCID: PMC9583557 DOI: 10.1186/s12889-022-14252-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing focus on moving populations towards healthier and more environmentally sustainable dietary patterns. The Australian Dietary Guidelines provide dietary patterns that promote health and wellbeing. It is unclear how these guidelines align with the more recently published global recommendations of the EAT-Lancet Planetary Health Reference Diet, and how Australian diets compare to both sets of recommendations. METHODS Data from one 24-h recall collected for the 2011-13 National Nutrition and Physical Activity Survey were analysed for 5,920 adults aged 19-50 years. Subgroups of this population were identified by diet quality and lower or higher consumption of foods often considered to be environmentally intensive (higher animal meat and dairy foods) or associated with healthiness (higher vegetables and lower discretionary choices). Food group and nutrient composition of Australian diets were compared to diets modelled on the Australian Dietary Guidelines and Planetary Health Reference Diet. The environmental impacts of diets were estimated using an index of combined metrics. RESULTS Compared with the Planetary Health Reference Diet, the Australian Dietary Guidelines contained more servings of the vegetable, dairy and alternatives, fruit, and discretionary choices. The amount of meat and alternatives was higher in the Planetary Health Reference Diet than Australian Dietary Guidelines due to the inclusion of more plant-based meat alternatives. The average Australian diet contained two to almost four times the Australian Dietary Guidelines and Planetary Health Reference Diet maximum recommended intake of discretionary choices, and provided inadequate amounts of the vegetables, cereals, unsaturated fats and meats and alternatives food groups, primarily due to lower intakes of plant-based alternatives. The average Australian diet also contained less dairy and alternatives than the Australian Dietary Guidelines. In the average Australian diet, red meat and poultry contributed 73% to the total servings of meat and alternatives compared to 33% and 10% for the Australian Dietary Guidelines and Planetary Health Reference Diet respectively. The modelled Australian Dietary Guidelines diet met the relevant nutrient reference value for all 22 nutrients examined, whereas the Planetary Health Reference Diet contained an inadequate amount of calcium. The environmental impact scores of the Planetary Health Reference Diet and Australian Dietary Guidelines were 31% and 46% lower than the average Australian diet. CONCLUSIONS Significant changes are required for Australians' dietary intake to align more closely with national and global dietary recommendations for health and environmental sustainability.
Collapse
Affiliation(s)
- Gilly A Hendrie
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia.
| | - Megan A Rebuli
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | | | - Danielle L Baird
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | | | | | - Bradley Ridoutt
- CSIRO Agriculture and Food, Clayton South, Victoria, Australia
| |
Collapse
|
13
|
Ridoutt BG, Baird D, Hendrie GA. The importance of protein variety in a higher quality and lower environmental impact dietary pattern. Public Health Nutr 2022; 25:1-6. [PMID: 36210777 PMCID: PMC9991774 DOI: 10.1017/s1368980022002221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/17/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Eating a variety of nutritious foods is fundamental to good nutrition. However, this principle is challenged when recommendations seeking to improve the environmental sustainability of diets call for avoidance of foods considered to have a higher environmental footprint, such as animal-sourced foods. Our objective was to assess the implications for nutritional adequacy of protein choice across Australian adult diets preselected as having higher quality and lower environmental impact scores. DESIGN Each individual diet was assessed for variety of food choice within the 'Fresh meat and alternatives' food group defined in the Australian Dietary Guidelines, which includes protein-rich foods such as eggs, nuts, tofu and legumes in addition to animal meats. Diets were grouped according to variety score and whether they included only animal meats, only alternatives or a variety of meat and alternatives. Nutrient content was assessed relative to estimated average requirements (EAR). SETTING Australia. PARTICIPANTS 1700 adults participating in the Australian Health Survey. RESULTS For diets with higher diet quality and lower environmental impact, the likelihood of achieving nutrient EAR significantly increased as variety of food choice in the 'Fresh meat and alternatives' food group increased (P < 0·001). Variety score and number of serves were also correlated (r = 0·52, P < 0·001) which is relevant since most diets did not meet the recommended minimum number of serves for this food group. CONCLUSIONS Greater variety within the 'Fresh meat and alternatives' food group is beneficial to meeting EAR and lower environmental impact diets can include three or more selections including foods of animal origin.
Collapse
Affiliation(s)
- Bradley G Ridoutt
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, Clayton South, VIC3168, Australia
- Department of Agricultural Economics, University of the Free State, Bloemfontein, South Africa
| | - Danielle Baird
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Gilly A Hendrie
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| |
Collapse
|
14
|
Ridoutt B, Baird D, Hendrie GA. Diets with Higher Vegetable Intake and Lower Environmental Impact: Evidence from a Large Australian Population Health Survey. Nutrients 2022; 14:nu14071517. [PMID: 35406130 PMCID: PMC9002518 DOI: 10.3390/nu14071517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 12/21/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Bradley Ridoutt
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, Clayton, VIC 3169, Australia
- Department of Agricultural Economics, University of the Free State, Bloemfontein 9300, South Africa
- Correspondence: ; Tel.: +61-3-9545-2159
| | - Danielle Baird
- CSIRO Health and Biosecurity, Adelaide, SA 5000, Australia; (D.B.); (G.A.H.)
| | - Gilly A. Hendrie
- CSIRO Health and Biosecurity, Adelaide, SA 5000, Australia; (D.B.); (G.A.H.)
| |
Collapse
|
15
|
Rebuli MA, Hendrie GA, Baird DL, Mahoney R, Riley MD. Beverage Intake and Associated Nutrient Contribution for Aboriginal and Torres Strait Islander Australians: Secondary Analysis of a National Dietary Survey 2012–2013. Nutrients 2022; 14:nu14030507. [PMID: 35276866 PMCID: PMC8839560 DOI: 10.3390/nu14030507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
Beverages contribute significantly to dietary intake. Research exploring the impact of beverage types on nutrient intake for Australian Aboriginal and Torres Strait Islander people is limited. A secondary analysis of the Australian Aboriginal and Torres Strait Islander Health Survey 2012–2013 (n = 4109) was undertaken. The daily intake, percentage of consumers, and contribution to total nutrient intake was estimated for 12 beverage categories. Beverage intake contributed to 17.4% of total energy, 27.0% of total calcium, 26.3% of total vitamin C, and 46.6% of total sugar intake. The most frequently consumed beverage categories for children (aged 2 to 18 years) were water, fruit juice/drinks, soft drinks, and cordial; and for adults, water, tea, coffee and soft drinks. The primary sources of beverages with added sugar were fruit juice/drinks (for children), tea (for people living remotely), coffee (for adults in metropolitan/regional areas) and soft drinks (for everyone). Actions to modify beverage intake to improve health should maintain the positive nutrient attributes of beverage intake. This analysis of a large-scale national dietary survey provides benchmarking of beverage intake to support program and policy development to modify intake where this is determined as a priority by the community.
Collapse
Affiliation(s)
- Megan A. Rebuli
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, South Australian Health and Medical Research Institute Level 7, Adelaide 5000, Australia; (G.A.H.); (D.L.B.); (M.D.R.)
- Correspondence:
| | - Gilly A. Hendrie
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, South Australian Health and Medical Research Institute Level 7, Adelaide 5000, Australia; (G.A.H.); (D.L.B.); (M.D.R.)
| | - Danielle L. Baird
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, South Australian Health and Medical Research Institute Level 7, Adelaide 5000, Australia; (G.A.H.); (D.L.B.); (M.D.R.)
| | - Ray Mahoney
- Australian e-Health Research Centre, CSIRO Health and Biosecurity, Surgical, Treatment and Rehabilitation Service (STARS) Level 7, Herston 4029, Australia;
| | - Malcolm D. Riley
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, South Australian Health and Medical Research Institute Level 7, Adelaide 5000, Australia; (G.A.H.); (D.L.B.); (M.D.R.)
| |
Collapse
|
16
|
Prahalathan SV, Baird D, Hendrie GA, Rebuli MA, Cox DN. Sensory swap: Modelling the impact of swapping discretionary choices for similar tasting core foods on the energy, nutrients and sensory properties of Australian diets. Appetite 2021; 169:105866. [PMID: 34915107 DOI: 10.1016/j.appet.2021.105866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/29/2021] [Accepted: 12/11/2021] [Indexed: 11/02/2022]
Abstract
Food choice is strongly driven by the sensory characteristics of foods with sweet, salty and fatty mouthfeel considered highly palatable and rewarding. Attempts to improve diet quality have not addressed sensory characteristics of diets before. This report describes a data modelling exercise that could underpin a dietary strategy to help support consumption of higher quality diets without compromising sensory preferences. This study used the Australian National Nutrition and Physical Activity Survey data (in 9341 adults) and the CSIRO sensory-diet database. A method was developed to find core food swaps which had a similar sensory profile as discretionary foods. This study investigated the impact of such swaps on energy and nutrient intake and the impact of the swaps on servings of food groups. The modelling resulted in a similar sensory profile of core foods to that of discretionary foods with hardness, sweetness and fatty mouthfeel all within 1-3% but the saltiness approached a 4% change. There was a small (3.6%) increase in energy intake. This swap strategy decreased the intake of risk nutrients such as saturated fat and added sugars, but not sodium, while increasing the intake of beneficial nutrients like calcium, zinc and vitamin C. Results also show that there was an increase in the intake of servings of core food groups such as fruits, grains, and dairy products but little change in vegetables. In conclusion, similar sensory swaps are possible and could underpin a diet strategy, that could be further refined through food appropriateness, to improve quality.
