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Whole grain foods are rich in nutrients, dietary fibre, a range of antioxidants, and phytochemicals, and may have potential to act in an anti-inflammatory manner, which could help impact chronic disease risk. This systematic literature review aimed to examine the specific effects of whole grains on selected inflammatory markers from human clinical trials in adults. As per the Preferred Reporting Items for Systematic Reviews (PRISMA) protocol, the online databases MEDLINE, Embase, Cochrane, CINAHL, and Scopus were searched from inception through to 31 August 2021. Randomized control trials (RCTs) ≥ 4 weeks in duration, reporting ≥1 of the following: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF), were included. A total of 31 RCTs were included, of which 16 studies recruited overweight/obese individuals, 12 had pre-existing conditions, two were in a healthy population, and one study included participants with prostate cancer. Of these 31 RCTs, three included studies with two intervention arms. A total of 32 individual studies measured CRP (10/32 were significant), 18 individual studies measured IL-6 (2/18 were significant), and 13 individual studies measured TNF (5/13 were significant). Most often, the overweight/obese population and those with pre-existing conditions showed significant reductions in inflammatory markers, mainly CRP (34% of studies). Overall, consumption of whole grain foods had a significant effect in reducing at least one inflammatory marker as demonstrated in 12/31 RCTs.

Previous studies in Australian children/adolescents and adults examining added sugar (AS) intake were based on now out-of-date national surveys. We aimed to examine the AS and free sugar (FS) intakes and the main food sources of AS among Australians, using plausible dietary data collected by a multiple-pass, 24-h recall, from the 2011–12 Australian Health Survey respondents (n 8202). AS and FS intakes were estimated using a previously published method, and as defined by the WHO, respectively. Food groups contributing to the AS intake were described and compared by age group and sex by one-way ANOVA. Linear regression was used to test for trends across age groups. Usual intake of FS (as percentage energy (%EFS)) was computed using a published method and compared with the WHO cut-off of <10 %EFS. The mean AS intake of the participants was 60·3 (sd 52·6) g/d. Sugar-sweetened beverages accounted for the greatest proportion of the AS intake of the Australian population (21·4 (sd 30·1) %), followed by sugar and sweet spreads (16·3 (sd 24·5) %) and cakes, biscuits, pastries and batter-based products (15·7 (sd 24·4) %). More than half of the study population exceeded the WHO’s cut-off for FS, especially children and adolescents. Overall, 80–90 % of the daily AS intake came from high-sugar energy-dense and/or nutrient-poor foods. To conclude, the majority of Australian adults and children exceed the WHO recommendation for FS intake. Efforts to reduce AS intake should focus on energy-dense and/or nutrient-poor foods.

ObjectiveThis 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).DesignCross-sectional study.SettingNational Nutrition and Physical Activity Survey (2011-2012).Participants12,153 participants aged 2+ years.Main outcome measuresAverage dietary content of nutrients linked to NCDs and the prevalence of intake outside levels recommended for the prevention of NCDs.Data analysisFood 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.ResultsUltra-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 β 0.43, p<0.001); total (β 0.08, p<0.001), saturated (β 0.18, p<0.001) and trans fats (β 0.10, p<0.001); sodium (β 0.21, p<0.001) and diet energy density (β 0.41, p<0.001), while an inverse relationship was observed for dietary fibre (β -0.21, p<0.001) and potassium (β -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.ConclusionThe 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.

The high availability of energy-dense nutrient-poor discretionary foods in large serving and package sizes may have shifted portion size norms (described as a typical perception of how much people choose to eat from a given food at a single eating occasion) towards larger sizes. Few public health recommendations exist around appropriate discretionary food portion sizes. This qualitative study aimed to explore the underlying rationale of portion size norms of discretionary foods among Australian adults 18-65 years. Four focus group sessions were conducted. Collected data were analysed using inductive thematic analysis. Focus groups were held online via Zoom between September and October 2023. Thirty-four participants were recruited in the study (mean age 38 years, 19 females). The key themes raised from inductive analysis were personal factors, eating context factors and food environment factors relevant to the portion size norms. A framework was established to illustrate the interaction across these themes during the conceptualisation of the norms. For serving size availability, consumers found that there were limited serving size choices when making portion size selections and lacked the knowledge and skills in portion control. These findings highlight the need to make positive changes to the current food environment and develop relevant public health guidelines around appropriate portion sizes to promote healthier portion size norms and enable better portion control.

