Medical Sciences Forum

Moving towards healthy sustainable diets which replace a proportion of animal with plant-based protein requires effective population-based strategies. A variety of strategies in food service settings can support this. This systematic review aimed to evaluate the effectiveness of strategies to decrease animal protein and/or increase plant protein in foodservice settings. Outcomes included uptake (primary outcome), satisfaction, financial, environmental, and dietary intake (secondary outcomes). Both quantitative and qualitative outcomes were included. Seven databases were searched to identify peer-reviewed studies conducted in commercial and institutional foodservices using any strategy to decrease beef, lamb, pork, poultry, eggs, fish or seafood and/or increase legumes/pulses, legume/pulse-based meat substitutes or nuts. Titles/abstracts then full texts were screened independently by two authors. Quality appraisal was completed using the Mixed Methods Appraisal Tool. From 20,002 records identified, 38 studies from 29 manuscripts met the eligibility criteria, of which 16% were high quality. Almost half the manuscripts were published in the last two years. Most took place in institutional settings (n = 30) and all were in Europe or the United States. Strategies included forced restriction (n = 4), menu re-design (n = 6), recipe re-design (n = 6), service re-design (n = 4), menu labelling (n = 7), prompt at point of sale (n = 7) and multi-pronged strategies (n = 4). Menu labelling and re-designing menus, recipes, and service increased uptake of target foods in most studies with the largest consistent changes with menu re-design. Most recipe and service re-design strategies had a positive or neutral effect on satisfaction. Few studies explored financial, dietary or environmental outcomes. Future meat reduction initiatives should focus on menu and recipe re-design as these do not appear to negatively impact consumer satisfaction. More studies are needed to evaluate financial, environmental, and dietary outcomes. Full article

As pressure rises in the fight to reduce global warming, increasing scrutiny is falling on food systems. A growing number of individuals are looking to optimise their own diets for the benefit of the environment. To gain a holistic understanding on the impact of these choices on the world, and to ensure true sustainability for future populations, it is essential to consider these diets from the perspective of the global food production system and its nutrient supply. The DELTA Model is a tool to simulate global food production scenarios and the nutrients they supply. The model was used to simulate future scenarios of food production that aligned with common diets often adopted for improved environmental sustainability (vegan, vegetarian, and the EAT-Lancet reference diet). This was performed by altering production quantities of specific food groups. The resulting nutrient supply of the scenario was then analysed. All the modified scenarios saw reduced availability of many nutrients in future years (2030 and 2050) compared to 2018 data. Nutrient availability was compared to nutrient reference values scaled to the global population. All modified scenarios had a global nutrient undersupply, including calcium (>31% below requirement), iron (>27%), zinc (>26%), Vitamin B12 (>67%), and Vitamin E (>10%). It was also found that the increased cropland area required to produce food in these modified scenarios would put strain on the world’s limited resources. A transition to these scenarios irrespective of filling nutrient undersupply was estimated to increase the land area required to produce food by >22% compared to 2018, and >33% if nutrient requirements were fulfilled. The results of the DELTA Model emphasise the essential need to consider the practicalities and capacity of global food production systems, as well as the nutrition of populations, when advocating for worldwide diet adaptation. Full article

Nutrition content and health claims are voluntary statements regarding the nutrition content of food or how it relates to health. They are commonly used on food labels and in food advertising. The majority of packaged food products in New Zealand display nutrition content or a health claim on the label. This study aimed to investigate how consumers in New Zealand understand, perceive, and use the nutrition content and health claims on food labels. The study used a qualitative approach with semi-structured in-depth online interviews and in-person focus groups. Participants who were aged > 25 years and who were responsible for the food shopping in their household were selected. Ten participants took part in the interviews and the seven focus groups consisted of 39 participants. Transcripts were analysed using reflexive thematic analysis, where inductive coding identified five themes: (1) aware of claims but did not use, (2) mistrust and scepticism of nutrition content and health claims, (3) confusion and misinterpretation of nutrition content and health claims, (4) using claims to guide food choice, and (5) not all claims are equal. The findings from this study showed that nutrition content and health claims were used by a minority subgroup of consumers with specific dietary requirements. However, most consumers perceived nutrition content and health claims with scepticism and mistrust and were not aware that these are highly regulated, but rather believed that the claims were simply marketing tactics to increase product appeal and sales. Full article

