Professor Clare Collins

Dietary assessment is necessary to address the double burden of malnutrition evident among Cambodian women and children. However, the absence of mixed dishes in a Cambodian-specific food composition database (C-FCD) limits accurate dietary assessment. This study aimed to compare nutrient profiles of observed recipes with standard recipes from a bespoke C-FCD for commonly consumed mixed dishes. This involved collecting food intake and recipes through images and voice recordings via a specially-designed smartphone application from 119 Cambodian mothers and 91 children under five years old in Siem Reap province, Cambodia. Ingredient quantities for each observed recipe were used to create a consolidated observed recipe (COR) from ingredient medians, calculating their nutrient profiles. A total of 27 COR were created and compared against 17 most similar standard recipes; 15 COR had no similar standard recipe. Generally, COR were higher in fat, vitamin A, thiamin and vitamin B12 but lower in protein, iron, potassium and zinc than standard recipes. Collection of observed recipe data from real-world settings can improve accuracy of dietary intake assessment. From this study, 27 commonly consumed COR are recommended to be included in the C-FCD, which can be made available to researchers for more accurate assessment of local Khmer mixed dishes.

Background: There is evidence from qualitative and quantitative studies of the presence of weight stigma in the dental setting from the patient perspective. However, the perspectives of various members of the dental team and their observations and experiences of weight stigma are unknown. Given dental specialists in Special Needs Dentistry (SND) are often referred patients living with severe obesity for dental management, their perspectives are of specific importance, particularly with respect to currently employed and recommended weight stigma reduction strategies. Aims: Our qualitative study aimed to identify and explore among dental professionals and support staff in Australia, their perspectives and experiences of weight stigma. We aimed to identify any currently employed, and recommendations for, stigma reduction from SND specialists. Methods: Focus groups and semi-structured interviews (n = 34 participants) were conducted with two groups; dental professionals and support staff from regional New South Wales; and SND specialists in Australia. Recordings were transcribed verbatim and analysed using thematic (inductive) analysis. Results: Key themes emerged related to observed experiences with weight stigma, with differing perspectives based on professional roles. The impact of weight stigma on dental management was highlighted. Stigma reduction strategies with an educational focus were also identified from SND specialist participants. Conclusion: The current study explored observations of weight stigma in various dental settings and perspectives which differed based on participant awareness and professional role. The negative impact of weight stigma on preventive dental discussions was identified. Stigma reduction strategies need to target the identified barriers and address the complex drivers of weight stigma before implementation. The findings of the current study emphasise the role for team-based education, led and guided by SND specialists through their professional advocacy roles and encourages the development of a dental team action plan to respond to observed experiences of weight stigma in the workplace.

Aims: Behavioural weight management interventions facilitate short to medium-term weight and cardiometabolic improvements in adolescent obesity. However, recruiting adolescents to trials of such interventions is challenging. This study describes strategies used to recruit adolescents with obesity into the Fast Track to Health (Fast Track) trial, conducted at two tertiary paediatric centres in Australia. Methods: Fast Track (HREC/17/SCHN/164) was a randomised controlled trial that recruited 13¿17-year-olds with obesity and = 1 cardiometabolic complication, from December 2017 to March 2022. Families underwent phone screening, followed by in-person screening appointments. Recruitment strategies were grouped and enrolment yield by strategy was calculated. Results: Of 308 inquiries received, 141 (45.8 %) adolescents were recruited. The most successful strategy was referral from specialists at participating centres (21.2 % enrolment yield), followed by referrals from family/friends (6.5 %), other doctors/general practitioners (3.6 %), and social media (3.6 %). Social media was used for 11 months only (enrolment yield - 8.5 %). Recruitment strategies with low yield were study flyers/posters (1.6 %), digital/print media (1.3 %), and the study website (1.0 %). Of 137 adolescents excluded at phone screening, most were due to disinterest in participation or inability to make contact (60.6 %). Of 171 adolescents attending in-person screening, 30 did not meet inclusion criteria (n = 7 of those excluded had no metabolic complications, n = 7 were outside the BMI range). Conclusion: Connecting with medical specialists may be important to support the engagement of treatment-seeking adolescents with obesity in clinical trials. Further research is needed to identify methods of enhancing clinical trial recruitment in primary care, community settings, and online.

Background/Objectives: Thus far, no studies have examined the relationship between fruit and vegetable (F and V) intake, urinary metabolite quantities, and weight change. Therefore, the aim of the current study was to explore changes in urinary metabolomic profiles during and after a 10-week weight loss intervention where participants were prescribed a high F and V diet (7 servings daily). Methods: Adults with overweight and obesity (n = 34) received medical nutrition therapy counselling to increase their F and V intakes to national targets (7 servings a day). Data collection included weight, dietary intake, and urine samples at baseline at week 2 and week 10. Urinary metabolite profiles were quantified using 1H NMR spectroscopy. Machine learning statistical approaches were employed to identify novel urine-based metabolite biomarkers associated with high F and V diet patterns at weeks 2 and 10. Metabolic changes appearing in urine in response to diet were quantified using Metabolite Set Enrichment Analysis (MSEA). Results: Energy intake was significantly lower (p = 0.02) at week 10 compared with baseline. Total F and V intake was significantly higher at week 2 and week 10 (p < 0.05). In total, 123 urinary metabolites were quantified. At week 10, 21 metabolites showed significant changes relative to baseline. Of these, 11 metabolites also significantly changed at week 2. These overlapping metabolites were acetic acid, dimethylamine, choline, fumaric acid, glutamic acid, L-tyrosine, histidine, succinic acid, uracil, histamine, and 2-hydroxyglutarate. Ridge Classifier and Linear Discriminant Analysis provided best prediction accuracy values of 0.96 when metabolite level of baseline was compared to week 10. Conclusions: Urinary metabolites quantified represent potential candidate biomarkers of high F and V intake, associated with a reduction in energy intake. Further studies are needed to validate these findings in larger population studies.

Background: Many young adults report poor diet quality. However, research evaluating whether young adult males and females differ in diet quality is limited. Additionally, although diet quality has a known inverse association with body mass index (BMI), it is unclear whether this association is observed in young adults and whether it varies by gender. The present study aimed to evaluate gender differences in diet quality in young adults, as well as the associations between diet quality and BMI. Methods: Data collected via the Healthy Eating Quiz (HEQ) in respondents aged 18¿35 years between July 2019 and December 2021 were analysed, including demographics, and diet quality calculated using the Australian Recommended Food Score (ARFS). Differences in characteristics were analysed using a two-sample t-test, chi-squared and one-way analysis of covariance. Linear regressions were performed to estimate associations between diet quality and BMI. An interaction term was included in the model to test differences between genders. Results: The respondents (n = 28,969) were predominantly female (70.8%) with a mean ± SD age of 25.9 ± 5.0 years and BMI of 24.6 ± 5.2 kg/m2. The mean ± SD ARFS was significantly different between females and males (33.1 ± 8.6 vs. 31.4 ± 9.3 points out of 70; p < 0.001). Diet quality had a small, significant inverse association with BMI in both genders. The interaction effect between diet quality score and gender in predicting BMI was significant (p < 0.001), suggesting the impact of diet quality on BMI varies by gender, with lower diet quality more strongly associated with higher BMI in females compared to males. Conclusion: Interventions that target young adults are needed to improve diet quality and its potential contribution to BMI status. As a result of the small observed effect sizes, caution should be applied in interpreting these findings.

Determine how healthcare professionals perceive their role in nutrition assessment and management, and explore barriers and enablers to assessment and management of nutrition in individuals with DFU. Mixed methods including a cross-sectional online survey derived from current international guidelines and theoretical domains framework, and semi-structured interviews with conventional content analysis was performed. One hundred and ninety-one participants completed the survey, with 19 participating in interviews. Many health professionals are not confident in their ability in this area of practice, are uncertain their nutrition advice or management will be effective in assisting wound healing outcomes and are uncertain their intervention would result in adequate behaviour change by the individual with DFU. Major barriers to implementation of nutrition assessment and management were: inadequate time, lack of knowledge and lack of clinical guidance and enablers were as follows: professional development, a standardised clinical pathway and screening tool and a resource addressing wound healing and diabetes management. Nutrition assessment and management in individuals with DFU is not consistently applied. Whilst health professionals believed nutrition was important for wound healing, they lacked confidence in implementing into their practice. Further dissemination of existing guidance and implementation of education programs and resources would help overcome cited barriers.

Purpose: This study aims to understand university students' perception and engagement with sustainable food practices and the relationship with diet quality. Design/methodology/approach: A cross-sectional survey assessed Australian university students' sustainable food perceptions and purchasing behaviours, diet quality using the validated Australian Recommended Food Score and attitudes towards on campus sustainable food options. Findings: Of respondents (n = 197; 63% female), over half (58%) perceived it was important to purchase sustainable foods. These students were eight times more likely report purchasing sustainable foods (OR: 8.1; 95%CI 4.2¿15.7; SE: 0.3; p < 0.001) and had significantly higher diet quality (Beta coefficient: 2.9; 95% Confidence Intervals 0.4¿5.4; Standard Error: 1.3; p = 0.024). Students who reported frequently purchasing all types of sustainable foods, except organic foods, had significantly higher diet quality. Few students perceived there were sufficient sustainable food choices on campus (19%), but most supported the development of an edible campus (80%). Originality/value: The results highlight the potential impact of promoting sustainable food options and creating a supportive campus food environment towards improving students' diet quality.

Objective: Food insecurity may reduce diet quality, but the relationship between food insecurity severity and diet quality is under-researched. This study aimed to examine the relationship between diet quality and severity of household food insecurity. Design: A cross-sectional, online survey used the United States Department of Agriculture Household Food Security Six-item Short Form to classify respondents as food secure or marginally, moderately or severely food insecure. The Australian Recommended Food Score (ARFS; scored 0¿73) determined diet quality (ARFS total and sub-scale scores). Survey-weighted linear regression (adjusted for age, sex, income, education, location and household composition) was conducted. Setting: Tasmania, Australia. Participants: Community-dwelling adults (aged 18 years and over). Results: The mean ARFS total for the sample (n 804, 53 % female, 29 % aged > 65 years) was 32·4 (SD = 9·8). As the severity of household food insecurity increased, ARFS total decreased. Marginally food-insecure respondents reported a mean ARFS score three points lower than food-secure adults (B = ¿2·7; 95 % CI (¿5·11, ¿0·34); P = 0·03) and reduced by six points for moderately (B = ¿5·6; 95 % CI (¿7·26, ¿3·90); P < 0·001) and twelve points for severely food-insecure respondents (B = ¿11·5; 95 % CI (¿13·21, ¿9·78); P < 0·001). Marginally food-insecure respondents had significantly lower vegetable sub-scale scores, moderately food-insecure respondents had significantly lower sub-scale scores for all food groups except dairy and severely food-insecure respondents had significantly lower scores for all sub-scale scores. Conclusions: Poorer diet quality is evident in marginally, moderately and severely food-insecure adults. Interventions to reduce food insecurity and increase diet quality are required to prevent poorer nutrition-related health outcomes in food-insecure populations in Australia.

