Introduction

Week 1

There are six groups of nutrients that are considered vital for health and growth. These are carbohydrates (which include fibre), fat, protein, vitamins, minerals and water.

Essential (‘Necessary’) Nutrients

Required for normal human body function but cannot be synthesised by the body or cannot be synthesized by the body in amounts adequate for good health Must be obtained from dietary sources

• Fatty acids (from lipids/fats) → omega-3, omega-6
• Amino acids (from proteins) → arginine, cysteine, etc.
• Vitamins → Vitamin A, B group vitamins, Vitamin C, etc.
• Minerals → Calcium, iron, potassium, etc.
• Water

Energy is measured in kilojoules (kJ) or kilocalories (kcal or Cal); 1 kcal = ~4.2 kJ

Recommended Daily Intake

To avoid malnutrition?

µg = microgram (1 millionth of a gram) 

Energy Yielding Nutrients

Fat: 37 kJ/g (9 kcal/g)

Carbohydrate: 17 kJ/g (4 kcal/g)

Protein: 17 kJ/g (4 kcal/g)

Alcohol: 29 kJ/g, 7 kcal/g)

*Energy adjusted to include digestibility and metabolism

energy yield from carbohydrate of 17 kilojoules per gram is considered an average figure as monosaccharides (such as glucose), disaccharides (such as sucrose) and starch all yield slightly different amounts of energy per gram.

Chemical Composition of Nutrients: Organic vs Inorganic Compounds

Inorganic Nutrients: Minerals and water are inorganic nutrients, which means they do not contain carbon.

Organic Nutrients: Contain carbon, an element found in all living things. They are therefore called organic compounds (meaning, literally, alive).

Fats & Oils (AKA Lipids)

• Food fat/oil is chemically called triglycerides (main lipid in foods)
• Made of 3 fatty acids and glycerol backbone
• Fat is solid, oil is liquid at room temp (20°C)
• Non-polar = does not mix with water
• Lipids also include other substances in small amounts in foods (e.g. cholesterol)

Fatty Acids

• The carbons in fatty acids can be attached to each other as saturated or unsaturated (double) bonds
• Fats in foods are mixtures of fatty acids that can be either:
  • saturated (no double bonds)
  • monounsaturated (one double bond)
  • polyunsaturated (more than one double bond)
• Main factor in determining if fat (solid) or oil (liquid) at room temp is relative number of these fatty acids – more saturated fatty acids, the more solid, more unsaturated fatty acids, the more liquid. E.G. Coconut oil is more solid at room temp hence high sat fat.
• Smoke point of a FFA content. The lower FFA the more stable the fat e.g. vegetable oil.
• Excess fats or CHO are stored as lipoproteins or triglycerides in the liver.

 

Omega 3 is part of the polyunsaturated family.

We know the type of omega it is by counting the amount of C from the Omega end (left to right) until the first double bond. E.G. Monounsaturated is Omega 9 because once we count until we reach the first double bond there are 9 C atoms. 

Q: If there were many double bonds in the fatty acids of a lipid, would it be an oil or a fat at room temperature? Liquid because it would contain more unsaturated fatty acids.

Essential Fatty Acids (EFAs)

• Linoleic acid (omega-6) and α-linolenic acid (omega-3) are the only two essential fatty acids, although docosahexaenoic acid (O3) and γ-linolenic acid (O6) are conditionally essential
• Needed for immune function, vision, cell membrane and production of hormone-like compounds

Carbohydrates

1. Monosaccharides: Glucose, Fructose, Galactose (E.G. Dextrose Monohydrate)
   • Contains one saccharide molecule
   • The building blocks for disaccharides and polysaccharides
   • Only monosaccharides are absorbed by the intestinal cells for use in the body. Disaccharides and polysaccharides must be digested to monosaccharides before they can be absorbed for use in the body.
   • Propensity to raise blood sugar quicker than polysaccharides
2. Disaccharides: Sucrose (glucose + fructose e.g. sugarcane), Maltose (glucose + glucose (malt), Lactose (glucose + galactose e.g. milk)
   • Formed when two sugars join together
   • Composed of two monosaccharides
   • Propensity to raise blood sugar quicker than polysaccharides
3. Polysaccharides:
   • Composed of long chains of monosaccharides
   • Can be linear or highly branched
   • Digestible: Starch and Dextrins, Glycogen (polysaccharides are stored in animals like humans in the form of glycogen)
   • Partially Digestible: Inulin, Raffinose
   • Indigestible: Cellulose, Pectin (plants structural materials) dietary fibre.
     • Cooking leaves cellulose intake, unlike startch which heat breaks down into digestable CHO+-.

