Macronutrient (im)balance drives energy intake in an obesogenic food environment: An ecological analysis.

OBJECTIVE: The protein leverage hypothesis (PLH) postulates that strong regulation of protein intake drives energy overconsumption and obesity when human diets are diluted by fat and carbohydrates. The two predictions of the PLH are that humans (i) regulate intake to maintain protein within a narrow range and that (ii) energy intake is an inverse function of percentage energy from protein because absolute protein intake is maintained within narrow limits. METHODS: Multidimensional nutritional geometry was used to test the predictions of the PLH using dietary data from the Australian National Nutrition and Physical Activity Survey. RESULTS: Both predictions of the PLH were confirmed in a population setting: the mean protein intake was 18.4%, and energy intake decreased with increasing energy from protein (L = -0.18, p < 0.0001). It was demonstrated that highly processed discretionary foods are a significant diluent of protein and associated with increased energy but not increased protein intake. CONCLUSIONS: These results support an integrated ecological and mechanistic explanation for obesity, in which low-protein highly processed foods lead to higher energy intake because of the biological response to macronutrient imbalance driven by a dominant appetite for protein. This study supports a central role for protein in the obesity epidemic, with significant implications for global health.

Perceived barriers and facilitators to healthy eating and physical activity in endoscopic bariatric patients: a qualitative study.

PURPOSE: To explore the perceived barriers and facilitators to healthy eating and physical activity in individuals opting for endoscopic bariatric procedures. METHODS: A total of 55 participants were recruited from a metropolitan bariatric clinic in Australia. Participants were interviewed at one of two stages of treatment: pre-procedure (n = 34) or 5-6 months post-procedure (n = 18). Interviews were transcribed and analyzed using content analysis. RESULTS: Five themes emerged from analysis of participant responses in both groups including lifestyle, psychological, physiological, social, and eating behaviors. Each theme consisted of subthemes which were either perceived barriers, or facilitators, to healthy eating and physical activity. Perceived barriers consisted of factors such as time constraints, low motivation, unhealthy habits and portion control, low priority of personal health, emotional difficulties, and pain/mobility issues. Facilitators included subthemes such as planning/organization, high motivation, seeing results, improved self-esteem, increased energy, improved mobility, and changing mindset about portions. CONCLUSION: The results highlight the importance of delivering individualized and targeted treatment plans for individuals opting for bariatric procedures. LEVEL OF EVIDENCE: Level III: Evidence obtained from cohort or case-control analytic studies.

Endoscopic bariatric therapies for obesity: a review.

▪ Obesity is reaching pandemic proportions globally, with overweight or obesity affecting at least two-thirds of Australian adults. ▪ Bariatric surgery is an effective weight loss strategy but is constrained by high resource requirements and low patient acceptance. ▪ Multiple endoscopic bariatric therapies have matured, with well established and favourable safety and efficacy profiles in multiple randomised controlled trials (RCTs), and are best used within a multidisciplinary setting as an adjuvant to lifestyle intervention. ▪ Three types of intragastric balloon are currently in use in Australia offering average total weight loss ranging from 10% to 18%, with others available internationally. ▪ Endoscopic sleeve gastroplasty produces average total weight loss of 15-20% with low rates of severe complications, with RCT data anticipated in December 2021. ▪Bariatric and metabolic endoscopy is rapidly evolving, with many novel, promising therapies currently under investigation.

Cognitive remediation-enabled cognitive behaviour therapy for obesity: a case series.

PURPOSE: Despite varied treatment effects, weight recidivism is common and typically associated with the abandonment of prescribed weight management strategies. Literature suggests that difficulty with weight management is associated with deficits in executive functioning, in particular cognitive flexibility and response inhibition, the neurocognitive processes that are involved in goal-directed behaviours, such as dietary adherence. These processes are overlooked by mainstream weight loss programmes. The aim of the study was to assess the effectiveness of a cognitive remediation-enabled cognitive behaviour therapy (CR-CBT) in addressing the neurocognitive, psychological and behavioural correlates of weight loss. It was hypothesised that CR-CBT would improve cognitive flexibility and response inhibition, reduce binge eating, aid weight loss and improve metabolic health. METHODS: Four adults with obesity (body mass index > 30 kg/m2) received 7 weeks of manualised CR-CBT and were assessed via a case series analysis at baseline, end of treatment and 3-month follow-up. Treatment included 3 weekly 90-min group-based behaviour weight loss sessions for 3 weeks, followed by twice-weekly 50-min individualised CR-CBT sessions for 4 weeks. RESULTS: Cognitive remediation-enabled cognitive behaviour therapy produced improvements in response inhibition and cognitive flexibility, and reductions in binge eating frequency, weight, and metabolic health readings between baseline and 3-month follow-up. CONCLUSIONS: This is the first study to assess the effectiveness of CR-CBT in the treatment of obesity. Preliminary indications of treatment success are discussed with respect to study limitations. In light of these results, we recommend further investigation via a randomised control trial (RCT). LEVEL OF EVIDENCE: Level IV, case series.