Introduction: Contemporary data and knowledge management and exploration are challenging due to regular releases, updates, and different types and formats. In the food and nutrition domain, solutions for integrating such data and knowledge with respect to the FAIR (Findability, Accessibility, Interoperability, and Reusability) principles are still lacking. Methods: To address this issue, we have developed a data and knowledge management system called NutriBase, which supports the compilation of a food composition database and its integration with evidence-based knowledge. This research is a novel contribution because it allows for the interconnection and complementation of food composition data with knowledge and takes what has been done in the past a step further by enabling the integration of knowledge. NutriBase focuses on two important challenges; data (semantic) harmonization by using the existing ontologies, and reducing missing data by semi-automatic data imputation made from conflating with existing databases. Results and discussion: The developed web-based tool is highly modifiable and can be further customized to meet national or international requirements. It can help create and maintain the quality management system needed to assure data quality. Newly generated data and knowledge can continuously be added, as interoperability with other systems is enabled. The tool is intended for use by domain experts, food compilers, and researchers who can add and edit food-relevant data and knowledge. However, the tool is also accessible to food manufacturers, who can regularly update information about their products and thus give consumers access to current data. Moreover, the traceability of the data and knowledge provenance allows the compilation of a trustworthy management system. The system is designed to allow easy integration of data from different sources, which enables data borrowing and reduction of missing data. In this paper, the feasibility of NutriBase is demonstrated on Slovenian food-related data and knowledge, which is further linked with international resources. Outputs such as matched food components and food classifications have been integrated into semantic resources that are currently under development in various international projects.

Double-blind, placebo-controlled, randomized controlled trials are the gold standard for clinical trials in nutrition science. For trials of whole diets, dietary counseling is advantageous as they offer clinical translatability although can vary in the fidelity of the intended intervention from participant to participant and across studies. Feeding trials, in which most or all food is provided, offer high precision and can provide proof-of-concept evidence that a dietary intervention is efficacious and can also better evaluate the effect of known quantities of foods and nutrients on physiology. However, they come with additional methodological complexities. Feeding trials also call for a variety of unique methodological considerations, not least of which relate to the design and delivery of diets to participants. This review aims to provide a comprehensive summary of recommendations for design and conduct of feeding trials, encompassing domiciled and nondomiciled feeding trials. Several pertinent aspects of trial design and methodology are discussed, including defining the study population to maximize retention, safety, and generalizability of findings, recommendations for design of control interventions and optimizing blinding, and specific considerations for clinical populations. A detailed stepwise process for menu design, development, validation, and delivery are also presented. These recommendations aim to facilitate methodologic consistency and execution of high-quality feeding trials, ultimately facilitating improved understanding of the role of diet in treating disease and the underpinning mechanisms.

Aims: To evaluate relationships between diet quality and cardiovascular outcomes. Methods: Six databases were searched for studies published between January 2007 and October 2021. Eligible studies included cohort studies that assessed the relationship between a priori diet quality and cardiovascular disease mortality and morbidity in adults. The Academy of Nutrition and Dietetics Checklist was used to assess the risk of bias. Study characteristics and outcomes were extracted from eligible studies using standardised processes. Data were summarised using risk ratios for cardiovascular disease incidence and mortality with difference compared for highest versus lowest diet quality synthesised in meta-analyses using a random effects model. Results: Of the 4780 studies identified, 159 studies (n = 6 272 676 adults) were included. Meta-analyses identified a significantly lower cardiovascular disease incidence (n = 42 studies, relative risk 0.83, 95% CI 0.82¿0.84, p < 0.001) and mortality risk (n = 49 studies, relative risk 0.83, 95% CI 0.82¿0.84, p < 0.001) among those with highest versus lowest diet quality. In sensitivity analyses of a high number of pooled studies (=13 studies) the Mediterranean style diet patterns and adherence to the heart healthy diet guidelines were significantly associated with a risk reduction of 15% and 14% for cardiovascular disease incidence and 17% and 20% for cardiovascular disease mortality respectively (p < 0.05). Conclusions: Higher diet quality is associated with lower incidence and risk of mortality for cardiovascular disease however, significant study heterogeneity was identified for these relationships.

Background: Massive Open Online Courses (MOOCs) can engage large numbers of learners. Understanding motivations for enrolling and elements that engage learners may help meet learner needs. This study explored motivations, intentions, recruitment methods and course acceptability of learners enrolled in 'The Science of Weight Loss: Dispelling diet myths' (SWL101X) MOOC on EdX. Design and setting: Cross-sectional analysis included 29,666 learners from 180+ countries. Methods: Learners provided demographic data, while 8,454 learners provided optional pre-course data and 987 provided post-course data. The pre-course survey examined learners' motivations and intentions and recruitment method, and the post-course survey examined acceptability of course content. Descriptive statistics were reported as frequencies and percentages or medians (interquartile range)/means (standard deviation). Results: Learners (61% women, 51% aged between 25 and 44 years) enrolled in the MOOCs mainly to increase their nutrition knowledge (46%) and/or lose weight (62%). Most (61%) were recruited through EdX platforms (website, newsletters and blog). Course components were well received by the majority who completed the post-course survey. Conclusion: The SWL101X MOOC successfully delivered nutrition education. Future courses could consider trialling the text, videos and interactive features to further engage learners. Short, informal 'talking head' video content may facilitate engagement. Future courses should also ensure the inclusion of the most recent dietary practices for health, and the management of obesity as a chronic disease, as some of the content used in the course in this study does not represent current and/or best practice. The greater use of social media may enhance learner enrolment.

Aims: University students may experience food insecurity due to financial constraints, reducing the quality of their diet. This study aimed to identify students at higher risk of food insecurity, their engagement with on-campus food initiatives and evaluate the relationship between food insecurity and a validated index of diet quality. Methods: A cross-sectional online survey used the six-item Household Food Security Survey Module to assess food insecurity. Total diet quality and subscale scores for eight food groups were measured using the Australian Recommended Food Score (range 0¿73). Univariate and multivariate regression identified groups at risk of food insecurity, their engagement with campus food initiatives and relationship with diet quality scores. Results: Of student respondents (n = 197), over half (54%) experienced food insecurity (14% mild, 23% moderate and 18% severe food insecurity). Male students and students not living with parents were at significantly higher risk. Food-insecure students were significantly more likely to use the campus food pantry (odds ratio = 2.3 [95% confidence interval = 1.286¿4.142]; p = 0.005) but not a campus community garden. The mean diet quality score was 32.9 (standard deviation = 8.9). Food-insecure students reported a mean diet quality score over three points lower than food-secure respondents (B = -3.5 [95% confidence interval = -6.0 to -1.0]; p = 0.006), with significantly lower fruit and vegetable subscale scores. Conclusions: Results suggest a high occurrence of food insecurity and poor dietary quality in university students. Despite high levels of engagement with the campus food pantry, the poor diet quality of food-insecure students suggests an urgent need for greater university-led interventions to improve students' dietary intake.

In high-income nations, multiple micronutrient (MMN) supplementation during pregnancy is a common practice. We aimed to describe maternal characteristics associated with supplement use and daily dose of supplemental nutrients consumed in pregnancy, and whether guideline alignment and nutrient status are related to supplement use. The Queensland Family Cohort is a prospective, Australian observational longitudinal study. Maternal characteristics, nutrient intake from food and supplements, and biochemical nutrient status were assessed in the second trimester (n = 127). Supplement use was reported by 89% of participants, of whom 91% reported taking an MMN supplement. Participants who received private obstetric care, had private health insurance and had greater alignment to meat/vegetarian alternatives recommendations were more likely to report MMN supplement use. Private obstetric care and general practitioner shared care were associated with higher daily dose of supplemental nutrients consumed compared with midwifery group practice. There was high reliance on supplements to meet nutrient reference values for folate, iodine and iron, but only plasma folate concentrations were higher in MMN supplement versus nonsupplement users. Exceeding the upper level of intake for folic acid and iron was more likely among combined MMN and individual supplement/s users, and associated with higher plasma concentrations of the respective nutrients. Given the low alignment with food group recommendations and potential risks associated with high MMN supplement use, whole food diets should be emphasized. This study confirms the need to define effective strategies for optimizing nutrient intake in pregnancy, especially among those most vulnerable where MMN supplement use may be appropriate.

Background: People with intellectual disability have diverse needs and experience higher rates of diet-related chronic disease such as type 2 diabetes compared to people without disability. However, they are infrequently included in development and implementation of interventions to address diet-related chronic disease. The present study describes the process to plan, develop and refine the Food and Lifestyle Information Program (FLIP) culinary nutrition intervention for adults with mild-to-moderate intellectual disability. Methods: The project was initiated by a disability service provider and was guided by the Cook-Ed¿ model and inclusive research principles. Initially the disability service provider and academic research team members co-designed pre-program consultation and pilot studies, and draft program resources. Pre-program consultation explored paid disability support worker (n = 10) perceptions of cooking and food skills, nutrition priorities and optimal program format, which guided further program drafting. Program resources and pilot study design were further developed and refined with co-researchers with lived experience of intellectual disability who attended a pre-pilot and then pilot study sessions as remunerated co-facilitators. Results: Key characteristics of the FLIP intervention arising from pre-program consultation included providing cooking task instruction in small steps, enabling participant choice in program activities, promoting an inclusive and social atmosphere, and providing paper-based resources. Conclusions: FLIP intervention co-design was enabled through ongoing input from the disability service provider and people with lived experience of intellectual disability. Evaluation of FLIP feasibility, acceptability and preliminary effectiveness to improve diet-related health is underway.

Background: Culinary nutrition education can support improved diet-related health and wellbeing. This pre-post pilot study aimed to assess feasibility and acceptability of an eight-session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild-to-moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness. Method: Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality. Results: Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess. Conclusions: Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild-to-moderate intellectual disability.

Aim: Social media platforms are being increasingly used to support participant recruitment into paediatric health-related research. This study aimed to develop a multi-phase approach for using social media as a recruitment strategy for paediatric research studies. Methods: The process was informed by the authors' prior experiences recruiting for paediatric obesity-related research studies, expertise in social media marketing and digital participant/ patient recruitment. Reflection on these experiences resulted in the iterative creation of a draft process which was further refined. A narrative literature review using a structured search was conducted to refine and augment the content and finalise the process. Results: A six-phase recruitment approach was developed that includes: (i) plan for social media use as a recruitment strategy, (ii) explore relevant ethical considerations to protect the wellbeing of potentially vulnerable groups and create an ethical management plan, (iii) identify and understand the different target audiences and develop the advertising strategy, (iv) develop and design campaign content, (v) implement, monitor and iteratively refine the recruitment campaign, (vi) evaluate the campaign success. Potential activities and key considerations relevant for paediatric research are presented within each phase. Conclusion: Due to the widespread use and diverse characteristics of social media users, social media has the potential to disseminate details of research opportunities to community members who may otherwise not hear about, engage with,¿and potentially benefit from research participation. Researchers should collaborate with communication experts and target audiences to generate relevant and effective recruitment campaigns. Researchers should implement processes to protect vulnerable audiences' wellbeing at each stage of the process. Recruitment via social media may support wider community participation in research studies designed to improve young people's health.