Research has demonstrated that cannabis use is linked with a greater risk of psychotic-like experiences (PLEs), particularly in young people. As many people use cannabis for the alleviation of pain, it is important to examine the impact that PLEs have on pain. This is because the current literature finds that psychotic and schizophrenic disorders impact pain experience, and PLEs are subclinical positive symptoms of psychosis. There is limited research on the impact of PLEs on pain experience, particularly in cannabis users, and thus, the current study aims to address this gap in the literature. The study also examines whether childhood trauma and mental health problems contribute to the heightened risk of pain in cannabis users, and whether these relationships are moderated by PLEs. The current study was a cross-sectional design including young cannabis users aged 18–25 (n = 2630). Participants completed questionnaire measures of cannabis use, PLEs, self-reported pain, childhood trauma, anxiety, and depression. Logistic regression analyses revealed that young cannabis users experiencing more PLEs reported significantly higher pain. Additionally, experiencing a history of childhood trauma and depression were also found to result in higher pain in these cannabis users. Moderation analyses revealed that PLEs moderated the relationship between depression and pain; however, in contrast to our predictions, PLEs did not moderate the relationship between childhood trauma and pain. Anxiety did not significantly predict higher pain. The results of the current study have important implications for the use and legalisation of THC medically, and the social, emotional, and cognitive aspects of pain and cannabis use. We propose recommendations for mitigating the risk of PLEs associated with cannabis use in chronic pain patients who are medically prescribed THC for its analgesic effects and we include suggestions for future research. Full article

Perceived insufficient milk supply (PIM) is the most common reason for breastfeeding women to introduce formula before 6 months postpartum. Anecdotal evidence suggests that galactagogues (substances to enhance breast milk supply) are commonly used in Aotearoa New Zealand. The aim of this study is to investigate galactagogue use and its relationship to mother’s perceptions of their breast milk supply. Breastfeeding women with an infant aged 1–7 months old were invited to complete a survey that included a series of questions to evaluate PIM and other perceptions of their breast milk supply. Participants self-reported the use of galactagogues, including medications, herbs, and supplements as well as special foods. Women were also asked to keep 24 h breastfeeding records. Seventy-two women completed the survey. A total of 64% of the women (n = 46) used galactagogues, with 52% of them (n = 24) using more than one galactagogue. There were no differences between galactagogue users and non-users in terms of maternal age, education, parity, or breastfeeding frequency and total breastfeeding time over 24 h. Frequently used galactagogues were lactation cookies (n = 28), lactation teas (n = 10), and lactation blends (n = 7), and most of them were commercial products. Most of the participants perceived their milk as being in good quality and nutritious and that their infants were satisfied with the amount of breast milk received. However, 18% women (n = 13) reported PIM. Galactagogue use was not associated with PIM or other perceptions of breast milk supply. Interestingly, 59% of the women who thought they had sufficient milk used galactagogues. Galactagogues were widely used regardless of the women’s perceptions of their breast milk supply. Research in a sample including more women reporting PIM is required to understand how galactagogues are used in response to PIM. Full article

Our ability to effectively nourish an increasing global population is one of the key challenges facing humanity. The global food system is incredibly complex: it is the world’s largest economic sector; it has multiple inputs and outputs; it is often politicised; it is subject to various social and cultural forces; and it touches every human being on the planet through food. There are a range of voices telling us how we should change the food system. Before we know what to think about changes to make to our diets or food supply, we need to first determine how to think about the food system. Under what scenarios is it possible for the global food system to provide the bioavailable nutrients to feed the global population? What scenarios are practical to deliver, for example, in terms of level of change required, cost of that change, or affordability of food? What is the most optimal to deliver a sustainable food system? This talk will focus on several aspects of the work of the Riddet Institute and the Sustainable Nutrition Initiative^® that aim to inform the future of food systems and nutrition. At the foundation of this work is the idea that nutrition is integral to a sustainable food system: if we fail to produce and provide the food and nutrients to enable people to survive and thrive, we have failed, regardless of what else we achieve. The presentation will cover the DELTA Model^®, our tool for assessing the nutritional adequacy of global food system scenarios; NZ nutrient production, trade and availability; global nutrient trade and its impact on nutrition. Full article

