Dr Amanda Patterson

There is a lack of evidence to determine if diet quality is associated with cognitive performance in older adults. Therefore, the aim of this study was to examine whether diet quality is associated with cognitive performance among older adults. A cross-sectional, secondary analysis of baseline data from the Hunter Community Study (HCS), comparing diet quality, measured using the Australian Recommended Food Score (ARFS), along with validated cognitive performance instruments the Audio Recorded Cognitive Screen (ARCS) and the Mini-Mental State Examination (MMSE) were undertaken in adults aged 55¿85 years, living in Newcastle, NSW, Australia. Adjusted linear regression analyses showed that, compared with the lowest ARFS quintile, those in the highest quintile had an ARCS score 5.883 units greater (p < 0.001; R2 = 0.0098). Furthermore, when quintiles of ARFS score were tested against each ARCS sub-scale score, statistically significant associations were observed with the greatest effect for the Memory (ß = 4.055; p = 0.001; R2 = 0.0065) and Attention (ß = 4.136; p = 0.002; R2 = 0.0047) domains. No statistically significant associations were observed between quintiles of ARFS and MMSE score in the adjusted linear regression analyses. In conclusion, a positive association was observed between diet quality and cognitive performance within this sample of older Australian adults. Further investigation of the above association over time, when follow-up data becomes available, in longitudinal analysis is recommended.

University food environments are typically dominated by unhealthy food choices. The aim was to investigate associations between on-campus food purchasing behaviours and dietary intake in an Australian university student sample. An online cross-sectional survey was conducted in 2017¿2018 with students (n = 362, 71.0% female, mean age 27.5 ± 10.5 years) from the University of Newcastle, Australia. On-campus food purchasing behaviours (purchasing frequency and weekly expenditure), dietary intake (diet quality and percentage energy/day from energy-dense, nutrient-poor (EDNP) foods) and sociodemographic and student characteristics (e.g., time spent on campus) were measured. Linear regression was used to explore associations between food purchasing be-haviours and dietary intake, adjusted for potential confounders. Mean percentage energy/day from EDNP foods was 31.7 ± 14.4. Mean diet quality score was 32.6 ± 10.2 out of 73. Higher percentage energy/day from EDNP foods was associated with higher weekly expenditure (ß = 0.203, p < 0.001) and more frequent purchase (ß = 18.041, p < 0.001 for =4 times a week vs. never) of food/drinks on campus. Diet quality was not significantly associated with purchase frequency or expenditure (p > 0.05). Findings are supportive of changes being made to university food environments, as a strategy to improve dietary intake among university students.

Healthcare costs are lower for adults who consume more vegetables; however, the association between healthcare costs and fruit and vegetable varieties is unclear. Our aim was to investigate the association between (i) baseline fruit and vegetable (F&V) varieties, and (ii) changes in F&V varieties over time with 15-year healthcare costs in an Australian Longitudinal Study on Women¿s Health. The data for Survey 3 (n = 8833 women, aged 50¿55 years) and Survey 7 (n = 6955, aged 62¿67 years) of the 1946¿1951 cohort were used. The F&V variety was assessed using the Fruit and Vegetable Variety (FAVVA) index calculated from the Cancer Council of Victoria¿s Dietary Questionnaire for Epidemiological Studies food frequency questionnaire. The baseline FAVVA and change in FAVVA were analysed as continuous predictors of Medicare claims/costs by using multiple regression analyses. Healthy weight women made, on average, 4.3 (95% confidence interval (CI) 1.7¿6.8) fewer claims for every 10-point-higher FAVVA. Healthy weight women with higher fruit varieties incurred fewer charges; however, this was reversed for women overweight/obese. Across the sample, for every 10-point increase in FAVVA over time, women made 4.3 (95% CI 1.9¿6.8) fewer claims and incurred $309.1 (95% CI $129.3¿488.8) less in charges over 15 years. A higher F&V variety is associated with a small reduction in healthcare claims for healthy weight women only. An increasing F&V variety over time is associated with lower healthcare costs.

