Equations to estimate human milk intake in infants aged 7 to 10 months: prediction models from a cross-sectional study.

BACKGROUND: Obtaining valid estimates of nutrient intake in infants is currently limited by the difficulties of accurately measuring human milk intake. Current methods are either unsuitable for large-scale studies (i.e., the gold standard dose-to-mother stable isotope technique) or use set amounts, regardless of known variability in individual intake. OBJECTIVES: This cross-sectional study aimed to develop equations to predict human milk intake using simple measures and to carry out external validation of existing methods against the gold standard technique. METHODS: Data on human milk intake were obtained using the dose-to-mother stable isotope technique in 157 infants aged 7-10 mo and their mothers. Predictive equations were developed using questionnaire and anthropometric data (Model 1) and additional dietary data (Model 2) using lasso regression. Bland-Altman plots and intraclass correlation coefficients (ICC) also assessed the validity of existing methods (FITS and ALSPAC studies). RESULTS: The strongest univariate predictors of human milk intake in infants of 8.3 mo on average (46% female) were infant age, infant body mass index (BMI), number of breastfeeds a day, infant formula consumption, and energy from complementary food intake. Mean [95% confidence interval (CI)] differences in predicted versus measured human milk intake [mean (SD): 762 (257) mL/day] were 0.0 mL/day (-26, 26) for Model 1 (ICC 0.74) and 0.5 mL/day (-21, 22) for Model 2 (ICC 0.83). Corresponding differences were -197 mL/day (-233, -161; ICC 0.32) and -175 mL/day (-216, -134; ICC 0.41) for the methods used by FITS and ALSPAC, respectively. CONCLUSIONS: The Human Milk Intake Level Calculation provides substantial improvements on existing methods to estimate human milk intake in infants aged 7-10 mo, while utilizing data commonly collected in nutrition surveys. Although further validation in an external sample is recommended, these equations can be used to estimate human milk intake at this age with some confidence. This clinical trial was registered at http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436) as ACTRN12620000459921.

Baby Food Pouches, Baby-Led Weaning, and Iron Status in New Zealand Infants: An Observational Study.

Iron deficiency in infants can impact development, and there are concerns that the use of baby food pouches and baby-led weaning may impair iron status. First Foods New Zealand (FFNZ) was an observational study of 625 New Zealand infants aged 6.9 to 10.1 months. Feeding methods were defined based on parental reports of infant feeding at "around 6 months of age": "frequent" baby food pouch use (five+ times per week) and "full baby-led weaning" (the infant primarily self-feeds). Iron status was assessed using a venepuncture blood sample. The estimated prevalence of suboptimal iron status was 23%, but neither feeding method significantly predicted body iron concentrations nor the odds of iron sufficiency after controlling for potential confounding factors including infant formula intake. Adjusted ORs for iron sufficiency were 1.50 (95% CI: 0.67-3.39) for frequent pouch users compared to non-pouch users and 0.91 (95% CI: 0.45-1.87) for baby-led weaning compared to traditional spoon-feeding. Contrary to concerns, there was no evidence that baby food pouch use or baby-led weaning, as currently practiced in New Zealand, were associated with poorer iron status in this age group. However, notable levels of suboptimal iron status, regardless of the feeding method, emphasise the ongoing need for paying attention to infant iron nutrition.

The Effects of GreenShell Mussel Powder (Brand-Named PERNAULTRA) on Physical Performance and Subjective Pain, Symptoms, and Function Measures in Knee Osteoarthritis: A 6-Mo Randomized, Double-Blind, Placebo-Controlled Trial.