An optimal nutrient intake is required for the health of both breastfeeding women and their infants. This study aims to assess the nutrient adequacy of breastfeeding women living in New Zealand. A cohort of breastfeeding women residing in the Palmerston North area was enrolled in the longitudinal follow-up Mother and Infant Nutrition Investigation study. Seventy-six women completed a weighed four-day diet diary, including supplement use at three months postpartum. Maternal demographic information was collected via a self-administered online questionnaire. Dietary data were analysed using Foodworks 9 Professional (Xyris Software, Australia) using the dataset from New Zealand Foodfiles 2016. Nutrient intakes from food were compared to the nutrient reference values for Australia and New Zealand (2006) to assess dietary adequacy. Considering food only, the median (Q1, Q3) energy intake was 9706 (8143, 10,952) kJ. Median intakes of macronutrients as a percentage of energy were 16.6% for protein, 37.8% for total fat, 15.5% for saturated/trans-fat and 40.0% for carbohydrates. Many participant intakes were above the acceptable macronutrient distribution range (AMDR) for total fat (68%) and saturated/trans-fat (88%) and below the AMDR for carbohydrates (80%). The median fibre intake was 29 (21, 34) g with 55% below the estimated average requirement (EAR) of 30g. Many participants had intakes below the EAR or adequate intake and were at risk of dietary inadequacy for micronutrients, including thiamin (26%), folate (42%), vitamin A (38%), vitamin E (61%), calcium (36%), selenium (59%) and zinc (32%). Considering both food and supplements, some participants had intakes above the upper level of intake (UL), including iron (12%, 45 mg/day) and folic acid (3%, 1000 mcg/day). This research suggests a high-fat, low-carbohydrate intake coupled with micronutrient inadequacy among breastfeeding women. Some women had high intakes of micronutrients from supplements. Research is required to determine whether such deviations from recommendations have detrimental effects on mothers and infants. Full article

Food policies can make healthier foods more accessible for the population. In this study, progress on implementing recent policies and commitments of the government and food companies was monitored. Sub-studies were conducted following INFORMAS (International Network for Obesity/non-communicable diseases, Research, Monitoring and Action Support) protocols: benchmarking government implementation of healthy food policies; the impact of a voluntary advertising code on the exposure of children to unhealthy food marketing; the impact of healthy food and drink policies on retailers in district health boards and on the beverage environments in leisure centres; supermarket retail environments; food composition and display of the ‘Health Star Rating’; and commitments of food companies to nutrition. The level of implementation of food policy by the New Zealand government has not improved over nine years. The voluntary Children and Young People’s Advertising Code is too weak to have an impact on the exposure of children to unhealthy food marketing. Improvements to the beverage environment in leisure centres occurred where sufficient support was available, and all District Health Boards adopted a healthy food policy. There is considerable variation in the actions of the major food companies: in 2019 the Health Star Rating was displayed on 94% of private label products but only 25% of packaged foods overall; one-third of supermarkets did not have a check-out free of junk food, and two-thirds of the major food companies improved on their nutrition commitments since 2017. New Zealand’s food environments are largely unhealthy and policy implementation is low. Where policies, codes and commitments by government and food industry do exist, the progress on implementing these is patchy and there are many remaining gaps. There is considerable scope for the government, food companies, and local setting to make major changes towards a healthier, more equitable food environment with food policy in the form of mandatory regulations required to ensure real progress. Full article

Optimal dietary intakes are essential for the health of both breastfeeding women and their infants. Few recent dietary intake data exist concerning this group in New Zealand. This study aimed to determine the adherence to national dietary recommendations of breastfeeding women living in New Zealand. A cohort of breastfeeding women residing in the Palmerston North area was enrolled in the longitudinal follow-up Mother and Infant Nutrition Investigation study. Seventy-six women completed a weighed four-day diet diary at three months postpartum. Maternal demographic information was collected via a self-administered online questionnaire. The number of servings consumed for each food group was calculated based on the revised Eating and Activity Guidelines for New Zealand Adults (2020). All data were analysed using IBM SPSS version 20. Overall, 25% of women met the recommended number of servings (RNS) for fruits (≥2 servings/day), and none met the RNS for vegetables (≥7.5 servings/day). Only 5% of women reached the RNS for grain foods (≥9 servings/day), 34% met the RNS for meat and eggs (≥2.5 servings/day), and 13% met the RNS for milk and milk products including plant-based products (≥2.5 servings/day). In total, 49% of women met the RNS for one food group, but none of the women met the recommendations for all food groups. Based on independent t tests, women who had tertiary qualifications consumed a higher number of servings of grain foods (p = 0.001) and vegetables (p = 0.010) compared with those without tertiary education. Pearson correlation showed the number of servings consumed in the meat and eggs was positively correlated with the number of servings of vegetables (r = 0.350, p = 0.02). This research shows a low adherence to the current national dietary guidelines among this cohort. Future research is required to identify the barriers to healthy eating and develop effective initiatives to encourage and support breastfeeding women to achieve healthy eating behaviours. Full article