Background: The relationship between diet quality and health care costs is unclear. Objective: The aim of this study was to investigate the relationship between baseline diet quality and change in diet quality over time, with 15-year cumulative health care claims/costs. Design: Data from a longitudinal cohort study were analyzed. Participants/setting: Data for survey 3 (2001) (n = 7,868) and survey 7 (2013) (n = 6,349 both time points) from the 1946-1951 cohort of the Australian Longitudinal Study on Women's Health were analyzed. Main outcome measures: Diet quality was assessed using the Australian Recommended Food Score (ARFS). Fifteen-year cumulative Medicare Benefits Schedule (Australia's universal health care coverage) data were reported by baseline ARFS quintile and category of diet quality change (¿diet quality worsened¿ [ARFS change = ¿4 points], ¿remained stable¿ [¿3 = change in ARFS =3 points], or ¿improved¿ [ARFS change =4 points]). Statistical analyses: Linear regression analyses were conducted adjusting for area of residence, socioeconomic status, lifestyle factors, and private health insurance status. Results: Consuming a greater variety of vegetables at baseline but fewer fruit and dairy products was associated with lower health care costs. For every 1-point increment in the ARFS vegetable subscale, women made 3.3 (95% CI, 1.6-5.0) fewer claims and incurred AU$227 (95% CI, AU$104-350 [US$158; 95% CI, US$72-243]) less in costs. Women whose diet quality worsened over time made more claims (median, 251 claims; quintile 1, quintile 3 [Q1; Q3], 168; 368 claims) and incurred higher costs (AU$15,519; Q1; Q3, AU$9,226; AU$24,847 [US$10,793; Q1; Q3, US$6,417; US$17,281]) compared with those whose diet quality remained stable (median, 236 claims [Q1; Q3, 158; 346 claims], AU$14,515; Q1; Q3, AU$8,539; AU$23,378 [US$10,095; Q1; Q3, US$5,939; US$16,259]). Conclusions: Greater vegetable variety was associated with fewer health care claims and costs; however, this trend was not consistent across other subscales. Worsening diet quality over 12 years was linked with higher health care claims and costs.

University students have high rates of health risk behaviours, and these may be predictive of academic success. This cross-sectional study aimed to determine the association between individual and multiple health risk behaviours and academic achievement in a sample of Australian university students. Data from the University of Newcastle Student Healthy Lifestyle Survey 2019 were used. Health risk behaviours (diet, physical activity, sitting time, sleep, alcohol consumption, smoking) were assessed, and total number of risk factors calculated. Academic achievement was assessed using self-reported grade point average (GPA). The association between health risk behaviours and GPA was explored using linear regression, adjusted for socio-demographic and student characteristics. The sample included 1543 students (mean age 25.0 ± 7.9 years, 70.6% female). Lower GPA was associated with not meeting fruit consumption recommendations (ß = -0.203), consuming >1 cup of soft drink/week (ß = -0.307), having takeaway foods =1 time/week (ß = -0.130), not consuming breakfast daily (ß = -0.261), not meeting sleep recommendations (ß = -0.163), exceeding single occasion alcohol consumption risk (ß = -0.277), smoking (ß = -0.393), and having a higher number of risk factors (ß = -0.105). This study identified modest associations between GPA and health risk behaviours, suggesting that further research is warranted into whether strategies to improve university students¿ health could modestly improve their academic achievement.

Cognitive decline is a broad syndrome ranging from non-pathological/age-associated cognitive decline to pathological dementia. Mild cognitive impairment MCI) is defined as the stage of cognition that falls between normal ageing and dementia. Studies have found that early lifestyle interventions for MCI may delay its pathological progression. Hence, this review aims to determine the most efficient cognitive tools to discriminate mild cognitive decline in its early stages. After a systematic search of five online databases, a total of 52 different cognitive tools were identified. The performance of each tool was assessed by its psychometric properties, administration time and delivery method. The Montreal Cognitive Assessment (MoCA, n = 15), the Mini-Mental State Examination (MMSE, n = 14) and the Clock Drawing Test (CDT, n = 4) were most frequently cited in the literature. The preferable tools with all-round performance are the Six-item Cognitive Impairment Test (6CIT), MoCA (with the cut-offs of =24/22/19/15.5), MMSE (with the cut-off of =26) and the Hong Kong Brief Cognitive Test (HKBC). In addition, SAGE is recommended for a self-completed survey setting whilst a 4-point CDT is quick and easy to be added into other cognitive assessments. However, most tools were affected by age and education levels. Furthermore, optimal cut-off points need to be cautiously chosen while screening for MCI among different populations.