Background: Osteoarthritis (OA) can cause disability and reduce quality of life (QoL). Objectives: This study aimed to determine whether GreenShell mussel (GSM) powder (PERNAULTRA) consumption was more effective than placebo at improving physical performance and subjective measures of symptoms and function in adults with early signs of knee OA. Methods: The Researching Osteoarthritis and GSM study was a 6-mo randomized, double-blind, placebo-controlled trial in adults aged 55-80 y, screened for signs of OA (n = 120, 65.9 ± 6.43 y, 63% female). Participants consumed either 3 g of powdered whole GSM or placebo (pea protein) daily. Baseline and end data collection included 30-s chair stand, stair test, 40-m fast-paced walk test, Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire categorized into 5 subscales [pain (P), symptoms except pain (S), function in activities of daily living (ADL), function in sports/recreation (SP), and QoL], a measure of Intermittent and Constant Osteoarthritis Pain, and visual analog scale of pain and symptoms. Results: Visual analog scale symptoms showed a significantly greater reduction in percentage change for GSM than that for placebo [-28.1 (-59.2, 43.2) compared with 0.00 (-28.6, 100); P = 0.03]. Further, a trend for improvement in percentage change for GSM compared with placebo was seen in 40m fast-paced walk [2.51 (-3.55, 8.12) compared with 0.20 (-6.58, 4.92); P = 0.09], KOOS-SP [11.4 (-4.48, 27.0) compared with 0.00 (-11.1, 17.7); P = 0.09], and Intermittent and Constant Osteoarthritis Pain intermittent pain scale [-27.7 (-77.3, 0.00) compared with -14.6 (-50.0, 36.4); P = 0.08]. In those with body mass index (BMI; in kg/m2) <25, GSM consumption significantly improved KOOS-S compared with placebo [6.35 (3.49, 12.7) compared with 0.00 (-4.65, 4.49); P = 0.03] and showed a trend for improvement in KOOS-ADL [3.29 (1.01, 8.79) compared with 1.01 (-5.75, 4.30); P = 0.07]. Those with BMI of ≥25, consuming GSM showed a trend for improvement in KOOS-SP [13.6 (-4.76, 33.3) compared with 0.00 (-12.5, 20.0); P = 0.07]. Conclusions: This research suggests consumption of GSM has potential to alleviate symptoms and improve functionality in OA.This trial was registered at Clinical Trial Registry as ACTRN12620001112954p (https://www.anzctr.org.au/ACTRN12620001112954p.aspx).

Baby food pouches and Baby-Led Weaning: Associations with energy intake, eating behaviour and infant weight status.

Although concern is frequently expressed regarding the potential impact of baby food pouch use and Baby-Led Weaning (BLW) on infant health, research is scarce. Data on pouch use, BLW, energy intake, eating behaviour and body mass index (BMI) were obtained for 625 infants aged 7-10 months in the First Foods New Zealand study. Frequent pouch use was defined as ≥5 times/week during the past month. Traditional spoon-feeding (TSF), "partial" BLW and "full" BLW referred to the relative proportions of spoon-feeding versus infant self-feeding, assessed at 6 months (retrospectively) and current age. Daily energy intake was determined using two 24-h dietary recalls, and caregivers reported on a variety of eating behaviours. Researchers measured infant length and weight, and BMI z-scores were calculated (World Health Organization Child Growth Standards). In total, 28% of infants consumed food from pouches frequently. Frequent pouch use was not significantly related to BMI z-score (mean difference, 0.09; 95% CI -0.09, 0.27) or energy intake (92 kJ/day; -19, 202), but was associated with greater food responsiveness (standardised mean difference, 0.3; 95% CI 0.1, 0.4), food fussiness (0.3; 0.1, 0.4) and selective/restrictive eating (0.3; 0.2, 0.5). Compared to TSF, full BLW was associated with greater daily energy intake (BLW at 6 months: mean difference 150 kJ/day; 95% CI 4, 297; BLW at current age: 180 kJ/day; 62, 299) and with a range of eating behaviours, including greater satiety responsiveness, but not BMI z-score (6 months: 0.06 (-0.18, 0.30); current age: 0.06 (-0.13, 0.26)). In conclusion, neither feeding approach was associated with weight in infants, despite BLW being associated with greater energy intake compared with TSF. However, infants who consumed pouches frequently displayed higher food fussiness and more selective eating.

Vitamin B and One-Carbon Metabolite Profiles Show Divergent Associations with Cardiometabolic Risk Markers but not Cognitive Function in Older New Zealand Adults: A Secondary Analysis of the REACH Study.

