Associate Professor Melinda Hutchesson

Introduction: Many university students have poor mental health, and co-occurring health risk behaviors. Targeting health behavior change in this population may improve mental health outcomes. This scoping review describes the extent and range of randomized controlled trials (RCT) evaluating interventions targeting health risk behaviors and measuring a mental health outcome, among university students. Methods: Six electronic databases were searched for RCTs published until the 18th May 2021. Eligible RCTs included university students, evaluated interventions that promoted health behavior change (i.e., dietary intake, physical activity, sedentary behavior, alcohol and drug use, smoking, and sleep), and measured a mental health-related outcome. Results: Fifty-nine RCTs met the inclusion criteria that were published from 2000 to 2021, and over half (n = 33) were conducted in the United States. Interventions evaluated within the RCTs (n = 92) predominantly targeted changes to dietary intake (n = 41 interventions), physical activity (n = 39), or alcohol intake (n = 35). Most interventions targeted one (n = 51) or two (n = 27) health behaviors only. Included RCTs considered mental ill health outcomes (n = 24), psychological wellbeing outcomes (n = 20), or both (n = 15). Discussion: This scoping review identified a moderate volume of experimental research investigating the impact of health behavior interventions on university students' mental health. There is scope for further research examining health behavior interventions targeting university students, particularly interventions taking a multi-behavioral approach.

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.

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

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

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

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

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

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.

Aim: To compare the theoretical costs of best-practice weight management delivered by dietitians in a traditional, in-person setting compared to remote consultations delivered using eHealth technologies. Methods: Using national guidelines, a framework was developed outlining dietitian-delivered weight management for in-person and eHealth delivery modes. This framework mapped one-on-one patient¿dietitian consultations for an adult requiring active management (BMI = 30 kg/m2) over a one-year period using both delivery modes. Resources required for both the dietitian and patient to implement each treatment mode were identified, with costs attributed for material, fixed, travel and personnel components. The resource costs were categorised as either establishment or recurring costs associated with the treatment of one patient. Results: Establishment costs were higher for eHealth compared to in-person costs ($1394.21 vs $90.05). Excluding establishment costs, the total (combined dietitian and patient) cost for one patient receiving best-practice weight management for 12 months was $560.59 for in-person delivery, compared to $389.78 for eHealth delivery. Compared to the eHealth mode, a higher proportion of the overall recurring delivery costs was attributed to the patient for the in-person mode (46.4% and 33.9%, respectively). Conclusions: Although it is initially more expensive to establish an eHealth service mode, the overall reoccurring costs per patient for delivery of best-practice weight management were lower compared to the in-person mode. This theoretical cost evaluation establishes preliminary evidence to support alternative obesity management service models using eHealth technologies. Further research is required to determine the feasibility, efficacy and cost-effectiveness of these models within dietetic practice.

Objective: Human skin colour is influenced by three pigments: haemoglobin, carotenoids, and melanin. Carotenoids are abundant in fruits and vegetables, and when consumed accumulate in all layers of the skin, predominantly imparting yellowness (b*). This study investigated the effect of the manipulation of carotenoid-based skin colour, relative to the skin colour conferred by melanin on the perceptions of health amongst a group of Australian adults. Method: Fifty-seven participants (n = 4 male; mean age 27.9 ± 7.5 years) completed three computer-based experiments on 50 trial faces. In the first two experiments, face image colour was manipulated along one or two independent single carotenoid or melanin axes on each trial to ¿make the face appear as healthy as possible¿. In the third trial, face colour was manipulated on both the carotenoid and melanin axes simultaneously. Results: For the single axis, participants significantly increased melanin colouration and added carotenoid colouration to facial images that were initially low in skin yellowness (b*). When carotenoid and melanin axes were simultaneously manipulated, carotenoid colouration was raised (¿E = 3.15 (SE ±0.19)) and melanin colouration was lowered (¿E = -1.04 (SE ±0.1)). Conclusions: Young Australian adults perceive facial skin colouration, associated with both carotenoid intake from fruit and vegetables and melanin due to sun exposure as conveying the appearance of health in young adults. However, carotenoid colouration was more important to health perception.