Collapse
Affiliation(s)
- Sanju V Prahalathan
- CSIRO Health and Biosecurity, PO Box 10041, Adelaide, 5001, Australia; Wageningen University and Research, Wageningen, 6708PB, the Netherlands.
| | - Danielle Baird
- CSIRO Health and Biosecurity, PO Box 10041, Adelaide, 5001, Australia.
| | - Gilly A Hendrie
- CSIRO Health and Biosecurity, PO Box 10041, Adelaide, 5001, Australia.
| | - Megan A Rebuli
- CSIRO Health and Biosecurity, PO Box 10041, Adelaide, 5001, Australia.
| | - David N Cox
- CSIRO Health and Biosecurity, PO Box 10041, Adelaide, 5001, Australia.
| |
Collapse
|
17
|
Hendrie GA, Baird DL, Brindal E, Williams G, Brand-Miller J, Muhlhausler B. Weight Loss and Usage of an Online Commercial Weight Loss Program (the CSIRO Total Wellbeing Diet Online) Delivered in an Everyday Context: Five-Year Evaluation in a Community Cohort. J Med Internet Res 2021; 23:e20981. [PMID: 34096869 PMCID: PMC8218211 DOI: 10.2196/20981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/04/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obesity is a global public health challenge, and there is a need for more evidence-based self-management programs that support longer-term, sustained weight loss. OBJECTIVE This study used data from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) Total Wellbeing Diet Online program to determine the reach and weight loss results over its first 5 years. METHODS Participants were adults who joined the commercial weight loss program of their own volition between October 2014 and September 2019 (N=61,164). Information collected included year of birth, sex, height, weight, and usage data (eg, entries into the food diary, views of the menu, and program content). Weight loss and percentage of starting body weight lost were calculated. Members were divided into 2 groups for analysis: "stayers" were members who signed up for at least 12 weeks of the program and recorded a weight entry at baseline and at the end of the program, while "starters" began the program but did not record a weight after 12 weeks. Descriptive statistics and multiple linear regression were used to describe weight loss and determine the member and program characteristics associated with weight loss. RESULTS Data were available from 59,686 members for analysis. Members were predominately female (48,979/59,686, 82.06%) with an average age of 50 years (SD 12.6). The average starting weight was 90.2 kg (SD 19.7), and over half of all members (34,195/59,688, 57.29%) were classified as obese. At week 12, 94.56% (56,438/59,686) of the members had a paid program membership, which decreased to 41.48% (24,756/59,686) at 24 weeks. At week 12, 52.03% (29,115/55,958) of the remaining members were actively using the platform, and by week 24, 26.59% (14,880/55,958) were using the platform. The average weight loss for all members was 2.8 kg or 3.1% of their starting body weight. Stayers lost 4.9 kg (5.3% of starting body weight) compared to starters, who lost 1.6 kg (1.7% of starting body weight). Almost half (11,082/22,658, 48.91%) the members who stayed on the program lost 5% or more of their starting body weight, and 15.48% (3507/22,658) achieved a weight loss of 10% or more. Of the members who were classified as class 1 obese when they joined the program, 41.39% (3065/7405) who stayed on the program were no longer classified as obese at the end, and across all categories of obesity, 24% (3180/13,319) were no longer classified as obese at the end of the program. Based on multiple linear regression, platform usage was the strongest predictor of weight loss (β=.263; P<.001), with higher usage associated with greater weight loss. CONCLUSIONS This comprehensive evaluation of a commercial, online weight loss program showed that it was effective for weight loss, particularly for members who finished the program and were active in using the platform and tools provided. If the results demonstrated here can be achieved at an even greater scale, the potential social and economic benefits will be extremely significant.
Collapse
Affiliation(s)
- Gilly A Hendrie
- Nutrition and Health Program, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Danielle L Baird
- Nutrition and Health Program, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Emily Brindal
- Nutrition and Health Program, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Gemma Williams
- Nutrition and Health Program, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Jennie Brand-Miller
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
| | - Beverly Muhlhausler
- Nutrition and Health Program, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| |
Collapse
|
18
|
Curtis RG, Olds T, Ferguson T, Fraysse F, Dumuid D, Esterman A, Hendrie GA, Brown WJ, Lagiseti R, Maher CA. Changes in diet, activity, weight, and wellbeing of parents during COVID-19 lockdown. PLoS One 2021; 16:e0248008. [PMID: 33657182 PMCID: PMC7928513 DOI: 10.1371/journal.pone.0248008] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/17/2021] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 pandemic has dramatically impacted lifestyle behaviour as public health initiatives aim to “flatten the curve”. This study examined changes in activity patterns (physical activity, sedentary time, sleep), recreational physical activities, diet, weight and wellbeing from before to during COVID-19 restrictions in Adelaide, Australia. This study used data from a prospective cohort of Australian adults (parents of primary school-aged children; n = 61, 66% female, aged 41±6 years). Participants wore a Fitbit Charge 3 activity monitor and weighed themselves daily using Wi-Fi scales. Activity and weight data were extracted for 14 days before (February 2020) and 14 days during (April 2020) COVID-19 restrictions. Participants reported their recreational physical activity, diet and wellbeing during these periods. Linear mixed effects models were used to examine change over time. Participants slept 27 minutes longer (95% CI 9–51), got up 38 minutes later (95% CI 25–50), and did 50 fewer minutes (95% CI -69–-29) of light physical activity during COVID-19 restrictions. Additionally, participants engaged in more cycling but less swimming, team sports and boating or sailing. Participants consumed a lower percentage of energy from protein (-0.8, 95% CI -1.5–-0.1) and a greater percentage of energy from alcohol (0.9, 95% CI 0.2–1.7). There were no changes in weight or wellbeing. Overall, the effects of COVID-19 restrictions on lifestyle were small; however, their impact on health and wellbeing may accumulate over time. Further research examining the effects of ongoing social distancing restrictions are needed as the pandemic continues.
Collapse
Affiliation(s)
- Rachel G. Curtis
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- * E-mail:
| | - Timothy Olds
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Ty Ferguson
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - François Fraysse
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Adrian Esterman
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Gilly A. Hendrie
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia
| | - Wendy J. Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Rajini Lagiseti
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Carol A. Maher
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
19
|
Cox DN, Baird DL, Rebuli MA, Hendrie GA, Poelman AAM. Sensory characteristics of vegetables consumed by Australian children. Public Health Nutr 2021; 25:1-12. [PMID: 33618787 PMCID: PMC9991597 DOI: 10.1017/s1368980021000847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/18/2021] [Accepted: 02/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Consumption is driven by children's sensory acceptance, but little is known about the sensory characteristics of vegetables that children commonly eat. A greater understanding could help design more effective interventions to help raise intakes, thus realising beneficial health effects. This study sought to: (1) Understand the vegetable consumption patterns in children, with and without potatoes, using the Australian and WHO definitions. (2) Describe the sensory characteristics of vegetables consumed by children by age group, level of intake and variety. (3) Determine the vegetable preferences of children, by age group, level of intake and variety. DESIGN Analysis of National Nutrition Survey data, combining reported vegetable intake with sensory characteristics described by a trained panel. SETTING Australia. PARTICIPANTS A nationally representative sample of Australian children and adolescents aged 2-17·9 years (n 2812). RESULTS While consumption increased in older age groups, variety remained constant. Greater variety, however, was associated with higher vegetable consumption. Potato intake increased with consumption, contributing over one-third of total vegetable intake for highest vegetable consumption and for older age groups. Children favoured relatively sweet vegetables and reported lower consumption of bitter vegetables. There were no differences in the sensory properties of vegetables consumed by children in different age groups. After potatoes, carrots, sweetcorn, mixtures, fruiting and cruciferous types were preferred vegetables. CONCLUSION Children tend to prefer vegetables with sensory characteristics consistent with innate taste preferences (sweet and low bitterness). Increasing exposure to a variety of vegetables may help increase the persistently low vegetable consumption patterns of children.
Collapse
Affiliation(s)
- David N Cox
- CSIRO Health and Biosecurity, Adelaide, SA5000, Australia
| | | | - Megan A Rebuli
- CSIRO Health and Biosecurity, Adelaide, SA5000, Australia
| | | | | |
Collapse
|
20
|
James-Martin G, Baird DL, Hendrie GA. Strategies to Reduce Consumption of Unhealthy Foods and Beverages: Scenario Modeling to Estimate the Impact on the Australian Population's Energy and Nutrient Intakes. J Acad Nutr Diet 2021; 121:1463-1483. [PMID: 33495107 DOI: 10.1016/j.jand.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Overconsumption of energy-dense, nutrient-poor "discretionary" foods and beverages can indicate poor diet quality, which is a risk factor for obesity and chronic disease. With 60% of Australians exceeding the recommended intake of discretionary foods, there is a need for interventions to reduce their consumption. OBJECTIVE The objective was to model the impact of 26 specific scenarios to limit discretionary food intake on energy and nutrient intake. DESIGN The scenario modeling analysis was based on reduction strategies targeting portion size, frequency, or variety of discretionary food and beverage items consumed. PARTICIPANTS/SETTING Data from 12,153 respondents aged 2 to 85 years from the 2011-12 Australian National Nutrition and Physical Activity Survey were used. OUTCOME MEASURES The outcome measures were change in servings of discretionary foods and key nutrients (energy, total fat, saturated fat, sugar, alcohol, sodium, trans fat) for the population, and by sex, age group, weight status, and socioeconomic status. STATISTICAL ANALYSES PERFORMED Descriptive and inferential statistical analysis were conducted. RESULTS Scenarios reduced total energy intake by up to 26% across the population as a whole. The removal of discretionary foods (not beverages) resulted in the greatest reduction in servings and energy (74.8% and 25.6%, respectively), followed by the removal of discretionary items in portions greater than 143 kcal (59.1% and 24.3%) and not consuming discretionary items at main meals (51.2% and 17.8%). Targeting single categories of discretionary foods reduced energy intake by an average of 5.6% for the removal of cakes and biscuits, 4.4% for alcohol, and 3.9% for sugar-sweetened beverages. Strategies reduced total fat, saturated fat, and sugar by up to 35%, 38%, and 40% respectively. CONCLUSIONS Strategies that are specific to discretionary food and beverage intake targeting reductions in portion size, frequency, or variety have the potential to reduce energy intake and improve diet quality. These findings have implications for designing interventions with potential to tailor messages to current dietary habits. Exploration of how these strategies could be effectively implemented will be the focus of further research.