Double Burden of Malnutrition in the Asia-Pacific Region-A Systematic Review and Meta-analysis.

BACKGROUND: Double Burden of Malnutrition (DBM)-the coexistence of undernutrition along with overnutrition-is a significant public health issue in the Asia-Pacific region. The scope of the DBM in this region is largely unknown. This review aims to determine the prevalence of under- and overnutrition as major DBM components and to investigate whether there has been a shift from under- to overnutrition in the Asia-Pacific region. METHODS: Online databases including PubMed and Web of Science were searched for original studies on DBM prevalence in the Asia-Pacific region; particularly, those published from January 2008 to December 2018 were screened for eligibility. We collected data on indicators of under- and overnutrition on the population level and adapted the ratio of prevalence of overweight/obesity versus prevalence of underweight as the main outcome indicator. Pooled prevalence estimates of DBM and the ratio of overnutrition versus undernutrition were generated using R (3.4.0). RESULTS: In total, 33 studies were included in this review. Pooled analysis demonstrated that DBM was generally presented among countries/areas in the Asia-Pacific region except in high-income countries (HICs). Overall, the prevalence of undernutrition was 8.8% (95% CI 7.3-10.6%) while overnutrition among the same population reached 23.0% (95% CI 20.3-26.0%). Countries in the Oceania region or HICs reported low level of undernutrition (less than 3%). All subgroup analysis (geolocation, income level, sex, age) reported pooled prevalence of overweight/obesity as more than 18%. Overall, the whole region and all subgroups were more likely to experience a higher prevalence of overnutrition than undernutrition, except that low- and lower-middle-income countries (L-MICs) had similar prevalence for over- and undernutrition. CONCLUSION: DBM in the Asia-Pacific region is alarmingly high and is titled toward overnutrition. As a result, future interventions/policy targeting to maintain a healthy weight for the population should not just focus on prevention and treatment toward one direction.

Older Australians are eating more protein: Secondary analysis of the 1995 & 2011/12 national nutrition surveys.

BACKGROUND/OBJECTIVES: Diet is important in healthy ageing. Protein is essential for physical function, immunity, maintaining quality of life and ability to live independently. SUBJECTS/METHODS: Protein intakes, sources and the protein content of meals and snacks among adults aged ≥65 years from the 1995 National Nutrition Survey (n = 1960) and the 2011/12 National Nutrition and Physical Activity Survey (n = 2103) were examined. Usual protein intakes were estimated using the National Cancer Institute method, and intakes and adequacy were compared between the two surveys. RESULTS: Participants reported a higher total protein intake in 2011/12 than 1995 (81.0 vs. 73.4 g, p < 0.001). Mean protein intake per kg body weight (1995, 1.0 g/kg vs. 2011/12, 1.1 g/kg) and ability to meet the Australian (1995, 85% vs. 2011/12, 88%) and World Health Organisation (1995, 90% vs. 2011/12, 94%) protein requirements increased over time. Males >70 years or those with poor self-assessed health status were more likely to report inadequate protein intake compared with other respondents. Higher protein intake was associated with greater consumption of vegetables, fruit, dairy products, meat and alternatives and lower consumption of discretionary foods and alcohol. Participants obtained 17% of their protein intake from breakfast, 30% from lunch, 43% from dinner and 10% from snacks. Main protein sources included lean red meat, poultry and full cream milk. CONCLUSION: Specific dietary advice for older Australians, particularly older men and those with poor health, to promote healthy food choices with adequate protein content is needed for disease prevention and maintenance of quality of life.