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

Carotenoids are fat-soluble pigments primarily found in fruits and vegetables. They accumulate in human skin and contribute to skin yellowness, which has a favorable effect on appearance. The association between specific fruit and vegetable intakes and skin yellowness is currently unknown and could help to promote increased fruit and vegetable consumption in those motivated by appearance, such as young women. The objective was to evaluate associations between specific fruit and vegetable intakes and skin yellowness in young women. It was hypothesized that the intake of fruits and vegetables known to be rich in carotenoids, particularly ß-carotene, would account for the greatest variation in skin yellowness. One hundred and eighteen women (18¿40 years) were recruited from the Hunter region, NSW, Australia. Fruit and vegetable intakes were assessed using the 2010 Australian Eating Survey Food Frequency Questionnaire and skin yellowness was measured using reflectance spectroscopy. Multiple linear regression was used to assess how much of the variation in skin yellowness is explained by fruit and vegetable intakes. Higher combined fruit and vegetable intake (P =.0004) and higher total fruit intake (P =.005) were associated with increased skin yellowness. Three specific fruits (apple/pear, mango/pawpaw and dried fruit) and five vegetables (beans/lentils, spinach, broccoli, corn, baked beans) also accounted for a significant proportion of the variation in skin yellowness (P <.05). In conclusion, the consumption of eight specific fruits and vegetables and total combined fruit and vegetable intake are positively associated with skin yellowness and this confers a desirable effect on appearance.

Young adult men are under-represented in health research, and little is known about how to reach and engage them in lifestyle interventions. This mixed-methods study aimed to explore young males¿ preferences for recruitment strategies, content, format (delivery mode and program duration and frequency), and facilitator characteristics for future physical activity and nutrition interventions. Ten focus groups involving 61 men (aged 18¿25 years) in the Hunter region, New South Wales, Australia and an online survey distributed within Australia were completed by 282 males (aged 18¿25 years). Key focus group themes included a preference for recruitment via multiple sources, ensuring images and recruiters were relatable; intervention facilitators to be engaging and refrain from discussing negative consequences of being unhealthy. Key program content preferences included skill development and individualized goals and feedback. Focus groups and the survey confirmed a preference for multiple delivery modes, including; face-to-face (group and individual), with support using eHealth technologies. Survey results confirmed the most favored program content as: ¿healthy eating on a budget,¿ ¿quick and easy meals,¿ and ¿resistance training.¿ Focus group responses suggested a program duration of =6 months, with 2¿3 combined face-to-face and supportive eHealth sessions per week. Survey intervention duration preference was 3 months with 4 face-to-face sessions per month. Findings can guide the design, conduct, and evaluation of relevant contemporary physical activity and or nutrition interventions for young men. There is a need to identify the most effective ways to address young men¿s individual preferences in intervention research.

Many Australian young men (18-25 years) fail to meet recommendations in national dietary or physical activity (PA) guidelines. However, there is a lack of understanding of their perspectives on PA and diet to inform intervention design. This study examined young men¿s motivators and barriers to healthy eating and PA, along with differences by demographic and behavioral factors. A cross-sectional online survey was completed by 282 men aged 18 to 25 years in Australia. Results identified the most common motivators for healthy eating included improving health (63.5%), body image (52.3%), and increasing energy (32.1%). Motivators for PA included improving body image (44.6%), fitness (44.2%), and health (41.0%). Common barriers to healthy eating were access to unhealthy foods (61.1%), time to cook/prepare healthy foods (55.0%), and motivation to cook healthy foods (50.7%). Barriers for PA included motivation (66.3%), time (57.8%), and cost of equipment/facilities (33.3%). Significant differences (p <.01) in motivators to healthy eating and/or PA were identified for BMI category, marital status, PA level, alcohol intake, and stress levels. Significant differences were identified for barriers to healthy eating and/or PA by BMI, PA level, stress, and fruit and vegetable intake, assessed using Pearson¿s chi-square test. Findings suggest that promotion of benefits related to health, appearance/body image, increased energy and fitness, and addressing key barriers including motivation, time, financial restraints, and accessibility of unhealthy foods, could engage young men in improving lifestyle behaviors. Differences by demographic and behavioral factors suggest development of tailored programs to address diversity among young men may be required.