Collapse
|
21
|
Curtis RG, Olds T, Fraysse F, Dumuid D, Hendrie GA, Esterman A, Brown WJ, Ferguson T, Lagiseti R, Maher CA. Annual rhythms in adults' lifestyle and health (ARIA): protocol for a 12-month longitudinal study examining temporal patterns in weight, activity, diet, and wellbeing in Australian adults. BMC Public Health 2021; 21:70. [PMID: 33413247 PMCID: PMC7791783 DOI: 10.1186/s12889-020-10054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost one in three Australian adults are now obese, and the rate continues to rise. The causes of obesity are multifaceted and include environmental, cultural and lifestyle factors. Emerging evidence suggests there may be temporal patterns in weight gain related, for example, to season and major festivals such as Christmas, potentially due to changes in diet, daily activity patterns or both. The aim of this study is to track the annual rhythm in body weight, 24 h activity patterns, dietary patterns, and wellbeing in a cohort of Australian adults. In addition, through data linkage with a concurrent children's cohort study, we aim to examine whether changes in children's body mass index, activity and diet are related to those of their parents. METHODS A community-based sample of 375 parents aged 18 to 65 years old, residing in or near Adelaide, Australia, and who have access to a Bluetooth-enabled mobile device or a computer and home internet, will be recruited. Across a full year, daily activities (minutes of moderate to vigorous physical activity, light physical activity, sedentary behaviour and sleep) will be measured using wrist-worn accelerometry (Fitbit Charge 3). Body weight will be measured daily using Fitbit wifi scales. Self-reported dietary intake (Dietary Questionnaire for Epidemiological Studies V3.2), and psychological wellbeing (WHOQOL-BREF and DASS-21) will be assessed eight times throughout the 12-month period. Annual patterns in weight will be examined using Lowess curves. Associations between changes in weight and changes in activity and diet compositions will be examined using repeated measures multi-level models. The associations between parent's and children's weight, activity and diet will be investigated using multi-level models. DISCUSSION Temporal factors, such as day type (weekday or weekend day), cultural celebrations and season, may play a key role in weight gain. The aim is to identify critical opportunities for intervention to assist the prevention of weight gain. Family-based interventions may be an important intervention strategy. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry, identifier ACTRN12619001430123 . Prospectively registered on 16 October 2019.
Collapse
Affiliation(s)
- Rachel G Curtis
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Timothy Olds
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - François Fraysse
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Gilly A Hendrie
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia
| | - Adrian Esterman
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Ty Ferguson
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Rajini Lagiseti
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Carol A Maher
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.
| |
Collapse
|
22
|
Hendrie GA, Lyle G, Mauch CE, Haddad J, Golley RK. Understanding the Variation within a Dietary Guideline Index Score to Identify the Priority Food Group Targets for Improving Diet Quality across Population Subgroups. Int J Environ Res Public Health 2021; 18:E378. [PMID: 33418998 PMCID: PMC7825319 DOI: 10.3390/ijerph18020378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 11/18/2022]
Abstract
Globally, population dietary intakes fall below the guideline recommendations and large-scale interventions have had modest success in improving diet quality. To inform the development of more targeted approaches, this study analysed the variations in self-reported data from an online survey of Australian adults collected between 2015 and 2020, to identify common combinations of low scoring components within a dietary guideline index. A low score was defined as meeting less than half the guideline recommendations (a score <50 out of 100). Among 230,575 adults, a single component analysis showed that 79.5% had a low score for discretionary choices, 72.2% for healthy fats and 70.8% for dairy. The combinations approach showed 83.0% of individuals had two to five low scoring components, with men, younger adults aged 18-30 years and individuals with obesity (BMI ≥ 30) more likely to have five or more. The most common dietary pattern combination included low scores for discretionary choices, dairy and healthy fats. There was a considerable but systematic variation in the low scoring components within the dietary patterns, suggesting that interventions with the flexibility to address particular combinations of key food groups across subgroups could be an effective and resource efficient way to improve diet quality in the population.
Collapse
Affiliation(s)
- Gilly A. Hendrie
- Nutrition and Health Program, Health & Biosecurity, CSIRO, Adelaide, SA 5000, Australia; (G.A.H.); (J.H.)
| | - Greg Lyle
- School of Public Health, Curtin University, Bentley Campus, Perth, WA 6102, Australia;
| | - Chelsea E. Mauch
- Nutrition and Health Program, Health & Biosecurity, CSIRO, Adelaide, SA 5000, Australia; (G.A.H.); (J.H.)
| | - Joyce Haddad
- Nutrition and Health Program, Health & Biosecurity, CSIRO, Adelaide, SA 5000, Australia; (G.A.H.); (J.H.)
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Rebecca K. Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| |
Collapse
|
23
|
Johnson BJ, Golley RK, Zarnowiecki D, Hendrie GA, Huynh EK. Understanding the influence of physical resources and social supports on primary food providers' snack food provision: a discrete choice experiment. Int J Behav Nutr Phys Act 2020; 17:155. [PMID: 33256737 PMCID: PMC7706064 DOI: 10.1186/s12966-020-01062-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Snack eating occasions contribute approximately a third of children's energy intake, with approximately half of all unhealthy foods consumed during snack times. Therefore, it is critical to understand the drivers of primary food providers' snack provision. The study aims were to determine the relative importance of physical resources and social supports when primary food providers are choosing snacks to provide to their child, and to investigate how these attributes differ in social versus non-social occasions, and between subgroups of primary food providers based on socio-economic position. METHODS Primary food providers of three to seven-year olds completed an online discrete choice experiment, by making trade-offs when completing repeated, hypothetical choice tasks on the choice of snacks to provide to their child in: 1) non-social and 2) social condition. Choice tasks included two alternatives consisting of varying attribute (i.e. factor) levels, and an opt-out option. The order of conditions shown were randomized across participants. Multinomial logit model analyses were used to determine utility weights for each attribute. RESULTS Two-hundred and twenty-five primary food providers completed the study, providing 1125 choice decisions per condition. In the non-social condition, the top three ranked attributes were type of food (utility weight 1.94, p < 0.001), child resistance (- 1.62, p < 0.001) and co-parent support (0.99, p < 0.001). In the social condition, top ranking attributes were child resistance (utility weight - 1.50, p < 0.001), type of food (1.38, p < 0.001) and co-parent support (1.07, p < 0.001). In both conditions, time was not a significant influence and cost was of lowest relative importance. Subgroup analyses revealed cost was not a significant influence for families from higher socio-economic backgrounds. CONCLUSIONS Type of food, child resistance and co-parent support were of greatest relative importance in primary food providers' snack provision decision-making, regardless of social condition or socio-economic position. In designing future interventions to reduce unhealthy snacks, researchers should prioritize these influences, to better support primary food providers in changing their physical and social opportunity. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry no. ACTR N12618001173280.
Collapse
Affiliation(s)
- Brittany J Johnson
- Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia.
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
- Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney, New South Wales, Australia
| | - Dorota Zarnowiecki
- Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
- Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney, New South Wales, Australia
| | - Gilly A Hendrie
- Health & Biosecurity Flagship, Commonwealth Scientific Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Elisabeth K Huynh
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Acton, Australian Capital Territory, Australia
| |
Collapse
|
24
|
Hendrie GA, Hussain MS, Brindal E, James-Martin G, Williams G, Crook A. Impact of a Mobile Phone App to Increase Vegetable Consumption and Variety in Adults: Large-Scale Community Cohort Study. JMIR Mhealth Uhealth 2020; 8:e14726. [PMID: 32301739 PMCID: PMC7195662 DOI: 10.2196/14726] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/16/2019] [Accepted: 11/12/2019] [Indexed: 01/22/2023] Open
Abstract
Background Large-scale initiatives to improve diet quality through increased vegetable consumption have had small to moderate success. Digital technologies have features that are appealing for health-related behavior change interventions. Objective This study aimed to describe the implementation and evaluation of a mobile phone app called VegEze, which aims to increase vegetable intake among Australian adults. Methods To capture the impact of this app in a real-world setting, the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was utilized. An uncontrolled, quantitative cohort study was conducted, with evaluations after 21 and 90 days. The app was available in the Apple App Store and was accompanied by television, radio, and social media promotion. Evaluation surveys were embedded into the app using ResearchKit. The primary outcomes were vegetable intake (servings per day) and vegetable variety (types per day). Psychological variables (attitudes, intentions, self-efficacy, and action planning) and app usage were also assessed. Descriptive statistics and multiple linear regression were used to describe the impact of the app on vegetable intake and to determine the characteristics associated with the increased intake. Results Data were available from 5062 participants who completed the baseline survey; 1224 participants completed the 21-day survey, and 273 completed the 90-day survey. The participants resided across Australia and were mostly women (4265/5062, 84.3%) with a mean age of 48.2 years (SD 14.1). The mean increase in intake was 0.48 servings, from 3.06 servings at baseline to 3.54 servings at the end of the 21-day challenge (t1223=8.71; P<.001). The variety of vegetables consumed also increased by 0.35 types per day (t1123=9.59; P<.001). No changes in intake and variety were found from day 21 to the 90-day follow-up. Participants with the highest app usage increased their vegetable intake by 0.63 (SD 2.02) servings per day compared with 0.32 (SD 1.69) servings per day for those with the lowest app usage. On the basis of multiple linear regression, gender; age; BMI; psychological variables of self-efficacy, attitudes, intentions, and action planning specific to vegetable intake; baseline vegetable intake; and active days of app usage accounted for 23.3% of the variance associated with the change in intake (F9,1208=42.09; P<.001). Baseline vegetable intake was the strongest predictor of change in intake (beta=−.495; P<.001), with lower baseline intake associated with a greater change in intake. Self-efficacy (beta=.116; P<.001), action planning (beta=.066; P=.02), BMI (beta=.070; P=.01), and app usage (beta=.081; P=.002) were all significant predictors of the change in intake. Conclusions The VegEze app was able to increase intake by half a serving in a large sample of Australian adults. Testing the app in a real-world setting and embedding the consent process allowed for greater reach and an efficient, robust evaluation. Further work to improve engagement is warranted.
