Nutrient composition of milk and plant-based milk alternatives: A cross-sectional study of products sold in Australia and Singapore.

Dairy and non-dairy (plant-based) alternatives are promoted as an essential component of a healthy diet. The purpose of this study was to evaluate the range of dairy milks and plant-based milk alternatives in supermarkets in Australia and Singapore, and to explore nutritional differences within the category, and between countries. Product information was collected in store from packaging. Products were sorted into dairy milks and plant-based milk alternatives, and further categorised as (i) breakfast drinks (12 % of products); (ii) plain milks (62 %); or (iii) flavoured milks (26 %). The nutrient profiles of products were tested for differences using Kruskal Wallis and Mann-Whitney U tests. Flavoured products contained almost double the median sugar content of plain products (8.3 g v. 4.6 g, p = 0.005). Two-thirds of the product range were dairy milks, which contained nearly four times the median saturated fat content (1.1 g v. 0.3 v, p < 0.0001) and more than double the amount of sugar (5.1 g v. 2.6 g, p < 0.0001) of plant-based milk alternatives, but three times more protein (3.3 g v. 1.0 g, p < 0.0001). Between countries, generally, calcium contents were similar across products, likely due to fortification of plant-based milk alternatives. Compared to Singapore, dairy milk and plant-based milk alternative products sold in Australia were generally higher in energy, protein and fat, but lower in carbohydrate content. Food supply differences between Singapore and Australia may be cultural and have nutritional implications.

Oh So Sweet: A Comparative Investigation of Retail Market Composition of Sweetened and Flavoured Beverages in Singapore and Australia.

The consumption of sugar and non-nutritive sweeteners has been associated with poor health outcomes. The aim of this paper was to provide a comparison of the range of sweetened or flavoured beverages between two high-income countries in the Asia-Pacific region: Australia and Singapore. Following the FoodTrackTM methodology, nutrition, labelling, and price data were collected from major Australian and Singaporean supermarket chains and convenience stores. The nutrient profiles of products were tested for differences using Kruskal−Wallis and Mann−Whitney U tests. The greatest number of products collected in Australia were from the 'carbonated beverages' category (n = 215, 40%), and in Singapore the greatest number of products were from the 'tea and coffee ready-to-drink' category (n = 182, 35%). There were more calorically sweetened beverages in Singapore compared with Australia (n = 462/517 vs. n = 374/531, p < 0.001). For calorically sweetened products, the median energy of Singaporean products was significantly higher than Australian products (134 kJ vs. 120 kJ per 100 mL, p = 0.009). In Australia, 52% of sweetened or flavoured beverages displayed a front-of-pack nutrient signposting logo, compared with 34% of sweetened or flavoured beverages in Singapore. These findings also indicate that the consumption of just one serving of calorically sweetened carbonated beverages or energy drinks would exceed the WHO maximum daily free sugar recommendations.

Assessment of artificial and natural sweeteners present in packaged non-alcoholic beverages (NABs) sold on the Singapore market.

BACKGROUND: New Nutri-Grade labelling, aimed at reducing Singaporeans' sugar consumption will be implemented for all pre-packaged non-alcoholic beverages (NABs) sold in retail outlets from end 2021 onwards. It is expected such labelling will have a major impact on sugar content of beverages, as well as the replacement of sugar with non-caloric alternatives. METHODS: This study used product label data obtained from in-store surveys to investigate sugar and sweetener composition of NABs present on the Singapore market. Using this data we calculated products prospective Nutri-Grade classification in order to compare the current market composition with relation to sugar and/or sweetener use. RESULTS: Over half of the NABs on market were sweetened with sugar (59%) and were associated with less healthy Nutri-Grades of 'C' and 'D'. The use of natural sweeteners; Stevia and Monk fruit, remains low (6%). CONCLUSION: With continuous efforts by the government in promoting public health nutrition, it is expected that there will be a greater usage of sugar substitutes among NABs in response to the upcoming implementation of Nutri-Grade and ever-fluctuating consumers' demands. The data collected in this study provide a point estimate (July-September 2020) on market composition and use of both sugar and artificial sweeteners in beverages prior to integration of the mandatory labelling requirements.

Are dietary inequalities among Australian adults changing? a nationally representative analysis of dietary change according to socioeconomic position between 1995 and 2011-13.