A systematic review of randomized control trials (RCT) was undertaken to evaluate the effectiveness of eHealth behavioral interventions aiming to improve smoking rates, nutrition behaviors, alcohol intake, physical activity levels and/or obesity (SNAPO) in young adults. Seven electronic databases were searched for RCTs published in English from 2000 to April 2015 and evaluating eHealth interventions aiming to change one or multiple SNAPO outcomes, and including young adult (18¿35¿years) participants. Of 2,159 articles identified, 45 studies met the inclusion criteria. Most interventions targeted alcohol (n¿=¿26), followed by smoking (n¿=¿7), physical activity (n¿=¿4), obesity (n¿=¿4) and nutrition (n¿=¿1). Three interventions targeted multiple behaviors. The eHealth interventions were most often delivered via websites (79.5%). Most studies (n¿=¿32) compared eHealth interventions to a control group (e.g. waiting list control, minimal intervention), with the majority (n¿=¿23) showing a positive effect on a SNAPO outcome at follow-up. Meta-analysis demonstrated a significantly lower mean number of drinks consumed/week in brief web or computer-based interventions compared to controls (Mean Difference -¿2.43 [-¿3.54, -¿1.32], P¿<¿0.0001, n¿=¿10). Sixteen studies compared eHealth delivery modes, with inconsistent results across target behaviors and technology types. Nine studies compared eHealth to other modes of delivery (e.g. in person) with all finding no difference in SNAPO outcomes between groups at follow-up. This review provides some evidence for the efficacy of eHealth SNAPO interventions for young adults, particularly in the short-term and for alcohol interventions. But there is insufficient evidence for their efficacy in the longer-term, as well as which mode of delivery is most effective.

Background Consumption of dietary carotenoids from fruits and vegetables (F/V) leads to accumulations in human skin, altering skin yellowness. The influence of the quantity of F/V consumed on skin yellowness and plasma carotenoid concentrations has not been examined previously. Objective To compare the influence of consuming high-carotenoid-containing F/V (HCFV) (176,425 µg beta carotene/wk) vs low-carotenoid F/V (LCFV) (2,073 µg beta carotene/wk) on skin yellowness and plasma carotenoid concentrations, over 4 weeks. Design and intervention A single-blind randomized controlled crossover trial from October 2013 to March 2014. Thirty women were randomized to receive 7 daily servings of HCFV or LCFV for 4 weeks. Following a 2-week washout period they followed the alternate intervention. Main outcome measures Skin color (Commission Internationale de l'Eclairage L*a*b* color space, where L* represents skin lightness and positive values of a* and b* represent degrees of redness and yellowness, respectively) was assessed by reflectance spectroscopy in both sun-exposed and nonexposed skin areas. Fasting plasma carotenoids were determined by high-performance liquid chromatography, before and after each intervention period. Statistical analyses performed Linear mixed models were used to determine the HCFV and LCFV response on skin color and plasma carotenoids, adjusting for intervention order, time, and interaction between baseline differences and time. Results There were no significant differences in mean daily fruit (P=0.42) and vegetable (P=0.17) intakes between HCFV and LCFV groups. Dietary alpha carotene, beta carotene, lutein, and beta cryptoxanthin intakes were significantly different between the two groups (P<0.01). Following HCFV there was a significantly greater increase in skin yellowness (b*) in both sun-exposed (P<0.001) and unexposed areas, (P<0.001), with no change in skin lightness (L*) or redness (a*). Significantly higher plasma alpha carotene (P=0.004), beta carotene (P=0.001), and lutein (P=0.028) concentrations were found following the HCFV intervention. Skin yellowness correlated with alpha carotene and beta carotene. Conclusions Skin yellowness (b*) and fasting plasma carotenoid concentrations were significantly higher following HCFV than LCFV over 4 weeks.