Collapse
Affiliation(s)
- Gilly A Hendrie
- Nutrition and Health Program, CSIRO Health & Biosecurity, Adelaide, Australia
| | - M Sazzad Hussain
- The Australian eHealth Research Center, CSIRO Health & Biosecurity, Sydney, Australia
| | - Emily Brindal
- Nutrition and Health Program, CSIRO Health & Biosecurity, Adelaide, Australia
| | | | - Gemma Williams
- Nutrition and Health Program, CSIRO Health & Biosecurity, Adelaide, Australia
| | - Anna Crook
- SP Health Co. Pty Ltd, Sydney, Australia
| |
Collapse
|
25
|
Brownlee IA, Low J, Duriraju N, Chun M, Ong JXY, Tay ME, Hendrie GA, Santos-Merx L. Evaluation of the Proximity of Singaporean Children's Dietary Habits to Food-Based Dietary Guidelines. Nutrients 2019; 11:nu11112615. [PMID: 31683840 PMCID: PMC6893683 DOI: 10.3390/nu11112615] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 01/29/2023] Open
Abstract
Dietary habits in children may not only impact current health status but could also shape future, lifelong dietary choices. Dietary intake data in Singaporean children are limited. The current study aimed to define the overall diet quality of Singaporean children using an existing cross-sectional dataset and to consider how demographic factors (i.e., body mass index (BMI) status, ethnicity, age, and sex) were associated with these scores. Existing, cross-sectional dietary data (n = 561 children aged 6–12 years, collected in 2014–2015) from duplicate 24-h recalls were assessed for diet quality using an index based on the Singaporean Health Promotion Board dietary guidelines. Total diet quality scores were calculated from ten different components (frequencies of rice and alternatives, whole grains, fruits, vegetables, meat and alternatives, dairy and alternatives, total fat, saturated fat, sodium intake, and added sugars). Association with demographic factors and BMI category was evaluated by one-way multivariate ANOVA (MANOVA) tests, with Bonferroni post hoc analyses. Median (interquartile range) total diet quality scores were 65.4 (57.1–73.0). Median scores for whole grains (0.0, 0.0–33.4), fruits (24.1, 0.0–65.3), vegetables (36.5, 10.4-89.8), and sodium (58.4, 0.0–100.0) intake were frequently sub-optimal. Children of Malay ethnic origin had statistically lower total diet quality scores ((55.3, 47.5–60.3) vs. other ethnic groups (combined median 65.4 (57.1, 73.0); p < 0.001). These findings highlight the need for continuing efforts to improve dietary intake in young Singaporeans and for longitudinal dietary monitoring in this group.
Collapse
Affiliation(s)
- Iain A Brownlee
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne NE1 8ST, UK.
- Newcastle Research and Innovation Institute, Devan Nair Building, Singapore 600201, Singapore.
- CSIRO Nutrition & Health Program, SAHMRI Building, Adelaide SA5000, Australia.
| | - Jasmine Low
- Newcastle Research and Innovation Institute, Devan Nair Building, Singapore 600201, Singapore.
| | - Naageswari Duriraju
- Newcastle Research and Innovation Institute, Devan Nair Building, Singapore 600201, Singapore.
| | - Mavis Chun
- CSIRO Nutrition & Health Program, SAHMRI Building, Adelaide SA5000, Australia.
| | - Jessica Xiu Yan Ong
- Newcastle Research and Innovation Institute, Devan Nair Building, Singapore 600201, Singapore.
| | - Mia Eng Tay
- School of Chemical & Life Sciences, Nanyang Polytechnic, Singapore 569830, Singapore.
| | - Gilly A Hendrie
- Newcastle Research and Innovation Institute, Devan Nair Building, Singapore 600201, Singapore.
| | - Lourdes Santos-Merx
- Newcastle Research and Innovation Institute, Devan Nair Building, Singapore 600201, Singapore.
- Institute of Allied Health Sciences Research, De Montfort University, Leicester LE1 9BH, UK.
| |
Collapse
|
26
|
Brindal E, Hendrie GA, Freyne J, Noakes M. A Mobile Phone App Designed to Support Weight Loss Maintenance and Well-Being (MotiMate): Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e12882. [PMID: 31486407 PMCID: PMC6834303 DOI: 10.2196/12882] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/29/2019] [Accepted: 06/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background Few people successfully maintain lost weight over the longer term. Mobile phones have the potential to deliver weight loss management programs that can encourage self-monitoring while also providing some behavioral therapy to assist users in developing personal skills that may be necessary for improved longer term weight loss maintenance. Objective The aim of this study was to evaluate a program supporting weight maintenance, which uses a behaviorally based mobile phone app to manage weight, food, exercise, mood, and stress. Methods In a randomized controlled trial over 24 weeks, the full version of the app (MotiMate) was compared with a control app (monitoring only; excluding mood and stress) for its effect on weight, diet, and psychological well-being. Both apps had the same visual appearance and were designed to deliver all intervention content without face-to-face contact. The control version included features to track weight, food intake, and exercise with limited feedback and no encouraging/persuasive features. The intervention app included more persuasive and interactive features to help users track their weight, food intake, and physical activity and prompted users to enter data each day through notifications and included a mood and stress workshopping tool. Participants were recruited through advertising and existing databases. Clinic visits occurred at baseline, 4 weeks, 8 weeks, 12 weeks, and 24 weeks. At all visits, the clinical trial manager recorded body weight, and participants then completed a computer-delivered survey, which measured psychological and lifestyle outcomes. Objective app usage data were recorded throughout the trial. Results A total of 88 adults who had lost and maintained at least 5% of their body weight within the last 2 years were randomized (45 MotiMate and 43 control). Overall, 75% (66/88) were female, and 69% (61/88) completed week 24 with no differences in dropout by condition (χ21,87=0.7, P=.49). Mixed models suggested no significant changes in weight or psychological outcomes over 24 weeks regardless of condition. Of 61 completers, 53% (32/61) remained within 2% of their starting weight. Significant increases occurred over 24 weeks for satisfaction with life and weight loss self-efficacy regardless of app condition. Diet and physical activity behaviors did not vary by app or week. Negative binomial models indicated that those receiving the full app remained active users of the app for 46 days longer than controls (P=.02). Users of the full version of the app also reported that they felt more supported than those with the control app (P=.01). Conclusions Although some aspects of the intervention app such as usage and user feedback showed promise, there were few observable effects on behavioral and psychological outcomes. Future evaluation of the app should implement alternative research methods or target more specific populations to better understand the utility of the coping interface. Trial Registration Australia New Zealand Clinical Trials Registry ACTRN12614000474651; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366120
Collapse
Affiliation(s)
- Emily Brindal
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Gilly A Hendrie
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Jill Freyne
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Epping, Australia
| | - Manny Noakes
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| |
Collapse
|
27
|
Ridoutt BG, Baird D, Anastasiou K, Hendrie GA. Diet Quality and Water Scarcity: Evidence from a Large Australian Population Health Survey. Nutrients 2019; 11:nu11081846. [PMID: 31404949 PMCID: PMC6723970 DOI: 10.3390/nu11081846] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 01/19/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Bradley G Ridoutt
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, Clayton South, VIC 3168, Australia.
- Department of Agricultural Economics, University of the Free State, Bloemfontein 9300, South Africa.
| | - Danielle Baird
- CSIRO Health and Biosecurity, Adelaide, SA 5000, Australia
| | | | | |
Collapse
|
28
|
Bogard JR, Farmery AK, Baird DL, Hendrie GA, Zhou S. Linking Production and Consumption: The Role for Fish and Seafood in a Healthy and Sustainable Australian Diet. Nutrients 2019; 11:nu11081766. [PMID: 31374858 PMCID: PMC6723351 DOI: 10.3390/nu11081766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 11/16/2022] Open
Abstract
Fish and seafood consumption in Australia has been growing, yet the implications of this trend across the food system, from both a health and sustainability perspective have not been fully explored. This paper aims to map out the fish and seafood food system in Australia, linking production and consumption, to articulate challenges and opportunities for enhancing the sector’s contribution to future healthy and sustainable diets. We conducted a secondary analysis of publicly available datasets on fish and seafood production and consumption, triangulated and supplemented with peer-reviewed and grey literature on environmental, economic and social sustainability issues throughout the food system. A key challenge for health is the high proportion of fish and seafood consumed as discretionary food, particularly among children. Key challenges for sustainability include the narrow focus on environmental sustainability (with little consideration of the other domains), and the focus on production with little consideration for sustainability throughout post-harvest handling, processing, retail, distribution and consumption. Key opportunities for health and sustainability include the innovative use of processing and packaging technology to maximise nutritional quality; creation of markets and supply chains for a greater diversity of underutilised fish and seafood species and processing by-products; and reductions in waste and loss throughout the entire supply chain.