BACKGROUND: Increasing inequalities in rates of obesity and chronic disease may be partly fuelled by increasing dietary inequalities, however very few nationally representative analyses of socioeconomic trends in dietary inequalities exist. The release of the 2011-13 Australian National Nutrition and Physical Activity Survey data allows investigation of change in dietary intake according to socioeconomic position (SEP) in Australia using a large, nationally representative sample, compared to the previous national survey in 1995. This study examined change in dietary intakes of energy, macronutrients, fiber, fruits and vegetables among Australian adults between 1995 and 2011-13, according to SEP. METHODS: Cross-sectional data were obtained from the 1995 National Nutrition Survey, and the 2011-13 National Nutrition and Physical Activity Survey. Dietary intake data were collected via a 24-h dietary recall (n = 17,484 adults) and a dietary questionnaire (n = 15,287 adults). SEP was assessed according to educational level, equivalized household income, and area-level disadvantage. Survey-weighted linear and logistic regression models, adjusted for age, sex/gender and smoking status, examined change in dietary intakes over time. RESULTS: Dietary intakes remained poor across the SEP spectrum in both surveys, as evidenced by high consumption of saturated fat and total sugars, and low fiber, fruit and vegetable intakes. There was consistent evidence (i.e. according to ≥2 SEP measures) of more favorable changes in dietary intakes of carbohydrate, polyunsaturated and monounsaturated fat in higher, relative to lower SEP groups, particularly in women. Intakes of energy, total fat, saturated fat and fruit differed over time according to a single SEP measure (i.e. educational level, household income, or area-level disadvantage). There were no changes in intake of total sugars, protein, fiber or vegetables according to any SEP measures. CONCLUSIONS: There were few changes in dietary intakes of energy, most macronutrients, fiber, fruits and vegetables in Australian adults between 1995 and 2011-13 according to SEP. For carbohydrate, polyunsaturated and monounsaturated fat, more favorable changes in intakes occurred in higher SEP groups. Despite the persistence of suboptimal dietary intakes, limited evidence of widening dietary inequalities is positive from a public health perspective. TRIAL REGISTRATION: Clinical trials registration: ACTRN12617001045303 .

Socioeconomic Inequities in Diet Quality and Nutrient Intakes among Australian Adults: Findings from a Nationally Representative Cross-Sectional Study.

Poor diet may represent one pathway through which lower socioeconomic position (SEP) leads to adverse health outcomes. This study examined the associations between SEP and diet quality, its components, energy, and nutrients in a nationally representative sample of Australians. Dietary data from two 24-h recalls collected during the cross-sectional Australian Health Survey 2011-13 (n = 4875; aged ≥ 19 years) were analysed. Diet quality was evaluated using the Dietary Guidelines Index (DGI). SEP was assessed by index of area-level socioeconomic disadvantage, education level, and household income. Linear regression analyses investigated the associations between measures of SEP and dietary intakes. Across all of the SEP indicators, compared with the least disadvantaged group, the most disadvantaged group had 2.5-4.5 units lower DGI. A greater area-level disadvantage was associated with higher carbohydrate and total sugars intake. Lower education was associated with higher trans fat, carbohydrate, and total sugars intake and lower poly-unsaturated fat and fibre intake. Lower income was associated with lower total energy and protein intake and higher carbohydrate and trans fat intake. Lower SEP was generally associated with poorer diet quality and nutrient intakes, highlighting dietary inequities among Australian adults, and a need to develop policy that addresses these inequities.

High variation in manufacturer-declared serving size of packaged discretionary foods in Australia.

Despite the potential of declared serving size to encourage appropriate portion size consumption, most countries including Australia have not developed clear reference guidelines for serving size. The present study evaluated variability in manufacturer-declared serving size of discretionary food and beverage products in Australia, and how declared serving size compared with the 2013 Australian Dietary Guideline (ADG) standard serve (600 kJ). Serving sizes were obtained from the Nutrition Information Panel for 4466 packaged, discretionary products in 2013 at four large supermarkets in Sydney, Australia, and categorised into fifteen categories in line with the 2013 ADG. For unique products that were sold in multiple package sizes, the percentage difference between the minimum and the maximum serving size across different package sizes was calculated. A high variation in serving size was found within the majority of food and beverage categories - for example, among 347 non-alcoholic beverages (e.g. soft drinks), the median for serving size was 250 (interquartile range (IQR) 250, 355) ml (range 100-750 ml). Declared serving size for unique products that are available in multiple package sizes also showed high variation, particularly for chocolate-based confectionery, with median percentage difference between minimum and maximum serving size of 183 (IQR 150) %. Categories with a high proportion of products that exceeded the 600 kJ ADG standard serve included cakes and muffins, pastries and desserts (≥74 % for each). High variability in declared serving size may confound interpretation and understanding of consumers interested in standardising and controlling their portion selection. Future research is needed to assess if and how standardising declared serving size might affect consumer behaviour.

Typical food portion sizes consumed by Australian adults: results from the 2011-12 Australian National Nutrition and Physical Activity Survey.