Yacon (Smallanthus sonchifolius), a sustainable foodstuff, is perceived as a functional food because it contains biologically active components, e.g., fructooligosaccharides (FOS), inulin, and phenolic compounds that may provide physiological benefits beyond basic nutrition to reduce the risk of chronic diseases. There is a growing public interest in why and how to use yacon. Yacon, originally from South America, has been grown in New Zealand (NZ) since the 1980’s. NZ-produced yacon concentrate NZFOS+ contains the purest natural prebiotic FOS. Our study aimed to examine the phytochemical contents of NZFOS+ and its health-related properties. The glycemic index of yacon concentrate was measured by ISO 26642:2010(E) (n = 10). Total phenolic and flavonoid contents were measured by the spectrometric method. The chlorogenic acid content and phenolic profiling were measured using the liquid chromatography coupled with mass spectrometry (LC-MS). The antioxidant activity of the yacon concentrate and Manuka honey were compared using the cupric reducing antioxidant capacity (CUPRAC), ferric ion reducing antioxidant power (FRAP), and 2,2-diphenyl-1-picrylhydrazyl (DPPH) assays. The results indicated that compared to Manuka honey, yacon concentrate has a lower glycemic index (40 vs. 52); a higher content of total phenolic (5430 mg vs. 744 mg GAE/100 g), total flavonoid (329 mg vs. 22 mg QE/100 g), and chlorogenic acid (11.88 μg vs. 0.08 μg CA/g); and across all assays observed, a significantly higher antioxidant capacity (CUPRAC assay, 892 mg vs. 52.6 mg TE/100 g; FRAP assay, 633 mg vs. 47 mg TE/100 g; DPPH assay, 383 mg vs. 22 mg TE/100 g, respectively). Yacon concentrate has proven potential health benefits and applications associated with the maintenance of health and wellbeing and prevention of chronic diseases. Further investigations are needed for human studies and new applications and use of yacon concentrate. Yacon concentrate (NZFOS+) has potential markets in the development of new food products and new diet therapy applications, e.g., in the form of syrup, and functional prebiotic drinks. Full article

Background: Animal protein sources are more efficient in increasing muscle protein synthesis and maintaining muscle mass in older adults, but little is known about when they are consumed across the day in New Zealand (NZ) older adults. Objectives: to investigate sources of protein across the day and at each meal in community-dwelling older adults living in NZ. Methods: data were obtained from the Researching Eating Activity and Cognitive Health (REACH) study, a cross-sectional study aimed at investigating dietary patterns and associations with cognitive function and metabolic syndrome in adults aged 65 to 74 years. Dietary intake was collected using a 4-day food record. Sources of protein intake were assessed across the day and at breakfast, midday and the evening meal. Results are presented as a percentage of the total protein intake for the day and for each meal. Results: participants (n = 327; 65.4% female) had a median relative protein intake of 1.2 [0.9, 1.4] g/kg in males and 1.1 [0.9, 1.3] g/kg in females. At breakfast, participants primarily consumed protein from milk (28.1%), breakfast cereal (21.6%) and bread (12.2%). Protein intake at the midday meal was derived from bread (17.4%), cheese (9.5%) and milk (9.2%). At the evening meal, 21.2%, 15.2% and 13.6% of total protein was derived from red meat (beef, lamb, pork), poultry and fish, respectively. Conclusion: in this cohort, cereals and dairy products at breakfast and the midday meal, and meat sources at the evening meal contributed the most to daily protein intake. Full article