Efficacy and Safety of Endoscopic Sleeve Gastroplasty: A Systematic Review and Meta-Analysis.

BACKGROUND & AIMS: Bariatric surgery is the most successful treatment for obesity. However, many patients avoid surgery due to its perceived invasive nature and fear of complications. Endoscopic sleeve gastroplasty (ESG) is a seemingly less invasive option for patients with obesity. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of ESG in adults. METHODS: We searched MEDLINE, Embase, Web of Science, and Cochrane Library through July 2019. Investigated outcomes included the percent total body weight loss (TBWL), body mass index reduction, percent excess weight loss (EWL), and adverse events. RESULTS: We extracted data from 8 original studies, published from 2016 through 2019, which included a total of 1772 patients. At 6 months, mean TBWL was 15.1% (95% CI, 14.3-16.0), mean decrease in body mass index was 5.65 kg/m2 (95% CI, 5.07-6.22), and mean excess weight loss was 57.7% (95% CI, 52.0-63.4). Weight loss was sustained at 12 months and 18-24 months with a TBWL of 16.5% (95% CI, 15.2-17.8) and 17.2% (95% CI, 14.6-19.7), respectively. The pooled post-ESG rate of severe adverse events was 2.2% (95% CI, 1.6%-3.1%), including pain or nausea requiring hospitalization (n = 18, 1.08%), upper gastrointestinal bleeding (n=9, 0.56%), and peri-gastric leak or fluid collection (n = 8, 0.48%). CONCLUSIONS: In a systematic review and meta-analysis, we found ESG to produce clinically significant weight loss that was reproducible among independent centers and to have a low rate of severe adverse events. ESG appears to be an effective intervention for patients with obesity, although comparative studies and randomized controlled trials are necessary. PROSPERO Identifier: CRD42019121921.

Concurrent Placements of a Duodenal-Jejunal Bypass Liner and an Intragastric Balloon Among Severely Obese Patients: A Case Series.

The duodenal-jejunal bypass liner and the intragastric balloon are endoscopically deployed devices used in the treatment of obesity and diabetes. These devices use differing mechanisms of action, and concurrent use may lead to improved efficacy. Three obese patients who suffered from weight loss plateau with the liner had the intragastric balloon inserted concurrently. All 3 patients reported subsequent significant weight loss. None of the patients reported any symptom that indicate the interference between the devices. This is the first case series in humans of successfully combining 2 independent endoscopic bariatric therapies to overcome weight loss plateau in the primary treatment of obesity.

Ultra-processed foods and recommended intake levels of nutrients linked to non-communicable diseases in Australia: evidence from a nationally representative cross-sectional study.

OBJECTIVE: This study aimed to describe the consumption of ultra-processed foods in Australia and its association with the intake of nutrients linked to non-communicable diseases (NCDs). DESIGN: Cross-sectional study. SETTING: National Nutrition and Physical Activity Survey (2011-2012). PARTICIPANTS: 12,153 participants aged 2+ years. MAIN OUTCOME MEASURES: Average dietary content of nutrients linked to NCDs and the prevalence of intake outside levels recommended for the prevention of NCDs. DATA ANALYSIS: Food items were classified according to the NOVA system, a classification based on the nature, extent and purpose of industrial food processing. The contribution of each NOVA food group and their subgroups to total energy intake was calculated. Mean nutrient content of ultra-processed food and non-ultra-processed food fractions of the diet were compared. Across quintiles of the energy contribution of ultra-processed foods, differences in the intake of nutrients linked to NCDs as well as in the prevalence of intakes outside levels recommended for the prevention of NCDs were examined. RESULTS: Ultra-processed foods had the highest dietary contribution (42.0% of energy intake), followed by unprocessed or minimally processed foods (35.4%), processed foods (15.8%) and processed culinary ingredients (6.8%). A positive and statistically significant linear trend was found between quintiles of ultra-processed food consumption and intake levels of free sugars (standardised ß 0.43, p<0.001); total (ß 0.08, p<0.001), saturated (ß 0.18, p<0.001) and trans fats (ß 0.10, p<0.001); sodium (ß 0.21, p<0.001) and diet energy density (ß 0.41, p<0.001), while an inverse relationship was observed for dietary fibre (ß -0.21, p<0.001) and potassium (ß -0.27, p<0.001). The prevalence of non-recommended intake levels of all studied nutrients increased linearly across quintiles of ultra-processed food intake, notably from 22% to 82% for free sugars, from 6% to 11% for trans fat and from 2% to 25% for dietary energy density, from the lowest to the highest ultra-processed food quintile. CONCLUSION: The high energy contribution of ultra-processed foods impacted negatively on the intake of non-ultra-processed foods and on all nutrients linked to NCDs in Australia. Decreasing the dietary share of ultra-processed foods would substantially improve the diet quality in the country and help the population achieve recommendations on critical nutrients linked to NCDs.