Aim: This study aimed to explore clustering among individual eating behaviours in a sample of Australian university students, and explore associations between clustered eating behaviours and demographic characteristics. Methods: A cross-sectional analysis of data from the University of Newcastle (UON) Student Healthy Lifestyle Survey 2017 was conducted. Measures included eating behaviours (eg, vegetables, energy-dense nutrient poor [EDNP] food intakes) assessed using short diet questions, and demographic characteristics (eg, age, undergraduate/postgraduate student). Factor analysis was used to explore clustering of individual eating behaviours (ie, identify factors). Linear regression models were used to explore associations between eating behaviour factors identified and demographic characteristics. Results: A total of 3062 students (70% female; 56% aged 17-24 years) were included in the analysis. The six eating behaviour factors identified (characterised by higher consumption of the named foods/drinks) were; EDNP snack foods, meat and takeaway foods, fruit and vegetables, sugary drinks, breakfast, and breads and cereals. A higher fruit and vegetable factor score was associated with being female (P <.001), and a higher meat and takeaway foods factor score was associated with being male (P <.001) and of younger age (P <.001). Conclusions: Nutrient-rich foods clustered together and EDNP foods clustered together, that is, the identified factors represent either nutrient-rich or EDNP foods. Interventions in the university setting should target students with the poorest eating behaviours, including males and younger students.

Objective: To explore if better diet quality scores as a measure of adherence to the Australian Dietary Guidelines (ADG) and the Mediterranean diet (MedDiet) are associated with a lower incidence of hypertension and non-fatal CVD.Design: Prospective analysis of the 1946-1951 cohort of the Australian Longitudinal Study on Women's Health (ALSWH). The Australian Recommended Foods Score (ARFS) was calculated as an indicator of adherence to the ADG; the Mediterranean Diet Score (MDS) measured adherence to the MedDiet. Outcomes included hypertension and non-fatal CVD. Generalised estimating equations estimated OR and 95 % CI across quartiles of diet quality scores.Setting: Australia, 2001-2016.Participants: 1946-1951 cohort of the ALSWH (n 5324), without CVD, hypertension and diabetes at baseline (2001), with complete FFQ data.Results: There were 1342 new cases of hypertension and 629 new cases of non-fatal CVD over 15 years of follow-up. Multivariate analysis indicated that women reporting better adherence to the ARFS (=38/74) had 15 % (95 % CI 1, 28 %; P = 0·05) lower odds of hypertension and 46 % (95 % CI 6, 66 %; P = 0·1) lower odds of non-fatal CVD. Women reporting better adherence to the MDS (=8/17) had 27 % (95 % CI 15, 47 %; P = 0·0006) lower odds of hypertension and 30 % (95 % CI 2, 50 %; P = 0·03) lower odds of non-fatal CVD.Conclusions: Better adherence to diet quality scores is associated with lower risk of hypertension and non-fatal CVD. These results support the need for updated evidenced based on the ADG as well as public health nutrition policies in Australia.

Background and aims: Most studies measure baseline diet quality exclusively and hence the impact of longitudinal changes in dietary intake in relation to weight change is not considered. Therefore, this study aimed to examine whether change in diet quality over nine-years was associated with weight change over the same period in mid-age Australian women. Methods and results: Healthy mid-age (45¿49 years) women from the Australian Longitudinal study on Women's Health (ALSWH) were eligible a valid total energy intake (TEI) was reported at baseline (n = 2381), determined using Goldberg cut-offs. Diet quality was measured by the Australian Recommended Food Score (ARFS) using data derived from a validated food frequency questionnaire. Multiple linear regressions were used to evaluate relationships between change in diet quality and weight in mid-age women (n = 1999). Women in the highest tertile of ARFS change improved diet quality [mean ± SD] [7 ± 4 points], while those in the lowest [-9 ±5 points] and middle [-1±2 points] tertiles had worse diet quality at follow-up. Overall, mean weight gain was 2.3 ± 7.2 kg over nine years. Those in the highest tertile of ARFS change gained significantly less weight, compared to the lowest tertile; ß = -1.2 kg [95% CI: -2.31, -0.11; p = 0.03] after adjustment for changes in confounders and baseline weight, baseline ARFS, and total energy intake. Conclusions: Improving diet quality could be an important strategy for promoting modest weight loss and potentially contribute to preventing weight gain in mid-age women, which is important for metabolic health.