Considerable evidence has associated increasing portion sizes with elevated obesity prevalence. This study examines typical portion sizes of commonly consumed core and discretionary foods in Australian adults, and compares these data with the Australian Dietary Guidelines standard serves. Typical portion sizes are defined as the median amount of foods consumed per eating occasion. Sex- and age-specific median portion sizes of adults aged 19 years and over (n = 9341) were analysed using one day 24 hour recall data from the 2011-12 National Nutrition and Physical Activity Survey. A total of 152 food categories were examined. There were significant sex and age differences in typical portion sizes among a large proportion of food categories studied. Typical portion sizes of breads and cereals, meat and chicken cuts, and starchy vegetables were 30-160% larger than the standard serves, whereas, the portion sizes of dairy products, some fruits, and non-starchy vegetables were 30-90% smaller. Typical portion sizes for discretionary foods such as cakes, ice-cream, sausages, hamburgers, pizza, and alcoholic drinks exceeded the standard serves by 40-400%. The findings of the present study are particularly relevant for establishing Australian-specific reference portions for dietary assessment tools, refinement of nutrition labelling and public health policies.

A high-protein diet with resistance exercise training improves weight loss and body composition in overweight and obese patients with type 2 diabetes.

OBJECTIVE To evaluate the effects of two low-fat hypocaloric diets differing in the carbohydrate-to-protein ratio, with and without resistance exercise training (RT), on weight loss, body composition, and cardiovascular disease (CVD) risk outcomes in overweight/obese patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 83 men and women with type 2 diabetes (aged 56.1 +/- 7.5 years, BMI 35.4 +/- 4.6 kg/m(2)) were randomly assigned to an isocaloric, energy-restricted diet (female subjects 6 MJ/day, male subjects 7 MJ/day) of either standard carbohydrate (CON; carbohydrate:protein:fat 53:19:26) or high protein (HP; 43:33:22), with or without supervised RT (3 days/week) for 16 weeks. Body weight and composition, waist circumference (WC), and cardiometabolic risk markers were assessed. RESULTS Fifty-nine participants completed the study. There was a significant group effect (P or= 0.17). CONCLUSIONS An energy-restricted HP diet combined with RT achieved greater weight loss and more favorable changes in body composition. All treatments had similar improvements in glycemic control and CVD risk markers.

Weight loss maintenance in women 3 years after following a 12-week structured weight loss program.

SUMMARY: Structured weight loss programs such as those using meal replacements are associated with both short-term and long-term weight loss, but the effectiveness of structured weight loss programs using whole foods has not been established. The primary aim of the present study was to retrospectively establish self-reported weight status in women, 3 years after participation in a 12-week food based structured weight loss program monitored by dietitians. The secondary aim was to determine which factors were associated with successful weight loss maintenance. Eighty-five of the 100 participants who completed the 12-week program participated in an 18-question telephone interview which included self-reported weight. Weight loss from baseline was 3.8 (S.D. 5.5) kg (4.4 (S.D. 6.1) %) (P < 0.001). Overall, 61% of participants weighed less than at baseline, 13% had gained weight, and the remaining 26% had maintained their baseline weight. From baseline, 37 (44%) participants had a clinically important weight loss of ≥ 5%, and were, on average, 9.8 (S.D. 4.2) % lighter (P < 0.001). The remaining 48 (56%) participants (weight loss < 5%) were not significantly different to their weight at baseline (P = 0.77). We conclude that a food based structured weight loss program monitored by dietitians, as defined by this intervention, was associated with long-term weight loss maintenance.:

Long-term follow-up using a higher target range for lamotrigine monitoring.

The aims of the study were (1) to review the clinical application of the higher target plasma lamotrigine (LTG) concentration of 3-14 mg/L previously proposed by our therapeutic drug monitoring (TDM) laboratory following our initial study 7 years earlier, and (2) to survey clinical application of LTG assays by experienced neurologists (n = 11) who frequently use LTG. There was a 2.9-fold increase in LTG assay requests received by our laboratory from 1996 to 2003. By comparison, data for the number of LTG prescriptions filled throughout Australia were limited to the 4 years from 1997 to 2000, where a 1.7-fold increase was seen. LTG assay requests increased 1.5-fold in this same 4-year period (r2 = 0.97), indicating that the growth in assay requests paralleled the growth in prescriptions. The distribution of LTG concentrations measured in 2003 was compared with those for 1996 and 1997. This indicated there was a significantly increased (P < 0.01) clinical usage of the higher LTG target range. This result was reinforced by questionnaire responses. Respondents (100% of those surveyed), (1) considered the target LTG concentration (3-14 mg/L) to be one of the primary parameters applied in individualizing LTG dosage regimens, (2) were using target concentrations above 7 mg/L in 75% of patients, and (3) reported dose-limiting toxicities in some (but not all) patients typically at concentrations above, or well above, 13 mg/L. In conclusion, the growth in LTG assay requests received by our laboratory paralleled prescribing of this drug. The clinical use of the higher LTG target concentration range was increased during the 7 years since its introduction, indicating clinical acceptance and therapeutic benefit as well as the absence of long-term adverse effects associated with higher plasma LTG concentrations.