BACKGROUND: Vitamin B inadequacies and elevated homocysteine status have been associated with impaired cognitive and cardiometabolic health with aging. There is, however, a scarcity of research investigating integrated profiles of one-carbon (1C) metabolites in this context, including metabolites of interconnected folate, methionine, choline oxidation, and transsulfuration pathways. OBJECTIVES: The study aimed to examine associations between vitamins B and 1C metabolites with cardiometabolic health and cognitive function in healthy older adults, including the interactive effects of Apolipoprotein E-ε4 status. METHODS: Three hundred and thirteen healthy participants (65-74 y, 65% female) were analyzed. Vitamins B were estimated according to dietary intake (4-d food records) and biochemical status (serum folate and vitamin B12). Fasting plasma 1C metabolites were quantified by liquid chromatography with tandem mass spectrometry. Measures of cardiometabolic health included biochemical (lipid panel, blood glucose) and anthropometric markers. Cognitive function was assessed by the Computerized Mental Performance Assessment System (COMPASS) and Montreal Cognitive Assessment (MoCA). Associations were analyzed using multivariate linear (COMPASS, cardiometabolic health) and Poisson (MoCA) regression modeling. RESULTS: Over 90% of participants met dietary recommendations for riboflavin and vitamins B6 and B12, but only 78% of males and 67% of females achieved adequate folate intakes. Higher serum folate and plasma betaine and glycine concentrations were associated with favorable cardiometabolic markers, whereas higher plasma choline and homocysteine concentrations were associated with greater cardiometabolic risk based on body mass index and serum lipids concentration values (P< 0.05). Vitamins B and homocysteine were not associated with cognitive performance in this cohort, though higher glycine concentrations were associated with better global cognitive performance (P = 0.017), episodic memory (P = 0.016), and spatial memory (P = 0.027) scores. Apolipoprotein E-ε4 status did not modify the relationship between vitamins B or 1C metabolites with cognitive function in linear regression analyses. CONCLUSIONS: Vitamin B and 1C metabolite profiles showed divergent associations with cardiometabolic risk markers and limited associations with cognitive performance in this cohort of healthy older adults.

Associations of protein intake, sources and distribution on muscle strength in community-dwelling older adults living in Auckland, New Zealand.

Protein intake, sources and distribution impact on muscle protein synthesis and muscle mass in older adults. However, it is less clear whether dietary protein influences muscle strength. Data were obtained from the Researching Eating Activity and Cognitive Health (REACH) study, a cross-sectional study aimed at investigating dietary patterns, cognitive function and metabolic syndrome in older adults aged 65-74 years. Dietary intake was assessed using a 4-d food record and muscle strength using a handgrip strength dynamometer. After adjusting for confounders, in female older adults (n 212), total protein intake (ß = 0⋅22, P < 0⋅01); protein from dairy and eggs (ß = 0⋅21, P = 0⋅03) and plant food sources (ß = 0⋅60, P < 0⋅01); and frequently consuming at least 0⋅4 g/kg BW per meal (ß = 0⋅08, P < 0⋅01) were associated with higher BMI-adjusted muscle strength. However, protein from meat and fish intake and the coefficient of variance of protein intake were not related to BMI-muscle strength in female older adults. No statistically significant associations were observed in male participants (n = 113). There may be sex differences when investigating associations between protein intake and muscle strength in older adults. Further research is needed to investigate these sex differences.

Body Fat Percentage and Blood Donation are the Strongest Determinants of Iron Stores in Premenopausal Women Joining the New Zealand Army.

INTRODUCTION: Suboptimal iron status is an issue for women joining the military because of its association with impaired aerobic performance, yet no studies have investigated dietary and non-dietary determinants of iron status simultaneously in this population. The purpose of this study was to explore associations between iron stores, dietary patterns (DPs), and potential non-dietary determinants of iron status in premenopausal women at the commencement of basic military training (BMT) in the New Zealand Army. METHODS: During week 1 of BMT, demographic, body composition, lifestyle, medical history, and dietary data were measured as potential determinants of serum ferritin (SF) in 101 participants. Following univariate analysis, age, body fat percentage, previous blood donation, at least 6 h of exercise per week that raised the heart rate, and a vegetarian DP were analyzed using a multiple linear regression model. RESULTS: An increase in body fat percentage was associated with increased SF (P < .009), although blood donation in the past year decreased SF (P < .011) compared to those participants who did not donate blood. There was no association between SF and a vegetarian DP or hours of exercise per week. The model explained 17.5% of the variance in SF at the commencement of BMT. CONCLUSION: Body fat percentage and blood donation in the past year were the strongest determinants of iron stores in healthy premenopausal women commencing BMT. It is recommended that women joining the New Zealand Army are provided information to maintain or improve their iron status based on these findings. This includes clinical screening of iron status, advice for women considering blood donation, and dietary advice regarding total energy requirements and iron bioavailability.