Background: Greater numbers of women are entering young adulthood overweight, but traditional weight loss programs do not appeal to them. This article describes the development and evaluation of an e-health weight loss intervention for young women (18-30 years of age). Materials and Methods: Young women's preferences for a targeted weight loss program were investigated via a cross-sectional online survey. A 3-month targeted weight loss program for young women was developed based on the formative research. A single-arm pre-post study was conducted to evaluate the acceptability of the intervention (process evaluation survey and objective usage data) and to estimate the treatments' effects on weight-related outcomes from baseline to 3 months. Results: Online survey respondents (n = 274) indicated preferences for various technologies (Web site, online quizzes with e-mail feedback and goal setting, an online discussion forum, smartphone application, e-mail newsletters, and text messages). Eighteen (mean ± standard deviation [SD] age, 22.8 ± 3.2 years; body mass index, 27.3 ± 1.6 kg/m2) women entered the pre-post study. Mean satisfaction was 3.4 ± 1.0 (maximum of 5), and 66.7% of participants completed the study. Significant reductions in mean ± SD weight (-1.5 ± 2.4 kg; p = 0.02) and waist circumference (-0.7 ± 1.4 cm; p = 0.04) were observed. Conclusions: Due to lower than anticipated participant satisfaction, modifications to the program content and modes of delivery are required to ensure a higher proportion of young women complete and actively engage with the program. The positive effects of treatment on weight-related outcomes supports further refinement and evaluation of targeted, e-health weight loss interventions for young women.

Objective To examine young Australian women's weight expectations, motivations for weight change and perceived factors influencing weight management, and to determine if these factors differ by age, BMI, marital status, education or income. Design Cross-sectional study. An online survey captured respondents' weight, height, ideal weight, main reasons for wanting to change their weight and challenges to managing their weight. Setting Online survey in Australia. Subjects Six hundred and twenty women aged 18-30 years currently living in Australia who completed the survey between 31 July and 30 September 2012. Results Approximately half of participants (53·1 %) were a healthy weight, 25·2 % overweight and 19·0 % obese. Women unhappy at their current weight (78·1 %) reported a median ideal weight -12·3 % less than their current weight. The key motivators for weight change were to improve health (24·4 %, ranked 1), feel better in oneself (22·3 %) and improve self-confidence (21·5 %). Lack of motivation, time constraints because of job commitments and cost were the most commonly reported factors influencing weight management. Age, BMI, marital status, education and income were found to influence weight expectations, motivations for weight change and/or factors perceived to influence weight management. Conclusions The findings suggest potential implications for weight management interventions and public health messaging targeting young women, to improve long-term health outcomes. Strategies that promote the health benefits of physical activity and healthy eating, feeling better about oneself and improved self-confidence, and address the main factors influencing weight management including lack of motivation, time constraints and cost, may be used to engage this target group.

Issues addressed It is not known whether individuals can accurately estimate the portion size of foods usually consumed relative to standard serving sizes in national food selection guides. The aim of the present cross-sectional pilot study was to quantify what adults and children deem a typical portion for a variety of foods and compare these with the serving sizes specified in the Australian Guide to Healthy Eating (AGHE). Methods Adults and children were independently asked to serve out their typical portion of 10 common foods (rice, pasta, breakfast cereal, chocolate, confectionary, ice cream, meat, vegetables, soft drink and milk). They were also asked to serve what they perceived a small, medium and large portion of each food to be. Each portion was weighed and recorded by an assessor and compared with the standard AGHE serving sizes. Results Twenty-one individuals (nine mothers, one father, 11 children) participated in the study. There was a large degree of variability in portion sizes measured out by both parents and children, with means exceeding the standard AGHE serving size for all items, except for soft drink and milk, where mean portion sizes were less than the AGHE serving size. The greatest mean overestimations were for pasta (155%; mean 116 g; range 94-139g) and chocolate (151%; mean 38 g; range 25-50g), each of which represented approximately 1.5 standard AGHE servings. Conclusion The findings of the present study indicate that there is variability between parents' and children's estimation of typical portion sizes compared with national recommendations. So what? Dietary interventions to improve individuals' dietary patterns should target education regarding portion size.

With the growth of Internet technologies, offering interventions for child and family weight management in an online format may address barriers to accessing services. This study aimed to investigate (i) whether an eHealth family healthy lifestyle program would be of interest to parents; and (ii) preferences and/or expectations for program components and features. Parents of children aged four to18 years were recruited through social media and completed an online survey (54 items) including closed and open-ended questions. Responses were collated using descriptive statistics and thematic analysis. Seventy-five participants were included (92% mothers, mean age 39.1 ± 8.6 years, mean BMI 27.6 ± 6.3 kg/m2). The index child had a mean age of 11 ± 6.2 years with 24% overweight/obese. The majority of parents (90.3%) reported interest in an online program, with preference expressed for a non-structured program to allow flexibility users to log-on and off as desired. Parents wanted a program that was easy to use, practical, engaging, endorsed by a reputable source, and able to provide individual tailoring and for their children to be directly involved. The current study supports the need for online delivery of a healthy lifestyle program that targets greater parental concerns of diet rather than child weight.

