Does a standardised dinner meal consumed the evening prior to testing add methodological integrity to an acute meal test study design?

Abstract of an oral paper that was presented at the Dietitians Association of Australia 31st National Conference. Incorporating: 2nd World Forum on Nutrition Research - Translating the Principles of the Mediterranean Diet, 15-17 May 2014, Brisbane Convention and Exhibition Centre, Brisbane, Queensland, Australia

Nutrition employability and graduate readiness:The Australian Working in Nutrition study

Background: Nutrition science graduates contribute to the nutrition workforce by bringing specialist knowledge and skills needed to address future food challenges. This study aims to provide a snapshot of the current employment landscape for nutrition science graduates in Australia and how well their degrees prepare them for employment. Method: A cross-sectional survey of Australian tertiary nutrition graduates was conducted to explore tertiary training, employment pathways and their perceived preparedness for practice. Results: This study included a final sample of 119 graduates from 17 Australian tertiary institutions. Almost two-thirds of respondents had completed further training. Most graduates (77%, n = 91) had worked in a food, nutrition science or health-related role after their degree; the most frequently cited employment settings were government or public health organisations; research, not-for-profit or nongovernment organisations; and the food industry. Work-integrated learning was identified as a key predictor of graduates working in a role that differed from their expectations as a student. The skill categories developed during nutrition training that were most valued in the workplace included nutrition and scientific knowledge, and professional and communication skills. Conclusions: This study offers first insights into the current employment landscape for nutrition graduates across Australia. Findings show that current nutrition science professionals are highly qualified and prepared to navigate the evolving demands of nutrition practice. Regular review of graduate employment will inform nutrition science curriculum to enable graduates to be well equipped in the face of dynamic practice settings.</p

Investigating the potential of whole grain sorghum as an ingredient in foods to assist in the prevention of chronic disease