Background and objective: Maternal nutrition has profound and lasting effects on growth and health from infancy into adulthood. The aim of this manuscript was to assess diet quality and nutrient adequacy in preconception and pregnancy in BABY1000 pilot study participants (n = 171). Study design and methods: The Australian Eating Survey (AES) Food Frequency Questionnaire was administered to women based in Sydney, Australia, at preconception or 12 weeks' gestation (n = 158), and again at 36 weeks' gestation (n = 99). Primary outcomes were diet quality and nutrient intake. Diet quality was evaluated using the AES diet quality subscale, the Australian Recommended Food Score (ARFS). Nutrient intakes were compared to Australian Nutrient Reference Values. Diet quality and nutrient intakes were not consistent with Australian recommendations. Over 83% of women exceeded the suggested target limits for percentage energy from saturated fat. Median ARFS was 37 at baseline, and 38 in late pregnancy (maximum score 73). Inadequate micronutrient intakes from food were common; no participants met the Estimated Average Requirement for iron, 76%¿84% for iodine, 70%¿78% for calcium and 44%¿50% for folate. Maternal diet quality and nutrient intakes in the current sample are inconsistent with pregnancy recommendations and therefore may not be supporting optimal perinatal or long-term offspring health. Stronger messaging around the importance of prenatal nutrition, prevalence of dietary inadequacy, and availability of reliable support and information specific to nutrition in pregnancy is crucial in supporting women to improve their nutrition both before and during pregnancy.

Background: The COVID-19 pandemic has further exacerbated physical inactivity, poor dietary intake and reduced mental wellbeing, contributing factors to non-communicable diseases in children. Cooking interventions are proposed as having a positive influence on children's diet quality. Motor skills have been highlighted as essential for performance of cooking skills, and this movement may contribute to wellbeing. Additionally, perceived competence is a motivator for behaviour performance and thus important for understanding intervention effectiveness. Therefore, this research aimed to assess the effectiveness of an adapted virtual theory-based cooking intervention on perceived cooking competence, perceived movement competence and wellbeing. Methods: The effective theory-driven and co-created 'Cook Like A Boss' was adapted to a virtual five day camp-styled intervention, with 248 children across the island of Ireland participating during the pandemic. Pre- and post-intervention assessments of perceived cooking competence, perceived movement competence and wellbeing using validated measurements were completed through online surveys. Bivariate Correlations, paired samples t-tests and Hierarchical multiple regression modelling was conducted using SPSS to understand the relationships between the variables and the effect of the intervention. Results: 210 participants had matched survey data and were included in analysis. Significant positive correlations were shown between perceived cooking competence, perceived movement competence and wellbeing (P < 0.05). Children's perceived cooking competence (P < 0.001, medium to large effect size), perceived movement competence (P < 0.001, small to medium effect size) and wellbeing (P = 0.013, small effect size) all significantly increased from pre to post intervention. For the Hierarchical regression, the final model explained 57% of the total variance in participants' post-intervention perceived cooking competence. Each model explained a significant amount of variance (P < 0.05). Pre-intervention perceived cooking competence, wellbeing, age and perceived movement competence were significant predictors for post-intervention perceived cooking competence in the final model. Conclusion: The 'Cook Like A Boss' Online intervention was an adapted virtual outreach intervention. It provides initial evidence for the associations between perceived cooking competence, perceived movement and wellbeing as well as being effective in their improvement. This research shows the potential for cooking to be used as a mechanism for targeting improvements in not only diet quality but also movement and wellbeing. Trial Registration: NCT05395234. Retrospectively registered on 26th May 2022.

This study investigated the implementation model and research methods of a peer education program for new parents focused on infant feeding and nutrition. Two hundred and sixty-nine parents with an infant aged birth to two years old were invited to become co-researchers in a Participatory Action Research (PAR) study over three years. Data included focus group and online participant meeting transcripts, social media data, correspondence between the implementation team and peer educators, and field notes. All data were consolidated regularly and discussed by project participants and the research team. After each PAR cycle, structured content analysis was conducted, informing the next iteration of the implementation model and research methods. Participating parents were highly engaged in child feeding peer-to-peer education, but felt more effective and comfortable being considered as a child-feeding information resource sharer or 'champion' rather than a formal peer educator. Similarly, quantitative data collection was only effective when it was integrated seamlessly into the implementation model. PAR methodology suited the diversity and dynamic real-life study setting, facilitating substantial improvements to the peer nutrition intervention model and data collection methods. Our study demonstrated that a genuine collaboration between health professionals and participants to implement research in practice can achieve both intervention outcomes and research aims.

2D images can be used to capture food intake data in nutrition studies. Estimates of food volume from these images are required for nutrient analysis. Although 3D image capture is possible, it is not commonplace. Additionally, nutrition studies often require multiple food images taken by non-expert users, typically collected using mobile phones, due to their convenience. Current 2D image to 3D volume approaches are restricted by the need for prescribed camera placement, image metadata analysis and/or significant computational resources. A new method is presented combining 2D image capture and automated 3D scene projection with manual placement and resizing of wire mesh objects. 2D images, with a reference object, are taken on low specification mobile phones. 3D scene projection is calculated by twinning a cuboid in 3D space to the reference object in the 2D image. A manually selected 3D wire mesh object is then positioned over the target food item and manually transformed to improve accuracy. The virtual wire mesh object is then projected into the 3D scene and the volume of the target food item calculated. The whole process is computationally light and runs in real-time as an app on a standard Apple iPad. Based on a user study with 60 participants, experimental evaluations of volume estimates over regular shape and ground truth food items demonstrate that this approach provides acceptable accuracy. We demonstrate that the accuracy of estimates can be increased by combining multiple independent estimates.

Introduction Codesign is a meaningful end-user engagement in research design. The integrated knowledge translation (IKT) framework involves adopting a collaborative research approach to produce and apply knowledge to address real-world needs, resulting in useful and useable recommendations that will more likely be applied in policy and practice. In the field of food addiction (FA), there are limited treatment options that have been reported to show improvements in FA symptoms. Objectives The primary aim of this paper is to describe the step-by-step codesign and refinement of a complex intervention delivered via telehealth for adults with FA using an IKT approach. The secondary aim is to describe our intervention in detail according to the TIDieR checklist. Design This study applies the IKT process and describes the codesign and refinement of an intervention through a series of online meetings, workshops and interviews. Participants This study included researchers, clinicians, consumers and health professionals. Primary outcome measure The primary outcome was a refined intervention for use in adults with symptoms of FA for a research trial. Results A total of six female health professionals and five consumers (n=4 female) with lived overeating experience participated in two interviews lasting 60 min each. This process resulted in the identification of eight barriers and three facilitators to providing and receiving treatment for FA, eight components needed or missing from current treatments, telehealth as a feasible delivery platform, and refinement of key elements to ensure the intervention met the needs of both health professionals and possible patients. Conclusion Using an IKT approach allowed for a range of viewpoints and enabled multiple professions and disciplines to engage in a semiformalised way to bring expertise to formulate a possible intervention for FA. Mapping the intervention plan to the TIDieR checklist for complex interventions, allowed for detailed description of the intervention and the identification of a number of areas that needed to be refined before development of the finalised intervention protocol.

Objective: To systematically review and meta-analyze randomized controlled trials on the effects of technology-based interventions for maintenance of lost weight. Methods: A systematic literature search was performed to identify randomized controlled trials with at least one intervention arm delivered through the internet or mobile application, published in English until September 2021. Weight change at the end of the weight loss maintenance phase was considered the primary outcome. Results: Twelve manuscripts with 2941 adults were included in the review; 10 studies were meta-analyzed. Included interventions had a duration of 3¿30 months and were tested compared with minimum interventions (no contact with the study staff or intervention with only a limited number of features) or in-person groups. Technology-based interventions resulted in similar weight regain when compared with minimum interventions (ES = -0.07 kg; 95% CI = [-0.57, 0.42]; p = 0.770). However, when compared with in-person interventions, technology-based interventions were found to lead in significantly higher weight regain (ES = 1.36 kg; 95% CI = [0.29, 2.43]; p = 0.010). Conclusion: Web- and app-based interventions for weight loss maintenance produced similar results with minimum interventions and resulted in greater weight regain compared with in-person interventions. Appropriate interventions for weight loss maintenance provide benefits against weight regain, only when provided in-person.

Background: Focused antenatal care currently implemented in Tanzania recommends that women receive nutrition care during routine clinic visits. However, little detail is documented in regard to the nutrition information provided to pregnant women during these visits. The present study aimed to investigate whether pregnant women recalled nutrition information or support provided and, if so, who provided this during routine antenatal clinic visits. The secondary aim was to determine how pregnant women intended to implement the information and what mode of delivery was preferred for receiving nutrition information. Methods: An exploratory cross-sectional study comprising exit interviews was conducted with 50 pregnant women attending antenatal clinics in three regional referral hospitals in Dar es Salaam, Tanzania. Results: All participants (n¿=¿50) reported receiving nutrition care from healthcare workers in regard to; haemoglobin checks (79% of participants), iron and folic acid supplementation (70%), weight measurement (70%), eating advice (60%), and dietary intake assessment (38%). However, the information recalled on each category was inconsistent. For 60% of participants, nurses were reported as the source of nutrition care during pregnancy, followed by medical doctors (22%). The most preferable mode for receiving nutrition information was reported as individual face-to-face sessions with health practitioners, followed by mobile phone. All of the participants who received nutrition information indicated that they intended to implement. Conclusions: Nurses were the main source of nutrition information for pregnant women attending antenatal clinics, followed by medical doctors. However, the content of nutrition information recalled by participants was inconsistent. Healthcare facilities need to implement strategies to ensure pregnant women understand and can implement nutrition information provided by healthcare workers during routine antenatal care.

Background: Depression and obesity are major health concerns and commonly co-exist, but men rarely seek help for these conditions. SHED-IT: Recharge was a gender-tailored eHealth program for men that generated clinically meaningful improvements in weight and depressive symptoms. Purpose: To evaluate behavioral and psychological outcomes from the SHED-IT: Recharge intervention designed for overweight/obese men with low mood. Methods: Overall, 125 men (18-70 years) with a BMI between 25 and 42 kg/m2 and depressive symptoms (PHQ-9 = 5) were randomly allocated to SHED-IT: Recharge (n = 62) or wait-list control (n = 63) groups. The self-directed program targeted key health behaviors combined with online mental fitness modules based on cognitive behavioral therapy. Behavioral (e.g., physical activity) and psychological outcomes (e.g., cognitive flexibility) were assessed with validated measures at baseline, 3 months (post-test) and 6 months (follow-up). Intention-to-treat linear mixed models examined treatment effects, which were adjusted for covariates, and effect size estimated (Cohen's d). Results: At post-test, intervention men achieved small-to-medium improvements in several health behavior outcomes including moderate-to-vigorous physical activity, light physical activity, sedentary behavior, sleep, energy intake, portion size, and risky alcohol consumption (range, d = 0.3-0.5), when compared with the control group. Intervention effects were also observed for perceived physical self-worth, perceived physical strength, cognitive flexibility, and behavioral activation (range, d = 0.3-0.8). No effects were found for fruit and vegetable intake, or mindful attention. Most effects were maintained at follow-up. Conclusions: This gender-tailored, eHealth program with integrated mental fitness support elicited meaningful improvements in health behaviors and psychological outcomes for men with low mood. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12619001209189).