Plasma nervonic acid levels were negatively associated with attention levels in community-living older adults in New Zealand.

The global population is aging. Preserving function and independence of our aging population is paramount. A key component to maintaining independence is the preservation of cognitive function. Metabolomics can be used to identify biomarkers of cognition before noticeable deterioration. Our study investigated the plasma metabolome of 332 community-living New Zealanders between 65 and 74 years of age, using gas chromatography-mass spectrometry. Six cognitive domains were assessed. Of the 123 metabolites identified using an in-house mass spectral libraries of standards, nervonic acid had a significant, inverse association with the attention domain (P-value = 1.52E- 4; FDR = 0.019), after adjusting for covariates (apolipoprotein E -ε4 genotype, sex, body fat percentage (standardised by sex), age, education, deprivation index, physical activity, metabolic syndrome, polypharmacy, smoking status, and alcohol intake) and multiple testing. Attention is defined as the ability to concentrate on selected aspects of the environment while ignoring other stimuli. This is the first study to identify nervonic acid as a potential biomarker of attention in older adults. Future research should confirm this association in a longitudinal study.

Starting complementary feeding with vegetables only increases vegetable acceptance at 9 months: a randomized controlled trial.

BACKGROUND: Starting complementary feeding (CF) with vegetables only may improve vegetable acceptance throughout childhood. OBJECTIVES: We aimed to test whether exposure to vegetables only during the first 4 wk of CF increases later vegetable acceptance compared with a control group receiving fruit and vegetables. METHODS: In this randomized, controlled, parallel-group study, 117 Auckland infants received either vegetables only (veg-only, n = 61) or a combination of fruit and vegetables (control, n = 56) for a duration of 4 wk, starting from the first day of CF at ∼4-6 mo of age. The primary outcome measure was intake of target vegetables (broccoli, spinach) provided by the study at 9 mo of age. Daily intake of vegetables (FFQs) at 9 mo was a supporting measure. Infants' iron status (serum ferritin, hemoglobin) was examined at all time points. RESULTS: The veg-only infants consumed more broccoli and spinach than controls [mean difference (95% CI): 11.83 (0.82, 22.84) g, P = 0.036 and 10.19 (0.50, 19.87) g, P = 0.039, respectively]. Intake of pear was comparable among intervention groups (P = 0.35). At 9 mo, veg-only infants consumed target vegetables at a faster rate [mean difference (95% CI): broccoli, 3.37 (1.26, 5.47), P = 0.002; spinach, 4.12 (0.80, 7.45), P = 0.016] and showed greater acceptance for target vegetables [mean difference (95% CI): broccoli, 0.38 (0.07, 0.70), P = 0.019; spinach, 032 (0.04, 0.60), P = 0.024] than controls. The rate of eating and acceptance of pear was comparable among intervention groups (P = 0.42 and P = 0.98, respectively). Also, veg-only infants consumed more vegetables than controls [86.3 (52.5, 146.3) compared with 67.5 (37.5, 101.3) g, respectively, P = 0.042]. Introducing vegetables as the first food was not associated with 9-mo iron status. CONCLUSIONS: Providing vegetables as first foods increased vegetable intake at 9 mo of age and may be an effective strategy for improving child vegetable consumption and developing preferences for vegetables in infancy.

Relative Validity and Reproducibility of a Semi-Quantitative Food Frequency Questionnaire for Determining Nutrient Intake in Older Adults in New Zealand: The REACH Study.