Adherence and accuracy of self-monitoring of dietary intake influences success in weight management interventions. Information technologies such as computers and smartphones have the potential to improve adherence and accuracy by reducing the burden associated with monitoring dietary intake using traditional paper-based food records. We evaluated the acceptability and accuracy of three different 7-day food record methods (online accessed via computer, online accessed via smartphone, and paper-based). Young women (N=18; aged 23.4±2.9 years; body mass index 24.0±2.2) completed the three 7-day food records in random order with 7-day washout periods between each method. Total energy expenditure (TEE) was derived from resting energy expenditure (REE) measured by indirect calorimetry and physical activity level (PAL) derived from accelerometers (TEE=REE×PAL). Accuracy of the three methods wasassessed by calculating absolute (energy intake [EI]-TEE) and percentage difference (EI/TEE×100) between self-reported EI and TEE. Acceptability was assessed via questionnaire. Mean±standard deviation TEE was 2,185±302 kcal/day and EI was 1,729±249 kcal/day, 1,675±287kcal/day, and 1,682±352 kcal/day for computer, smartphone, and paper records, respectively. There were no significant differences between absolute and percentage differences between EI and TEE for the three methods: computer, -510±389 kcal/day (78%); smartphone, -456±372 kcal/day (80%); and paper, -503±513 kcal/day (79%). Half of participants (n=9) preferred computer recording, 44.4% preferred smartphone, and 5.6% preferred paper-based records. Most participants (89%) least preferred the paper-based record. Because online food records completed on either computer or smartphone were as accurate as paper-based records but more acceptable to young women, they should be considered when self-monitoring of intake is recommended to young women.

Fruit and vegetables contain carotenoid pigments, which accumulate in human skin, contributing to its yellowness. This effect has a beneficial impact on appearance. The aim was to evaluate associations between diet (fruit, vegetable and dietary carotenoid intakes) and skin color in young women. Ninety-one Caucasian women (Median and Interquartile Range (IQR) age 22.1 (18.1¿29.1) years, BMI 22.9 (18.5¿31.9) kg/m2) were recruited from the Hunter region (Australia). Fruit, vegetable and dietary carotenoid intakes were estimated by a validated food frequency questionnaire. Skin color was measured at nine body locations (sun exposed and unexposed sites) using spectrophotometry. Multiple linear regression was used to assess the relationship between fruit and vegetable intakes and skin yellowness adjusting for known confounders. Higher combined fruit and vegetable intakes (ß = 0.8, p = 0.017) were associated with higher overall skin yellowness values. Higher fruit combined fruit and vegetable intakes (ß = 1.0, p = 0.004) were associated with increased unexposed skin yellowness. Combined fruit and vegetables plus dietary carotenoid intakes contribute to skin yellowness in young Caucasian women. Evaluation of interventions using improvements in appearance as an incentive for increasing fruit and vegetable consumption in young women is warranted.

Objectives: To investigate the effectiveness of Smoking, Nutrition, Alcohol, Physical activity and Obesity (SNAPO) interventions in young men exclusively. The secondary aim was to evaluate the recruitment, retention and engagement strategies. Methods: A search with no date restrictions was conducted across seven databases. Randomized controlled trials recruiting young men only (aged 18-35. years) into interventions targeting any SNAPO risk factors were included. Results: Ten studies were included (two nutrition, six alcohol use, two targeting multiple SNAPO risk factors). Six studies (two nutrition, three alcohol use and one targeting multiple SNAPO risk factors) demonstrated significant positive short-term intervention effects, but impact was either not assessed beyond the intervention (n = 3), had short-term follow-up (= 6 months) (n = 2) or not sustained beyond six months (n = 1). Overall, a high risk of bias was identified across studies. Only one study undertook a power calculation and recruited the required sample size. Adequate retention was achieved in three studies. Effectiveness of engagement strategies was not reported in any studies. Conclusions: Despite preliminary evidence of short-term effectiveness of SNAPO interventions in young men, few studies characterized by a high risk of bias were identified. High quality SNAPO interventions for young men are warranted.