Collapse
Affiliation(s)
| | - Anna K Farmery
- University of Wollongong, Australian National Centre for Ocean Resources and Security, Wollongong 2522, Australia.
| | | | | | - Shijie Zhou
- CSIRO, Oceans and Atmosphere, Brisbane 4072, Australia
| |
Collapse
|
29
|
Johnson BJ, Hendrie GA, Zarnowiecki D, Huynh EK, Golley RK. Examining Constructs of Parental Reflective Motivation towards Reducing Unhealthy Food Provision to Young Children. Nutrients 2019; 11:nu11071507. [PMID: 31266219 PMCID: PMC6682954 DOI: 10.3390/nu11071507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 11/28/2022] Open
Abstract
Parents are an ideal target to reduce children’s unhealthy food intake. Motivation is one component of behavior change; however, there is a paucity of research exploring parental motivation in unhealthy food provision. This study aimed to understand the relationships between, and relative importance of, constructs of parents’ reflective motivation and children’s intake of unhealthy foods. An online survey captured parent-rated reflective motivation constructs based on the health action process approach (HAPA) model, and children’s intake of unhealthy food using the short food survey. The HAPA model includes constructs of self-efficacy, risk perception, outcome expectancies, intention, and planning. Structural equation modelling was used to examine relationships between constructs and the HAPA model in its structural form. Four-hundred and ninety-five parents of three to seven-year olds completed the study. Model fit statistics (X2 = 210.03, df = 83, p < 0.001; Comparative fit index (CFI) = 0.96; Tucker Lewis index (TLI) = 0.94) supported suitability of the HAPA model. The HAPA model explained 9.2% of the variance in children’s unhealthy food intake. Constructs of self-efficacy (action to maintenance β = 0.69; maintenance to recovery β = 0.70; maintenance to planning β = 0.82) were found to be the most important constructs for reducing children’s unhealthy food intake, followed by planning (to unhealthy food intake β = −0.32) and intention (to planning β = 0.21). This study provides an initial insight into parental motivation and identifies primary intervention targets to enhance parental motivation to reduce unhealthy food provision, and subsequently children’s unhealthy food intake.
Collapse
Affiliation(s)
- Brittany J Johnson
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park 5042, South Australia, Australia.
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5000, South Australia, Australia.
| | - Gilly A Hendrie
- Health and Biosecurity Flagship, Commonwealth Scientific Industrial Research Organisation, Adelaide 5000, South Australia, Australia
| | - Dorota Zarnowiecki
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park 5042, South Australia, Australia
- Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney 2006, New South Wales, Australia
| | - Elisabeth K Huynh
- College of Health and Medicine, The Australian National University, Acton 2600, Australian Capital Territory, Australia
| | - Rebecca K Golley
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park 5042, South Australia, Australia
- Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney 2006, New South Wales, Australia
| |
Collapse
|
30
|
Riley MD, Hendrie GA, Baird DL. Drink Choice is Important: Beverages Make a Substantial Contribution to Energy, Sugar, Calcium and Vitamin C Intake among Australians. Nutrients 2019; 11:nu11061389. [PMID: 31226860 PMCID: PMC6627926 DOI: 10.3390/nu11061389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022] Open
Abstract
It is important to understand the role of beverages in population dietary intake in order to give relevant advice. Population estimates were derived from one-day food recall dietary data from 12,153 participants in the 2011–2012 Australian National Nutrition and Physical Activity Survey. Almost all Australians (99.9%) consumed at least one beverage on the day of the survey, accounting for 16.6% of the total energy intake for adults (aged 19 years and over) and 13.0% for children (aged 2–18 years). Similarly, beverages contributed 26–29% to calcium intake, 22–28% to vitamin C intake, and 35–36% to sugar intake. Water was consumed on the day of the survey by 84.1% of Australian adults and 90.5% of children. For adults, the greatest beverage contributors to total energy intake were alcoholic drinks (5.6%), coffee (3.1%), and soft drinks (1.9%), and for children, plain milk (3.1%), flavoured milk (2.8%), and fruit juice (2.6%). Coffee (10.6%) made the greatest contribution to calcium intake for adults; and plain milk (9.9%) and flavoured milk (7.6%) for children. The greatest contributors to vitamin C intake were fruit juice (13.4%) and alcoholic drinks (6.1%) for adults; and fruit juice (23.4%) for children. For total sugar intake, soft drinks (8.0%), coffee (8.4%), and fruit juice (5.9%) made the highest contribution for adults; and fruit juice (9.8%) and soft drinks (8.7%) for children. The type and amount of beverage consumption has considerable relevance to dietary quality for Australians.
Collapse
Affiliation(s)
- Malcolm D Riley
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, P.O. Box 10041, Adelaide BC, SA 5000, Australia.
| | - Gilly A Hendrie
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, P.O. Box 10041, Adelaide BC, SA 5000, Australia.
| | - Danielle L Baird
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, P.O. Box 10041, Adelaide BC, SA 5000, Australia.
| |
Collapse
|
31
|
Hendrie GA, James-Martin G, Williams G, Brindal E, Whyte B, Crook A. The Development of VegEze: Smartphone App to Increase Vegetable Consumption in Australian Adults. JMIR Form Res 2019; 3:e10731. [PMID: 30916653 PMCID: PMC6456819 DOI: 10.2196/10731] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/25/2018] [Accepted: 12/30/2018] [Indexed: 01/19/2023] Open
Abstract
Background Poor-quality dietary patterns are often characterized by inadequate consumption of fruits and vegetables. Changing dietary behavior is difficult, and although it is often clear what needs to change, how to enact change is more difficult. Smartphones have characteristics that may support the complexity of changing dietary behavior. Objective This paper describes the iterative process of developing a theory-based smartphone app called VegEze that aimed to increase vegetable consumption. Methods To upscale, reach target users, and create a user-friendly end product, a collaborative research-industry partnership was formed to build the app over a 20-week period. The Integrate, Design, Assess, and Share framework was used as a scientific basis to guide the development. The behavior change wheel was also used as a theoretical grounding in combination with other theory-based strategies, such as self-monitoring, social comparison, and gamification—which have all been shown to be successful in dietary change or digital health interventions. We conducted 1 consumer survey (N=1068), 1 usability testing session (N=11), and a pilot effectiveness and usability trial (N=283) to inform the design of the app. Results The target behavior for the app was defined as having 3 different types of vegetables at dinner. The perceived achievability of this target behavior was high; 93% of respondents (993/1068 users) felt they were likely or very likely to be able to regularly achieve the behavior. App features that users wanted included the following: recipes and meal ideas (876/1068, 82% of users), functionality to track their intake (662/1068, 62%), and information on how to prepare vegetables (545/1068, 51%). On the basis of importance of self-monitoring as a behavior change technique (BCT) and its rating by users, the vegetable tracker was a core feature of the app and was designed to be quick and simple to use. Daily feedback messages for logging intake and communicating progress were designed to be engaging and fun, using friendly, positive language and emoji icons. Daily and weekly feedback on vegetable consumption was designed to be simple, informative, and reinforce monitoring. A creative team was engaged to assist in the branding of the app to ensure it had an identity that reflected the fun and simple nature of the underlying behavior. The app included 16 BCTs, most of which were from the goals and planning subsection of the BCT taxonomy. Conclusions Combining a theoretical framework with an industry perspective and input resulted in an app that was developed in a timely manner while retaining its evidence-base. VegEze is an iOS app currently available in the App Store, and the overall impact of the VegEze app will be evaluated in an uncontrolled, quantitative study. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618000481279; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12618000481279 (Archived by WebCite: at http://www.webcitation.org/769oG9EaA)
Collapse
Affiliation(s)
- Gilly A Hendrie
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Genevieve James-Martin
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Gemma Williams
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Emily Brindal
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Ben Whyte
- SP Health Co Pty Ltd, Sydney, Australia
| | | |
Collapse
|
32
|
Golley S, Baird D, Hendrie GA, Mohr P. Thinking about going wheat-free? Evidence of nutritional inadequacies in the dietary practices of wheat avoiders. Nutr Diet 2019; 76:305-312. [PMID: 30873744 DOI: 10.1111/1747-0080.12521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/10/2018] [Accepted: 01/28/2019] [Indexed: 11/30/2022]
Abstract
AIM To assess dietary intake and nutritional adequacy amongst self-identified symptomatic wheat-avoiders. METHODS Thirty-four self-identified symptomatic avoiders of wheat-based products without a diagnosis of coeliac disease or wheat allergy were recruited to participate in a dietary assessment study. Dietary intake was assessed via a three-day weighed food record. Participants were aged 33 to 83 years, were predominantly women (n = 30) and had been avoiding wheat for a mean of six years. Nutrient intakes were compared with Nutrient Reference Values. Food group intakes were assessed and consumption of wheat-containing and wheat-free cereal-based foods described. RESULTS Inadequate intakes of key protective nutrients such as fibre and calcium were common; many participants reported avoiding dairy as well as wheat. Intakes of total and saturated fat exceeded recommendations. Although 85% of the sample reported avoiding all wheat products, at least one third of cereal products and dishes consumed in this group, comprising mostly discretionary-type foods, were wheat based. CONCLUSIONS Dietary intake patterns and resulting nutrient imbalances in individuals restricting or eliminating wheat to manage symptoms are cause for concern. The situation is likely exacerbated by the tendency for many wheat avoiders to report also avoiding other foods, especially dairy products. A bi-disciplinary approach from medical practitioners and dietitians to individuals experiencing unexplained gastro-intestinal symptoms and strategies to support informed food choice is needed to combat longer-term health consequences of a diet with this nutritional profile.
