Patterns of discretionary food intake among Australian children and their association with socio-demographic, lifestyle, and adiposity measures.

AIM: Australian children consume 35% of energy from discretionary food and beverages which increases their risk of non-communicable diseases like type 2 diabetes. Despite this concerning statistic, broad analysis of the profile of discretionary food intake has not been fully undertaken. This study asks: what is the discretionary food and beverage intake profile, contribution to nutrient intakes, and associations with demographic and health characteristics? METHODS: Cross-sectional data from the 2011-12 National Nutrition and Physical Activity Survey (n = 2812, 2-18 years) were used to profile discretionary food consumption. Dietary intake was assessed by 24-h recall. General linear models tested the difference in respondent characteristics by age group, sex, and quartiles of discretionary food energy contribution. RESULTS: Ninety-nine percent of respondents consumed discretionary foods, 74% exceeded the maximum discretionary food recommended serves. Among 10 eating occasions available to select: snack, dinner, lunch and morning tea appeared to contribute 76% of discretionary food energy, with snack and dinner contributing 24% each. Age and frequency of discretionary food consumption were positively associated with energy intake from discretionary foods (p < 0.001); while sex, socio-economic status, physical activity and body composition had no association. High discretionary food consumers chose specific discretionary food items in a large quantity (1.0-3.5-serves/discretionary food) compared to low discretionary food consumers (0.4-1.4-serves/discretionary food). CONCLUSIONS: Nearly all Australian children and adolescents consumed discretionary food daily. No demographic or anthropometric characteristics beyond increasing age were associated with higher discretionary food. Targeted public health policy and community interventions are required to focus on addressing the largest contributors to discretionary food intake in terms of equivalent serve sizes, popularity, and eating occasion.

Contribution of dietary snacking behaviours to discretionary energy intake and anthropometric measures in Australian adults: A comparison using an objective vs subjective definition for snacking.

AIM: There is limited information on the snacking behaviour of Australian adults, and the role of snacking in the diet may depend on how it is defined. This study aimed to compare the dietary snacking behaviours and associated nutritional intake and body composition in Australian adults, using an objective vs a subjective definition for snacking. METHODS: Cross-sectional data were analysed from the 2011 to 2012 National Nutrition and Physical Activity Survey (n = 8361, 19+ years). Objective snacking was defined based on time of day between main meals. Subjective snacking was self-reported by participants. RESULTS: Using the objective definition, 88.2% of adults were snack consumers; where snacking contributed 20.0% (SD 20.0%) of total daily energy intake and 27.0% (SD 31.4%) of total daily discretionary energy. 41.3% (SD 37.1%) of snacking energy intake came from discretionary foods. Using the subjective definition, 98.5% of adults were snack consumers, where discretionary foods contributed 52.6% (SD 35.2%) of all snacking energy. The proportion of objective and subjective snacking energy from discretionary foods did not differ across body mass index groups. CONCLUSIONS: Objective snacking energy contributed more to core food groups than discretionary, was not associated with anthropometric measures, and contributed less to total discretionary energy than the evening meal. When snacking was defined subjectively, more than half of snacking energy was discretionary, suggesting that adults are more likely to perceive discretionary foods as snacks. Differences between snacking definitions means that associations between self-reported snacking and diet or health outcomes, should be interpreted with caution.

Vegetable intake in Australian children and adolescents: the importance of consumption frequency, eating occasion and its association with dietary and sociodemographic factors.

OBJECTIVE: We aimed to profile vegetable consumption and its association with dietary and sociodemographic factors. DESIGN: Secondary analysis of a nationally representative nutrition survey. 'Vegetables' refers to non-discretionary 'vegetables and legumes/beans' as defined by the Australian Dietary Guidelines (ADG). Prevalence of vegetable consumption, frequency of intake, proportion meeting ADG recommendations, most popular food groups, intake at each reported eating occasion, and the profile of high and low vegetable consumers (based on the median servings) were determined. SETTING: Australian 2011-2012 National Nutrition and Physical Activity Survey. PARTICIPANTS: Children and adolescents aged 2 to 18 years (n 2812). RESULTS: Vegetables were consumed by 83·0% (95% CI 81·6, 84·4%) of participants, but the median vegetable servings was less than a third of the ADG recommendations. 'Leaf and stalk vegetables' and 'potatoes' were the most popular vegetable-dense food groups at lunch and dinner, respectively. Sixty-four percent had vegetables once a day, and predominantly at dinner. Vegetable frequency was positively associated with daily vegetable servings and variety. Participants who consumed vegetables twice a day generally had vegetables at both lunch and dinner and had nearly double the servings (2·6, sd 1·9) of those who consumed them once (1·5, sd 1·5). High vegetable consumers were older, had higher total energy, but lower discretionary energy intake and were less likely to be at risk of metabolic complications. CONCLUSION: Increasing the frequency of vegetable consumption may assist with increasing daily vegetable servings. A focus on consuming vegetables at lunch may assist with increasing both total servings and variety.