Background/objectives: We previously demonstrated that fruit and vegetable consumption, was associated with less weight gain over 6 years in young women for all body mass index (BMI) categories. This study evaluated the relationship between diet quality and 6-year weight change, in Australian women initially in the healthy weight range (=18.5 BMI <25 kg/m2) at baseline. Subjects/methods: A total of 4083 young women (27¿31 years) in the healthy weight range (=18.5 BMI <25 kg/m2) enroled in the Australian Longitudinal study on Women¿s Health (ALSWH) were analysed. Diet quality was measured by the Australian Recommended Food Score (ARFS) and the Fruit and Vegetable Index (FAVI) using dietary data derived from a validated food frequency questionnaire. Weight change was calculated as the difference between baseline and 6-year follow-up weight (kg). Multiple linear regression models were used to analyse the association between baseline ARFS and FAVI and 6-year weight change. Results: At baseline, mean diet quality was low for both indices [ARFS (maximum 72) = 29.9 and FAVI (maximum 333) = 94.2] and women gained 3.7 kg of weight during 6 years of follow-up. Regression modelling revealed that every one point increase over 6 years in either the ARFS or FAVI score was associated with statistically significantly less weight gain over 6 years, although the amount was small (33 and 12 g, respectively). Conclusions: Higher diet quality predicts lower prospective weight gain in young women however, further research is needed over a longer follow-up period and in diverse population groups.

Background: Unhealthy diets are typical of university students and the effects may be wider reaching than health. The present study aimed to describe the association between dietary intake and academic achievement in a sample of Australian university students. Methods: A cross-sectional analysis of data from an online survey of 278 students from the University of Newcastle (UON), Australia [mean (SD) age 26.9¿(10.5)¿years; 70.9% female] was conducted. Dietary intake, in terms of diet quality score [Australian Recommended Food Score (ARFS)], including individual sub-scales, and percentage energy per day from energy-dense nutrient poor (EDNP) foods, including individual sub-groups, was assessed using the validated Australian Eating Survey Food Frequency Questionnaire, and academic achievement was assessed as self-reported grade point average (GPA). The association between GPA and dietary intake was explored using linear regression, with adjustment for socio-demographic and student characteristics. Results: Higher GPA was associated with higher diet quality (ARFS) (ß¿=¿0.02, P¿=¿0.011), higher sub-scale scores for vegetables (ß¿=¿0.03, P¿=¿0.026) and fruit (ß¿=¿0.05, P¿=¿0.029) and with lower percentage energy per day from EDNP foods overall (ß¿=¿-0.01, P¿=¿0.047) and also from sweetened drinks (ß¿=¿-0.06, P¿<¿0.001). Conclusions: The results of the present study demonstrate small associations between a healthier dietary intake and higher academic achievement, as well as vice versa. Given that the associations were small, they may not be particularly meaningful. However, this evidence could be used as a motivator for efforts aiming to improve dietary intake among university students.

Objective: To describe and compare body composition and fat distribution of Australian women 18¿44 years from an urban and rural location. Design: Cross-sectional survey and collection of anthropometric and body composition measurements. Setting: Newcastle and Tamworth in New South Wales. Participants: Convenience sample of women recruited through media and community. Main outcome measures: Weight, height, waist and hip girths, visceral fat area, body fat (kg and %) and skeletal muscle mass. Results: Of the total sample (n = 254), 53% resided in an urban area and the mean age was 28.0 (7.6) years. The mean age of rural women was significantly higher than for urban women. The majority of women (66.5%) had a Body Mass Index within the healthy range (18.5¿24.9 kg m -2 ) and there was no significant difference in mean Body Mass Index between rural and urban women. Measures of central fat distribution, waist circumference and waist-to-hip ratio were significantly higher in rural residents. Visceral fat area was significantly higher among rural women. After adjustment for age, differences in waist circumference, waist-to-hip ratio and visceral fat area were no longer statistically significant. Conclusion: While we did not find statistically significant differences in body composition among urban and rural women, these results highlight the dramatic effect of age on measures of central adiposity. Population surveillance needs to incorporate measures of excess central adiposity, particularly visceral fat area, to better investigate changes in body composition among women in their 20s and 30s.