Collapse
Affiliation(s)
- Sinéad Golley
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Danielle Baird
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Gilly A Hendrie
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Philip Mohr
- School of Psychology, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
33
|
Farmery AK, Hendrie GA, O'Kane G, McManus A, Green BS. Sociodemographic Variation in Consumption Patterns of Sustainable and Nutritious Seafood in Australia. Front Nutr 2018; 5:118. [PMID: 30560133 PMCID: PMC6287033 DOI: 10.3389/fnut.2018.00118] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
National dietary guidelines (DGs) consistently recommend consuming seafood for health benefits, however, the sustainability of increasing seafood consumption is often challenged. Seafood products vary in environmental performance as well as health benefits, yet there is no information integrating the health and ecological impacts of different seafood choices. The first step in optimising improved health and environmental outcomes is to examine more closely the types of seafood being consumed at population and individual levels, to develop the means to increase the intake of seafood that is optimal for human health and the environment. The purpose of this analysis was to better understand the specific types and amounts of seafood consumed by the Australian population, and by socioeconomic subgroups within the population, to determine the relative nutritional content and sustainability of seafood consumed by these groups. Secondary analysis of the Australian Health Survey (AHS) (2011-2013), which reached 32,000 people (25,000 households) was undertaken. The majority of respondents (83%) did not consume any seafood on the day of the survey. Results indicated the proportion of seafood consumers was lowest among adults who were unemployed, had the least education and were the most socio-economically disadvantaged. Crustaceans and farmed fish with low omega 3-content, such as basa and tilapia, were identified as the least nutritious and least sustainable seafood categories. These two categories constituted a substantial amount of total seafood intake for the lowest socio-economic consumers, and over 50% for unemployed consumers. In contrast, consumers in the highest socio-demographic group consumed mainly high trophic level fish (moderate nutrition and sustainability) and farmed fish with high omega-3 content (high nutrition, moderate sustainability). Fewer than 1% of adults or children reported eating seafood identified as both more nutritious and less resource intensive, such as small pelagics or molluscs. Opportunities exist to increase seafood intakes to improve health outcomes by varying current seafood consumption patterns to maximise nutritional outcomes and minimise environmental impacts. Initiatives to promote the health and environmental benefits of seafood should be promoted at the population level, with targeted interventions for specific groups, and should encourage consumption of highly nutritious low resource intensive types of seafood.
Collapse
Affiliation(s)
- Anna K Farmery
- Australian National Centre for Ocean Resources and Security, University of Wollongong, Wollongong, NSW, Australia
| | - Gilly A Hendrie
- Commonwealth Scientific and Industrial Research Organisation, Health and Biosecurity, Adelaide, SA, Australia
| | - Gabrielle O'Kane
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | - Bridget S Green
- Institute for Marine and Antarctic Studies, University of Tasmania, Taroona, TAS, Australia
| |
Collapse
|
34
|
Cox DN, Hendrie GA, Lease HJ, Rebuli MA, Barnes M. How does fatty mouthfeel, saltiness or sweetness of diets contribute to dietary energy intake? Appetite 2018; 131:36-43. [DOI: 10.1016/j.appet.2018.08.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
|
35
|
Johnson BJ, Zarnowiecki D, Hendrie GA, Mauch CE, Golley RK. How to reduce parental provision of unhealthy foods to 3- to 8-year-old children in the home environment? A systematic review utilizing the Behaviour Change Wheel framework. Obes Rev 2018; 19:1359-1370. [PMID: 30092606 DOI: 10.1111/obr.12702] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/04/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE The effectiveness of obesity prevention interventions to improve children's diet can be enhanced. Deconstructing past interventions can identify components with potential to change behaviour. This systematic review using the Behaviour Change Wheel aimed to examine the behaviour change content of interventions supporting parents of 3- to 8-year olds to reduce provision of unhealthy foods to children. METHODS Ebscohost, Ovid, Scopus and Web of Science were searched. Eligible studies included controlled interventions with active parent involvement, at least one intervention strategy and outcome measure for unhealthy foods ≥3 months from baseline. Seventeen interventions were included describing 18 intervention arms. RESULTS Interventions frequently targeted parents' reflective motivation (n = 17) and psychological capability (n = 15), through education (n = 15) or enablement (n = 15) intervention functions and service provision (n = 18) policy category. Only 24 of the 93 behaviour change techniques were used with an average of five techniques used per intervention. CONCLUSIONS Existing interventions achieving small reductions in unhealthy food intake are homogenous in approach. There is potential to utilize untapped behaviour change techniques, through comprehensive intervention design and behavioural analysis guided by the Behaviour Change Wheel. Interventions targeting opportunity through persuasion, modelling or environmental restructuring, and using different policy categories are urgently needed to provide an evidence base to inform policy and practice.
Collapse
Affiliation(s)
- B J Johnson
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - D Zarnowiecki
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney, Australia
| | - G A Hendrie
- Health and Biosecurity Flagship, Commonwealth Scientific Industrial Research Organisation Adelaide, Adelaide, Australia
| | - C E Mauch
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney, Australia
| | - R K Golley
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney, Australia
| |
Collapse
|
36
|
|
37
|
Hendrie GA, Rebuli MA, Golley RK, Noakes M. Adjustment Factors Can Improve Estimates of Food Group Intake Assessed Using a Short Dietary Assessment Instrument. J Acad Nutr Diet 2018; 118:1864-1873. [PMID: 29724505 DOI: 10.1016/j.jand.2018.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 02/23/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Methods to address misreporting associated with short dietary assessment instruments are needed. OBJECTIVE Our objective was to develop and evaluate the direct and indirect validity of adjustment factors applied to a short dietary assessment instrument to improve estimates of usual consumption of core and discretionary food and beverage intake. DESIGN Validation of the Short Food Survey relative to 24-hour recalls was performed. The Short Food Survey requires individuals to report their usual intake of fruit, vegetables, grains, meat, dairy, and discretionary choices in multiples of standard servings. Adjustment factors were developed based on a ratio (usual portion size estimated from national data to standard serving size). The estimates of food group intakes (unadjusted and adjusted) were compared to 24-hour recalls. PARTICIPANTS/SETTING Three population samples were used in this study. The direct validation used data from 61 Australian adults (collected 2013-2014). The indirect validation compared data from the 2011-2013 Australian National Nutrition and Physical Activity Survey (n=9,435) to a sample of 145,975 who completed the Short Food Survey in a format that is freely available online (2015-2016). MAIN OUTCOME MEASURES Food group intake (in servings) was measured. STATISTICAL ANALYSES PERFORMED Descriptive and inferential statistical analyses were conducted. RESULTS Direct validation showed the adjustment factors improved the survey-derived estimates of intake for all food groups except grain foods. For grains, the mean difference went from -0.6 servings to +1.2 to 1.5 servings. The absolute difference in food group intake between the adjusted Short Food Survey and recalls remained statistically significant for fruit, meat, dairy, and grains, but was not different for vegetables and discretionary foods. The indirect validation showed that the adjusted estimates of intake from the online Short Food Survey were closer to the population estimates reported by 24-hour recall for all food groups except meat. CONCLUSIONS Adjustment factors can improve estimates of food group intake assessed using a short dietary assessment instrument for some but not all food groups.
Collapse
|
38
|
Brindal E, Hendrie GA, Freyne J, Noakes M. Incorporating a Static Versus Supportive Mobile Phone App Into a Partial Meal Replacement Program With Face-to-Face Support: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e41. [PMID: 29669704 PMCID: PMC5932334 DOI: 10.2196/mhealth.7796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/20/2017] [Accepted: 10/30/2017] [Indexed: 11/23/2022] Open
Abstract
Background Mobile phone apps may be acceptable to users and could improve retention and adherence over more traditional methods, but there is mixed literature supporting their efficacy. In the weight management space, very little is known about how a mobile phone app integrating features beyond text messaging (short message service) can affect behavior, particularly when combined with face-to-face support. Objective The objective of this study was to examine the effectiveness of a mobile phone app when combined with a partial meal replacement program including face-to-face support. This paper compares a static versus supportive app over a 6-month randomized trial for effects on weight loss, weight-related biomarkers, and psychological outcomes. Methods Overweight and obese adults (71.2% female, 104/146; mean 48.11, SD 11.75 years) were recruited to participate in the weight loss study, and they were randomized on a 1:1 basis using a computer algorithm. The supportive app (n=75) provided information, food intake recording, rewards, prompts for regular interaction through reminders, and the opportunity to review personal compliance with the dietary program. The static app (n=71) included only recipes and weight loss information. Both groups recieved equal amounts of face-to-face support in addition to app. Results The overall reduction in app usage over 24 weeks was lower for the supportive app in comparison with the static app; approximately 39.0% (57/146) of the users were still using the app at week 24. Despite the promising results for app usage, there were no differences in weight loss between groups (F1,128.12=0.83, P=.36). However, it should be noted that almost 60% (49/84) of all participants lost 5% or more of body weight during the trial. No weight-related biomarkers were significantly different between groups. Both groups experienced an increase in positive mood, but this was significantly higher for those who received the static app (F1,118.12=4.93, P=.03). Conclusions Although the supportive app was well received by users, we found little evidence of the added benefit of this versus the static app in combination with face-to-face support in a community-delivered weight loss program. Future versions of the app may incorporate more unique behavioral techniques beyond those provided by the consultant to improve the potency of the app. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12613000547741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364187 (Archived by WebCite http://www.webcitation.org/6yivwfMI9)
Collapse
Affiliation(s)
| | | | - Jill Freyne
- CSIRO Australian E-Health Research Centre, Marsfield, Australia
| | | |
Collapse
|
39
|
Johnson BJ, Zarnowiecki D, Hendrie GA, Golley RK. Predictors of parental discretionary choice provision using the health action process approach framework: Development and validation of a self-reported questionnaire for parents of 4-7-year-olds. Nutr Diet 2018; 75:431-442. [PMID: 29468790 DOI: 10.1111/1747-0080.12413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/21/2017] [Accepted: 01/08/2018] [Indexed: 12/01/2022]
Abstract
AIM Children's intake of discretionary choices is excessive. This study aimed to develop a questionnaire measuring parents' attitudes and beliefs towards limiting provision of discretionary choices, using the Health Action Process Approach model. METHODS The questionnaire items were informed by the Health Action Process Approach model, which extends the Theory of Planned Behaviour to include both motivational (intention) and volitional (post-intention) factors that influence behaviour change. The questionnaire was piloted for content and face validity (expert panel, n = 5; parents, n = 4). Construct and predictive validity were examined in a sample of 178 parents of 4-7-year-old children who completed the questionnaire online. Statistical analyses included exploratory factor analyses, Cronbach's alpha and multiple linear regression. RESULTS Pilot testing supported content and face validity. Principal component analyses identified constructs that aligned with the eight constructs of the Health Action Process Approach model. Internal consistencies were high for all subscales, in both the motivational (Cronbach's alpha 0.77-0.88) and volitional phase (Cronbach's alpha 0.85-0.92). CONCLUSIONS Initial results from validation tests support the development of a new questionnaire for measuring parent attitudes and beliefs regarding provision of discretionary choices to their 4-7-year-old children within the home. This new questionnaire can be used to gain greater insight into parents' attitudes and beliefs that influence ability to limit discretionary choices provision to children. Further research to expand understanding of the questionnaires' psychometric properties would be valuable, including confirmatory factor analysis and reproducibility.
