Professor Karen Charlton

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.

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.

Despite evidence for favourable health outcomes associated with plant-based diets, a database containing the plant and animal content of all foods eaten is required to undertake a reliable assessment of plant-based diets within a population. This study aimed to expand an existing Australian food database to include the plant and animal content of all whole foods, beverages, multi-ingredient products and mixed dishes. Twenty-three plant- and animal-based food group classifications were first defined. The food servings per 100 g of each product were then systematically calculated using either a recipe-based approach, a food label-based approach, estimates based on similar products or online recipes. Overall, 4687 (83·5 %) foods and beverages were identified as plant or plant-containing products, and 3701 (65·9 %) were animal or animal-containing products. Results highlighted the versatility of plant and animal ingredients as they were found in various foods across many food categories, including savoury and sweet foods, as well as discretionary and core foods. For example, over 97 % of animal fat-containing foods were found in major food groups outside the AUSNUT 2011-2013 'fats and oils' group. Surprisingly, fruits, nuts and seeds were present in a greater percentage of discretionary products than in core foods and beverages. This article describes a systematic approach that is suitable for the development of other novel food databases. This database allows more accurate quantitative estimates of plant and animal intakes, which is significant for future epidemiological and clinical research aiming to investigate plant-based diets and their related health outcomes.

Objectives: Universal salt iodization has been adopted by many countries to address iodine deficiency. More recently, salt-reduction strategies have been widely implemented to meet global salt intake targets of <5 g/d. Compatibility of the two policies has yet to be demonstrated. This study compares urinary iodine excretion (UIE) according to 24-h urinary sodium excretion, between South Africa (SA) and Ghana; both countries have implemented universal salt iodization, but in Ghana no salt-reduction legislation has been implemented. Methods: Participants from the World Health Organization's Study on Global Ageing and Adult Health Wave 3, with survey and valid 24-h urinary data (Ghana, n = 495; SA, n = 707), comprised the sample. Median 24-h UIE was compared across salt intake categories of <5, 5¿9 and >9 g/d. Results: In Ghana, median sodium excretion indicated a salt intake of 10.7 g/d (interquartile range [IQR] = 7.6), and median UIE was 182.4 µg/L (IQR = 162.5). In SA, both values were lower: median salt = 5.6 g/d (IQR = 5.0), median UIE = 100.2 µg/L (IQR = 129.6). UIE differed significantly across salt intake categories (P < 0.001) in both countries, with positive correlations observed in both¿Ghana: r = 0.1501, P < 0.0011; South Africa: r = 0.4050, P < 0.0001. Participants with salt intakes <9 g/d in SA did not meet the World Health Organization's recommended iodine intake of 150 µg/d, but this was not the case in Ghana. Conclusions: Monitoring and surveillance of iodine status is recommended in countries that have introduced salt-reduction strategies, in order to prevent reemergence of iodine deficiency.

The prevalence of hypertension is increasing in low- and middle-income countries, however statistics are generally derived from cross sectional surveys that utilize different methodologies and population samples. We investigated blood pressure (BP) changes over 11-12 years in a large cohort of adults aged 50 years and older (n = 820) included in the World Health Organization's Study on global AGEing and adult health (WHO-SAGE Ghana) Wave 1 (2007/8) with follow up in Wave 3 (2019). Participants' BP were measured in triplicate and a survey completed at both time points. Survey instruments collected information on sociodemographic characteristics, lifestyle, health behaviors and chronic conditions. While no significant difference was found in systolic BP between Waves 1 and 3, diastolic BP decreased by 9.7mmHg (mean = 88.6, 15.4 to 78.9, 13.6 respectively) and pulse pressure increased by 9.5mmHg (44.8, 13.7 to 54.3, 14.1). Awareness of hypertension increased by 37%, from (20% to 57%), but no differences were found for the proportion of hypertensives receiving treatment nor those that had controlled BP. Mixed effects modelling showed a decrease in diastolic BP was associated with increasing age, living in rural areas and having health insurance. Factors associated with an increased awareness of hypertension were residing in urban areas, having health insurance and increasing body mass index. While diagnosis of hypertension has improved over time in Ghana, there is an ongoing need to improve its treatment in older adults.