Globally, there has been a renewed focus on addressing gestational weight gain (GWG). In Australia, the Department of Health pregnancy care guidelines recommend women be offered routine weighing and receive brief nutritional and physical activity support during antenatal care visits. Women gaining weight outside the Institute of Medicine (IOM)'s weight gain reference values are further recommended to be referred to a dietitian. However, professional and organizational barriers, including an absence of weight gain referral pathways and limited workforce resources, exist with the translation and scaling of these recommendations into practice. This study aimed to explore patterns of GWG among a cohort of Australian pregnant women and to determine if pregnancy weight gains of above or below 2 kg or 5 kg in the second and third trimester can be used to predict total GWG outside recommendations. Sensitivity, specificity, negative, and positive likelihood ratios were calculated. The most predictive time point was 24 weeks' gestation using the minimum weight change parameter of +/-2 kg, demonstrating reasonable sensitivity (0.81, 95% CI 0.61¿0.83) and specificity (0.72, 95% CI 0.61¿0.83), resulting in 55% (n = 72/131) of the cohort qualifying for dietetic referral. Given the current health service constraints, a review of dietetic services within maternity care is warranted.

Due to global advances in technology, image-based food record methods have emerged as an alternative to traditional assessment methods. The use of image-based food records in low and lower-middle income countries such as Tanzania is limited, with countries still using traditional methods. The current study aimed to determine the feasibility of using a new voice and image-based dietary assessment system (VISIDA) in Dar es Salaam, Tanzania. This mixed-method study recruited 18 nutritionists as participants who collected image-based records of food and drinks they consumed using the VISIDA smartphone app. Participants viewed an online demonstration of the VISIDA web platform and the analysis process for intake data collected using the VISIDA app. Then, participants completed an online survey and were interviewed about the VISIDA app and web platform for food and nutrient intake analysis. The method was reported as being acceptable and was found to be easy to use, although technical challenges were experienced by some participants. Most participants indicated a willingness to use the VISIDA app again for one week or longer and were interested in using the VISIDA system in their current role. Participants acknowledged that the VISIDA web platform would simplify some aspects of their current job. Image-based food records could potentially be used in Tanzania to improve the assessment of dietary intake by nutritionists in urban areas. Participants recommended adding sound-on notifications, using the VISIDA app in both Apple and Android phones, enabling installation from the app store, and improving the quality of the fiducial markers.

Diet quality is influenced by demographics and can change over time. This study aimed to (1) compare diet quality among adolescents/adults who completed the online Healthy Eating Quiz (HEQ) by demographic characteristics, and (2) to evaluate change in score over time for repeat completers. HEQ data collected between July 2016 and May 2022 were analysed, including demographics (age, gender, vegetarian status, socio-economic status, number of people main meals are shared with, country), and diet quality calculated using the Australian Recommended Food Score (ARFS) (range 0¿73) for respondents aged = 16 years. Differences in ARFS by demographic characteristics and change in score over time, adjusted for age, gender and vegetarian status, were tested by linear regression. The participants (n = 176,075) were predominantly female (70.4%), Australian (62.8%), and aged 18¿24 years (27.7%), with 4.0% (n = 7087) repeat completers. Mean ± SD ARFS was 33.9 ± 9.4/73. Results indicate that ARFS was significantly lower among males and significantly higher with increasing age group, higher socio-economic status, in vegetarians, those who shared main meals with others, and those living in Australia (p-values < 0.001). Mean change in ARFS over time (2.3 ± 6.9) was significantly higher for those with lower baseline scores (p < 0.001). Publicly available, brief dietary assessment tools have the potential to improve diet quality at the population level.

Objective: To investigate associations between eating behavior constructs (social eating, perceived competence, habit automaticity, self-determined motivation) and diet quality among young adults. Design: Cross-sectional analysis. Participants: Young adults (n = 1,005; mean age, 21.7 ± 2.0 years; 85% female) enrolled in the Advice, Ideas, and Motivation for My Eating (Aim4Me) study. Main outcome measures: Four eating behavior measures collected via online surveys: Social Eating Scale, Perceived Competence in Healthy Eating Scale, Self-Report Behavioral Automaticity Index, and Regulation of Eating Behaviors scales. Diet quality was assessed using the Australian Recommended Food Score (ARFS) and percentage energy from energy-dense, nutrient-poor (EDNP) foods. Analysis: Multivariate linear regression investigating associations between eating behavior measures (independent variables) and ARFS and EDNP foods (dependent variables), adjusting for sociodemographic and lifestyle confounders. Results: Greater perceived competence in healthy eating and behavioral automaticity for consuming healthy foods, limiting EDNP food intake, and higher intrinsic motivation, integrated regulation, and identified regulation of eating behaviors were associated with higher ARFS and lower percentage energy EDNP foods (P < 0.001). Greater self-reported social influence on eating behaviors was associated with higher ARFS (P = 0.01). Higher amotivation was associated with greater % energy from EDNP foods (P < 0.001). Conclusions and Implications: Perceived competence, habit automaticity, and self-determined motivation are determinants of diet quality in young adults. These findings support the development of interventions that promote healthy eating habits by focusing on eating behavior constructs and evaluating their use in improving diet quality.

Background and aims: Over seven million women die from cardiovascular disease (CVD) annually. While lifestyle modification is recommended for CVD prevention, there are no systematic reviews evaluating the effectiveness of interventions targeted to women. The primary aim of this systematic review is to determine the efficacy of primary and secondary CVD prevention interventions targeting lifestyle risk factors in women. Methods: Six electronic databases were searched up to January 2022. Eligible studies included randomized controlled trials of primary or secondary CVD prevention interventions targeting CVD lifestyle risk factors (diet, physical activity, sedentary behavior, smoking, alcohol, sleep, and weight management) in women (=18 years) that reported CVD risk markers or lifestyle risk factors. Meta-analyses were conducted on CVD risk markers and body mass index (BMI), and the level of evidence was applied to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria and reported. Results: Thirty-five RCTs were included (24 primary and 11 secondary prevention). Meta-analyses demonstrated that lifestyle CVD prevention interventions achieved statistically significant reductions in BMI at = 6 months (0.95 kg/m2, 95% CI = 0.54 to 1.35, p < 0.0001), 12 months (0.61 kg/m2, 95% CI = 0.07 to 1.16, p = 0.03) and >12 months (0.58 kg/m2, 95% CI = 0.01 to 1.16, p = 0.05), and systolic blood pressure (mmHg) at = 6 months (3.51, p < 0.001). Conclusions: Lifestyle interventions are important for the prevention of CVD in women, specifically to reduce systolic blood pressure in the short term (= 6 months) and BMI long term (>12 months). Systematic review registration: https://osf.io/bkwqm, identifier: osf-registrations-bkwqm-v1.

Background: Changing people's behaviour by giving advice and instruction, as traditionally provided in healthcare consultations, is usually ineffective. Healthy Conversation Skills (HCS) training enhances health professionals' communication skills and ability to empower and motivate people in health behaviour change. Guided by the Theoretical Domains Framework (TDF), this¿study examined the impact of HCS training on health professional barriers to conducting behaviour change conversations in both clinical and non-clinical settings. Secondary aims were to i) identify health professionals' barriers to having behaviour change conversations, and explore the ii) effect of HCS training on health professionals' competence and attitudes to adopting HCS, iii) feasibility, acceptability and appropriateness of using HCS in their clinical and non-clinical roles, and iv) acceptability and quality of HCS training. Methods: HCS training was conducted in October-November 2019 and February 2020. Pre-training (T1), post-training (T2) and follow-up (T3; 6-10 weeks post-training) surveys collected data on demographics and changes in competence, confidence, importance and usefulness (10-point Likert scale, where 10 = highest score) of conducting behaviour change conversations. Validated items assessing barriers to having these conversations were based on eight TDF domains. Post-training acceptability and quality of training was assessed. Data were summarised using descriptive statistics, and differences between TDF domain scores at the specific time points were analysed using Wilcoxon matched-pairs signed-rank tests. Results: Sixty-four participants consented to complete surveys (97% women; 16% identified as Aboriginal), with 37 employed in clinical settings and 27 in non-clinical settings. The training improved scores for the TDF domains of skills (T1: median (interquartile range) = 4.7(3.3-5.3); T3 = 5.7(5.3-6.0), p < 0.01), belief about capabilities (T1 = 4.7(3.3-6.0); T3 = 5.7(5.0-6.0), p <¿0.01), and goals (T1 = 4.3(3.7-5.0); T3 = 4.7(4.3-5.3), p < 0.01) at follow-up. Competence in using 'open discovery questions' increased post-training (T1 = 25% of responses; T2 = 96% of responses; T3 = 87% of responses, p < 0.001), as did participants' confidence for having behaviour change conversations (T1 = 6.0(4.7-7.6); T2 = 8.1(7.1-8.8), p <¿0.001), including an increased confidence in having behaviour change conversations with Aboriginal clients (T1 = 5.0(2.7-6.3); T2 = 7.6(6.4-8.3), p <¿0.001). Conclusions: Provision of additional support strategies to address intentions; memory, attention and decision processes; and behavioural regulation may enhance adoption and maintenance of HCS in routine practice. Wider implementation of HCS training could be an effective strategy to building capacity and support health professionals to use a person-centred, opportunistic approach to health behaviour change.

Problem: Studies investigating the direct and indirect relationships between psychosocial factors (i.e. attitudes, beliefs and values), health related behaviour (diet and physical activity) and gestational weight gain are increasing. To date heterogeneity of psychosocial measurement tools has limited research progress in this area, preventing measurement of effects by meta-analysis techniques. Aim: To conduct a revalidation analysis of a Weight Related Behaviours Questionnaire, originally developed by Kendall, Olson and Frangelico within the United States of America and assess its performance for use within the Australian context. Methods: A revalidation study using Exploratory Factor Analysis was undertaken to assess the factor structure and internal consistency of the six psychosocial scales of the Weight Related Behaviours Questionnaire, within the Woman and Their Children's Health (WATCH), pregnancy cohort. The questionnaire was self-completed between 18 ¿ 20 weeks gestation. Psychosocial factors included; Weight locus of control; Self-efficacy; Attitudes towards weight gain; Body image, Feelings about the motherhood role; and Career orientation. Findings: Weight locus of control, Self-efficacy and Body image, retained the same factor structure as the original analysis. The remaining psychosocial factors observed a different factor structure in terms of loadings or number of factors. Deleted items modelling suggests the questionnaire could be strengthened and shortened. Conclusion: Weight Locus of control, Self-efficacy and Body image were observed as consistent, valid and reliable psychosocial measures for use within the Australian context. Further research is needed to confirm the model and investigate the potential for combining these scales into a shorter psychosocial measurement tool.

Aim: To investigate associations between changes in vegetable and fruit (V&F) intakes and anthropometric indices (weight, BMI, % body fat, waist circumference), including differences by sex, during a dietary weight-loss intervention. Methods: Adults (18-45 years) with overweight/obesity (BMI 25-35 kg/m2) entered a 10-week pre-post study, receiving individualised consults with an Accredited Practising Dietitian targeting increased V&F intakes. Dietary intake was assessed using 24-hour recalls and food frequency questionnaires. Linear mixed models were used to examine how much of the changes in anthropometric indices were explained by changes in V&F intakes. Sex differences were assessed by Wilcoxon rank sum tests. Results: Of the 43 participants enrolled, 34 completed the study (53% female). Significant differences in energy intake and anthropometric indices were observed between males and females at baseline. After 10 weeks, females significantly reduced their weight (-2.9%, P <.01), BMI (-0.82 kg/m2, P <.01), waist circumference (-1.70 cm, P <.01), energy intake (-824 kJ/day, P =.01) and improved diet quality (-14.0% energy-dense, nutrient-poor foods, P <.01). Males significantly reduced weight (-2.5%, P =.04), BMI (-0.76 kg/m2, P =.03), waist circumference (-2.40 cm, P =.02), energy intake (-2875 kJ/day, P <.01), increased fruit intake (+0.89 serves/day, P =.02) and improved diet quality (-6% energy-dense, nutrient-poor foods, P <.01). Compared to the other sex, greater reductions were observed in energy intake in males and energy-dense, nutrient-poor foods in females. Linear mixed models identified that changes in V&F intakes did not explain the variation in anthropometric measures. Conclusion: Future interventions may benefit from trialling sex tailored messages to enhance effects on anthropometric changes.