Accurate dietary assessment is difficult yet fundamental for deriving meaningful findings from diet-related studies. Commonly used dietary assessment methods such as food diaries, recalls, and questionnaires rely on self-reporting and are often subject to bias. Furthermore, nutrition research often focuses on individual foods and nutrients, which has several limitations. Dietary pattern analysis considers the total diet and combinations of food eaten and can be derived empirically (e.g., factor analysis) using a diet index or a combination of both (e.g., reduced rank regression). Metabolomics, the study of low-molecular-weight compounds (metabolites), has been used for disease biomarker detection, and the technologies employed have advanced rapidly in recent years. As such, studies exploring the application of metabolomics for identifying objective biomarkers of dietary intake have also increased. The aim of our systematic review was to investigate observational studies exploring the relationship between dietary pattern consumption and the metabolome. A comprehensive search strategy was employed, using five search databases. Of the 14,328 studies screened, 35 met the pre-defined inclusion criteria and were included. All studies found a significant correlation between metabolites measured and dietary pattern scores. This demonstrates the potential for using the metabolome as a source of objective biomarkers of dietary pattern consumption. However, similar dietary patterns did not always result in similar metabolomic profiles across different study populations. This is likely due to the wide range of metabolomics methodologies employed, different biospecimens analysed, and a wide variety of populations and dietary patterns explored. In conclusion, although there is evidence that dietary pattern consumption can be reflected in the metabolomic profile of individuals, robust markers for specific dietary patterns have not yet been identified. Future studies should consider performing discovery and validation studies within a similar population, replicating the same methodology, to determine robust biomarkers of dietary pattern consumption. Full article

In children and other young people, diets high in sodium and low in potassium lead to increases in blood pressure and a higher risk of cardiovascular disease later in life. Our primary objective was to assess daily sodium and potassium intakes in children and young people aged 2–18 years from upper-middle and high-income countries, using gold-standard 24 h urinary sodium and potassium excretion studies. Secondary objectives were to assess: (1) the sodium-to-potassium molar ratio; (2) differences by gender, age, and geographical region; and (3) the sodium concentration in children’s diets. The following databases were searched to identify relevant studies published between 1998 and 2021: Cochrane Database of Systematic Reviews, Embase, Food Science and Technology Abstracts, Google Scholar, MEDLINE and Scopus. Data were pooled using random-effects meta-analysis, and meta-regression was used to quantify heterogeneity. A total of 2592 studies were identified, with 22 meeting the inclusion criteria (n = 5323, 48% girls; mean age 9.7 years). Mean 24 h urinary sodium excretion in boys was 2730 mg/d (95% CI, 2460–3001), potassium excretion was 1564 mg/d (95% CI, 1400–1728), and the sodium-to-potassium molar ratio was 3.2 (95% CI, 2.8–3.6). Corresponding values for girls were 2336 mg/d (95% CI, 2139–2534), 1428 mg/d (95% CI, 1300–1556), and 3.0 (95% CI, 2.6–3.4), respectively. There was a positive association between sodium and potassium excretion and the sodium-to-potassium ratio and age. Geographically, European and Oceanian participants excreted more potassium and had a lower mean sodium-to-potassium ratio than their Asian counterparts. Mean sodium intake in children as young as 5–6 years old exceeded the World Health Organization (WHO) upper limit of 2000 mg/d, while potassium intake was subpar. Public health monitoring, policies, and programmes to reduce dietary sodium and increase potassium intake are essential to protect the future cardiovascular health of children and young people. Full article

Obesity has become a concern in low- and middle-income countries, such as Indonesia, in recent years. This is an important issue for the country because the detrimental health impacts of obesity on non-communicable diseases are well established. The aims of this research are to understand the epidemiology of overweight and obesity and to model the trajectories of body mass index (BMI) in the Indonesian population. Data come from the Indonesian Family Life Survey, a large population-based longitudinal study over a 21-year period (1993–2014). The survey included 42,537 adults (20,778 males; 21,759 females) aged 19 to 75+ years and 105,820 total observations (49,684 males; 56,136 females). We examined changes in BMI across time, by gender, age, and birth cohort. A Group Based Trajectory Model (GBTM) was used to estimate the shape and number of BMI trajectory groups. A GBTM uses a finite mixture model to identify groups of individuals following similar developmental trajectories of BMI over time. Probability distributions based on maximum likelihood estimation were used to determine group membership. The mean BMI in adults increased between 1993 and 2014 (21.4 kg/m² in 1993 to 23.5 kg/m² in 2014), with females having a higher mean BMI than males. Mean BMI increased with time more rapidly for those born in recent decades (people born in the 1930s had average BMIs of 20.7 kg/m² in 1993 and 20.5 kg/m² in 2014, while people born in the 1970s had average BMIs of 20.8 kg/m² in 1993 and 24.4 kg/m² in 2014). Three distinct BMI trajectories were identified: group 1 (56.7%—maintained a healthy weight throughout adulthood), group 2 (34.7%—BMI increased from a healthy weight to obese), group 3 (8.6%—consistently obese over the adult years). The shape of these trajectories differed by gender (p < 0.001) and birth cohort (p < 0.001). These findings support the urgent need for overweight and obesity prevention and intervention programs in Indonesia. Full article