Background & aims: Postprandial metabolic imbalances are important indicators of later developing cardiovascular disease (CVD). This study investigated the effects of food anthocyanins on vascular and microvascular function, and CVD associated biomarkers following a high fat high energy (HFHE) meal challenge in overweight older adults. Methods: Sixteen subjects (13 female, 3 male, mean age 65.9 SD 6.0 and body mass index 30.6 kg/m2 SD 3.9) participated in a crossover, randomized, controlled, double-blind clinical trial (registered under Australian New Zealand Clinical Trials Registry, identifier no. ACTRN12620000437965). Participants consumed a HFHE meal with a 250 mL dose of either intervention (anthocyanins-rich Queen Garnet Plum) or control (apricot) juice. Blood samples and blood pressure measures were collected at baseline, 2 h and 4 h following the HFHE meal. Vascular and microvascular function were evaluated at baseline and 2 h after the HFHE meal. Results: Participants had a higher 2 h postprandial flow-mediated dilatation (+1.14%) and a higher microvascular post-occlusive reactive hyperaemia (+0.10 perfusion units per mmHg) when allocated to the anthocyanin compared to the control arm (P = 0.019 and P = 0.049, respectively). C-reactive protein was lower 4 h postprandially in the anthocyanins (1.80 mg/L, IQR 0.90) vs control arm (2.30 mg/L, IQR 1.95) (P = 0.026), accompanied by a trend for lower concentrations of interleukin-6 (P = 0.075). No significant postprandial differences were observed between treatments for blood pressure, triacylglycerol, total cholesterol, serum derivatives of reactive oxidative metabolites, tumor necrosis factor alpha, interleukin-1 beta, or maximum microvascular perfusion following iontophoresis of acetylcholine. Conclusion: Fruit-based anthocyanins attenuated the potential postprandial detrimental effects of a HFHE challenge on parameters of vascular and microvascular function, and inflammatory biomarkers in overweight older adults. Anthocyanins may reduce cardiovascular risk associated with endothelial dysfunction and inflammatory responses to a typical high fat 'Western' meal. Further studies are required to better elucidate the clinical implications of postprandial biomarkers of CVD.

South Africa implemented legislation in June 2016 mandating maximum sodium (Na) levels in processed foods. A pre-post impact evaluation assessed whether the interim legislative approach reduced salt intake and blood pressure. Baseline Na intake was assessed in a nested cohort of the WHO Study on global AGEing and adult health (WHO-SAGE) Wave 2 (Aug-Dec 2015). 24-hour urine samples were collected in a random subsample (n = 1,299; of which n = 750 were considered valid (volume = 300 mL and creatinine = 4 mmol/day (women) or = 6 mmol/day (men))). Follow-up urine samples were collected in Wave 3 (Jun 2018-Jun 2019), with replacements included for those lost to follow-up (n = 1,189; n = 548 valid). In those aged 18 - 49y, median salt intake was 7.8 (4.7, 12.0) g/day in W2 (n = 274), remaining similar in the W3 sample (7.7 (4.9, 11.3) g salt/day (n = 92); P = 0.569). In older adults (50 + y), median salt intake was 5.8 (4.0, 8.5) g/day (n = 467) in W2, and 6.0 (4.0, 8.6) g/day (n = 455) in W3 (P = 0.721). Controlling for differences in background characteristics, overall salt intake dropped by 1.15 g/day (P = 0.028). 24hr urinary Na concentrations from a countrywide South African sample suggest that salt intakes have dropped during the interim phase of mandatory sodium legislation. Further measurement of population level salt intake following stricter Na targets, enforced from June 2019, is necessary.

Background: There is mounting evidence that individuals with kidney disease and kidney stones have an abnormal gut microbiota composition. No studies to date have summarised the evidence to categorise how the gut microbiota profile of these individuals may differ from controls. Synthesis of this evidence is essential to inform future clinical trials. This systematic review aims to characterise differences of the gut microbial community in adults with kidney disease and kidney stones, as well as to describe the functional capacity of the gut microbiota and reporting of diet as a confounder in these studies. Methods: Included studies were those that investigated the gut microbial community in adults with kidney disease or kidney stones and compared this to the profile of controls. Six scientific databases (CINHAL, Medline, PubMed, Scopus, Web of Science and Cochrane Library), as well as selected grey literature sources, were searched. Quality assessment was undertaken independently by three authors. The system of evidence level criteria was employed to quantitatively evaluate the alteration of microbiota by strictly considering the number, methodological quality and consistency of the findings. Additional findings relating to altered functions of the gut microbiota, dietary intakes and dietary methodologies used were qualitatively summarised. Results: Twenty-five articles met the eligibility criteria and included data from a total of 892 adults with kidney disease or kidney stones and 1400 controls. Compared to controls, adults with kidney disease had increased abundances of several microbes including Enterobacteriaceae, Streptococcaceae, Streptococcus and decreased abundances of Prevotellaceae, Prevotella, Prevotella 9 and Roseburia among other taxa. Adults with kidney stones also had an altered microbial composition with variations to Bacteroides, Lachnospiraceae NK4A136 group, Ruminiclostridium 5 group, Dorea, Enterobacter, Christensenellaceae and its genus Christensenellaceae R7 group. Differences in the functional potential of the microbial community between controls and adults with kidney disease or kidney stones were also identified. Only three of the 25 articles presented dietary data, and of these studies, only two used a valid dietary assessment method. Conclusions: The gut microbiota profile of adults with kidney disease and kidney stones differs from controls. Future study designs should include adequate reporting of important confounders such as dietary intake to assist with interpretation of findings.