Background: The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development. Objective: Despite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems. Methods: Tapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development. Results: The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact. Conclusions: System designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research.

Suboptimal nutrition during pregnancy is recognised as a significant modifiable determinant in the development of chronic disease in offspring in later life. The current study aimed: (i) to assess the dietary intakes of pregnant Indigenous Australian women against national recommendations and (ii) to investigate the associations between maternal nutrition during pregnancy and the growth of the offspring, including kidney development in late gestation in the Gomeroi gaaynggal cohort (n = 103). Maternal dietary intake in the third trimester was assessed using the Australian Eating Survey Food Frequency Questionnaire. Estimated fetal weight (EFW) and kidney size were obtained by ultrasound. Birth weight was retrieved from hospital birth records. Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the nutrient reference values (NRVs) were zinc (75.7%) and folate (57.3%), whereas iron was the lowest. Only four people achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. Sodium and saturated fat intake exceeded recommended levels and diet quality was low, with a median score of 28 out of 73 points. After adjusting for smoking and pre-pregnancy body mass index, only maternal intake of retinol equivalents and the proportion of energy from nutrient-dense or energy-dense, nutrient-poor (EDNP) foods were associated with fetal growth. EFW decreased by 0.13 g and birth weight decreased by 0.24 g for every µg increase in maternal dietary retinol intake. Interestingly, EFW, but not actual birth weight, was positively associated with percentage energy from nutrient dense foods and negatively associated with percentage energy from EDNP foods. Dietary supplement usage was associated with increased birthweight, most significantly iron and folate supplementation. Current dietary intakes of pregnant Australian women from this cohort do not align with national guidelines. Furthermore, current findings show that maternal retinol intake and diet composition during pregnancy can influence fetal growth, but not fetal kidney growth in late gestation. Strategies that aim to support and optimise nutrient intakes of Indigenous pregnant women are urgently needed. Future studies with long-term follow-up of the children in the current cohort to assess renal damage and blood pressure are imperative.

Nutrition plays an important role in pain management. Healthy eating patterns are associated with reduced systemic inflammation, as well as lower risk and severity of chronic non-cancer pain and associated comorbidities. The role of nutrition in chronic non-cancer pain management is an emerging field with increasing interest from clinicians and patients. Evidence from a number of recent systematic reviews shows that optimising diet quality and incorporating foods containing anti-inflammatory nutrients such as fruits, vegetables, long chain and monounsaturated fats, antioxi-dants, and fibre leads to reduction in pain severity and interference. This review describes the current state of the art and highlights why nutrition is critical within a person-centred approach to pain management. Recommendations are made to guide clinicians and highlight areas for future research.

Background: The effect of fathers on dietary intake in preschool-aged children is under-explored. The aims were to: (i) evaluate the efficacy of a family-based lifestyle intervention, Healthy Youngsters, Healthy Dads, on change in dietary intake in fathers and their preschool-aged children post-intervention (10 weeks) and at 9 months follow-up compared to a waitlist control group and (ii) investigate associations in father¿child dietary intakes. Methods: Linear mixed models estimated group-by-time effects for all dietary outcomes, measured by food frequency questionnaires. Cohen's d determined effect sizes, while correlation tests determined associations in father¿child dietary intakes. Results: For children, medium group-by-time effects sizes were identified at 10 weeks for sodium intake (d = 0.38) and percentage energy from core foods (d = 0.43), energy-dense, nutrient-poor (EDNP) foods (d = 0.43) and prepacked snacks (d = 0.45). These findings were sustained at 9 months follow-up. For fathers, medium to large, group-by-time effect sizes were identified at 10 weeks for energy intake (d = 0.55), sodium intake (d = 0.64) and percentage energy from core foods (d = 0.49), EDNP foods (d = 0.49), and confectionary (d = 0.36). For all of these dietary variables, except sodium, effects were sustained at 9 months. Moderate to strong associations existed in father¿child dietary intakes for some of the dietary variables. Conclusions: Although further research is required, this study provides preliminary support for targeting fathers as agents of change to improve dietary intakes in their preschool-aged children.

The prevalence of Gestational Diabetes Mellitus (GDM) increased from 7% to 13.1% between 2013 and 2017 in NSW, Australia. Limited detail has been reported on dietary patterns prior to GDM diagnosis. Aim: To evaluate adequacy of micronutrient intakes and contribution of nutrient-dense versus energy-dense, nutrient-poor food groups to total energy. Method: Dietary intake of women with GDM was assessed over the six months prior to attending the first outpatient nutrition education group using the Australian Eating Survey: food frequency questionnaire with food group serves compared to the Australian Guide to Healthy Eating recommendations. Nutrient intakes compared to Estimated Average Requirements (EARs). Diet quality was evaluated using the Australian Recommended Food Score diet quality index. Results: Fifty women with a mean age of 30.8±4.6 years completed the Australian Eating Survey. Mean percentage (SD) energy intake derived from nutrient-dense versus energy-dense, nutrient-poor foods was 66.6% (12.4) and 33.4% (12.4); respectively. Median intakes of iron, calcium, fibre, iodine and folate were below EARs. Median (IQR) total Australian Recommended Food Score was 31(15) from a maximum 73 points. Adherence to the Australian Guide to Healthy Eating recommendations was low, with no participants meeting recommendations for serves of bread and cereals, 92% below dairy and dairy alternatives and 82% below vegetable intake recommendations. Conclusions: Before being diagnosed with GDM, women derive a high percentage of total energy from energy-dense, nutrient-poor foods, have low dietary variety amongst nutrient-dense foods, and sub-optimal intakes of key pregnancy micronutrients. Poor dietary patterns require attention within medical nutrition therapy for GDM in order to optimise nutrition-related health outcomes.

Socio-economic status and ethnic background are recognized as predictors of risk for the development of obesity in childhood. The present review assesses the effectiveness of treatment for children according to their socio-economic and ethnic background. Sixty-four systematic reviews were included, from which there was difficulty reaching general conclusions on the approaches to treatment suitable for different social subgroups. Eighty-one primary studies cited in the systematic reviews met the inclusion criteria, of which five directly addressed differential effectiveness of treatment in relation to social disparities, with inconsistent conclusions. From a weak evidence base, it appears that treatment effectiveness may be affected by family-level factors including attitudes to overweight, understanding of the causes of weight gain and motivation to make and maintain family-level changes in health behaviours. Interventions should be culturally and socially sensitive, avoid stigma, encourage motivation, recognize barriers and reinforce opportunities and be achievable within the family's time and financial resources. However, the evidence base is remarkably limited, given the significance of social and economic disparities as risk factors. Research funding agencies need to ensure that a focus on social disparities in paediatric obesity treatment is a high priority for future research.

Background: Unhealthy lifestyle behaviours contribute to the poor health of people attending alcohol and other drug (AOD) treatment. Healthy Recovery is an 8-session group-based intervention that targets smoking, diet and physical inactivity as part of an integrated healthy lifestyle approach. The current study aimed to examine the effectiveness of Healthy Recovery when delivered within residential AOD treatment settings. Methods: The study design was a stepped-wedge cluster randomised trial. Participants were 151 current smokers attending residential AOD programs provided by the Australian Salvation Army (n = 71, Control condition; n = 80, Intervention condition). The primary outcome was number of cigarettes smoked per day. Secondary outcomes examined other smoking behaviours (7-day point prevalence, use of nicotine replacement therapy [NRT]), diet (servings and variety of fruit and vegetables), and physical activity. Results: The mean number of cigarettes smoked per day was significantly lower in the Intervention condition at 2-, 5-, and 8-month follow-up. There were also significant differences in favour of the Intervention condition for number of quit attempts, use of NRT and variety of fruit. There were no other significant differences for other dietary or physical activity variables. Conclusions: Healthy Recovery had a positive impact on smoking behaviours. Future research should consider strategies to further promote smoking cessation (e.g. promoting longer-term use of NRT), as well as addressing physical activity and dietary behaviours. The introduction of broader organisational approaches (e.g. smoke free policies, organised group exercise and cooking activities) might help to enhance healthy lifestyle approaches within AOD treatment settings.

Objectives: In order to manage blood glucose levels in pregnancy, women need to know what and how much to eat, particularly for foods containing carbohydrate. The aim was to assess pregnant women's carbohydrate and standard serve size knowledge and examine whether health professionals provided nutrition education. Methods: Between July 2017 and April 2018 Australian pregnant women were recruited to complete an online survey, including a modified PedCarbQuiz carbohydrate knowledge questionnaire and an online buffet, where they selected images equivalent to one Australian Guide to Healthy Eating (AGHE) standard serve size. Results: 186 pregnant women (mean age 30.9¿years, SD = 4.7¿years) 12¿22¿weeks gestation completed the survey. Participants achieved a median score of 27/36 for identification of carbohydrate-containing foods and a median score of 1/12 (range 0¿11) for identification of grams of carbohydrate in specific portions. Participants achieved a median score of 14/22 (range 4¿19) for identification of one AGHE standard serve of 11 carbohydrate-containing foods. Less than half (n = 92, 49.5%) received nutrition education from health professionals. Conclusions for Practice: Pregnant women had sub-optimal carbohydrate knowledge. This could contribute to impaired blood glucose concentrations and risk of adverse health outcomes in pregnancy. Opportunities for pregnant women to access nutrition advice from health professionals should be explored.

Introduction: Innovative eHealth solutions that improve access to child weight management interventions are crucial to address the rising prevalence of childhood obesity globally. The study aimed to evaluate the feasibility and preliminary efficacy of a 12-week online telehealth nutrition intervention to improve child weight and dietary outcomes, and the impact of additional text messages (SMS) targeted to mothers and fathers. Methods: Families with children aged 4 to 11 were randomised across three groups: Telehealth, Telehealth+SMS, or Waitlist control. Telehealth and Telehealth+SMS groups received two telehealth consultations delivered by a dietitian, 12 weeks access to a nutrition website and a private Facebook group. The Telehealth+SMS group received additional SMS. Feasibility was assessed through recruitment, retention, and intervention utilisation. Efficacy was assessed through changes in measured child body mass index (BMI), waist circumference and diet. Results: Forty-four (96%) and 36 (78%) families attended initial and second telehealth consultations, respectively. Thirty-six families (78%) completed week 12 assessments. Child BMI and waist circumference changes from baseline to week 12 were not statistically different within or between groups. Children in Telehealth+SMS had significantly reduced percentage energy from energy-dense nutrient-poor food (95% CI -21.99 to -0.03%E; p =.038) and increased percentage energy from healthy core food (95% CI -0.21 to 21.89%E; p =.045) compared to Waitlist control. Discussion: A family-focused online telehealth nutrition intervention is feasible. While the modest sample size reduced power to detect between-group changes in weight status, some improvements in child dietary intakes were identified in those receiving telehealth and SMS.