Background: Whole grain intake is associated with reduced risk of chronic diseases, such as cardiovascular disease and Type 2 diabetes. Unlike more commonly recognised whole grains, sorghum is a so-called “ancient”, gluten-free whole grain food that is gaining attention from food manufacturers, consumers and researchers as a beneficial ingredient in novel product development. Sorghum is widely cultivated globally due to its adaptability to semi-arid/arid conditions and high temperatures, and has significant potential for sustainable grain production in harsh climates. It is a dietary staple in some communities of Asia, Africa and Central America, however in countries such as the United States and Australia, sorghum is predominantly used as an animal feed, with only small quantities utilised for the manufacture of human foods. If sorghum is to be accepted as a common food, attention to food formulations and processing methods that produce desirable sorghum-based cereal products, whilst preserving the grain’s beneficial nutritional and functional attributes, is required. Sorghum whole grain has been shown to have lower starch and protein digestibility in vitro, resulting in reduced metabolisable energy and hence smaller weight gains in animals, and some cultivars are high in dietary fibre and rich in polyphenolic compounds. Based on their purported mechanisms, these attributes may contribute to positive effects on metabolic markers and body weight and therefore may more broadly influence chronic disease prevention in humans when they consume sorghum-based foods regularly. However, there is a paucity of human studies to date. Research Hypothesis and Study Aims: This thesis proposes that sorghum grain consumption may assist in chronic disease prevention via weight management, especially in populations where food is ubiquitous and obesity-related chronic diseases are prevalent. Research examining the effects of sorghum intake on health outcomes, such as weight loss and disease biomarkers, requires clinical studies. These studies may also expose potential protective roles of the sorghum grain as part of a whole diet. The key hypothesis of this thesis is that sorghum is a viable alternative to more commonly consumed whole grain cereals in the human diet and may have positive benefits on factors associated with metabolic health including weight management. A review of the literature described sorghum grain structure and composition which relate to mechanisms by which sorghum grain components may influence weight management and chronic disease risk; and summarised the evidence on effects of sorghum consumption on health outcomes related to chronic disease prevention. This review provided insights into the knowledge gaps and study imperatives that informed the experimental components of the thesis. In order to conduct human trials successfully, particularly with participants who do not typically consume traditional sorghum foods, suitable ready-to-eat sorghum grained cereal foods in the form of flaked breakfast cereal biscuits were formulated and tested prior to intervention trials commencing. A randomised, crossover, feeding study using the flaked sorghum biscuits was conducted to investigate mechanisms related to general metabolic markers and antioxidant status, as well as acute satiety. A randomised controlled trial (RCT) was then conducted with the aim to test the weight-loss effects of longer-term whole grain sorghum flaked biscuits consumption incorporated into an energy-restricted diet plan. This study also examined the effects on key biomarkers of metabolic health, inflammation and oxidative stress. Methods: Gaps in the knowledge of effects of sorghum consumption on indicators of metabolic disease, including weight, were identified and elements of study designs were incorporated into the experimental components of the thesis. Whole grain flaked cereal biscuits were formulated on a pilot line by our industry partner (Sanitarium Health and Wellness) using a multistep process involving steaming, drying, rolling and baking. For the acute satiety study, forty subjects (20 males and 20 females) were tested on four occasions after a 12-hour fast. At baseline, they consumed 50 grams (or 3 biscuits) of one of four treatment meals: white, red or brown whole grain sorghum flaked biscuits or a whole grain flaked wheat biscuit control. Subjective satiety was measured at 8 time-points over four hours and food intake at the subsequent meal and for the rest of the day recorded. In a subset of 20 subjects, plasma glucose, insulin, and four appetite-related gut peptides (GIP, GLP-1, PYY and ghrelin) were also measured. In the subsequent RCT investigating chronic sorghum consumption, sixty subjects (14 males and 46 females) were randomised to either a sorghum (intervention) or wheat (control) group. Both groups received advice on an energy-restricted diet from an Accredited Practising Dietitian and were provided with 45 g of cereal products to include daily in their prescribed diets for 12 weeks. The primary outcome was weight loss. Secondary outcomes included: plasma glucose, HbA1c, insulin, total cholesterol, HDL-c, LDL-c, TAG, and various markers of inflammation and oxidative stress (IL1β, IL-6, IL-8, TNFα, hsCRP, HPX and TAC), measured at 0 and 12 weeks. Subjective satiety ratings were assessed at 0, 6 and 12 weeks. Results: A vast array of nutritional and bioactive sorghum grain components, such as slowly digestible starches, polyphenols including anthocyanins in red sorghum, unsaturated fatty acids, and dietary fibre (including resistant starch), were identified in the literature, with potential actions in health protective metabolic processes. There was a paucity of human studies that are necessary to better understand effects of sorghum consumption (as a whole food), especially those related to health outcomes and indicators of disease. These findings justified the human studies described. During the acute meal test study, subjects reported significantly lower satiety ratings after consuming wheat compared to sorghum biscuits. Incremental AUC of postprandial GLP-1, GIP and in males, PYY, were significantly higher (p=0.018, p=0.031, p=0.036 respectively) for sorghum breakfasts compared to wheat. Energy intake at a subsequent meal did not differ between treatments, nor did glucose, ghrelin and TAC responses. The red sorghum biscuit showed the greatest alteration in appetite hormones, suggesting that the specific combination of its components (such as unique anthocyanin flavonoids) requires further investigation. Hence, these results informed the choice of a red sorghum-based biscuit to test in the subsequent 3 month RCT. This trial did not identify any significant differences in weight loss or any clinical variables between a sorghum cereal group and a wheat control in an energy-restricted diet. For both groups, the majority of clinical indices changed significantly over time (p Conclusions: Research presented in this thesis provides human evidence for acute satiety effects from whole grain sorghum ingestion in the form of flaked cereal biscuits. However, it could not be concluded that whole grain sorghum assists specifically with weight management, or is superior to wheat (another whole grain product). Further clinical trials are necessary to establish an evidence base for weight loss effects from chronic sorghum consumption. In the longer term, this research would help to further evaluate the weight loss potential of sorghum consumption, especially red sorghum grown in abundance locally in Australia. Weight loss effects would be considered to assist in the prevention of chronic diseases, particularly those associated with obesity. Nevertheless, new knowledge was generated from these studies demonstrating the potential of sorghum consumption to enhance acute satiety. Sorghum is not only a gluten-free whole grain cereal, but also a promising ingredient in cereal foods targeting appetite control. Commercially, the results of the feeding trials may contribute to the development of the sorghum industry globally by adding to the evidence base on human health effects. This thesis also showcases the collaboration between food industry and science to progress sorghum, a relatively unknown human food in Australia, through the food product innovation pipeline with positive outcomes for all stakeholders including researchers, food manufacturers and also consumers