To examine the effectiveness of interventions aimed at improving physical activity, diet, and/or weight-related behaviors amongst university/college students. Five online databases were searched (January 1970 to April 2014). Experimental study designs were eligible for inclusion. Data extraction was performed by one reviewer using a standardized form developed by the researchers and checked by a second reviewer. Data were described in a narrative synthesis and meta-analyses were conducted when appropriate. Study quality was also established. Forty-one studies were included; of these, 34 reported significant improvements in one of the key outcomes. Of the studies examining physical activity 18/29 yielded significant results, with meta-analysis demonstrating significant increases in moderate physical activity in intervention groups compared to control. Of the studies examining nutrition, 12/24 reported significantly improved outcomes; only 4/12 assessing weight loss outcomes found significant weight reduction. This appears to be the first systematic review of physical activity, diet and weight loss interventions targeting university and college students. Tertiary institutions are appropriate settings for implementing and evaluating lifestyle interventions, however more research is needed to improve such strategies.

Appearance-based interventions have had some success in reducing smoking and sun exposure. Appearance may also motivate dietary behavior change if it was established that dietary improvement had a positive impact on appearance. The aims of this review are to evaluate the current evidence examining the relationship between dietary intake and appearance and to determine the effectiveness of dietary interventions on perceived or actual appearance. An electronic search of English-language studies up to August 2012 was conducted using Cochrane, MEDLINE, Embase, CINAHL, Web of Science, SCOPUS, and PsycINFO databases. Studies that included participants aged at least 18 years, that observed or altered dietary intake from actual food or dietary supplement use, and assessed appearance-related outcomes were considered eligible. Data from 27 studies were extracted and assessed for quality using standardized tools. Nineteen studies were assessed as being of "positive" and 4 of "neutral" quality. All observational studies (n = 4741 participants) indicated that there was a significant association between various aspects of dietary intake and skin coloration and skin aging. The majority (16 studies, 769 participants) evaluated the effect of dietary supplements on skin appearance among women. Only 1 study examined the effect of actual food intake on appearance. Significant improvements in at least 1 actual or perceived appearance-related outcome (facial wrinkling, skin elasticity, roughness, and skin color) following dietary intervention were shown as a result of supplementation. Further studies are needed in representative populations that examine actual food intake on appearance, using validated tools in well-designed high-quality randomized control trials.

Background: Diet quality tools provide researchers with brief methods to assess the nutrient adequacy of usual dietary intake. This study describes the development and validation of a pediatric diet quality index, the Australian Recommended Food Scores for Pre-schoolers (ARFS-P), for use with children aged two to five years. Methods. The ARFS-P was derived from a 120-item food frequency questionnaire, with eight sub-scales, and was scored from zero to 73. Linear regressions were used to estimate the relationship between diet quality score and nutrient intakes, in 142 children (mean age 4 years) in rural localities in New South Wales, Australia. Results: Total ARFS-P and component scores were highly related to dietary intake of the majority of macronutrients and micronutrients including protein, ß-carotene, vitamin C, vitamin A. Total ARFS-P was also positively related to total consumption of nutrient dense foods, such as fruits and vegetables, and negatively related to total consumption of discretionary choices, such as sugar sweetened drinks and packaged snacks. Conclusion: ARFS-P is a valid measure that can be used to characterise nutrient intakes for children aged two to five years. Further research could assess the utility of the ARFS-P for monitoring of usual dietary intake over time or as part of clinical management.

The present systematic review examined the effectiveness of weight management interventions comparing diets with varying macronutrient distributions on BMI and cardiometabolic risk factors in overweight or obese children and adolescents. A systematic search of seven databases for the period 1975-2013 identified 14 eligible randomized or quasi-randomized controlled trials conducted with 6-18-year-old subjects. Seven trials compared a low-fat (=33% energy or <40g/day) to an isocaloric (n=2) or ad libitum (n=5) low-carbohydrate diet (<20% energy or <60g/day). Meta-analysis indicated a greater reduction in BMI in the low-carbohydrate group immediately after dietary intervention; however, the quality of the studies was limited and cardiometabolic benefits were inconsistent. Six trials compared increased-protein diets (19-30% energy) to isocaloric standard-protein diets (15-20% energy) and one compared an increased-fat diet (40% energy) to an isocaloric standard-fat diet (27% energy); there were no differences in outcomes in these studies. Current evidence suggests that improved weight status can be achieved in overweight or obese children and adolescents irrespective of the macronutrient distribution of a reduced-energy diet. Tailoring the macronutrient content to target specific cardiometabolic risk factors, such as a low-carbohydrate diet to treat insulin resistance, may be possible, but further research is needed before specific recommendations can be made. © 2014 International Life Sciences Institute.