Introduction: Previous reviews of family-based interventions for childhood obesity treatment found that studies were of low methodological quality with inadequate details reported, especially related to intervention fidelity. The evaluation of fidelity is crucial to inform interpretation of the intervention outcomes. This study aimed to summarise intervention fidelity, participants' acceptability and satisfaction with a 12-week family-focused technology-based child nutrition and weight management intervention. Methods: Families with children aged 4¿11 years participated in a telehealth intervention with complementary components: website, Facebook group and text messages. Intervention fidelity was reported using National Institutes of Health Treatment Fidelity Framework. Delivery was measured using a dietitian-reported evaluation survey. Google Analytics and Bitly platform were used to objectively track data on frequency and pattern of intervention use. Participants' acceptability and satisfaction were measured using a process evaluation survey. Results: Telehealth consultations delivered by trained dietitians had good adherence (=83%) to the structured content. Process evaluation results indicated that parents (n = 30; mean age 41 years, 97% were female, body mass index 30 kg/m2) found the intervention components easy to use/understand (87¿100%), the programme had improved their family/child eating habits (93%), and they wanted to continue using telehealth and the website, as well as recommending it to other parents (90¿91%). Discussion: In summary, a family-focused technology-based child nutrition and weight management intervention using telehealth, website, Facebook and SMS can be delivered by trained dietitians with good fidelity and attain high acceptability and satisfaction among families with primary-school-aged children in New South Wales, Australia.

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.

Aim: The nutritional quality of foods consumed by infants and young children to complement breastfeeding or formula feeding influences growth and development. The aim of this study was to identify the dietary intake of Indigenous infants and young children in the Gomeroi gaaynggal cohort, and evaluate the nutritional adequacy of their intake compared with Australian recommendations. Methods: Dietary intake was assessed using diet recalls at approximately 9-, 12- and 24-month visits. Nutrient values of foods were obtained from AUSNUT 2011-13 and nutrient intake compared to the Australian Nutrient Reference Values. Foods were categorised into food groups and intakes compared to the Australian Guide to Healthy Eating. Results: A total of 206 infants and young children were included in the study. Of these, 95 individual children had dietary data collected between 7.6 and 24.7¿months. Infant formula and breastfeeding rates were highest among infants (70% and 20%, respectively). Cow's milk intake was highest among young children (75%). Infants and young children in the cohort met most macro- and micronutrient intake recommendations. Few young children met recommendation for iron (42%), no infant met recommendation for omega-3 fatty acids and almost all exceeded recommendation for sodium. Most young children met daily dairy and fruit recommendations although intake of discretionary foods was high. Conclusions: This study found that diets of Indigenous infants and young children met most key nutrient reference targets. Potential target areas that require dietary optimisation have been identified and will be the focus of community-led strategies in adequate infant nutrition promotion.

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.

It is the position of Dietitians Australia that clients can receive high-quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via telehealth. Outcomes of telehealth-delivered dietetic consultations are comparable to those delivered in-person, without requiring higher levels of additional training nor compromising quality of service provision. Dietitians Australia recommends that policy makers and healthcare funders broaden the recognition for telehealth-delivered dietetic consultations as a responsive and cost-effective alternative or complement to traditional in-person delivery of dietetic services. The successful implementation of telehealth can help to address health and service inequalities, improve access to effective nutrition services, and support people with chronic disease to optimise their diet-related health and well-being, regardless of their location, income or literacy level, thereby addressing current inequities.

AIM: To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden. MATERIALS AND METHODS: A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression. RESULTS: One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan. CONCLUSIONS: Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.

Introduction: Whole body magnetic resonance imaging (WB-MRI) may be more efficient in staging cancers, but can be harder for patients to tolerate. We examined predictors of patient preference for WB-MRI vs. CT/ PET-CT for staging colorectal or lung cancer. Methods: Patients recruited prospectively to two multicentre trials comparing diagnostic accuracy of WB-MRI with standard staging scans were sent two questionnaires: the first, administered at trial registration, captured demographics, educational level and comorbidities; the second, administered after staging completion, measured emotional distress (GHQ-12), positive mood (PANAS), perceived scan burden, patients' beliefs about WB-MRI, and preference for either WB-MRI or CT (colorectal trial), WB-MRI or PET-CT (lung trial). Preference for WB-MRI or CT/ PET-CT was analysed using logistic regression. Results: Baseline and post-staging questionnaires were completed by 97 and 107 patients, respectively. Overall, 56/107 (52%) preferred WB-MRI over standard scans and were more likely to have no additional comorbidities, higher positive mood, greater awareness of potential benefits of WB-MRI and lower levels of perceived WB-MRI scan burden. In adjusted analyses, only awareness of potential WB-MRI benefits remained a significant predictor (OR: 1.516, 95% CIs 1.006¿2.284, P¿=¿0.047). Knowledge that WB-MRI does not use radiation predicted preference (adjusted OR: 3.018, 95% CIs 1.099¿8.288, P¿=¿0.032), although¿only 45/107 (42%) patients were aware of this attribute. Conclusions: A small majority of patients undergoing staging of colorectal or lung cancer prefer WB-MRI to CT/ PET-CT. Raising awareness of the potential benefits of WB-MRI, notably lack of ionizing radiation, could influence preference.

Objectives: Supporting healthy ageing is a key priority worldwide. Physical activity, diet quality and sleep are all associated with health outcomes, but few studies have explored their independent associations with all-cause mortality in an older population in the same model. The study aim was to examine associations between step-count, self-reported diet quality, restless sleep, and all-cause mortality in adults aged 55¿85 years. Design: A prospective cohort study of adults in Newcastle, New South Wales, Australia. Method: Data were from 1697 participants (49.3% women; baseline mean age 65.4 ± 7.1 years). Daily steps (measured by pedometer), diet quality (from a modified Australian Recommended Food Score), and frequency of restless sleep (by self-report) were assessed in relation to all-cause mortality using Cox proportional hazard regression with adjustment for sex, age, household income and smoking. Baseline data were collected between January 2005 and April 2008, and last follow-up was in March 2017 (median follow-up 9.6 years). Results: Higher step count (HR: 0.93, 95%CI: 0.88¿0.98 per 1000-step increment) and higher diet quality (HR: 0.86, 95%CI: 0.74¿0.99 per 8-point increment in diet quality score) were associated with reduced mortality risk. Restless sleep for =3 nights/week was not associated with mortality risk (HR: 1.03, 95%CI: 0.78¿1.39). Sensitivity analyses, adjusting for chronic disease and excluding deaths <1 year after baseline, did not change these estimates. Conclusions: Increased daily steps and consumption of a greater variety of nutrient-dense foods every week would result in substantial health benefits for older people. Future research should include a greater variety of sleep measures.

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.

Dietary intakes are commonly assessed by established methods including food frequency questionnaires, food records, or recalls. These self-report methods have limitations impacting validity and reliability. Dietary biomarkers provide objective verification of self-reported food intakes, and represent a rapidly evolving area. This review aims to summarize the urinary biomarkers of individual foods, food groups, dietary patterns, or nutritional supplements that have been evaluated to date. Six electronic databases were searched. Included studies involved healthy populations, were published from 2000, and compared measured dietary intake with urinary markers. The initial search identified 9985 studies; of these, 616 full texts were retrieved and 109 full texts were included. Of the included studies, 67 foods and food components were studied, and 347 unique urinary biomarkers were identified. The most reliable biomarkers identified were whole grains (alkylresorcinols), soy (isoflavones), and sugar (sucrose and fructose). While numerous novel urinary biomarkers have been identified, further validation studies are warranted to verify the accuracy of self-reported intakes and utility within practice.

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.

The impact of pre-pregnancy obesity and maternal diet quality on the use of healthcare resources during the perinatal period is underexplored. We assessed the effects of body mass index (BMI) and diet quality on the use of healthcare resources, to identify whether maternal diet quality may be effectively targeted to reduce antenatal heath care resource use, independent of women's BMI. Cross-sectional data and inpatient medical records were gathered from pregnant women attending publicly funded antenatal outpatient clinics in Newcastle, Australia. Dietary intake was self-reported, using the Australian Eating Survey (AES) food frequency questionnaire, and diet quality was quantified from the AES subscale, the Australian Recommended Food Score (ARFS). Mean pre-pregnancy BMI was 28.8 kg/m2 (range: 14.7 kg/m2¿64 kg/m2). Mean ARFS was 28.8 (SD = 13.1). Higher BMI was associated with increased odds of caesarean delivery; women in obese class II (35.0¿39.9 kg/m2) had significantly higher odds of caesarean delivery compared to women of normal weight, (OR = 2.13, 95% CI 1.03 to 4.39; p = 0.04). Using Australian Refined Diagnosis Related Group categories for birth admission, the average cost of the birth admission was $1348 more for women in the obese class II, and $1952 more for women in the obese class III, compared to women in a normal BMI weight class. Higher ARFS was associated with a small statistically significant reduction in maternal length of stay (RR = 1.24, 95% CI 1.00, 1.54; p = 0.05). There was no evidence of an association between ARFS and mode of delivery or "midwifery-in-the-home-visits".

Background: Children with CF have been reported to consume significantly more energy-dense, nutrient-poor foods than controls where there are now concerns of inadequate micronutrient intake. There are no current or comprehensive dietary studies assessing micronutrient intake in CF children. Objectives: To evaluate micronutrient intake in children with CF compared to recommended dietary intakes (RDIs). Methods: Dietary intake of 13 micronutrients was measured in CF children aged 2¿18 years and age- and sex-matched controls using a validated food frequency questionnaire (The Australian Child and Adolescent Eating Survey). Results: CF children (n = 82) consumed significantly more energy than controls (n = 82) [3142(2531¿3822) kcal vs 2216(1660¿2941) kcal; p <.001]. Absolute intake in CF children was significantly higher in all micronutrients except vitamin C and folate, however energy-adjusted intake was significantly lower for all micronutrients except vitamin A, sodium, calcium and phosphorous. Energy-adjusted intake in primary school CF children was significantly less than controls in 8/13 micronutrients. Overall, median intakes exceeded the RDIs for all micronutrients however CF children fell short of the RDIs for folate (26.8%), iron (15.9%) and calcium (9.8%). In pre-school, 50% of CF children and 91.7% of controls did not meet the iron RDI. High school CF and control children failed to meet RDIs for 7/13 and 9/13 micronutrients respectively. Conclusion: Increased intake of most micronutrients in CF children was largely attributed to higher energy consumption. However, micronutrient density of the diet declined with increasing age, where high school children failed to meet RDIs for most key micronutrients.