Collapse
Affiliation(s)
- Brittany J Johnson
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, South Austalia, Australia
| | - Dorota Zarnowiecki
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, South Austalia, Australia
| | - Gilly A Hendrie
- Health and Biosecurity Flagship, Commonwealth Scientific Industrial Research Organisation, Adelaide, South Austalia, Australia
| | - Rebecca K Golley
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, South Austalia, Australia
| |
Collapse
|
40
|
Hendrie GA, Golley RK, Noakes M. Compliance with Dietary Guidelines Varies by Weight Status: A Cross-Sectional Study of Australian Adults. Nutrients 2018; 10:E197. [PMID: 29439463 PMCID: PMC5852773 DOI: 10.3390/nu10020197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 12/31/2022] Open
Abstract
Population surveys have rarely identified dietary patterns associated with excess energy intake in relation to risk of obesity. This study uses self-reported food intake data from the validated Commonwealth Scientific and Industrial Research Organisation (CSIRO) Healthy Diet Score survey to examine whether apparent compliance with dietary guidelines varies by weight status. The sample of 185,951 Australian adults were majority female (71.8%), with 30.2%, 35.3% and 31.0% aged between 18-30, 31-50 and 51-70 years respectively. Using multinomial regression, in the adjusted model controlling for gender and age, individuals in the lowest quintile of diet quality were almost three times more likely to be obese than those in the highest quintile (OR 2.99, CI: 2.88:3.11; p < 0.001). The differential components of diet quality between normal and obese adults were fruit (difference in compliance score 12.9 points out of a possible 100, CI: 12.3:13.5; p < 0.001), discretionary foods (8.7 points, CI: 8.1:9.2; p < 0.001), and healthy fats (7.7 points, CI: 7.2:8.1; p < 0.001). Discretionary foods was the lowest scoring component across all gender and weight status groups, and are an important intervention target to improve diet quality. This study contributes to the evidence that diet quality is associated with health outcomes, including weight status, and will be useful in framing recommendations for obesity prevention and management.
Collapse
Affiliation(s)
- Gilly A Hendrie
- CSIRO Health and Biosecurity, P.O. Box 10041, Adelaide, SA 5000, Australia.
| | - Rebecca K Golley
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia.
| | - Manny Noakes
- CSIRO Health and Biosecurity, P.O. Box 10041, Adelaide, SA 5000, Australia.
| |
Collapse
|
41
|
Abstract
The food system is a major source of environmental impact, and dietary change has been recommended as an important and necessary strategy to reduce this impact. However, assessing the environmental performance of diets is complex due to the many types of foods eaten and the diversity of agricultural production systems and local environmental settings. To assess the state of science and identify knowledge gaps, an integrative review of the broad topic of environment and diet was undertaken, with particular focus on the completeness of coverage of environmental concerns and the metrics used. Compared with the 14 discrete environmental areas of concern identified in the United Nations Sustainable Development Goals, the located journal literature mainly addressed greenhouse gas (GHG) emissions and, to a lesser extent, land and water use. Some relevant concerns were rarely addressed or not addressed at all. In the case of GHG emissions, changes in land use and soil carbon stocks were seldom considered. This represents a disconnect between the science informing strategic climate action in the agricultural sector and the science informing public health nutrition. In the case of land and water use, few studies used metrics that are appropriate in a life-cycle context. Some metrics produce inherently biased results, which misinform about environmental impact. The limited evidence generally points to recommended diets having lower environmental impacts than typical diets, although not in every case. This is largely explained by the overconsumption of food energy associated with average diets, which is also a major driver of obesity. A shared-knowledge framework is identified as being needed to guide future research on this topic. Until the evidence base becomes more complete, commentators on sustainable diets should not be quick to assume that a dietary strategy to reduce overall environmental impact can be readily defined or recommended.
Collapse
Affiliation(s)
- Bradley G Ridoutt
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, Victoria, Australia;,University of the Free State, Department of Agricultural Economics, Bloemfontein, South Africa; and
| | - Gilly A Hendrie
- CSIRO Biosecurity and Health, Adelaide, South Australia, Australia
| | - Manny Noakes
- CSIRO Biosecurity and Health, Adelaide, South Australia, Australia
| |
Collapse
|
42
|
Lyle G, Hendrie GA, Hendrie D. Understanding the effects of socioeconomic status along the breast cancer continuum in Australian women: a systematic review of evidence. Int J Equity Health 2017; 16:182. [PMID: 29037209 PMCID: PMC5644132 DOI: 10.1186/s12939-017-0676-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/03/2017] [Indexed: 12/31/2022] Open
Abstract
Background Globally, the provision of equitable outcomes for women with breast cancer is a priority for governments. However, there is growing evidence that a socioeconomic status (SES) gradient exists in outcomes across the breast cancer continuum – namely incidence, diagnosis, treatment, survival and mortality. This systematic review describes this evidence and, because of the importance of place in defining SES, findings are limited to the Australian experience. Methods An on-line search of PubMed and the Web of Science identified 44 studies published since 1995 which examined the influence of SES along the continuum. The critique of studies included the study design, the types and scales of SES variable measured, and the results in terms of direction and significance of the relationships found. To aid in the interpretation of results, the findings were discussed in the context of a systems dynamic feedback diagram. Results We found 67 findings which reported 107 relationships between SES within outcomes along the continuum. Results suggest no differences in the participation in screening by SES. Higher incidence was reported in women with higher SES whereas a negative association was reported between SES and diagnosis. Associations with treatment choice were specific to the treatment choice undertaken. Some evidence was found towards greater survival for women with higher SES, however, the evidence for a SES relationship with mortality was less conclusive. Conclusions In a universal health system such as that in Australia, evidence of an SES gradient exists, however, the strength and direction of this relationship varies along the continuum. This is a complex relationship and the heterogeneity in study design, the SES indicator selected and its representative scale further complicates our understanding of its influence. More complex multilevel studies are needed to better understand these relationships, the interactions between predictors and to reduce biases introduced by methodological issues.
Collapse
Affiliation(s)
- Greg Lyle
- Centre for Population Health Research, Curtin University, Perth, Australia.
| | | | - Delia Hendrie
- School of Public Health, Curtin University, Perth, Australia
| |
Collapse
|
43
|
Hendrie GA, Rebuli MA, Golley RK. Reliability and relative validity of a diet index score for adults derived from a self-reported short food survey. Nutr Diet 2016; 74:291-297. [DOI: 10.1111/1747-0080.12303] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 05/11/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Gilly A. Hendrie
- CSIRO Food and Nutrition Flagship; Adelaide South Australia Australia
| | - Megan A. Rebuli
- Department of Nutrition and Dietetics; Flinders University; Adelaide South Australia Australia
| | - Rebecca K. Golley
- Public Health Group, Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, Division of Health Sciences; University of South Australia; Adelaide South Australia Australia
| |
Collapse
|
44
|
Golley RK, Bell LK, Hendrie GA, Rangan AM, Spence A, McNaughton SA, Carpenter L, Allman-Farinelli M, de Silva A, Gill T, Collins CE, Truby H, Flood VM, Burrows T. Validity of short food questionnaire items to measure intake in children and adolescents: a systematic review. J Hum Nutr Diet 2016; 30:36-50. [PMID: 27561947 DOI: 10.1111/jhn.12399] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Short food questions are appealing to measure dietary intakes. METHODS A review of studies published between 2004 and 2016 was undertaken and these were included in the present study if they reported on a question or short item questionnaire (≤50 items, data presented as ≤30 food groups) measuring food intake or food-related habits, in children (aged 6 months to 18 years), and reported question validity or reliability. Thirty studies met the inclusion criteria. RESULTS Most questions assessed foods or food groups (n = 29), with the most commonly assessed being fruit (n = 22) or vegetable intake (n = 23), dairy foods and discretionary foods (n = 20 studies each). Four studies assessed food habits, with the most common being breakfast and meal frequency (n = 4 studies). Twenty studies assessed reliability, and 25 studies determined accuracy and were most commonly compared against food records. Evaluation of question performance relied on statistical tests such as correlation. CONCLUSIONS The present study has identified valid and reliable questions for the range of key food groups of interest to public health nutrition. Questions were more likely to be reliable than accurate, and relatively few questions were both reliable and accurate. Gaps in repeatable and valid short food questions have been identified that will provide direction for future tool development.