Snacking has increased over recent years and may account for excess energy intake and observed increases in overweight and obesity. Whole nuts are more commonly consumed as snacks than meals. Research suggests that nut consumption increases satiety, and so may support energy balance, as well as improving diet quality compared to other commonly consumed snacks. We aimed to compare the effects of consuming almonds versus sweet biscuits on appetite, energy intake, and diet quality. We used an acute crossover study involving 25 males and 75 females. Participants consumed isocaloric amounts (energy equivalent to 1030 kJ (42.5 g almonds) or 10% total energy, whichever was higher) of almonds or sweet biscuits in random order. Participants attended two clinic sessions where they initially consumed a standardised breakfast, followed two hours later by consumption of the snack food. Appetite ratings were measured before consuming the snack and at 15- or 30-min time intervals for two hours post-snack consumption. Two hours after consuming the snack, participants were offered an ad libitum lunch. They were then asked to record their food and beverage intake for the remainder of the day. Appetite ratings over the two hours did not differ between snacks (all p ≥ 0.097) and there was no difference in energy intake at the ad libitum lunch (p = 0.113). However, energy intakes over the remainder of the day were significantly lower after consuming almonds (mean (95% CI) difference: 638 kJ (44, 1233), p = 0.035). There was also a non-statistically significant pattern of lower absolute intakes of saturated fat (p = 0.056) and sugar (p = 0.053) after consuming the almond snack. Encouraging the regular consumption of nuts as a snack food may support energy balance and improve diet quality. Long-term studies are required to determine the effects on long-term anthropometry and nutrient intakes. Full article

Climate change is one of the top threats to human health and strategies to mitigate climate change are essential. International research has shown that policies to shift dietary consumption away from foods with high green-house gas (GHG) emissions associated with their production may produce health and climate co-benefits. A multi-state life-table model was used to estimate the health (in quality adjusted life years, QALY), health system costs and equity impacts of several scenarios in the New Zealand population. GHG emissions that have been assigned to the foods consumed by New Zealanders in the 2008/09 Adult Nutrition Survey have been added to this model to estimate the climate co-benefits of these scenarios. This presentation will outline an optimised healthy, sustainable diet for New Zealanders and describe the potential health and climate impacts of this and other population-wide theoretical shifts in dietary intake. Modelling results of price policies that could be implemented in New Zealand to shift dietary intake towards more healthy and sustainable foods will also be presented. Having information on the health and climate co-benefits of dietary shifts, policies and interventions can provide justification for policy makers to implement policies that both improve the health of the population and help to mitigate climate change. Full article

The COVID-19 pandemic forced the reorganization of the multidisciplinary healthcare system for Duchenne muscular dystrophy (DMD). Digital solutions seemed to be an optimal way for providing rehabilitation during this time. The aim of our study was to investigate whether it is possible to conduct respiratory physical therapy with the use of telerehabilitation methods in boys with Duchenne muscular dystrophy. Methods: The study was conducted during the online conference ‘DMD—Let’s be together’ for Polish families with DMD. During the physical therapy panel, we showed the video with the instructions of respiratory exercises: glossopharyngeal breathing, positive inspiratory pressure, and positive expiratory pressure. All participants (n = 152) were asked to fill in the online survey evaluating the quality of the instructions, its acceptance, and understanding. Results: The survey was filled in by 31 (20.4%) participants; the mean age of the patients was 13.8, and 19 (61.3%) were ambulant. The video was displayed 127 times. The overall mean rating of the session was 4.77/5, and intelligibility was rated 4.74/5. Fourteen (45.2%) patients declared that they had performed the exercises by themselves or with their caregiver’s assistance; all caregivers declared that it is possible to perform the proposed exercises a few times a week or daily. Only two respondents replied to the invitation for an individual online session. Conclusions: The findings from the study show that respiratory telerehabilitation may be implemented in DMD patients; however, the interest in digital rehabilitation among caregivers of DMD boys in Poland is low. The reason for this situation requires further research. Full article