Patient motivations and expectations prior to bariatric surgery: A qualitative systematic review.

Bariatric surgery is the most effective treatment for weight loss in individuals with severe and complex obesity. While the extant literature has mostly explored clinical outcomes of surgery, recent research has also examined patients' experiences prior to treatment. This systematic review synthesized findings from qualitative studies investigating patients' motives and expectations prior to undergoing bariatric surgery for weight loss. Twenty-eight studies published in English involving 580 participants were identified for inclusion. Data extraction and thematic synthesis yielded four global themes: physiological, emotional, cognitive, and interpersonal/environmental. These represented seven subthemes describing patients' presurgery experiences: relationship with food, physical health, activities of living, personal identity, social relations, presurgery information, and beliefs about surgery. In addition to improving physical and medical comorbidities associated with obesity, participants believed that postsurgery weight loss would produce positive psychosocial impacts by strengthening their personal identities, their relationships, and improving their engagement in public and professional life. The complex and widespread nature of the changes patients expected would result from bariatric surgery highlights the importance of providing pretreatment education focused on psychosocial well-being, as well as concurrent psychological support alongside surgery, to best inform individual treatment selection and clinical practice.

Recent trends in intensive treatments of obesity: Is academic research matching public interest?

BACKGROUND: The demand and the utilization of intensive treatments of obesity have been increased tremendously. OBJECTIVES: This study aimed to investigate trends in interest related to the intensive treatments of obesity in both academic research and the public domain, and assess whether they match each other. SETTING: The BMI Clinic, Double Bay, New South Wales, Australia. METHODS: Intensive treatment of obesity is defined as meal replacement, pharmacologic treatments, and surgical or endoscopic bariatric procedures identified by the national guidelines. To identify the academic research interests, the number of academic research publications for each search topic was identified as converted into relative popularity. To identify the public's interests, Google Trends relative search volume and Twitter message relative intensity for each topic was mined to identify the most recent interests in intensive obesity treatment among the public. RESULTS: There was an increase in academic publications in all treatment domains between 2007 and 2017, but that the research emphasis correlated poorly with public interest. Between 2007 and 2017, the most popular and increasing academic research interest in the intensive treatment of obesity was bariatric surgery, followed by weight loss medication. In 2007, the most popular public-interest treatment was weight loss medication followed by bariatric surgery. In contrast, in 2017, meal replacement and bariatric surgery were equally popular, while the interests in weight loss medication declined. Significant seasonal patterns were also recognized for the public's interests. CONCLUSION: Academic research and public interest are not currently sufficiently aligned in the area of obesity treatment.

Low calcium intakes among Australian adolescents and young adults are associated with higher consumption of discretionary foods and beverages.

OBJECTIVES: Calcium is an essential nutrient required for peak bone mass growth during adolescence and into young adulthood. The aim of this study was to examine the calcium intake of Australian adolescents and young adults from both food sources and supplements; and the relationship between calcium intake and intake of food groups. METHODS: Dietary data from 770 adolescents (14-18 y of age) and 774 young adults (19-25 y of age) from the 2011 to 12 National Nutrition and Physical Activity Survey were used. Analysis of covariances were conducted to identify associations between calcium intake and consumption of food groups. RESULTS: For adolescents, 83% of males and 95% of females did not meet the Estimated Average Requirement (EAR); whereas for young adults, 69% of males and 83% of females failed to meet the EAR. Food sources contributing to calcium intake were similar across age groups and sex. The largest contributors included regular milk (15-24%), cheese (10-12%), refined low-fiber bread (10%), and low-fat milk (7-9%). For both age groups, the lowest consumers of calcium were the poorest consumers of dairy products and the highest consumers of discretionary food choices and alcoholic beverages. A higher consumption of calcium was associated with a higher intake of dairy products and lower intakes of meat and alternatives and all discretionary choices. CONCLUSIONS: Calcium intake among Australian adolescents and young adults remains below recommendations, particularly in females. A higher intake of calcium was associated with a better dietary pattern. Further investment in interventions is indicated.