Simple & Complex CHO

• Distinguishes the difference in chemical structure of the CHO.
• Simple = shortest chemical structure with one monosaccharide.
• Complex = longer chemical structure with 2-3 monosaccharide

Starch:

• Plants produce starch in 2 different configurations of glucose molecules: a linear chain called amylose and a highy brained form called amylopectin.

Carbohydrates in the body

• Starch is digested into glucose in the small intestine
• Some of our tissues (the brain and some muscle cells in particular) use glucose as the main energy source –this is why carbohydrate is required in diet
• Blood glucose is therefore kept under tight control
• We can store some carbohydrate in the liver and muscle tissue as glycogen
• Cooking: when deep frying, the faster the oil comes back up to temperature after a food is added, the quicker the food cooks and the less oil it absorbs. Another example is boiling green vegetables. The faster the water comes back up to temperature after the vegetables are added, the better the retention of the colour and vitamins in the vegetables.

Dietary Fibre

• The edible parts of plants or their extracts that are resistant to digestion in the small intestine made up of polysaccharides
• Some examples are cellulose, oligosaccharides and lignins
• It’s chemical structure is large and we do not have the enzymes that break down the bonds between the sugars, therefore the large molecules cannot be absorbed and digested. The benefit of fibre is it helps gut motility by moving other food components along the GI tract that may be fermenting + helping form stool.

Soluble Fibre

• Traps cholesterol floating around in circulation and glucose, reducing their absorption
• Thus is linked to reductions in risk of cardiovascular disease
• Soluble fiber helps soften stool so it can slide through the GI tract more easily (gut motility).
• Sources include alliums (onion, garlic, scallion, shallot, leek, and chives), pulses (beans), fruit and oats

Insoluble Fibre

• Adds bulk to a bolus and stool, drawing in water
• Improves elimination (laxation), waste excretion and gut health
• It adds bulk to the waste produced in the gut, which helps keep you regular.
• Sources include whole grains, pulses, green leafy vegetables, bran

Protein in Foods

• Structure can change rapidly on exposure to heat, cold, acid, alkali (called denaturation). Protein is less chemically stable.
  • Proteins are built of folded chains of compounds called amino acids. … The process that causes a protein to lose its shape is known as denaturation. Denaturation is usually caused by external stress on the protein, such as solvents, inorganic salts, exposure to acids or bases, and by heat.
• Cooking: The browning time and heat-through times of meat are not necessarily the same. How can we cook meat so that it is appropriately cooked on the inside with overcooking the outside? Use more than one level of heat. One approach is to brown the meat by starting with very cold meat cooked quickly on high heat and then switch to very low heat to cook the inside of the meat. Another approach is to cook the meat using low heat first, let it cool a bit and use intense heat to brown the outside of the meat.
• Cooking: When hot food is placed on a plate, it begins to lose its heat energy and can lose its appeal. How can a cook reduce this loss of heat? By warming the plate prior to plating the food.

Amino Acids

• Protein in food is digested and absorbed as amino acids in the small intestine
• There are 20 amino acids in food and the body, 9 essential (body can’t product) and 11 non-essential (body can produce)
• Function: Including: muscle maintenance, enzymes, immune system, acid-base balance, blood pressure, transport, hormones, blood clotting, bone strength
• Cooking: Contribute to browning.