Food consumed away from home is contributing an increasing proportion of household food budgets in New Zealand (NZ). This study aimed to benchmark the healthiness of the NZ fast-food supply in 2020. Data on the serving size and nutrient content of products were collected from company websites and in-store visits of 27 fast-food chains. For each fast-food category and type of combo meal, the medians and interquartile ranges were calculated for serving size (g/mL) and energy (kilojoules-kJ), sodium (mg), total sugar (g) and saturated fat (g) per serving. The nutrient contents/servings were benchmarked against the United Kingdom (UK) soft drinks levy thresholds and targets for salt for foods consumed away from home; the NZ daily intake guidelines for energy, sodium and saturated fat; and the WHO recommendation for free sugars. Nutrition information was available for 1777 products and 176 meal combos. More than one in ten drinks would qualify for a UK soft drinks levy, and 47% (n = 1072) of products with sodium data exceeded the relevant UK targets. The categories with the highest median energy and nutrient contents per serving were: burgers (2585 kJ-energy and 1091 mg-sodium), savoury pastries (13 g saturated fat) and milkshakes/smoothies (49 g total sugar). The meal combos represented one meal occasion, but an average combo provided 50% of the daily energy requirement, 89% of the maximum sodium recommendation, 81% of the recommended sugar intake, and 46% of the recommended saturated fat intake. Fast-food products and combo meals in NZ contribute far more energy and negative nutrients to the recommended daily intake targets than is optimal for good health. The NZ Government needs to set reformulation targets and portion-size guidance to reduce the potential impact that increasing fast-food consumption is likely to have on the health of New Zealanders. All fast-food chains need to provide sufficient nutrition information about their products to inform consumers. Full article

Cis- isomers of lycopene have been reported to be more bioavailable than all-trans-lycopene. ‘Moonglow’(MG) is an orange heirloom tomato variety with >90% of its lycopene in the more bioavailable cis-isomeric form, compared to ‘Red’ (R) tomatoes with all trans- lycopene. Oestrogen deficiency after menopause changes the body composition and gut microbes. This study evaluated the plasma and liver lycopene concentration and the effect of lycopene on body composition and gut microbiota in female ovariectomised rats following ‘Red’ versus ‘Moonglow’ tomato feeding. Female Sprague Dawley rats underwent no surgery (Sham) or ovariectomy (OVX) surgery at the age of 16 weeks to induce a menopause-like status. Sham-C and OVX-C groups received a daily dietary supplement containing no tomato powder; ‘post-R’ and ‘post-MG’ received dietary supplements containing tomato powder for 8 weeks post-surgery; ‘pre-R’ and ‘pre-MG’ received dietary supplements containing tomato powder for 8 weeks prior to and post-surgery (N = 12–15/group). Each dietary tomato supplement contained 0.172 mg of lycopene (~0.35 mg lycopene/kg body weight/day). After 8 or 16 weeks of tomato supplementation, the mean plasma lycopene concentrations in ‘pre-MG’ and ‘post-MG’ groups were ~8X higher than ‘pre-R’ and ‘post-R’ groups, but liver lycopene stores did not differ between the groups. Caecal pH ranged from 6.79 ± 0.08 to 7.05 ± 0.11 and was not significantly different among the groups. Ovariectomy reduced the abundance of gut bacteria compared to Sham-C. Both ‘pre-MG’ and ‘post-MG’ restored the numbers of Lactobacillus, Enterococcus, Bacteroides and E. coli, whereas the ‘post-R’ group only increased Lactobacillus. A significant increase in fat mass and reduction in lean mass was found in all OVX rats compared to Sham-C after 16 weeks, and individual fat pad weights strongly correlated with total body fat, with no benefit from lycopene supplementation. These results demonstrate that ‘Moonglow’ cis- lycopene is significantly more bioavailable than ‘Red’ trans- lycopene and that ‘Moonglow’ tomato has a greater prebiotic-like effect. Full article