Endoscopic Sleeve Gastroplasty (ESG) Is a Reproducible and Effective Endoscopic Bariatric Therapy Suitable for Widespread Clinical Adoption: a Large, International Multicenter Study.

OBJECTIVE: Endoscopic sleeve gastroplasty (ESG), an incisionless endoscopic bariatric procedure, has shown impressive results in case series. This study examines the reproducibility, efficacy, and safety in three centers across two countries, and identifies key determinants for procedural success. DESIGN: Patients who underwent ESG between February 2016 and May 2017 at one of three centers (Australia and USA) were retrospectively analyzed. All procedures were performed on an outpatient basis using the Apollo OverStitch device (Apollo Endosurgery, Austin, TX). Primary outcomes included absolute weight loss (ΔWeight, kg), change in body mass index (∆BMI, in kg/m2), total body weight loss (TBWL, %), excess weight loss (EWL, in %), and immediate and delayed adverse events. RESULTS: In total, 112 consecutive patients (male 31%, age 45.1 ± 11.7 years, baseline BMI 37.9 ± 6.7 kg/m2) underwent ESG. At 1, 3, and 6 months, Δweight was 9.0 ± 4.6 kg (TBWL 8.4 ± 4.1%), 12.9 ± 6.4 kg (TBWL 11.9 ± 4.5%), and 16.4 ± 10.7 kg (TBWL 14.9 ± 6.1%), respectively. The proportion of patients who attained greater than 10% TBWL and 25% EWL was 62.2 and 78.0% at 3 months post-ESG and 81.0 and 86.5% at 6 months post-ESG. Weight loss was similar between the three centers. Multivariable analysis showed that male sex, greater baseline body weight, and lack of prior endoscopic bariatric therapy were predictors of greater Δweight at 6 months. Three (2.7%) severe adverse events were observed. CONCLUSIONS: ESG is an effective, reproducible, and safe weight loss therapy that is suitable for widespread clinical adoption.

Discrepancy in socioeconomic status does not fully explain the variation in diet quality between consumers of different coffee types.

PURPOSE: Habitual consumers of different coffee types may vary in socioeconomic status (SES), which is an important determinant of diet quality. Nonetheless, research on diet quality among coffee consumers was scarce. We aimed to compare the diet quality of coffee consumers with different preferences towards coffee type and additive usage. METHODS: In this cross-sectional analysis, intake data of food, coffee, and additive usage from the adult respondents of the 2011-2012 Australian Health Survey were used. Participants were grouped according to the type of coffee (espresso and ground coffee, E&G; coffee made from coffee mixes and instant coffee, M&I; non-consumers, NC) and additives (milk, sugar, and intense sweetener) consumed. Adjusted food group intake was compared between consumption groups using general linear model. RESULTS: E&G drinkers had better SES than M&I and NC. After adjusting for covariates, the mean dairy intake of E&G drinkers was 22.2% higher than M&I drinkers (p < 0.001) and 33.1% higher than NC (p < 0.001). Mean discretionary food intake of E&G drinkers was 12.1% lower than M&I (p = 0.003) and 12.3% lower than NC (p = 0.001). In terms of additive usage, non-users of coffee additive had the lowest dairy food intake and the highest discretionary food intake. CONCLUSIONS: Coffee consumers' different preferences towards coffee type and additive usages reflected significant variations in their diet quality, even after adjustment of SES. Therefore, future epidemiological studies should consider separating coffee drinkers according to their habitual consumption of different types of coffee.

A modeling study of beverage substitution and obesity outcomes among Australian adults.