Diabetes affects 9.8% of Australian women. Breakfast cereal consumption is potentially protective against diabetes. This study investigated the effects of breakfast cereal consumption on the 12-year risk of developing diabetes among mid-aged participants of the Australian Longitudinal Study of Women's Health (ALSWH). It was hypothesized that any breakfast cereal and higher-fiber breakfast cereals would be protective against the risk of developing diabetes. Data from Survey 3 (S3) to Survey 7 (S7) inclusive, from the 1946-51 ALSWH cohort were analyzed. Dietary data were obtained at S3 and the outcome was incident diabetes between S4-S7. Women were excluded if: they reported existing diabetes or impaired glucose tolerance at S3; dietary data were incomplete; or daily energy intake was <4,500 or >20,000 kJ. Logistic regression with discrete time survival analyses investigated the association between breakfast cereal intake and incident diabetes. Models were adjusted for income, BMI, smoking, physical activity, education, and dietary intakes and included a measure of time. There were 637 incident cases of diabetes. Breakfast cereal intake per se was not associated with incident diabetes (OR: 1.00; P =.98). Muesli consumption on its own (OR: 0.74; P =.00) or as a part of oats-based cereal (OR: 0.84; P =.047) was significantly associated with a decrease in the odds of developing diabetes. No other breakfast cereals were significantly associated with diabetes risk. Among mid-aged Australian women, muesli consumption was associated with a reduction in diabetes risk. This effect may be due to a particular profile of muesli eaters, but the relationship warrants further investigation.

Background: Better diets, as evaluated by diet quality indices, are associated with lower rates of morbidity and mortality. Although governments and researchers alike recognise the burden that obesity incurs for increased healthcare spending, there is insufficient evidence for the role of diet quality on healthcare costs. Methods: Diet quality was assessed by the Australian Recommended Food Score (ARFS) for 6328 women aged 50¿55 years from the Australian Longitudinal Study on Women's Health. The ARFS was ranked by quintile, and 10-year cumulative data on healthcare costs from Medicare (Australia's Universal healthcare cover) were reported by body mass index category, using generalised linear modelling. Results: Healthy weight women with the highest diet quality were found to make significantly fewer Medicare claims (P = 0.012) compared to those with the lowest diet quality. In healthy weight and overweight women, the number of healthcare claims and charges was inversely associated with consuming a greater variety of vegetables. For every 1 point increase in the ARFS vegetable component score, healthy weight women made 1.9 fewer healthcare claims and were charged $139 less, whereas overweight women made 2.3 fewer claims and were charged $176 less for healthcare over 10 years. Conclusions: The results of the present study support the need to prioritise an improved diet quality with the aim of reducing healthcare claims and overall costs in a population-based sample of Australian females. As the burden of overweight and obesity on the healthcare system increases, strategies to improve diet quality may be of particular importance; however, more research is required to further establish this relationship.