Background & aims: A brief assessment tool on frequency and variety of fruit and vegetable intake could provide a cost-effective and sustainable approach to improving diet. The primary aim was to evaluate the comparative validity of a brief index of Fruit And Vegetable VAriety (FAVVA) relative to food and nutrient intakes derived from a comprehensive food frequency questionnaire (FFQ). The secondary aim was to evaluate the FAVVA index in relation to fasting plasma carotenoid concentrations. Methods: Dietary intakes and fasting plasma carotenoid concentrations of 99 overweight and obese adults (49.5% female; 44.6 ± 9.9 years) were assessed at baseline and 3-months. Food and nutrient intakes were assessed using the Australian Eating Survey (AES) FFQ. The FAVVA index was derived from a sub-set of 35 AES questions related to fruit and vegetable intake frequency and variety. Associations were assessed using Spearman's correlation coefficients and linear regression analysis, and agreement using weighted kappa (K w ). Results: Total FAVVA score demonstrated moderate to strong, significant (all p < 0.01) correlations with total daily intakes of vegetables (r = 0.75), vitamin C (r = 0.71), fruit (r = 0.66), vitamin A (r = 0.49), fibre (r = 0.49), potassium (r = 0.46), magnesium (r = 0.39), iron (r = 0.26), riboflavin (r = 0.24), calcium (r = 0.23), zinc (r = 0.20) and niacin equivalent (r = 0.20). These associations remained significant in the adjusted regression analyses and agreement testing. Total FAVVA was significantly correlated with plasma carotenoid concentrations (µg/dL) of a¿carotene (r = 0.22, p < 0.01), ß¿carotene (r = 0.26, p < 0.001), ß¿cryptoxanthin (r = 0.22, p < 0.01) and total carotenoids (r = 0.18, p < 0.05). The associations with a¿carotene (ß = 0.09, p < 0.001), ß¿carotene (ß = 0.42, p < 0.05) and total plasma carotenoids (ß = 0.85, p < 0.05) remained significant in the adjusted regression analyses and for agreement testing. Conclusions: FAVVA is suitable as a brief tool to rank frequency and variety of fruit and vegetable intake.

Aim: There has been an increase in the use of text messaging to deliver and support health interventions. The aim was to develop a bank of text messages targeting healthy eating for children in the context of parenting partnerships that could be used in a family intervention. Methods: Text messages were developed using the Theoretical Domains Framework and Behaviour Change Wheel COM-B model by study investigators using a three-phase approach: (i) initial development of a message bank; (ii) messages were reviewed and evaluated by experts and parents on their clarity, usefulness, and relevance using a 5-point Likert scale and open text spaces for additional feedback and (iii) refinement of messages content and finalised the message bank. Results: Messages were reviewed for 'clarity', 'usefulness' and 'relevance' by 20 parents and 28 health experts, who were predominantly female (92%), parents of primary school age children (33%), of low to middle socioeconomic status (78%), with a mean age of 39 years (SD ± 9.87). From an initial set of 97 messages developed, 48 messages were retained through consultation. Messages were designed to complement the intervention, while engaging both parents. Conclusions: The three-phase development created a set of text messages acceptable to experts and parents that aim to support improvement in child eating behaviours. The process provides a template and practical guide for researchers and health providers looking to apply a systematic approach to text messages development. Future research should investigate acceptability and impact of these messages as a component of family-based nutrition intervention.

Evidence from animal models indicates that exposure to an obesogenic or hyperglycemic intrauterine environment adversely impacts offspring kidney development and renal function. However, evidence from human studies has not been evaluated systematically. Therefore, the aim of this systematic review was to synthesize current research in humans that has examined the relationship between gestational obesity and/or diabetes and offspring kidney structure and function. Systematic electronic database searches were conducted of five relevant databases (CINAHL, Cochrane, EMBASE, MEDLINE and Scopus). Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed, and articles screened by two independent reviewers generated nine eligible papers for inclusion. Six studies were assessed as being of 'neutral' quality, two of 'negative' and one 'positive' quality. Observational studies suggest that offspring exposed to a hyperglycemic intrauterine environment are more likely to display markers of renal dysfunction and are at higher risk of end-stage renal disease. There was limited and inconsistent evidence for a link between exposure to an obesogenic intrauterine environment and offspring renal outcomes. Offspring renal outcome measures across studies were diverse, with a large variation in offspring age at follow-up, limiting comparability across studies. The collective current body of evidence suggests that intrauterine exposure to maternal obesity and/or diabetes adversely impacts renal programming in offspring, with an increased risk of kidney disease in adulthood. Further high-quality, longitudinal, prospective cohort studies that measure indicators of offspring renal development and function, including fetal kidney volume and albuminuria, at standardized follow-up time points, are warranted.

Background: Whole-body MRI (WB-MRI) could be an alternative to multimodality staging of colorectal cancer, but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in colorectal cancer. Methods: The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer. Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or polyp cancer. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs), and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN43958015, and is complete. Findings: Between March 26, 2013, and Aug 19, 2016, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial; 68 (23%) had metastasis at baseline. Pathway sensitivity was 67% (95% CI 56 to 78) for WB-MRI and 63% (51 to 74) for standard pathways, a difference in sensitivity of 4% (-5 to 13, p=0·51). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (95% [95% CI 92¿97]) and standard pathways (93% [90¿96], p=0·48). Agreement with the multidisciplinary team's final treatment decision was 96% for WB-MRI and 95% for the standard pathway. Time to complete staging was shorter for WB-MRI (median, 8 days [IQR 6¿9]) than for the standard pathway (13 days [11¿15]); a 5-day (3¿7) difference. WB-MRI required fewer tests (median, one [95% CI 1 to 1]) than did standard pathways (two [2 to 2]), a difference of one (1 to 1). Mean per-patient staging costs were £216 (95% CI 211¿221) for WB-MRI and £285 (260¿310) for standard pathways. Interpretation: WB-MRI staging pathways have similar accuracy to standard pathways and reduce the number of tests needed, staging time, and cost. Funding: UK National Institute for Health Research.

The objective of this review was to evaluate the efficacy and safety of very low-energy diet (VLED) programs for weight loss in children and adolescents with obesity. Six electronic databases were searched identifying 24 eligible studies (16 pre-post studies, four nonrandomized trials, two randomized controlled trials [RCTs], and two chart reviews) published up to October 2018. Studies were in English, implemented a VLED (=3360¿kJF/day [=800¿kcal/day] or <50% estimated energy requirements) in 5- to 18-year-olds with obesity, and reported at least one weight-related outcome. Weight-related outcomes significantly improved postintervention in all studies. Meta-analysis of 20 studies indicated a mean 10.1¿kg (95% confidence interval [CI], 8.7-11.4¿kg, P¿<¿0.001; I2¿=¿92.3%) weight loss following interventions lasting 3 to 20¿weeks. Moderator analysis indicated greater weight loss in adolescent-only studies (10-18¿years) and formulated meal replacement interventions and inpatient settings. Meta-analysis of seven studies reporting weight at follow-up (5-14.5¿months from baseline) indicated 5.3 kg mean weight loss (CI, 2.5-8.0¿kg, P¿<¿0.001; I2¿=¿50.6%). Details of adverse events were limited. VLED programs are effective for treating children and adolescents with obesity. However, conclusions on their safety cannot be drawn from the existing literature at this time. Future studies should include long-term follow-up with ongoing support and comprehensive monitoring of all adverse events.

The aim of this study was to examine the effect of a six-week 2 × 2 design on pain scores, quality of life, and dietary intake in patients attending an Australian tertiary pain clinic. The two intervention components were (1) personalized dietary consultations or waitlist control, and (2) active or placebo dietary supplement (fruit juice). Sixty participants were randomized into one of four groups at baseline (68% female, mean age 49 ± 15 years) with 42 completing the study (70% retention). All groups had statistically significant improvements in three of five pain outcomes. The personalized dietary consultation groups had clinically important improvements in three of five pain outcomes compared to the waitlist control groups. All groups had a statistically significant improvement in six of eight quality-of-life categories post intervention. All groups increased percentage energy from nutrient-dense foods (+5.2 ± 1.4%, p < 0.001) with a significant group-by-time effect for percentage energy from total fat (p = 0.024), with the personalized dietary consultations plus placebo fruit juice reporting the largest reduction (-5.7 ± 2.3%). This study indicates that dietitian-delivered dietary intervention can improve pain scores, quality of life, and dietary intake of people experiencing chronic pain. Future research should evaluate efficacy in a full-powered randomized control trial.

Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother-child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight (P=0.005) and GROW customized birth weight centiles (P=0.008). There was a significant association between maternal percentage body fat (P=0.02) and visceral fat area (P=0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term (P=0.03). GROW customized birth weight centiles was significantly associated with body weight (P=0.01), BMI (P=0.007) and abdominal circumference (P=0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.

Background:: It is hypothesised that epigenetic mechanisms including DNA methylation may underlie the relationship between early-life nutrition and child cognitive outcomes. This study aimed to identify dietary patterns associated with the intake of one-carbon metabolism nutrients in children aged 2¿3 years. Methods:: A validated 120-item semi-quantitative food frequency questionnaires at 2¿3 years of age were used to estimate the intake of one-carbon metabolism nutrients (methionine, folate, choline and vitamins B2, B6, B12) and to quantify mean number of serves consumed of the food groups specified by the Australian Guide to Healthy Eating (AGHE). Descriptive statistics were used to analyse the contribution of each food group and food items to the total intake of one-carbon metabolism nutrients. Linear regression was used to test for linear trends in food group servings by nutrient intake quintiles. Results:: No child (n = 60) from the Women And Their Children's Health (WATCH) study consumed the recommended number of serves for all AGHE food groups. Dairy and alternatives (18¿44%), discretionary foods (6¿33%) and meat and alternatives (6¿31%) were the main sources of most one-carbon metabolism nutrients. Most child intakes of one-carbon metabolism nutrients exceeded the nutrient reference values (NRVs), except for the intake of choline, for which the mean intake was 9% below the adequate intake (AI). Conclusion:: Dairy and alternatives, discretionary foods and meat and alternatives food groups contributed significantly to the children's intake of one-carbon metabolism nutrients. The children generally had low intakes of meat and alternative foods, which may explain their inadequate intake of choline.

OBJECTIVES: The objective of the review was to synthesize the effectiveness and strategies used in family-based behavioral childhood obesity interventions in improving child weight-related outcomes. INTRODUCTION: Family-based interventions are common practice in the treatment of childhood obesity. Research suggests that direct parental involvement can improve child weight-related outcomes. However, challenges remain in assessing the effects of family-based interventions on child weight and weight-related behavior due to the lack of quality programs and diversity of treatment strategies. INCLUSION CRITERIA: The review included systematic reviews and/or meta-analyses of family-based behavioral interventions in children aged =18 who were classified as overweight and/or obese, and which reported child weight related outcomes, such as body mass index (BMI), body fat percentage and waist circumferences. METHODS: Seven databases were searched from 1990 to May 2016 to identify English language publications. Reference lists of included reviews and relevant registers were also searched for additional reviews. All included systematic reviews were critically appraised by two reviewers independently. Data extracted included characteristics of included systematic reviews and weight-related outcomes reported. Data synthesis involved categorizing the interventions into seven categories and presented findings in narrative and tabular format. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: The umbrella review included 14 systematic reviews (low to moderate methodological quality), published between 2004 and 2015, including 47 independent trials ranging from one month to seven years follow-up conducted in more than 16 countries. The majority of reviews (93%) reported weight outcomes of children aged six to 13 years. All reviews except one indicated that family-based interventions were successful in improving child weight and/or weight-related behavior. Five reviews highlighted that parent-only interventions had similar (n¿=¿4) or greater (n¿=¿1) effectiveness compared to parent-child interventions. Effective interventions employed parent-targeted strategies, including nutrition and physical activity education sessions, positive parenting skills, role modelling and child behavior management to encourage positive healthy eating/exercise behaviors in children and/or whole family. CONCLUSIONS: Family-based interventions targeting parents, alone or with their child, are effective for child weight management. Due to the lack of high quality evidence, especially in emerging parent-only interventions, further research is warranted. Health practitioners can work with parents as agents of change and focus on fostering positive parenting skills, such as monitoring, reinforcement, role modelling, and providing a nurturing environment, in order to support health behaviors in their children. Future research needs to explore whether parent-only interventions are more cost-effective compared to parent-child interventions, and to include larger populations, longer intervention duration and follow-up.