Collapse
Affiliation(s)
- R K Golley
- University of South Australia, Adelaide, SA, Australia
| | - L K Bell
- Flinders University, Adelaide, SA, Australia
| | | | - A M Rangan
- University of Sydney, Sydney, NSW, Australia
| | - A Spence
- Deakin University, Melbourne, VIC, Australia
| | | | - L Carpenter
- University of Melbourne, Melbourne, VIC, Australia
| | | | - A de Silva
- University of Melbourne, Melbourne, VIC, Australia
| | - T Gill
- University of Sydney, Sydney, NSW, Australia
| | - C E Collins
- University of Newcastle, Newcastle, NSW, Australia
| | - H Truby
- Monash University, Melbourne, VIC, Australia
| | - V M Flood
- University of Sydney, Sydney, NSW, Australia
| | - T Burrows
- University of Newcastle, Newcastle, NSW, Australia
| |
Collapse
|
45
|
Brindal E, Hendrie GA, Taylor P, Freyne J, Noakes M. Cohort Analysis of a 24-Week Randomized Controlled Trial to Assess the Efficacy of a Novel, Partial Meal Replacement Program Targeting Weight Loss and Risk Factor Reduction in Overweight/Obese Adults. Nutrients 2016; 8:nu8050265. [PMID: 27153085 PMCID: PMC4882678 DOI: 10.3390/nu8050265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/08/2016] [Accepted: 04/14/2016] [Indexed: 11/26/2022] Open
Abstract
Our aim was to design and evaluate a weight-loss program, including a partial meal replacement program, point-of-care testing and face-to-face and smartphone app support, appropriate for delivery in a community pharmacy setting. Overweight or obese adults (n = 146, 71.2% female, 48.18 ± 11.75 years old) were recruited to participate in a 24-week weight loss study and randomised to two app conditions. The dietary intervention was consistent regardless of app. Twelve weeks of clinic appointments with a trained consultant were followed by only app support for an additional 12 weeks. By week 24, retention was 57.5%. There were no differences between app conditions. Based on a cohort analysis of the trial, the mean decrease in weight from baseline to week 24 was 6.43 ± 1.06 kg for males (p < 0.001) and 5.66 ± 0.70 kg for females (p < 0.001). Mixed models also revealed decreases for LDL Cholesterol (−0.13 ± 0.08 mmol/L, nonsignificant), triglycerides (−0.08 ± 0.05 mmol/L, nonsignificant) and an increase in HDL cholesterol (+0.08 ± 0.04 mmol/L, ns) were not significant by week 24. Blood glucose (−0.23 ± 0.08 mmol/L, p = 0.040) and blood pressure (Systolic blood pressure −5.77 ± 1.21 Hg/mm, p < 0.001) were significantly lower at week 24 compared to baseline. Weight loss self-efficacy increased and remained significantly higher than baseline at week 24 (16.85 ± 2.93, p < 0.001). Overall, the program supported participants and was successful in achieving significant weight loss and improvements in health outcomes over 24 weeks.
Collapse
Affiliation(s)
- Emily Brindal
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organization (CSIRO), PO Box 10041, Adelaide, South Australia 5000, Australia.
| | - Gilly A Hendrie
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organization (CSIRO), PO Box 10041, Adelaide, South Australia 5000, Australia.
| | - Pennie Taylor
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organization (CSIRO), PO Box 10041, Adelaide, South Australia 5000, Australia.
| | - Jill Freyne
- Health and Biosecurity, CSIRO, GPO Box 76, Epping, New South Wales 1710, Australia.
| | - Manny Noakes
- Food and Nutrition, Commonwealth Scientific and Industrial Research Organization (CSIRO), PO Box 10041, Adelaide, South Australia 5000, Australia.
| |
Collapse
|
46
|
Lock C, Brindal E, Hendrie GA, Cox DN. Contextual and environmental influences on reported dietary energy intake at evening eating occasions. Eat Behav 2016; 21:155-60. [PMID: 26970728 DOI: 10.1016/j.eatbeh.2016.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/04/2016] [Accepted: 03/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study sought to determine the simultaneous effect of immediate eating environment variables; portion size, plate size, proximity to food, variety of food, side serves of salad/vegetables and presence of distraction on dietary energy intake (EI), of a reported evening meal, in the participants' real world setting. DESIGN A retrospective computer assisted telephone interview collected data on ten immediate eating environment variables, covariates and a 24-hour dietary recall of EI at an evening meal. Multiple regression analysis was conducted to determine relationships of these variables with EI. Significant (P<0.05) standardised beta coefficients (β) are reported. SETTING Australia wide, participants' homes. SUBJECTS Australian adult males and females (n 150) aged 18-65years. RESULTS Of the immediate eating environment variables, the absence of salads/vegetables (β=0.237), increased food variety (β=0.208), presence of music (β=0.207), and the consumption of pre-plated (as opposed to self-served) meals (β=0.195) had a positive association with EI, explaining 16.3% of the variance. Of the covariates, being male was the strongest predictor of EI (β=0.242); and hunger score also had a positive relationship with EI (β=0.190), explaining 17.5% of the variance. CONCLUSION This study provides evidence that some immediate food environment variables at an evening eating occasion are associated with EI. Findings suggest there are several strategies that people could implement to assist in controlling their EI and help address over consumption.
Collapse
Affiliation(s)
- Chelsea Lock
- Nutrition and Dietetics Department, Flinders University of South Australia, Bedford Park, SA 5042, Australia
| | - Emily Brindal
- CSIRO Food & Nutrition, Adelaide 5000, SA, Australia
| | | | - David N Cox
- CSIRO Food & Nutrition, Adelaide 5000, SA, Australia.
| |
Collapse
|
47
|
Cox DN, Hendrie GA, Carty D. Sensitivity, hedonics and preferences for basic tastes and fat amongst adults and children of differing weight status: A comprehensive review. Food Qual Prefer 2016. [DOI: 10.1016/j.foodqual.2015.01.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
48
|
Hendrie GA, Lease HJ, Bowen J, Baird DL, Cox DN. Strategies to increase children's vegetable intake in home and community settings: a systematic review of literature. Matern Child Nutr 2016; 13. [PMID: 26924706 DOI: 10.1111/mcn.12276] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022]
Abstract
A systematic review was undertaken to identify intervention characteristics associated with increasing consumption of vegetables in children (2-12 years). PubMed, PsychINFO and CABabstracts were used to identify studies published between 2004-2014 that had measures of vegetable consumption, a minimum of 3-month follow-up and were conducted in home and community settings (outside of schools). Twenty-two studies were included in the review. Details of the study design, population, setting, intervention characteristics, target behaviour, behaviour change techniques used and vegetable intake were extracted. Study quality and intensity were scored. Overall, 12/22 studies were effective short-term, and 6/10 were effective long-term (6 + months); mean short-term change in vegetable intake was 29%, equating to an increase of a quarter to a half of a serving of vegetables. Intervention effectiveness was associated with number of settings targeted and frequency of contact but not length of intervention. Planning for social support, vegetable exposure and provision of staff training were commonly used behaviour change techniques in effective interventions. This review has identified strategies that may optimise effectiveness of future home-based and community-based interventions aiming to increase vegetable intake in young children.
Collapse
Affiliation(s)
- Gilly A Hendrie
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - Haidee J Lease
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - Jane Bowen
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - Danielle L Baird
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - David N Cox
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| |
Collapse
|
49
|
Brindal E, Hendrie GA, Freyne J. Combining Persuasive Technology With Behavioral Theory to Support Weight Maintenance Through a Mobile Phone App: Protocol for the MotiMate App. JMIR Res Protoc 2016; 5:e5. [PMID: 26747725 PMCID: PMC4723725 DOI: 10.2196/resprot.4664] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/20/2015] [Accepted: 07/24/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of health-focused mobile phone apps available for download increases daily, with weight management apps being among the most proliferative. However, most lack theoretic grounding or evidence of efficacy. There is a significant body of literature which provides evidence for behaviors which are associated with successful weight loss maintenance. Behavioral theory also provides further insight regarding successful behavior change and maintenance. OBJECTIVE We aimed to apply this knowledge to the development of the functionality of an app targeting weight loss maintenance. METHODS We have subsequently undertaken the development of a persuasive and behavior targeting mobile app (MotiMate) to assist in maintenance of weight loss. MotiMate combines persuasive and behavior change theories in a practical targeted tool through its motivational messages, personalized feedback, and intelligent supportive tools to manage weight, food, exercise, mood and stress. RESULTS The development and trial of MotiMate received funding support in May 2014. All 88 volunteers started the trial by December 2014 and were in the process of completing their final visits when this paper was submitted (May 2015). Data analysis is currently underway. CONCLUSIONS The paper has presented a scientifically informed mobile phone app to support weight loss maintenance. Further evaluation of its efficacy is in progress. TRIAL REGISTRATION ANZCTR 12614000474651; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366120 (Archived by WebCite at http://www.webcitation.org/6eJeQiKxi).
Collapse
|
50
|
Pollard CM, Meng X, Hendrie GA, Hendrie D, Sullivan D, Pratt IS, Kerr DA, Scott JA. Obesity, socio-demographic and attitudinal factors associated with sugar-sweetened beverage consumption: Australian evidence. Aust N Z J Public Health 2015; 40:71-7. [DOI: 10.1111/1753-6405.12482] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/01/2015] [Accepted: 08/01/2015] [Indexed: 12/24/2022] Open
Affiliation(s)
- Christina M. Pollard
- School of Public Health; Curtin University; Western Australia
- Department of Health; Government of Western Australia
| | - Xingqiong Meng
- School of Public Health; Curtin University; Western Australia
- School of Medicine; Flinders University; South Australia
| | | | - Delia Hendrie
- School of Public Health; Curtin University; Western Australia
| | | | | | - Deborah A. Kerr
- School of Public Health; Curtin University; Western Australia
| | - Jane A. Scott
- School of Public Health; Curtin University; Western Australia
| |
Collapse
|