To examine intakes and variety of fruit and vegetables consumed by Australian young adults, also assessing differences by meal occasion and sociodemographic characteristics. 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. Representative sample of metropolitan and rural areas across Australia. Respondents aged 18-34 years were included (n 2397). 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). 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.

Diet quality indices are used to assess dietary behavior and adherence to dietary guideline recommendations. The aim of this study was to develop, apply, and validate a Healthy Eating Index for Australian Adults (HEIFA—2013) based on the updated Dietary Guidelines for Australians 2013. The HEIFA—2013 used an 11-component system of 5 food groups, 4 nutrients, water intake, and a measure of dietary variety. The total possible index score was 100. The HEIFA—2013 was applied to weighed food record (WFR) and food frequency questionnaire (FFQ) data of a sample (n = 100) of young adults. The HEIFA—2013 was assessed using principal components analysis (PCA), Cronbach's coefficient, and correlation coefficient with nutrient intakes. Scores for HEIFA—2013 components were compared between methods using means, frequencies, 95% limits of agreement, Bland and Altman methods, and weighted kappa. PCA indicated that multiple underlying dimensions compose the index, and Cronbach's coefficient α was 0.41. A higher HEIFA—2013 was associated with higher dietary quality, including a low intake of saturated fat and sodium and a high intake of selected vitamins and minerals. Low correlations with energy were observed. The mean HEIFA—2013 score ± standard error (SE) for the WFR was 53.84 ± 1 and for the FFQ was 54.82 ± 0.9. The total mean scores were 54.33 ± 0.1. Young adults had the lowest mean scores for sodium (2.9 ± 0.2), fat (3.0 ± 0.0), vegetables (4.7 ± 0.1), and grains (5.1 ± 0.1). The WFR and FFQ scored individual components differently, but at the group level the differences were not significant. The HEIFA—2013 will need to be catered for different diet collection methods. It is a useful index of overall diet quality and can be used to monitor changes in dietary intake of adults over time. The findings infer that even a highly educated affluent group of young adults fails to meet recommended dietary guidelines. •We developed, applied, and validated a diet quality index among Australian young adults.•We designed a measure of diet quality based on conformance with the dietary guidelines.•We examined differences in diet quality between two dietary assessment methods.•Index can be used to monitor changes in dietary intake of adults over time.

Differences in outcomes might be due to a number of factors, including underlying eating patterns of the population, dairy type (unfermented vs fermented, full fat vs low fat), measurement error, and potentially industry sponsorship.7 A variety of dairy food components, such as calcium, bioactive proteins, milk fatty acids, and the whole dairy food matrix, have been proposed as being protective against cardiovascular disease but mechanistic pathways are yet to be elucidated. Dehghan and colleagues reported that, in a median follow-up of 9·1 years, higher total dairy intake (>2 servings per day vs no intake) was associated with 14–23% reductions in the risks of major cardiovascular diseases and total mortality combined (hazard ratio 0·84, 95% CI 0·75–0·94), total mortality (0·83, 0·72–0·96), non-cardiovascular disease mortality (0·86, 0·72–1·02), cardiovascular disease mortality (0·77, 0·58–1·01), major cardiovascular disease alone (0·78, 0·67–0·90), and stroke (0·66, 0·53–0·82), with all ptrend values considered significant. [...]a big limitation of the PURE study is that it only assessed the diet of the participants at baseline. Because the dietary intake of individuals might change over time,11 and together with the recent economic growth in some of the included countries (eg, India and China), it seems inappropriate to assume the baseline dairy intake could truly reflect the dairy consumption of the participants over the course of follow-up.