A Cross-Sectional Audit of Sorghum in Selected Cereal Food Products in Australian Supermarkets

Sorghum (Sorghum bicolor (L.) Moench) may play a role in mechanisms that elicit favourable health effects. In Australia, sorghum is successfully grown, but it is not widely consumed, and its presence in common food products is unknown. This study examined the utilisation of sorghum in common food products, specifically breakfast cereals and snack bars, in a cross-sectional study of five supermarkets in New South Wales, over a 7-day period in February 2020. Details relating to ingredients, food format, brand, and product name were recorded. Sorghum was present in 6.1% (23/379) of breakfast cereals in a variety of formats, such as extruded shapes, flour, and puffed grain. In 8.7% of these, sorghum was listed as the first ingredient (greatest contribution by weight). Sorghum was utilised in 2% (6/298) of snack bars mainly as puffed sorghum and was listed in the fourth or subsequent position in the ingredient lists for all. ‘Sorghum’ did not appear in the name of any products. In conclusion, this baseline study indicates that sorghum is present in a small proportion of breakfast cereals and snack bars, highlighting the opportunity for greater investment in sorghum food innovation and marketing that would encourage consumer recognition and expand the product range

Considerations for progressing a mainstream position for sorghum, a potentially sustainable cereal crop, for food product innovation pipelines

Background Sorghum grain is a sustainable cereal crop. There is growing interest in sorghum as a food ingredient, particularly in Western societies that do not traditionally consume it. There is emerging food and nutrition science supporting this, but to achieve consumer acceptance requires a commitment to food innovation and the promotion of sorghum as a human food. Scope and approach This commentary highlights key considerations for progressing sorghum in Western food product innovation pipelines. It discusses evidence for health effects of sorghum consumption, market trends and commercialisation issues, food regulation matters and the significance of stakeholder collaborations. Conclusions are drawn by integrating current knowledge from scientific literature, market reports and consumer trends analyses, along with guidance on food regulation, and pragmatic, experiential knowledge of past research collaborations between academia and food industry. Key findings and conclusions Commercial investment in sorghum food product development is warranted, with value adding opportunities seen in sorghum\u27s gluten-free attribute, its valuable nutrients, slowly digestible starches, dietary fibre, and antioxidant compounds. To create successful sorghum-based products requires the integration of knowledge and expertise across a wide spectrum, from grain breeders and producers, to food scientists and technologists, nutrition scientists, and the whole food manufacturing team working with consumers and food regulators. A concerted research effort, with collaborations between stakeholders and academic researchers, along a defined value chain, and with an eye to food policy and regulations, is critical. With this collective approach, the outlook for sorghum as a human food in Western societies is positive

Perspective: the path to confirming and exploiting potential satiety-enhancing effects of sorghum-based foods for human diets

Consumer trends, particularly in populations burdened with high rates of obesity and overweight, indicate a growing demand for food products with specific satiety-enhancing effects to assist with appetite regulation and longer-term weight management. Sorghum whole grain, containing dietary fibre, slowly digestible starches and polyphenolic compounds, has been identified as a potential ingredient in the formulation of novel food products targeted for appetite control. Rigorous human clinical trials are necessary to build evidence for these purported effects, including studies that examine the underlying satiety-enhancing mechanisms. This paper provides perspectives on the path to confirming and exploiting potential satiety attributes of sorghum-based foods for human diets, highlighting research activities currently being undertaken by the Smart Foods Centre at the University of Wollongong, Australia, where preliminary clinical results from an acute satiety study with 40 healthy participants indicate that a breakfast cereal biscuit made from whole grain sorghum may increase short-term satiety to a greater extent than a wheat-based control

The gut microbiota profile of adults with kidney disease and kidney stones: a systematic review of the literature