Dietary intake is an important predictor of health and disease outcomes. This cross-sectional study evaluated the relative validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) for assessing energy and nutrient intake in older adults. Dietary data were collected 2018-2019 in Auckland, New Zealand from a convenience sample of community-dwelling adults (65-74 years, n = 294, 37% male) using a 109-item self-administered FFQ at baseline (FFQ1) and four weeks later to assess reproducibility. FFQ1 was compared to a four-day food record to determine relative validity. Agreement between dietary assessment tools was assessed for both raw and energy-adjusted nutrient intakes using paired t-tests, correlation coefficients, weighted kappa statistic, Bland-Altman plots, and linear regression analysis. Energy adjustments moderately improved the relative validity and reproducibility for most nutrients. For energy and energy-adjusted nutrient intakes, the mean correlation coefficients were 0.38 (validity) and 0.65 (reproducibility); the mean weighted kappa statistics were 0.27 (validity) and 0.51 (reproducibility). A significant slope of bias was present in 54% (validity) and 25% (reproducibility) of Bland-Altman plots. The Researching Eating, Activity, and Cognitive Health (REACH) FFQ has acceptable relative validity and good reproducibility for ranking nutrient intakes in older New Zealand adults, but is less suitable for assessing absolute nutrient intakes.

Dietary patterns and cognitive function in older New Zealand adults: the REACH study.

PURPOSE: The global population is ageing. Evidence show dietary patterns may be associated with cognitive status in older adults. This cross-sectional study investigated associations between dietary patterns and cognitive function in older adults in New Zealand. METHODS: The REACH study (Researching Eating, Activity, and Cognitive Health) included 371 participants (65-74 years, 36% male) living independently in Auckland, New Zealand. Valid and reproducible dietary patterns were derived, using principal component analysis, from dietary data collected by a 109-item validated food frequency questionnaire. Six cognitive domains (global cognition, attention and vigilance, executive function, episodic memory, working memory, and spatial memory) were tested using COMPASS (Computerised Mental Performance Assessment System). Associations between dietary patterns and cognitive scores, adjusted for age, sex, education, physical activity, energy, and Apolipoprotein E-ε4 status were analysed using multiple linear regression analysis. RESULTS: Three dietary patterns explained 18% of dietary intake variation-'Mediterranean style' (comprising: salad vegetables, leafy cruciferous vegetables, other vegetables, avocados and olives, alliums, nuts and seeds, white fish and shellfish, oily fish, and berries); 'Western' (comprising: processed meats, sauces and condiments, cakes, biscuits and puddings, meat pies and chips, and processed fish); and 'Prudent' (comprising: dried legumes, soy-based foods, fresh and frozen legumes, whole grains, and carrots). No associations between any cognitive domain and dietary pattern scores were observed. Global cognitive function was associated with being younger and having a university education. CONCLUSION: In this cohort of community-dwelling, older adults in New Zealand, current dietary patterns were not associated with cognitive function.

Associations between dietary patterns and the metabolic syndrome in older adults in New Zealand: the REACH study.

The metabolic syndrome is common in older adults and may be modified by the diet. The aim of this study was to examine associations between a posteriori dietary patterns and the metabolic syndrome in an older New Zealand population. The REACH study (Researching Eating, Activity, and Cognitive Health) included 366 participants (aged 65-74 years, 36 % male) living independently in Auckland, New Zealand. Dietary data were collected using a 109-item FFQ with demonstrated validity and reproducibility for assessing dietary patterns using principal component analysis. The metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III. Associations between dietary patterns and the metabolic syndrome, adjusted for age, sex, index of multiple deprivation, physical activity, and energy intake were analysed using logistic regression analysis. Three dietary patterns explained 18 % of dietary intake variation - 'Mediterranean style' (salad/leafy cruciferous/other vegetables, avocados/olives, alliums, nuts/seeds, shellfish and white/oily fish, berries), 'prudent' (dried/fresh/frozen legumes, soya-based foods, whole grains and carrots) and 'Western' (processed meat/fish, sauces/condiments, cakes/biscuits/puddings and meat pies/hot chips). No associations were seen between 'Mediterranean style' (OR = 0·75 (95 % CI 0·53, 1·06), P = 0·11) or 'prudent' (OR = 1·17 (95 % CI 0·83, 1·59), P = 0·35) patterns and the metabolic syndrome after co-variate adjustment. The 'Western' pattern was positively associated with the metabolic syndrome (OR = 1·67 (95 % CI 1·08, 2·63), P = 0·02). There was also a small association between an index of multiple deprivation (OR = 1·04 (95 % CI 1·02, 1·06), P < 0·001) and the metabolic syndrome. This cross-sectional study provides further support for a Western dietary pattern being a risk factor for the metabolic syndrome in an older population.