Given a global focus on salt reduction efforts to reduce cardiovascular risk, it is important to obtain accurate measures of salt intake on a population level. This study determined firstly whether adjustment for intra-individual variation in urinary sodium (Na) excretion using three repeated 24 h collections affects daily estimates and whether the use of repeated spot urine samples results in better prediction of 24 h Na compared to a single collection. Twenty three community-dwelling men and women from South Africa (mean age 59.7 years (SD = 15.6)) participating in the World Health Organization Study on global AGEing and adult health (WHO-SAGE) Wave 3 study collected 24 h and spot early morning urine samples over three consecutive days to assess urinary Na excretion. INTERSALT, Tanaka, and Kawasaki prediction equations, with either average or adjusted spot Na values, were used to estimate 24 h Na and compared these against measured 24 h urinary Na. Adjustment was performed by using the ratio of between-person (sb) and total (sobs) variability obtained from repeated measures analysis of variance. Sensitivity of the equations to predict daily urinary Na values below 5 g salt equivalent was calculated. The sb/sobs for urinary Na using three repeated samples for spot and 24 h samples were 0.706 and 0.798, respectively. Correction using analysis of variance for 3 × 24 h collections resulted in contraction of the upper end of the distribution curve (90th centile: 157 to 136 mmoL/day; 95th centile: 220 to 178 mmoL/day). All three prediction equations grossly over-estimated 24 h urinary Na excretion, regardless of whether a single spot urine or repeated collections corrected for intra-individual variation were used. Sensitivity of equations to detect salt intake equivalent values of =5 g/day was 13% for INTERSALT, while the other two equations had zero sensitivity. Correcting for intra-individual variability in Na excretion using three 24 h urine collections contracted the distribution curve for high intakes. Repeated collection of spot samples for urinary Na analysis does not improve the accuracy of predicting 24 h Na excretion. Spot urine samples are not appropriate to detect participants with salt intakes below the recommended 5 g/day.

Background and Objectives: The need for updated competencies for nutrition scientists in Australia was identified. The aim of this paper is to describe the process of revising of these competencies for undergraduate nutrition science degrees in Australia. Methods and Study Design: An iterative multiple methods approach comprising three stages was undertaken: 1. Scoping study of existing competencies; 2. Exploratory survey; and, 3. Modified Delphi process (2 rounds) involving 128 nutrition experts from industry, community, government and academia. A =70% consensus rule was applied to Rounds 1 and 2 of the Delphi process in order to arrive at a final list of competencies. Results: Stage 1: Scoping study resulted in an initial list of 71 competency statements, categorised under six core areas. Stage 2: Exploratory survey-completed by 74 Nutrition Society of Australia (NSA) members; 76% agreed there was a need to update the current competencies. Standards were refined to six core areas and 36 statements. Stage 3: Modified Delphi process-revised competencies comprise five core competency areas, underpinned by fundamental knowledge, skills, attitudes and values: Nutrition Science; Food and the Food System; Nutrition Governance, Sociocultural and Behavioural Factors; Nutrition Research and Critical Analysis; and Communication and Professional Conduct; and three specialist competency areas: Food Science; Public Health Nutrition; and Animal Nutrition. Conclusions: The revised competencies provide an updated framework of nutrition science knowledge for graduates to effectively practice in Australia. They may be used to benchmark current and future nutrition science degrees and lead to improved employability skills of nutrition science graduates.