Purpose To examine the intake and sources of added sugars (AS) of Australian children and adolescents, and compare their intake of free sugars (FS) to the recommended limit set by the World Health Organization (<10 % energy from FS). Method Data of 4140 children and adolescents aged 2–16 years with plausible intakes based on 2 × 24 h recalls from the 2007 Australian National Children Nutrition and Physical Activity Survey were used. AS content of foods was estimated based on a published method. Intakes of AS and FS, as well as food sources of AS, were calculated. One-way ANOVA was used for comparisons between age groups and gender. Results The mean (SD) AS intake was 58.9 (35.1) g/day, representing 11.9 (5.6) % of daily energy intake and 46.9 (17.5) % of daily total sugars intake. More than 80 % of the subjects had % energy from FS > 10 %. Significant increasing trends for AS intake, % energy from AS, % energy from FS across age groups were observed. Sugar-sweetened beverages (19.6 %), cakes, biscuits, pastries and batter-based products (14.3 %), and sugar and sweet spreads (10.5 %) were the top three contributors of AS intake in the whole sample. Higher contribution of AS from sugar-sweetened beverages was observed in adolescents ( p trend  < 0.001). Conclusions A large proportion of Australian youths are consuming excessive amounts of energy from AS. Since the main sources of AS were energy-dense, nutrient-poor foods, interventions which target the reduction in these foods would reduce energy and AS intake with minimal impact to core nutrient intake.

Purpose This study examined the association of free sugar (FS) intake with obesity measures and blood pressure (BP) among a nationally representative sample of Australian adults. Methods Data from adults (weighted n  = 5136) who completed 2 × 24-h recalls and had complete data for BP, waist circumference (WC), waist-to-height ratio (WHtR), and body mass index (BMI) were analyzed. Associations between percentage energy of FS from all food sources (%EFS total ), beverages only (%EFS beverages ), and non-beverages sources only (%EFS non-beverages ) and obesity measures and BP were examined using linear and non-linear regressions. Logistic regression was used to calculate the odds ratios (OR) of being classified as overweight and/or obese, having increased cardiometabolic risks, and elevated BP per 5% point increase in %EFS total , %EFS beverages , and %EFS non-beverages . All regression analyses were adjusted for known socio-economic and lifestyle confounders. Results %EFS beverage was positively associated with BMI, WC, and WHtR (all p  < 0.05), while %EFS non-beverage was inversely associated with these outcomes. Increases in odds of having an undesirable WC/WHtR were found with increasing %EFS beverages (OR per 5% point increase in %EFS beverages : 1.19 for WC; 1.23 for WHtR, both p  < 0.001). %EFS total and %EFS non-beverages were weakly and negatively associated with diastolic BP. A 5% point increase in %EFS total and %EFS non-beverage was associated with a 10–25% reduction in odds of having elevated BP. Conclusions Our results suggested that only a higher FS intake from beverages may be associated with obesity, and higher FS intake was associated with reduced odds of having elevated BP.

IntroductionExcessive water intake is rarely associated with life-threatening hyponatraemia. The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake.MethodsThis review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies (case reports, observational or interventional studies) reporting excess water intake and hyponatraemia in adults (1946–2019) were included.ResultsA total of 2970 articles were identified and 177 were included (88.7% case reports), consisting of 590 patients. The mean age was 46±16 years (95% CI 44 to 48 years), 47% female, 52% had a chronic psychiatric disorder and 31% had no underlying condition. The median volume of water consumed and serum sodium at presentation was 8 L/day (95% CI 8.9 to 12.2 L/day) and 118 mmol/L (95% CI 116 to 118 mmol/L), respectively. The motivator for increased water consumption was psychogenic polydipsia (55%); iatrogenic (13%); exercise (12%); habitual/dipsogenic polydipsia (7%) and other reasons (13%). The clinical features on presentation were severe in 53% (seizures, coma); moderate in 35% (confusion, vomiting, agitation) and mild in 5% (dizziness, lethargy, cognitive deficit) and not reported in 5% of studies. Treatment was supportive in 41% of studies (fluid restriction, treatment of the underlying cause, emergency care), and isotonic and hypertonic saline was used in 18% and 28% of cases, respectively. Treatment-related complications included osmotic demyelination (3%) and rhabdomyolysis (7%), and death occurred in 13% of cases.ConclusionWater intoxication is associated with significant morbidity and mortality and requires daily intake to substantially exceed population-based recommendations. The limitations of this analysis are the low quality and high risk of bias of the included studies.PROSPERO registration numberA pre-existing protocol in the international prospective register of systematic reviews was updated to incorporate any new amendments and reregistered at http://www.crd.york.ac.uk/PROSPERO (registration no. CRD42019129809).