Background: Stroke survivors sit for long periods each day. Uninterrupted sitting is associated with increased risk of cardiovascular disease. Breaking up uninterrupted sitting with frequent, short bouts of light-intensity physical activity has an immediate positive effect on blood pressure and plasma clotting factors in healthy, overweight, and type 2 diabetic populations. Aim: We examined the effect of frequent, short bouts of light-intensity physical activity on blood pressure and plasma fibrinogen in stroke survivors. Methods: Prespecified secondary analyses from a three-armed randomized, within-participant, crossover trial. Participants were 19 stroke survivors (nine female, aged 68 years old, 90% able to walk independently). The experimental conditions were sitting for 8 h uninterrupted, sitting with 3 min bouts of light-intensity exercise while standing every 30 min, or sitting with 3 min of walking every 30 min. Blood pressure was measured every 30 min over 8 h and plasma fibrinogen at the beginning, middle, and end of each day. Intention-to-treat analyses were performed using linear mixed models including fixed effects for condition, period, and order, and a random intercept for participant to account for repeated measures and missing data. Results: Sitting with 3 min bouts of light-intensity exercise while standing every 30 min decreased systolic blood pressure by 3.5 mmHg (95% CI 1.7¿5.4) compared with sitting for 8 h uninterrupted. For participants not taking antihypertensive medications, sitting with 3 min of walking every 30 min decreased systolic blood pressure by 5.0 mmHg (95% CI -7.9 to 2.0) and sitting with 3 min bouts light-intensity exercise while standing every 30 min decreased systolic blood pressure by 4.2 mmHg (95% CI -7.2 to -1.3) compared with sitting for 8 h uninterrupted. There was no effect of condition on diastolic blood pressure (p = 0.45) or plasma fibrinogen levels (p = 0.91). Conclusion: Frequent, short bouts of light-intensity physical activity decreases systolic blood pressure in stroke survivors. However, before translation into clinical practice, the optimal duration and timing of physical activity bouts needs to be determined. Clinical trial registration: Australian and New Zealand Clinical Trials Registry http://www.anzctr.org.au ANZTR12615001189516.

Objectives: People with stroke sit for long periods each day, which may compromise blood glucose control and increase risk of recurrent stroke. Studies in other populations have found regular activity breaks have a significant immediate (within-day) positive effect on glucose metabolism. We examined the effects of breaking up uninterrupted sitting with frequent, short bouts of light-intensity physical activity in people with stroke on post-prandial plasma glucose and insulin. Methods: Randomized within-participant crossover trial. We included people between 3 months and 10 years post-stroke, ambulant with minimal assistance and not taking diabetic medication other than metformin. The three experimental conditions (completed in random order) were: sitting for 8 h uninterrupted, sitting with 3 min bouts of light-intensity exercise while standing every 30 min, or sitting with 3 min of walking every 30 min. Meals were standardized and bloods were collected half- to one-hourly via an intravenous cannula. Results: A total of 19 participants (9 female, mean [SD] age 68.2 [10.2]) completed the trial. The majority (n = 12, 63%) had mild stroke symptoms (National Institutes of Stroke Scale score 0¿13). There was no significant effect of experimental condition on glucose (mean [SD] positive incremental area [+iAUC] mmol·L·h-1 under the curve during sitting 42.3 [29.5], standing 47.4 [23.1], walking 44.6 [26.5], p = 0.563) or insulin (mean + iAUC pmol·L·h-1 sitting 14,161 [7,560], standing 14,043 [8,312], walking 14,008 [8,269], p = 0.987). Conclusion: Frequent, short bouts of light-intensity physical activity did not have a significant effect on post-prandial plasma glucose and insulin in this sample of people with stroke. Further studies are needed to identify strategies that improve inactivity-related glucose metabolism after stroke.

Brief interventions are effective in improving health behaviours including alcohol intake, however the effectiveness of brief interventions targeting nutrition outcomes has not been determined. The aim of this systematic review was to determine the effectiveness of brief nutrition interventions in adults. Seven databases were searched for RCT/pseudo RCT studies published in English to April 2016, and evaluating brief interventions (i.e. single point of contact) designed to promote change in eating behaviours in healthy adults (=18 years). Of 4849 articles identified, 45 studies met inclusion criteria. Most studies targeted fruit and/or vegetable intake (n = 21) or fat intake (n = 10), and few targeted diet quality (n = 2). Median follow-up was 3.5 months, with few studies (n = 4) measuring longer-term outcomes (=12 months). Studies aimed to determine whether a brief intervention was more effective than another brief intervention (n = 30), and/or more effective than no intervention (n = 20), with 17 and 11 studies, respectively, reporting findings to that effect. Interventions providing education plus tailored or instructional components (e.g. feedback) were more effective than education alone or non-tailored advice. This review suggests that brief interventions, which are tailored and instructional, can improve short-term dietary behaviours, however evidence for longer-term behaviour change maintenance is limited.