South Africa has one of the highest levels of hypertension globally, coupled with poor rates of diagnosis, treatment and control. Risk factors that predict hypertension in high income countries may perform differently in the African context, where communicable disease, obesity and malnutrition co-exist. This study investigated traditional risk factors alongside other health and sociodemographic indicators to determine predictors of hypertension prevalence and management. Participants were recruited from households across South Africa as part of WHO's Study on global AGEing and adult health (WHO SAGE) Wave 2 (2015). Blood pressure (BP) was measured in triplicate and sociodemographic and health data collected by survey (n = 1847; 30% 18¿39 years, 39% 40¿59 years, 31% 60 years+; median age 51 years; 68% female). Of all adults, 43% were hypertensive (n = 802), of which 58% (n = 398) were unaware, 33% (n = 267) were on medication, with only 18% (n = 141) controlled on medication (BP < 140/90 mmHg). Multivariate logistic regression showed waist-to-height ratio > 0.5 and diabetes comorbidity were the most significant predictors of hypertension presence, awareness and treatment. Individuals with diabetes were twice as likely to have hypertension, 7.0 times more likely to be aware, 3.3 times more likely to be on antihypertensive medication, and 2.4 times more likely to be controlled on medication. Women and individuals reporting lower salt use were more likely to be aware and treated for hypertension. Applying the 2017 AHA/ACC hypertension guidelines showed only 1 in 4 adults had normal BP. As with HIV, similarly intensive efforts are now needed in the region to improve non-communicable disease diagnosis and management.

Background: Cotinine, a nicotine metabolite, is used to measure tobacco use and exposure, but recommended cut-offs to differentiate tobacco users from those exposed through the environment range from 3 to 58 ng/ml in serum, and 2.5 to 550 ng/ml in urine. Cut-offs may differ by ethnicity, sex and age. As data from adults in Africa are scarce, our aim was to evaluate cut-offs for serum and urine cotinine that best predict self-reported tobacco use in South African adults. Methods: Two datasets were explored: African-PREDICT (n = 941 black and white healthy young adults, 20¿30 years, serum cotinine); and WHO SAGE Wave 2 (n = 604 adults, 18¿102 years, urine cotinine). Population specific cut-offs (ROC analyses) were compared with published cut-offs and self-reported tobacco use. Results: Overall, 19% (293 of 1545) reported current tobacco use. The following cotinine cut-offs showed the highest sensitivity and specificity: serum =15 ng/ml in black and white men, and white women; serum =10 ng/ml in black women; urine =300 ng/ml for black, mixed ancestry, and older adults (50-plus years); urine =500 ng/ml for younger adults (18¿49 years). Specificity was lower for urine than for serum cotinine. Conclusion: Our study suggests that a serum cotinine level of =15 ng/ml and a urine cotinine level of =300 ng/ml best distinguish current tobacco users from non-users generally in the South African adult population.

Dietary guidelines around the world recommend increased intakes of fruits and non-starchy vegetables for the prevention of chronic diseases and possibly obesity. This study aimed to describe the association between body mass index (BMI) and habitual fruit and vegetable consumption in a large sample of 246,995 Australian adults aged 45 + year who had been recruited for the "45 and Up" cohort study. Fruit and vegetable intake was assessed using validated short questions, while weight and height were self-reported. Multinomial logistic regression was used, by sex, to assess the association between fruit and vegetable intake and BMI. Compared to the referent normal weight category (BMI 18.5 to 24.9), the odds ratio (OR) of being in the highest vegetable intake quartile was 1.09 (95% confidence interval (CI) 1.04-1.14) for overweight women (BMI 25.0-29.9) and 1.18 (95% CI 1.12-1.24) for obese women. The association was in the opposite direction for fruit for overweight (OR 0.85; 95% CI 0.80-0.90) and obese women (OR 0.75; 95% CI 0.69-0.80). Obese and overweight women had higher odds of being in the highest intake quartile for combined fruit and vegetable intake, and were more likely to meet the "2 and 5" target or to have five or more serves of fruit and vegetables per day. In contrast, overweight men were less likely to be in high intake quartiles and less likely to meet recommended target of 5 per day, but there was no consistent relationship between obesity and fruit and vegetable intake. Underweight women and underweight men were less likely to be in the highest intake quartiles or to meet the recommended targets. These data suggest that improving adherence to dietary targets for fruit and vegetables may be a dietary strategy to overcome overweight among men, but that overweight and obese women are already adhering to these targets. The association between fruit and vegetable intake and underweight in adults suggests that improving fruit and vegetables intakes are important for the overall dietary patterns of people in this group. © 2014 by the authors; licensee MDPI, Basel, Switzerland.