Background: Food frequency questionnaires (FFQ) are used in epidemiological studies to investigate the relationship between diet and disease. There is a need for a valid and reliable adult FFQ with a contemporary food list in Australia. Aims: To evaluate the reproducibility and comparative validity of the Australian Eating Survey (AES) FFQ in adults compared to weighed food records (WFRs). Methods: Two rounds of AES and three-day WFRs were conducted in 97 adults (31 males, median age and BMI for males of 44.9 years, 26.2 kg/m2, females 41.3 years, 24.0 kg/m2. Reproducibility was assessed over six months using Wilcoxon signed-rank tests and comparative validity was assessed by intraclass correlation coefficients (ICC) estimated by fitting a mixed effects model for each nutrient to account for age, sex and BMI to allow estimation of between and within person variance. Results: Reproducibility was found to be good for both WFR and FFQ since there were no significant differences between round 1 and 2 administrations. For comparative validity, FFQ ICCs were at least as large as those for WFR. The ICC of the WFR-FFQ difference for total energy intake was 0.6 (95% CI 0.43, 0.77) and the median ICC for all nutrients was 0.47, with all ICCs between 0.15 (%E from saturated fat) and 0.7 (g/day sugars). Conclusions: Compared to WFR the AES FFQ is suitable for reliably estimating the dietary intakes of Australian adults across a wide range of nutrients. © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.

Background: In 2005 a Bill was introduced to the New Zealand parliament to increase the alcohol minimum purchasing age (MPA) from 18 to 20 years and submissions were invited from interested parties. We sought to characterise and critique the arguments tendered for and against the proposal. Methods: We used template analysis to study written submissions on the Bill from 178 people and organisations in New Zealand. Independent raters coded submissions according to the source, whether for or opposed, and the arguments employed. Results: The most common sources of submissions were members of the public (28%), the alcohol industry (20%), and NGOs (20%). Overall, 40% opposed increasing the MPA, 40% were in favour, 4% supported a split MPA (18 years for on-premise, 20 years for off-premise), 7% were equivocal, and 8% offered no comment. The most common proponents of increasing the MPA were NGOs (36%) and members of the public (30%) and their arguments concerned the expected positive effects on public health (36%) and public disorder/property damage (16%), while 24% argued that other strategies should be used as well. The most common sources of opposition to increasing the MPA were the alcohol industry (50%) and the public (20%). It was commonly claimed that the proposed law change would be ineffective in reducing harm (22%), that other strategies should be used instead (16%), that it would infringe adult rights (15%), and that licensed premises are safe environments for young people (14%). There were noteworthy examples of NGOs and government agencies opposing the law change. The alcohol industry maximised its impact via multiple submissions appealing to individual rights while neglecting to report or accurately characterise the scientific evidence. Several health and welfare agencies presented confused logic and/or were selective in their use of scientific evidence. Conclusion: In contrast to the fragmented and inconsistent response from government and NGOs, the alcohol industry was organised and united, with multiple submissions from the sector with most at stake, namely the hospitality industry, and supporting submissions from the manufacturing, import, and wholesale sectors. Systematic reviews of research evidence should be routinely undertaken to guide the legislature and submissions should be categorised on the basis of pecuniary interest. © 2014 Elsevier B.V. All rights reserved.

Background: Obese men are more likely to have poor dietary patterns compared to women, increasing diet-related chronic disease risk. The impact of a male-only weight loss intervention on dietary intakes is under-evaluated. The aim was to deter-mine whether overweight/obese men randomised to self-help paper-based resources with or without online support, achieved greater improvements in diet compared with Wait-list controls at 3 and 6 months following a gender tailored weight-loss intervention.