BACKGROUND: There is mounting evidence that individuals with kidney disease and kidney stones have an abnormal gut microbiota composition. No studies to date have summarised the evidence to categorise how the gut microbiota profile of these individuals may differ from controls. Synthesis of this evidence is essential to inform future clinical trials. This systematic review aims to characterise differences of the gut microbial community in adults with kidney disease and kidney stones, as well as to describe the functional capacity of the gut microbiota and reporting of diet as a confounder in these studies. METHODS: Included studies were those that investigated the gut microbial community in adults with kidney disease or kidney stones and compared this to the profile of controls. Six scientific databases (CINHAL, Medline, PubMed, Scopus, Web of Science and Cochrane Library), as well as selected grey literature sources, were searched. Quality assessment was undertaken independently by three authors. The system of evidence level criteria was employed to quantitatively evaluate the alteration of microbiota by strictly considering the number, methodological quality and consistency of the findings. Additional findings relating to altered functions of the gut microbiota, dietary intakes and dietary methodologies used were qualitatively summarised. RESULTS: Twenty-five articles met the eligibility criteria and included data from a total of 892 adults with kidney disease or kidney stones and 1400 controls. Compared to controls, adults with kidney disease had increased abundances of several microbes including Enterobacteriaceae, Streptococcaceae, Streptococcus and decreased abundances of Prevotellaceae, Prevotella, Prevotella 9 and Roseburia among other taxa. Adults with kidney stones also had an altered microbial composition with variations to Bacteroides, Lachnospiraceae NK4A136 group, Ruminiclostridium 5 group, Dorea, Enterobacter, Christensenellaceae and its genus Christensenellaceae R7 group. Differences in the functional potential of the microbial community between controls and adults with kidney disease or kidney stones were also identified. Only three of the 25 articles presented dietary data, and of these studies, only two used a valid dietary assessment method. CONCLUSIONS: The gut microbiota profile of adults with kidney disease and kidney stones differs from controls. Future study designs should include adequate reporting of important confounders such as dietary intake to assist with interpretation of findings

Expansion of an Australian food composition database to estimate plant and animal intakes

Despite evidence for favourable health outcomes associated with plant-based diets, a database containing the plant and animal content of all foods eaten is required to undertake a reliable assessment of plant-based diets within a population. This study aimed to expand an existing Australian food database to include the plant and animal content of all whole foods, beverages, multi-ingredient products and mixed dishes. Twenty-three plant- and animal-based food group classifications were first defined. The food servings per 100g of each product were then systematically calculated using either a recipe-based approach, a food label-based approach, estimates based on similar products or online recipes. Overall, 4,687 (83.5%) foods and beverages were identified as plant or plant-containing products, and 3,701 (65.9%) were animal or animal-containing products. Results highlighted the versatility of plant and animal ingredients as they were found in various foods across many food categories, including savoury and sweet foods, as well as discretionary and core foods. For example, over 97% of animal fat-containing foods were found in major food groups outside the AUSNUT 2011-13 \u27fats and oils\u27 group. Surprisingly, fruits, nuts and seeds were present in a greater percentage of discretionary products than in core foods and beverages. This paper describes a systematic approach that is suitable for the development of other novel food databases. This database allows more accurate quantitative estimates of plant and animal intakes, which is significant for future epidemiological and clinical research aiming to investigate plant-based diets and their related health outcomes

Acceptability of Plant-Based Diets for People with Chronic Kidney Disease: Perspectives of Renal Dietitians

The purpose of this study was to explore the perspective of renal dietitians regarding plant-based diets for chronic kidney disease (CKD) management and evaluate the acceptability of a hypothetical plant-based dietary prescription aiming for the consumption of 30 unique plant foods per week. This study used an exploratory mixed methods design. Forty-six renal dietitians partici-pated in either an online survey (n = 35) or an in-depth interview (n = 11). Dietitians perceived that plant-based diets could address multiple clinical concerns relevant to CKD. Forty percent of survey respondents reported the hypothetical dietary prescription was realistic for people with CKD, 34.3% were unsure, and 25.7% perceived it as unrealistic. Strengths of the hypothetical prescription in-cluded shifting the focus to whole foods and using practical resources like recipes. Limited staffing, time, and follow-up opportunities with patients, as well as differing nutrition philosophies were the most commonly reported challenges to implementation; while a supportive multidisciplinary team was identified as an important enabler. To increase patient acceptance of plant-based dietary ap-proaches, education about plant food benefits was recommended, as was implementing small, incremental dietary changes. Successful implementation of plant-based diets is perceived to require frequent patient contact and ongoing education and support by a dietitian. Buy-in from the multi-disciplinary team was also considered imperative