Sugar-sweetened beverages consumption among New Zealand children aged 8-12 years: a cross sectional study of sources and associates/correlates of consumption.

BACKGROUND: The benefit of reducing sugar-sweetened beverage (SSB) consumption is widely accepted, but updated and in-depth data on New Zealand (NZ) children's SSB consumption is lacking. The aims of this study were to describe beverage consumption, focusing on SSBs in primary school age children living in Auckland; to examine the association of selected socio-demographic, home, community and school factors and children's beverage knowledge/attitudes with regards to beverage consumption; to explore the relationship between SSBs consumption and adiposity in children. METHODS: A cross-sectional, Auckland-wide survey of 578 school age children (8-12 years) was conducted using questionnaires to collect data on beverage consumption, beverage knowledge/attitudes, and selected socio-demographic and home, community, school factors. Body fat percentage (BF%) was assessed using bioelectrical impedance (BIA). RESULTS: Ninety-six percent of children consumed ≥1 serving of SSBs a week; with ≥5 servings reported by 62% of children. Of all SSBs assessed, consumption of ≥1 serving of sugar sweetened milk-based beverages (85%, mainly milk drinks made from powder) was most prevalent, followed by fruit juice (46%) and sugar-containing carbonated drinks (39%, mainly soft/fizzy drinks). Among unsweetened beverages, plain water was reported to be consumed < 2 times a day by 22% of children, and plain milk < 1 serving a day by 53%. Higher consumption of SSBs was associated with socio-economic disadvantage, non-NZ European ethnicities (Maori, Pacific, Asian, others), availability of SSBs in the home, frequent takeaway/convenience shop visits, children's incorrect perception of adequate SSBs consumption frequency, and higher BF% (females only). School health policy and encouragement of children to consume un-sweetened beverages was not associated with SSBs consumption. CONCLUSIONS: The consumption of SSBs is prevalent in NZ school age children, with higher consumption rates observed among those from socially disadvantaged areas. This high consumption is associated with higher BF% in females. Multi-contextual interventions to decrease SSBs should target children, and their families/environment, particularly those from socially disadvantaged areas.

Micronutrients and athletic performance: A review.

Optimising nutrition intake is a key component for supporting athletic performance and supporting adaption to training. Athletes often use micronutrient supplements in order to correct vitamin and mineral deficiencies, improve immune function, enhance recovery and or to optimise their performance. The aim of this review was to investigate the recent literature regarding micronutrients (specifically iron, vitamin C, vitamin E, vitamin D, calcium) and their effects on physical performance. Over the past ten years, several studies have investigated the impacts of these micronutrients on aspects of athletic performance, and several reviews have aimed to provide an overview of current use and effectiveness. Currently the balance of the literature suggests that micronutrient supplementation in well-nourished athletes does not enhance physical performance. Excessive intake of dietary supplements may impair the body's physiological responses to exercise that supports adaptation to training stress. In some cases, micronutrient supplementation is warranted, for example, with a diagnosed deficiency, when energy intake is compromised, or when training and competing at altitude, however these micronutrients should be prescribed by a medical professional. Athletes are encouraged to obtain adequate micronutrients from a wellbalanced and varied dietary intake.

Impact of a "vegetables first" approach to complementary feeding on later intake and liking of vegetables in infants: a study protocol for a randomised controlled trial.