Background: This systematic review aimed to evaluate the impact of nutrition interventions on participant reported pain severity and intensity in populations with chronic pain. Methods: Eight databases were systematically searched for studies that included adult populations with a chronic pain condition, a nutrition intervention and a measure of pain. Where possible, data were pooled using meta-analysis. Seventy-one studies were included, with 23 being eligible for meta-analysis. Results: Studies were categorised into four groups: (i) altered overall diet with 12 of 16 studies finding a significant reduction in participant reported pain; (ii) altered specific nutrients with two of five studies reporting a significant reduction in participant reported pain; (iii) supplement-based interventions with 11 of 46 studies showing a significant reduction in pain; and (iv) fasting therapy with one of four studies reporting a significant reduction in pain. The meta-analysis found that, overall, nutrition interventions had a significant effect on pain reduction with studies testing an altered overall diet or just one nutrient having the greatest effect. Conclusions: This review highlights the importance and effectiveness of nutrition interventions for people who experience chronic pain.

Background Stroke events often result in long-term negative health outcomes. People who experience a first stroke event are 30%-40% more likely to experience a second stroke event within 5 years. An online secondary prevention programme for stroke survivors may help stroke survivors improve their health risk behaviours and lower their risk of a second stroke. Objectives This paper describes the development and early iteration testing of the usability and acceptability of an online secondary prevention programme for stroke survivors (Prevent 2nd Stroke, P2S). P2S aims to address six modifiable health risk behaviours of stroke: blood pressure, physical activity, nutrition, depression and anxiety, smoking, and alcohol consumption. Methods P2S was developed as an eight-module online secondary prevention programme for stroke survivors. Modelled on the DoTTI (Design and development, Testing early iterations, Testing for effectiveness, Integration and implementation) framework for the development of online programmes, the following stages were followed during programme development: (1) content development and design; and (2) testing early iteration. The programme was pilot-tested with 15 stroke survivors who assessed P2S on usability and acceptability. Results In stage 1, experts provided input for the content development of P2S. In stage 2, 15 stroke survivors were recruited for usability testing of P2S. They reported high ratings of usability and acceptability of P2S. P2S was generally regarded as easy to use' and relevant to stroke survivors'. Participants also largely agreed that it was appropriate to offer lifestyle advice to stroke survivors through the internet. Conclusions The study found that an online secondary prevention programme was acceptable and easily usable by stroke survivors. The next step is to conduct a randomised controlled trial to assess the effectiveness of the programme regarding behaviour change and determine the cost-effectiveness of the intervention.

Objectives:The objective of this systematic review was to evaluate the effectiveness of interventions that include a nutrition component aimed at improving gestational weight gain and/or postpartum weight retention.Introduction:Excessive gestational weight gain and postpartum weight retention increase the risk of adverse maternal and neonatal outcomes. Current evidence comprises many interventions targeting gestational weight gain and postpartum weight retention that incorporate a nutrition component. To date, no review has synthesized evidence from pregnancy through the postpartum period or described the intervention approaches in detail.Inclusion criteria:The review included women (=18 years) during pregnancy and/or up to 12 months postpartum. Studies were included if they involved a weight management intervention with a nutrition component and had the primary objective of determining the impact of gestational weight gain and/or postpartum weight change. Interventions were compared to usual care (i.e. control conditions with no intervention or wait-list control or standard pregnancy or postpartum care) or "other" (alternative intervention). The review considered randomized controlled trials published between 1980 and January 21, 2016. Studies that included a weight related primary outcome measured during pregnancy and/or postpartum were included.Methods:Seven databases were searched and the reference lists of included studies were searched for additional studies not previously identified. Two independent reviewers assessed the methodological quality of studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI SUMARI). The JBI SUMARI standardized data extraction tool was used to extract data. A narrative synthesis was undertaken to qualitatively synthesize included studies, with meta-analyses used to pool weight outcome data from studies conducted separately for pregnancy and postpartum. Effect sizes for meta-analyses have been expressed as weighted mean differences (95% confidence intervals).Results:The search yielded 4063 articles of which 48 articles from 39 studies were included. Eleven of 20 studies during pregnancy reported significant reductions in gestational weight gain with the intervention when compared to control groups. One of five studies where the intervention was conducted during both pregnancy and postpartum reported statistically significant reductions in gestational weight gain, and postpartum weight retention between intervention and control groups. Nine of 14 studies conducted after childbirth reported statistically significant intervention effects, indicating lesser postpartum weight retention. Random effects meta-analyses indicated that despite considerable heterogeneity, interventions conducted during pregnancy (-1.25 kg; 95% CI:-2.10 kg,-0.40 kg; p = 0.004), and postpartum (-3.25 kg; 95% CI:-4.69 kg,-1.82 kg; p < 0.001) were significantly more effective at improving weight outcomes compared to usual care or other interventions. Most studies were of moderate quality due to lack of clarity in describing study details required for appraising methodological quality. Few interventions were conducted from pregnancy through the postpartum period (n = 5). Limited interventions adopted online modalities in intervention delivery (n = 4). Intention-to-treat analysis was used in only 12 studies.Conclusions:The pregnancy and postpartum period presents a unique opportunity to engage women in interventions to help optimize lifestyle behaviors for weight management, however the optimal approach is unclear. Improving consistency in intervention implementation and reporting will improve future evidence synthesis.

Issue addressed: The dietary intakes of Australian children are not optimal, with few meeting recommended vegetable and fruit intake targets. Nutrition education in childhood is important for developing healthy eating patterns, with schools an ideal setting for a wide reach. The aims of this study were to examine nutrition education within the NSW primary school syllabus, explore how much time teachers spend teaching nutrition, what is taught, what materials are used, and to identify attitudes towards nutrition education. Method: An online survey consisting of 29 closed questions (with options for comments) was specifically developed for the purpose of this study. Teachers currently teaching at a NSW primary school were eligible to participate. Results: A total of 33 NSW primary school teachers completed the survey. Results indicate that limited time is spent on teaching nutrition with some important nutrition education components currently missed, resources perceived to be inadequate and lack of time reported as the largest barrier to teaching nutrition. Conclusion: In order to improve the quality of nutrition education in NSW primary schools, several important topics need to be integrated into the curriculum, and time constraints of teachers should be taken into account. So what?: Findings from the current survey will inform the development of future nutrition education programs and resources with the aim of integrating nutrition education within the primary school curriculum.

Objectives: To determine the importance placed by patients on attributes associated with whole-body MRI (WB-MRI) and standard cancer staging pathways and ascertain drivers of preference. Methods: Patients recruited to two multi-centre diagnostic accuracy trials comparing WB-MRI with standard staging pathways in lung and colorectal cancer were invited to complete a discrete choice experiment (DCE), choosing between a series of alternate pathways in which 6 attributes (accuracy, time to diagnosis, scan duration, whole-body enclosure, radiation exposure, total scan number) were varied systematically. Data were analysed using a conditional logit regression model and marginal rates of substitution computed. The relative importance of each attribute and probabilities of choosing WB-MRI-based pathways were estimated. Results: A total of 138 patients (mean age 65, 61% male, lung n = 72, colorectal n = 66) participated (May 2015 to September 2016). Lung cancer patients valued time to diagnosis most highly, followed by accuracy, radiation exposure, number of scans, and time in the scanner. Colorectal cancer patients valued accuracy most highly, followed by time to diagnosis, radiation exposure, and number of scans. Patients were willing to wait 0.29 (lung) and 0.45 (colorectal) weeks for a 1% increase in pathway accuracy. Patients preferred WB-MRI-based pathways (probability 0.64 [lung], 0.66 [colorectal]) if they were equivalent in accuracy, total scan number, and time to diagnosis compared with a standard staging pathway. Conclusions: Staging pathways based on first-line WB-MRI are preferred by the majority of patients if they at least match standard pathways for diagnostic accuracy, time to diagnosis, and total scan number. Key Points: ¿ WB-MRI staging pathways are preferred to standard pathways by the majority of patients provided they at least match standard staging pathways for accuracy, total scan number, and time to diagnosis. ¿ For patients with lung cancer, time to diagnosis was the attribute valued most highly, followed by accuracy, radiation dose, number of additional scans, and time in a scanner. Preference for patients with colorectal cancer was similar. ¿ Most (63%) patients were willing to trade attributes, such as faster diagnosis, for improvements in pathway accuracy and reduced radiation exposure.

Background: Whole-body magnetic resonance imaging (WB-MRI) could be an alternative to multi-modality staging of non-small-cell lung cancer (NSCLC), but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in NSCLC. Methods: The Streamline L trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed NSCLC that was potentially radically treatable on diagnostic chest CT (defined as stage IIIb or less). Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or histologies other than NSCLC. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs) and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN50436483, and is complete. Findings: Between Feb 26, 2013, and Sept 5, 2016, 976 patients were screened for eligibility. 353 patients were recruited, 187 of whom completed the trial; 52 (28%) had metastasis at baseline. Pathway sensitivity was 50% (95% CI 37¿63) for WB-MRI and 54% (41¿67) for standard pathways, a difference of 4% (-7 to 15, p=0·73). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (93% [88¿96]) and standard pathways (95% [91¿98], p=0·45). Agreement with the multidisciplinary team's final treatment decision was 98% for WB-MRI and 99% for the standard pathway. Time to complete staging was shorter for WB-MRI (13 days [12¿14]) than for the standard pathway (19 days [17¿21]); a 6-day (4¿8) difference. The number of tests required was similar WB-MRI (one [1¿1]) and standard pathways (one [1¿2]). Mean per-patient costs were £317 (273¿361) for WBI-MRI and £620 (574¿666) for standard pathways. Interpretation: WB-MRI staging pathways have similar accuracy to standard pathways, and reduce the staging time and costs. Funding: UK National Institute for Health Research.

Healthy Dads Healthy Kids (HDHK) was the first program internationally to specifically target overweight and obese fathers to improve their children's health. In previous randomized controlled trials, HDHK generated meaningful short-Term improvements in the adiposity, physical activity, and eating behaviors of both fathers and children. The aim of this dissemination trial was to evaluate the 12-month impact of HDHK when delivered by trained facilitators across four low socioeconomic and regional communities in the Hunter Region, Australia. The study was a nonrandomized, prospective trial with minimal eligibility criteria (i.e., father body mass index [BMI] ? 25 kg/m2 and children aged 4-12 years). HDHK included eight weekly practical and theoretical sessions. Assessments were baseline, 3 months (post-intervention), 6-months, and 12-months. The primary outcome was fathers' weight. Secondary outcomes included child BMI z-score and validated lifestyle behavior measures (e.g., physical activity, diet). Overall, 189 fathers (mean age: 40.2 years, BMI: 32.6 kg/m2) and 306 children (mean age: 8.1 years) participated in one of 10 HDHK programs in four areas. Intention-To-Treat linear mixed models revealed a significant mean reduction in fathers' weight at post-intervention (?3.6 kg, 95% confidence interval: ?4.3, ?2.9), which was maintained at 12 months (71% retention). Corresponding improvements were also detected in children's BMI z-score and a range of lifestyle behaviors for both fathers and children. Attendance and satisfaction levels were high. Positive intervention effects observed in previous randomized controlled trials were largely replicated and sustained for 12 months when HDHK was delivered by trained local facilitators in underserved communities. Further investigation into the key systems, processes, and contextual factors required to deliver HDHK at scale appears warranted.