Issue addressed The present study investigated the association between diet quality, measured using the Australian Recommended Food Score (ARFS), and 6-year risk of becoming overweight or obese in mid-age women from the Australian Longitudinal Study of Women's Health (ALSWH). Methods Women (n=1107) aged 47.6-55.8 years who were a healthy weight (body mass index (BMI) between =18.5 and <25.0kgm-2) at baseline and who reported valid total energy intakes were included in the study. BMI was calculated from self-reported data in 2001 and 2007. ARFS scores were calculated from data collected using the Dietary Questionnaire for Epidemiological Studies Version 2. Logistic regression was used to examine the relationship between ARFS score as a continuous variable and risk of becoming overweight or obese. Results The 6-year incidence of overweight and obesity was 18.5% and 1.1%, respectively. The mean (± s.d.) ARFS (maximum possible 74) among those who remained within the healthy weight range and those who became overweight or obese at follow-up was 35.3±8.1 and 34.3±8.8, respectively. There was no relationship between baseline ARFS and risk of becoming overweight or obese over 6 years. Women who were smokers were more likely to become overweight or obese (odds ratio 1.5; 95% confidence interval 1.11-2.09; P=0.008). Conclusions Poor diet quality was common among mid-age women of a healthy weight in the ALSWH. Higher diet quality was not associated with the risk of overweight or obesity after 6 years, yet smoking status was. So what? Better diet quality alone will not achieve maintenance of a healthy weight, but should be encouraged to improve other health outcomes.

Iron deficiency (ID) is the most prevalent nutrient deficiency within the developed world. This is of concern as ID has been shown to affect immunity, thermoregulation, work performance and cognition. Animal flesh foods provide the richest and most bioavailable source of dietary (haem) iron, however, it is unclear whether low animal flesh diets contribute to ID. This systematic review aimed to investigate whether a higher consumption of animal flesh foods is associated with better iron status in adults. CINAHL, Cochrane, EMBASE and MEDLINE were searched for published studies that included adults (¥18 years) from developed countries and measured flesh intakes in relation to iron status indices. Eight experimental and 41 observational studies met the inclusion criteria. Generally, studies varied in population and study designs and results were conflicting. Of the seven high quality studies, five showed a positive association between animal flesh intake (85¿300 g/day) and iron status. However, the optimum quantity or frequency of flesh intake required to maintain or achieve a healthy iron status remains unclear. Results show a promising relationship between animal flesh intake and iron status, however, additional longitudinal and experimental studies are required to confirm this relationship and determine optimal intakes to reduce ID development.

Background/objectives Restricting energy intake for weight management in older adults has potential to adversely affect nutritional status and result in impairment of an already compromised immune system. Investigation of alternative strategies to combat adiposity and sustain lean muscle mass in older adults are warranted to minimise the risk of developing chronic diseases. Long chain omega-3 polyunsaturated fatty acids (LCn-3PUFA), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may play an important role through their impact on increased fat oxidation and reduced inflammation. This study aimed to examine the association between erythrocyte membrane LCn-3PUFA and anthropometric measures in an older population. Subjects/methods A cross-sectional sample of older adults (n¿=¿620; age 65¿95 years; 56.3% females) from the Retirement Health and Lifestyle Study (RHLS) was analysed. Anthropometric measurements, including height, weight, body mass index (BMI), waist (WC) and hip circumference (HC) were taken. The fatty acid composition of erythrocyte membranes was analysed via gas chromatography (GC) to determine the omega-3 index (%EPA plus %DHA). Results An inverse association was detected between the omega-3 index and anthropometric measures, BMI (r¿=¿-0.076, p=0.06), WC (r¿=¿-0.118, p¿<¿0.01) and waist-to-hip ratio (WHR; r¿=¿-0.149, p¿<¿0.001). Stratification of data by sex (females, n¿=¿349; males, n¿=¿271) indicated that these associations were sex-specific. Females displayed an inverse association between the omega-3 index and BMI (r¿=¿-0.146, p¿<¿0.01) and WC (r¿=¿-0.125, p¿<¿0.05). In contrast, no significant association between the omega-3 index and anthropometric measures was detected in males. After correcting for the potentially confounding effects of age, household income, fish oil supplement status, daily dietary energy intake and total physical activity times, the omega-3 index was inversely associated with BMI and WC in females but not males. Conclusions Omega-3 status was associated with weight status, particularly in older women but not in men. These results suggest the need for sex-based intervention trials to examine the role of dietary intake and/or supplementation of LCn-3PUFA in weight management of older adults.