BACKGROUND: Vegetables as first complementary foods for infants may programme taste preferences that lead to improved vegetable intake in children. Yet few studies have investigated the impact of a "vegetables first" approach to complementary feeding, especially in New Zealand. The purpose of this randomised control trial is to investigate the effect of starting complementary feeding with vegetables only on infants' later intake and liking of vegetables, compared to those starting with fruit and vegetables. METHODS/DESIGN: One-hundred and twenty mother-infant pairs living in Auckland, New Zealand, will be randomised to receive either vegetables only (intervention) or fruit and vegetables (control) for 28 days, starting from the first day of complementary feeding at around 4-6 months of age. Infants will be presented with a brassica (broccoli), followed by a green leafy vegetable (spinach) and sweet fruit (pear) at 9 months of age. The primary outcome measures of intake of each food will be assessed using a weighed food diary. Secondary outcome measures of overall intake, liking and wanting of vegetables will be assessed using a food frequency questionnaire, liking tool and video coding tool, respectively, at 9, 12, and 24 months of age. Infant growth and iron status will be assessed as part of health screening and monitoring at baseline, post intervention and 9 months of age. Other biological samples to be collected include infant stool samples, vitamin D (mother and infant), iron status (mother), and mothers' diet. DISCUSSION: This randomised, controlled trial will be the first to our knowledge to investigate a "vegetables first" approach to complementary feeding on infants' liking and intake of vegetables in New Zealand. Comparison against standard practice (fruit and vegetables as first foods) should complement other trials underway, such as the Baby's First Bites and Nordic OTIS trial. Results may contribute to the evidence supporting complementary feeding guidelines in New Zealand and worldwide. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12619000737134 . Registered on 16 May 2019.

Relative Validity and Reproducibility of a Food Frequency Questionnaire for Assessing Dietary Patterns and Food Group Intake in Older New Zealand Adults: The Researching Eating, Activity, and Cognitive Health Study.

BACKGROUND: Dietary pattern analysis considers the overall dietary intake and combinations of foods eaten. Valid and reproducible tools for determining dietary patterns are necessary to assess diet-disease relationships. OBJECTIVE: This study evaluated the relative validity and reproducibility of the Researching Eating, Activity, and Cognitive Health (REACH) Study food frequency questionnaire (FFQ) specifically designed to identify dietary patterns in older adults. DESIGN: A subset of participants from the REACH study completed two identical 109-item FFQs 1 month apart (FFQ1 and FFQ2) to assess reproducibility and a 4-day food record between FFQ administrations to assess relative validity. Foods from each dietary assessment tool were assigned to 57 food groups. Principal component analysis was applied to the food group consumption reported in each dietary assessment tool to derive dietary patterns. PARTICIPANTS AND SETTING: Dietary data were collected (2018 and 2019) from a subset of the REACH study (n = 294, 37% men) aged 65 to 74 years, living in Auckland, New Zealand. MAIN OUTCOME MEASURES: Daily intakes of 57 food groups and dietary patterns of older adults participating in REACH living in New Zealand. STATISTICAL ANALYSIS: Agreement of dietary pattern loadings were assessed using Tucker's congruence coefficient. Agreement of dietary pattern scores and food group intakes were assessed using Spearman correlation coefficients (acceptable correlation rho = 0.20 to 0.49), weighted kappa statistic (acceptable statistic κw = 0.20 to 0.60), and Bland-Altman analysis, including mean difference, limits of agreement, plots, and slope of bias. RESULTS: Three similar dietary patterns were identified from each dietary assessment tool: Mediterranean style, Western, and prudent. Congruence coefficients between factor loadings ranged from 0.54 to 0.80. Correlations of dietary pattern scores ranged from 0.47 to 0.59 (reproducibility) and 0.33 to 0.43 (validity) (all P values < 0.001); weighted kappa scores from 0.40 to 0.48 (reproducibility) and 0.27 to 0.37 (validity); limits of agreement from ± 1.79 to ± 2.09 (reproducibility) and ± 2.09 to ± 2.27 (validity); a negative slope of bias was seen in the prudent pattern for reproducibility and validity (P < 0.001). CONCLUSIONS: The REACH FFQ generated dietary patterns with acceptable reproducibility and relative validity and therefore can be used to examine associations between dietary patterns and health outcomes in older New Zealand adults.

Body composition associations with muscle strength in older adults living in Auckland, New Zealand.