Discretionary intake among Australian adults: prevalence of intake, top food groups, time of consumption and its association with sociodemographic, lifestyle and adiposity measures.

OBJECTIVE: To profile discretionary food and beverage (DF) consumption among Australian adults. DESIGN: Cross-sectional analysis. Dietary and sociodemographic data were used to profile DF intake. Prevalence of DF consumption, DF servings (1 serving=600 kJ), nutrient contribution from DF and top DF food groups by self-reported eating occasions were determined. DF consumers (>0 g) were classified according to quartile of DF intake and general linear models adjusted for age and sex were used to determine associations. SETTING: 2011-12 National Nutrition and Physical Activity Survey (NNPAS).ParticipantsAdults aged ≥19 years (n 9341) who participated in the NNPAS 2011-12. RESULTS: Most adults consumed DF (98 %) and over 60 % exceeded 3 DF servings/d, with a mean of 5·0 (se 0·0) DF servings/d. Cakes, muffins, scones, cake-type desserts contributed the most DF energy (8·4 %) of all food groups, followed by wines (8·1 %), pastries (8·0 %) and beers (6·1 %), with all these food groups consumed in large portions (2·3-3·0 DF servings). Lunch and dinner together contributed 45 % of total DF energy intake. High DF consumers had an average of 10 DF servings, and this group contained more younger adults, males, low socio-economic status, lower usual fruit intake and higher mean waist circumference, but not higher BMI. CONCLUSIONS: A focus on DF consumed in large portions at lunch and dinner may help improve interventions aimed at reducing DF intake and addressing negative adiposity-related measures found in high DF consumers.

Dietary Fibre Intake in Australia. Paper II: Comparative Examination of Food Sources of Fibre among High and Low Fibre Consumers.

Intakes of dietary fibre in Australia are lower than recommended. An understanding of food choices associated with fibre intake can help to inform locally relevant dietary interventions that aim to increase its consumption. This study aimed to profile the relationship between dietary choices and fibre intake of Australians. Using Day 1 data from the 2011⁻2012 National Nutrition and Physical Activity Survey (n = 12,153, ≥2 years), dietary fibre intake was classified by quartiles for children (2⁻18 years) and adults (≥19 years). Intakes of the Australian Dietary Guidelines (ADG) food groups were calculated, as well as the major, sub-major, and minor food groups from the Australian Food Composition Database. Each of these food groups provide a progressively greater level of detail. Associations with ADG food groups and major food groups were determined, and the leading sub-major and minor food group sources of fibre for low (Quartile 1) and high (Quartile 4) fibre consumers were profiled. Energy-adjusted intakes of wholegrain and/or high fibre but not refined grain (cereal) foods, vegetables, and fruit were positively associated, and discretionary foods negatively associated, with quartile of fibre intake (p < 0.001). The top three sub-major food group sources of fibre were regular breads, cereal mixed dishes, and ready-to-eat breakfast cereals in high fibre consumers and regular breads, cereal mixed dishes, and potatoes in low fibre consumers. White breads was the leading minor food group contributor in low fibre consumers, and apples and lower sugar wheat based breakfast cereal were the leading fibre contributors in high fibre consumers in children and adults, respectively. Higher intakes of wholegrain, fruits, and vegetables, and a lower discretionary intake were associated with higher fibre intake. Encouraging these foods as part of any public health intervention is likely to be effective for increasing dietary fibre intakes.

Dietary Fibre Intake in Australia. Paper I: Associations with Demographic, Socio-Economic, and Anthropometric Factors.

Dietary fibre is important for regular laxation and reduces chronic disease risk. The National Health and Medical Research Council outlines daily fibre intake targets, yet the proportion of the population that meets these targets is unknown. Using the 2011⁻2012 National Nutrition and Physical Activity Survey, we profiled fibre intake among Australian children and adults. Data from one-day dietary recalls were analysed (n = 12,153, ≥2 years) as well as demographic and anthropometric factors. The median fibre intake was 18.2 g (interquartile range [IQR] 13.2⁻25.0) in children and 20.7 g (IQR 14.3⁻28.7) in adults. We found that 42.3% (95% CI 40.5⁻44.1%) of children and 28.2% (95% CI 27.3⁻29.1%) of adults met the Adequate Intake (AI), and less than 20% of adults met the Suggested Dietary Target (SDT) to reduce the risk of chronic disease. Older children (aged 14⁻18 years), girls, young adults (19⁻30 years), males, and those of lower socio-economic status were less likely to meet the AI (p < 0.001). Those with a higher energy intake were more likely to meet the AI. Anthropometric measures were not associated with fibre intake or the likelihood of meeting the AI. Fibre is a nutrient of concern in Australian diets, with most children and adults falling short of recommendations. Adolescents, girls, young adults, men, and those of lower socio-economic status were less likely to meet the recommendations and may benefit most from public health interventions.

Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis.

An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million-$1.6 billion for CVD and AUD$18.2 million-$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia.

Breakfast and Breakfast Cereal Choice and Its Impact on Nutrient and Sugar Intakes and Anthropometric Measures among a Nationally Representative Sample of Australian Children and Adolescents.

There is limited evidence in Australia that compares the nutritional impact of a breakfast cereal breakfast to a non-cereal breakfast, and includes the type of cereal. This study investigated the impact of breakfast choice and the total sugar content of breakfast cereal on nutrient intakes and anthropometric measures among Australian children and adolescents. Data from 2 to 18-year-old in the 2011-2012 National Nutrition and Physical Activity Survey were used (n = 2821). Participants were classified as breakfast cereal consumers (minimally pre-sweetened (MPS) or pre-sweetened (PS)), non-cereal breakfast consumers, or breakfast skippers. Foods consumed for breakfast, foods added to the cereal bowl, and the impact of breakfast choice on daily nutrient intakes and anthropometric measures were determined. Although only 9% of children skipped breakfast, 61% of skippers were aged 14-18 years. Among breakfast consumers, 49% had breakfast cereal, and 62% of these exclusively consumed MPS cereal. Breakfast skippers had a higher saturated fat intake than breakfast cereal consumers, and lower intakes of dietary fibre and most micronutrients (p < 0.001). Compared with non-cereal breakfast consumers, breakfast cereal consumers had additional free sugars intake, lower sodium, and higher total sugars, carbohydrate, dietary fibre, and almost all other micronutrients (p < 0.001). The only difference in nutrient intakes between MPS and PS cereal consumers was higher folate among PS consumers. No associations between anthropometric measures and breakfast or breakfast cereal choice were found. The highest prevalence of breakfast skipping was among 14-18-year old. Breakfast cereal consumers had higher intakes of dietary fibre and most micronutrients compared with non-cereal breakfast consumers and skippers, and almost no differences were found between MPS and PS cereal consumers.

The Cross-Sectional Association between Consumption of the Recommended Five Food Group "Grain (Cereal)", Dietary Fibre and Anthropometric Measures among Australian Adults.

The Australian Dietary Guidelines recommended "grain (cereal)" core food group includes both refined and whole grain foods, but excludes those that are discretionary (i.e., cakes). We investigated the association between daily serves from the "grain (cereal)" group and its effect on fibre and adiposity. Data from Australian adults in the 2011-2012 National Nutrition and Physical Activity Survey were used (n = 9341). Participants were categorised by serves of core grain foods and general linear models were used to investigate the effect of demographic, socioeconomic, and dietary covariates on waist circumference, body mass index (BMI) and fibre intake. Compared to core grain avoiders (0 serves), high consumers (6+ serves/day) were: more likely male and socially advantaged, had a healthier dietary pattern, less likely dieting, overweight or obese, and were at lower risk of metabolic complications. After adjustment for age, sex and energy intake, there was an inverse relationship between core grain serves intake and BMI (p < 0.001), waist circumference (p = 0.001) and a positive relationship with fibre (p < 0.001). Model adjustments for diet and lifestyle factors resulted in a smaller difference in waist circumference (p = 0.006) and BMI (p = 0.006). Core grain serves was significantly associated with higher fibre, but marginally clinically significant for lower adiposity.

Psychogenic propriospinal myoclonus.

We report a case of probable psychogenic propriospinal myoclonus (PSM) in a patient who developed a sudden onset of disabling axial flexor myoclonus following a cosmetic surgical procedure. The electrophysiological findings were consistent with previous reports of PSM. Spontaneous remissions and disappearance of the jerks, sustained for 2 years, following removal of superficial surgical screws support the diagnosis of a psychogenic movement disorder.

Inter-rater reliability of the International Cooperative Ataxia Rating Scale (ICARS).

We assessed the inter-rater reliability of the 100-point International Cooperative Ataxia Rating Scale (ICARS). Three neurologists independently rated videotaped ICARS examinations of 22 subjects with genetically determined ataxias (spinocerebellar ataxia [SCA] Type 1 in 11; SCA Type 2 in 1; Friedreich's ataxia in 10) and 4 controls. Scores on live ICARS assessment had ranged from 0 to 7 for controls and 11 to 74 for ataxic subjects (clinically very mildly affected to wheelchair-bound). Inter-rater correlation was very high for the total score (Kendall's omega 0.994, 95% confidence interval, 0.988-0.997), and high to very high for each component subscore (0.791 for speech to 0.994 for posture/gait). All correlations were significant at P < 0.00001. The ICARS exhibits very high inter-rater reliability even without prior observer standardisation and is sensitive to a range of ataxia severities from very mild to severe.