This systematic review examines the relationship between diet quality and weight gain in adults over time and is an update of our previous review of the same topic. The goal was to synthesise the best available current evidence on diet quality and weight change within longitudinal analyses. The inclusion criteria were case-control or cohort studies, and adults aged =18¿years. The dependent variable was diet quality indexes and the independent variable was any measurement of body weight. The current systematic review identified 16 studies published between 1970 and 2014. Of these, eight were published since our last review. The findings of these recent studies confirm the results of our previous review, that higher diet quality is associated with relatively lower prospective weight gain, as well as a lower risk of becoming overweight or obese, compared with poor diet quality. Across the 16 studies, it appears that the diet quality indexes based on foods alone, or food and nutrient components, are more predictive of weight change. However, further research is needed to confirm this. Additionally, high-quality analyses that assess change in diet quality over time are needed.

Previous research on the relationships between general nutrition knowledge and dietary intake, and dietary iron intake and iron status has produced inconsistent results. Currently, no study has focused on knowledge of dietary iron and its effect on dietary iron intake. Objectives: This study aimed to determine whether nutrition knowledge of iron is related to dietary iron intake in young women, and subsequently whether greater knowledge and intake translates into better iron status. Methods: A cross-sectional assessment of nutrition knowledge of iron, dietary iron intake and iron status was conducted in women aged 18-35 years living in Newcastle, NSW, Australia. Iron status was assessed by serum ferritin, haemoglobin, soluble transferrin receptor and alpha-1-glycoprotein. Results: One hundred and seven women (27.8 ± 4.7 years) completed the nutrition knowledge questionnaire and FFQ. Of these, 74 (70%) also had biomarkers of iron status measured. Mean iron intake was 11.2 ± 3.8 mg/day. There was no association between nutrition knowledge score and whether the women met the RDI for iron (F (1, 102) = .40, P = .53). A positive correlation was shown between nutrition knowledge score and iron intake (mg/day) (r = 0.25, P = .01). Serum ferritin was positively associated with the frequency of flesh food intake (r = .27 P = .02). Vegetarians (including partial vegetarians) had significantly lower serum ferritin levels than non-vegetarians (F (1, 71) = 7.44, P = .01). Conclusions: Significant positive correlations found between higher flesh food intake and biomarkers of iron status suggest that educating non-vegetarians about the benefits of increased flesh food consumption and vegetarians about dietary iron enhancers and inhibitors may have potential for addressing the high rates of iron deficiency among young women. © 2014.

Aim: To report fish and potential mercury intakes in women of child-bearing age and the impact on nutrient intakes. Methods: Women (n = 7486) aged 25-30 years who participated in the Australian Longitudinal Study on Women's Health were categorised according to pregnancy status. Daily fish and nutrient intakes were compared with national recommendations and Nutrient Reference Values. Estimated exposure to fish contaminants was modelled from the National Residue Survey and compared with Provisional Tolerable Weekly Intakes. Results: Mean fish intake for pregnant women was 28.2g/day, and for women who had given birth within the last 12 months, 27.8g/day. Both were significantly lower than 'other' women, consuming 33.0g/day (P = 0.01 and P < 0.001, respectively), and well below the latest suggested intakes by Food Standards Australia and New Zealand. Pregnant women and women who had recently given birth also had significantly lower consumption of long-chain omega-3 fatty acids than 'other' women (P < 0.01 for both) and no groups met suggested dietary targets. Fish can provide up to 915% of a pregnant woman's Adequate Intake for long-chain omega-3s. Contamination of Australian fish is low, with estimated maximum weekly exposure to mercury below the Provisional Tolerable Weekly Intake. Conclusions: Limiting fish intake during pregnancy to minimise exposure to mercury may compromise nutritional adequacy and increase the risk of inadequate intakes of nutrients essential for maternal health and fetal growth and development. Public health recommendations need to balance the risks and benefits of fish consumption within specific countries. © 2014 Dietitians Association of Australia.