BACKGROUND: Aging is associated with decreases in muscle strength and simultaneous changes in body composition, including decreases in muscle mass, muscle quality and increases in adiposity. METHODS: Adults (n = 369; 236 females) aged 65-74 years living independently were recruited from the cross-sectional Researching Eating Activity and Cognitive Health (REACH) study. Body fat percentage and appendicular skeletal muscle mass (ASM) (sum of lean mass in the arms and legs) were assessed using Dual-energy X-ray Absorptiometry (Hologic, QDR Discovery A). The ASM index was calculated by ASM (kilograms) divided by height (meters) squared. Isometric grip strength was measured using a hand grip strength dynamometer (JAMAR HAND). RESULTS: Linear regression analyses revealed that muscle strength was positively associated with the ASM index (R2 = 0.431, p < 0.001). When exploring associations between muscle strength and muscle mass according to obesity classifications (obesity ≥30% males; ≥40% females), muscle mass was a significant predictor of muscle strength in non-obese participants. However, in participants with obesity, muscle mass was no longer a significant predictor of muscle strength. CONCLUSIONS: Body fat percentage should be considered when measuring associations between muscle mass and muscle strength in older adults.

Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study.

BACKGROUND: The complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food "pouches" and "baby-led weaning" (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed purées, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined. OBJECTIVE: The aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not. METHODS: Dietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide "dose-to-mother" technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect. RESULTS: This observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022. CONCLUSIONS: This large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/29048.

Pre-diabetes prevalence and associated factors in New Zealand school children: a cross-sectional study.

AIMS: The incidence of pre-diabetes and type 2 diabetes mellitus (T2DM) is increasing in children. Early identification of pre-diabetes is an important first step in preventing the progression to T2DM. The aim was to investigate the association of selected factors with pre-diabetes in children. METHODS: This data were from a subset of the 685 children recruited for the Children's Bone Study, a cross-sectional study of children aged 8-11 years in Auckland, New Zealand. Glycated haemoglobin (HbA1c) was measured from a finger-prick blood test. Children were classified as normoglycaemic (HbA1c≤39mmol/mol) and pre-diabetic (HbA1c>39mmol/mol). Anthropometry included weight, height, waist circumference (WC) and percentage body fat (%BF) measured using bioelectrical impedance analysis. Information about age, gender, ethnicity and physical activity was collected by questionnaires. RESULTS: HbA1c was measured in 451 children (10.4±0.6years, 45% male). Pre-diabetes was present in 71 (16%) children and was greatest in South Asian (n=13, 30%), Pacific Island (n=29, 27%) and Maori (n=10, 18%) children, compared with European children (n=10, 6.0%) (P< 0.001). South Asian and Pacific Island ethnicity, high WC, high %BF and low physical activity were associated with pre-diabetes. CONCLUSIONS: Factors associated with pre-diabetes in children were ethnicity, anthropometric measures and physical-activity levels. The prevalence of pre-diabetes in children of South Asian and Pacific Island ethnicities suggests the need for appropriate and timely identification and intervention to halt the progression to T2DM.

Validity of quantitative ultrasound and bioelectrical impedance analysis for measuring bone density and body composition in children.

BACKGROUND/OBJECTIVES: Using dual X-ray absorptiometry (DXA) to assess body composition in children has limitations including expense, lack of portability, and exposure to radiation. The aims of this study were to examine: (1) validity of quantitative ultrasound (QUS) against DXA for measuring bone density and (2) the validity of in-built algorithm of bioelectrical impedance analysis (BIA) for measuring body composition in children (8-13 years) living in New Zealand. SUBJECTS/METHODS: Total body less head (TBLH), bone mineral content (BMC), bone mineral density (BMD), and body composition were measured with DXA (QDR Discovery A, Hologic, USA); calcaneal BMD and stiffness index (SI) with QUS (Sahara QUS, Hologic, USA), and BIA on the InBody 230 (Biospace Ltd., Seoul, Korea). Relative validity was assessed using Pearson's and Lin's concordance correlation coefficients (CCC), and Bland-Altman plots. RESULTS: In 124 healthy children, positive correlations between QUS SI and DXA (BMC and BMD) were observed (range = 0.30-0.45, P < 0.01). Results from Lin's CCC test showed almost perfect correlations between BIA and DXA fat free mass (0.96), fat mass (0.92), and substantial correlation for percentage of fat mass (0.75) (P < 0.05). CONCLUSION: Although BIA results were not as accurate as DXA and DXA remains the gold standard method for clinical assessment, BIA can be an alternative method for investigating body composition among children in large cohort field studies. Calcaneal QUS and DXA are not interchangeable methods for measuring bone density in children similar to our study population.