OBJECTIVE: The aim of this study was to investigate the cross-sectional associations among sugar-sweetened beverage (SSB) consumption, its substitution with beverage alternatives, and obesity outcomes in an Australian population. METHODS: We used data from 9341 adults ages ≥19 y from the 2011-2012 Australian National Nutrition and Physical Activity Survey. Multivariate linear regression with adjustment for covariates was used to examine the associations between SSB consumption and body mass index (BMI) and waist circumference (WC). Substitution modeling was used to simulate the effect of replacing SSB with water, coffee/tea, fruit juice, and milk. RESULTS: SSB intake (100 g/d) was associated with higher BMI (ß = 0.06 kg/m2; P = 0.001) and WC (ß = 0.19 cm; P < 0.001). A linear trend with BMI and WC also was seen when SSB intake was examined as categories of servings per day (Ptrend ≤ 0.001). Replacing SSB with water, coffee/tea, or milk was inversely associated with BMI (ß = -0.07 to -0.09 kg/m2; P < 0.001) and WC (ß = -0.25 to -0.28 cm; P < 0.001). CONCLUSIONS: The results of the present study suggested that SSB intake is associated with obesity and that coffee/tea, water, and milk may be good alternatives for SSB. Further longitudinal and intervention studies are warranted to examine the effects of beverage substitution on obesity.

The fruit and vegetable intake of young Australian adults: a population perspective.

OBJECTIVE: To examine intakes and variety of fruit and vegetables consumed by Australian young adults, also assessing differences by meal occasion and sociodemographic characteristics. DESIGN: Secondary analysis of cross-sectional 24 h recall data collected through the 2011-12 National Nutrition and Physical Activity Survey. Crude means and proportions consuming fruits and vegetables were calculated. Pearson χ 2 tests, Kruskal-Wallis analyses and linear regression models were used to assess differences in mean intakes by age, BMI and sociodemographic variables. The variety eaten was determined based on the number of fruit and vegetable subgroups consumed. SETTING: Representative sample of metropolitan and rural areas across Australia. SUBJECTS: Respondents aged 18-34 years were included (n 2397). RESULTS: Mean daily intake of fruit (128 g/0·9 servings) and vegetables (205 g/2·7 servings) was lower than the minimum recommended intake set at 2 and 5 servings, respectively. Age was positively associated with fruit and vegetable intake (P=0·002, P<0·001), with 18-24-year-olds reporting the poorest vegetable variety compared with 25-29- and 30-34-year-olds (P=0·002). When controlling for total energy, males consumed less vegetables than females (P=0·002). A large proportion of the 15 % of respondents who consumed adequate amounts of fruits and vegetables on the day prior to the survey reported intake across all meal occasions (P<0·001). CONCLUSIONS: Fruit and vegetable intake is suboptimal among Australian young adults. An age-appropriate campaign is recommended to target increased consumption, particularly for those aged 18-24 years, with opportunity to promote increased variety and consumption across the day.

Exploratory analysis of meal composition in Australia: meat and accompanying foods.

OBJECTIVE: The study of meal patterns and overall diet in relation to health outcomes may be more important than focusing on single nutrients or food groups. The present study aimed to explore the composition of main meals and snacks in the Australian population and examine associations between meat/poultry/fish and other foods. DESIGN: The study utilised 24 h recalls. Meal composition was defined based on average intakes of food groups per meal disaggregated from all food sources. SETTING: 2011-12 National Nutrition and Physical Activity Survey. SUBJECTS: Australian people (n12153) aged 2 years or above. RESULTS: Overall, breakfast was the smallest meal of the day, typically consisting of grains, dairy products and fruit. Lunch was the second largest meal, consisting mostly of grains, non-starchy vegetables and meat/poultry/fish. The largest meal was dinner, comprising meat/poultry/fish, vegetables (starchy and non-starchy), grains and often including discretionary beverages (children) or alcohol (adults). The main food groups consumed at snacking occasions were dairy, fruit, discretionary foods and beverages (including alcohol for adults). The most frequently consumed meat types were beef and chicken at dinner and ham at lunch. Non-starchy vegetables were accompanying foods for red meat, poultry and fish/seafood consumed in varying portion sizes, but did not accompany processed meat. CONCLUSIONS: The present study considered meat, poultry and fish as the meal centre and their accompaniments of other food groups at different eating occasions. These findings expand the background evidence for health professionals developing meal-based framework/guidelines and public health messages.

Socio-Demographic Determinants of Diet Quality in Australian Adults Using the Validated Healthy Eating Index for Australian Adults (HEIFA-2013).

Diet quality indices have been shown to predict cardiovascular disease, cancer, Type 2 Diabetes, obesity and all-cause mortality. This study aimed to determine the socio-demographics of Australian adults with poor diet quality. Diet quality was assessed for participants of the 2011-2012 National Nutrition and Physical Activity Survey aged 18 years or above (n = 9435), with the validated 11-component Healthy Eating Index for Australians (HEIFA-2013), based on the 2013 Australian Dietary Guidelines. Differences in scores by demographics (ANOVA) and regression models for associations between the HEIFA-2013 score and demographic characteristics were conducted. The mean (SD) HEIFA-2013 score was 45.5 (14.7) out of 100 due to poor intakes of vegetables, fruit, grains, dairy and fat and high intakes of added sugar, sodium and discretionary foods. Lower mean HEIFA-2013 scores (SD) were found for males 43.3 (14.7), young-adults 41.6 (14.2) obese 44.1 (14.3), smokers 40.0 (14.2), low socio-economic status 43.7 (14.9) and Australian country-of-birth 44.2 (14.6) (p < 0.05). The overall diet quality of the Australian population is poor and targeted interventions for young-adults, males, obese and those with lower socio-economic status are recommended.

Consumption patterns of meat, poultry, and fish after disaggregation of mixed dishes: secondary analysis of the Australian National Nutrition and Physical Activity Survey 2011-12.

BACKGROUND: With the increased consumption of mixed dishes, the need for more precise quantitative data on individual food components is becoming more important. This paper aims to examine the consumption of meat, poultry, and fish before and after disaggregation of mixed dishes, and its contribution to energy and nutrient intakes in a representative sample of Australians. METHODS: This study utilised a 24-h recall of 12,153 people aged two years and over participating in the 2011-12 National Nutrition and Physical Activity Survey. Consumption of meat/poultry/fish was examined before and after disaggregation of mixed dishes where all meat products and mixed dishes were separated into individual food components. Comparison between these two methods was undertaken for consumption data and contribution to energy and nutrient intakes, reported by meat type. RESULTS: Disaggregation of mixed dishes resulted in lower estimated intakes of red meat (9%), poultry (25%), and fish (18%) but higher estimates of processed meat (17%). Meat/poultry/fish contributed approximately 25% of total energy intake, 49% protein, 29% saturated fat, 26% iron, and 38% of zinc intake after disaggregation, which was significantly higher than their contributions reflected in survey data containing mixed dishes. Per-capita consumption of all meat/poultry/fish was 118 g/day for children and 162 g/day for adults, with chicken and beef being the highest contributors. CONCLUSION: These findings provide a detailed picture of meat/poultry/fish consumption in Australia, and emphasise the need for population studies to disaggregate reported food information to provide a more precise estimate of consumption.

Discretionary food and beverage consumption and its association with demographic characteristics, weight status, and fruit and vegetable intakes in Australian adults.

OBJECTIVE: Excessive consumption of discretionary foods/beverages in the Australian population has been identified, increasing the risk of obesity and chronic disease. The present study aimed to examine the associations between demographic, anthropometric and dietary factors and the consumption of discretionary foods, discretionary beverages and discretionary foods/beverages combined. DESIGN: Discretionary food/beverage consumption reported in two 24 h recalls was analysed, stratified by gender, age, socio-economic status, country of birth, BMI, waist circumference, and fruit and vegetable intakes. SETTING: 2011-12 National Nutrition and Physical Activity Survey. SUBJECTS: Australian adults (n 7873) aged 19 years or above. RESULTS: Mean discretionary food and beverage consumption was 631 g (28 % by weight from foods; 72 % from beverages), providing 2721 kJ of energy intake (72 % from foods; 28 % from beverages). Total discretionary food/beverage consumption was higher in younger age groups (P<0·001), those in lower socio-economic categories (P<0·001), those born in Australia (P<0·001), those with higher BMI (P<0·001) and those with lower fruit (P<0·001) or vegetable intake (P<0·001). Discretionary beverage consumption (ß=6·6, P<0·001) was more strongly associated with BMI than discretionary food consumption (ß=0·5, P=0·01). CONCLUSIONS: Total discretionary food/beverage consumption as well as discretionary foods alone and discretionary beverages alone were associated with BMI in Australian adults. In addition, high intakes were associated with younger age, lower socio-economic status, and lower consumption of fruit and vegetables.