Water

• Meat ~75%
• Fruits and vegetables up to 95%
• Water molecules bind with themselves well (hydrogen bonds) and this gives water many of its unique properties:
  • Stable and liquid over high temp range
  • Natural tendency to form bonds with itself and other polar substances like protein and CHO (slightly positive and slightly negative) , i.e. +ve and –ve charge (e.g. carbohydrate and protein)

In foods and cooking, water has many important properties:

• Acts as solvent (dissolve) is polar (e.g. fruit juice)
• Involved in heat transfer (e.g. boiling)
• Solid, liquid, or gas depending on temperature
• Is a plasticiser (softener of foods – e.g. pasta, biscuits)

Phytochemicals

Phytochemicals are chemical compounds produced by plants, generally to help them thrive or thwart competitors, predators, or pathogens (hence the bitter taste).

• Occur naturally in plant based foods (e.g. fruits vegetables, beans, grains, olive oil)
• Some responsible for the colour of the plants
• They may affect health
• Examples include phytoestrogens in seeds or resveratrol in red wine
• NOT nutrients

Alcohol

• Ethanol – type of alcohol normally found in beer, wine and spirits
• Methanol – simplest form of alcohol and VERY toxic
• One standard drink = 10g of pure alcohol (~12.5mL)

Absorption of Alcohol

• Alcohol requires no digestion
• Passive diffusion from the stomach (20%) – Remainder absorbed from the small intestine
• Food in stomach retards absorption

Absorption is increased by:

• Rapid gastric emptying
• An empty stomach
• Carbonation (Champagne) encourages gastric empyting and absorption

Metabolism of Alcohol

Alcohol is water soluble:

• Diffuses into all cells
• Cannot be stored
• 95% metabolised (broken down) in the liver
• Liver oxidises the alcohol and releases it into the blood stream (80%)
• The rest is released via sweat, urine, breath

Micronutrients

Fat Soluable Vitamins: A/D/K/E

Only dissolve in fats and oils (won’t dissolve in water) which help transfer nutrients (these above vitamins) which is a reason to consume these vitamins with a meal containing fat.

• Stable during cooking and processing
• A: Dark green leafy vegetables, organ meats (liver) fish oils, butter, dairy
• D: Oily fish, egg, liver
• E: Oil, sweet potato, seeds
• K: green leafy vegetables, greens beans, peas, liver

Water Soluble: B-Group/C

• Dissolve in body fluids
• Excess intake passed through urine
• Heat sensitive and may be affected by cooking
• B1 (Thiamine): whole-grain bread, yeast, legumes, seeds, pork
• B2: (Riboflavin): Dairy, yeast, whole-grain bread, organ meats, eggs, broccoli, asparagus, spinach
• B3 (Niacin): eggs, organ meats, whole-grain, fish, mushrooms, potato, tomatoes
• B6 (Pyridoxine): Meat, fish, poultry, bananas, potatoes
• B9 (Folate): Grain, green leafy vegetables, liver (folic acid is the exogenous chemically made form)
• B12: Dairy, liver, eggs
• C: Citrus fruits, cauliflower, Brussel sprouts, green vegetables, tomatoes, potato, mango, strawberries

Commonality: LIVER = nutrient density powerhouse.

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Measuring Food Intake & Food Intake Behaviours

Week 2

Nutrition Assessment

Why do we assess nutritional status?

• Determining the likelihood of a nutrient deficiency (or toxicity) being present.
• Establish the nature and aetiology (root cause) of a problem in order to provide the appropriate treatment and to prevent re-occurrence of the problem.
• In the population, the objective is usually to establish the extent and distribution of a problem in the community, and to identify associated environmental factors in order not only to provide appropriate therapeutic facilities, but also to institute preventive programs.
• Allows investigation and interpretation of relationships between diet and disease
• Allows for assessment of individual and population nutrition status

Actual intake of food may be different from usual intake of food.

• because individuals are recording their intake for a purpose, they may eat differently
• because it doesn’t take into consideration lifestyle changes over a year and how that influences nutrition intake
• because it doesn’t take into consideration seasonal changes which may influence nutrition intake

4 components (ABCD)

• Anthropometric
• Biochemical
• Clinical
• Dietary

Anthropometric Assessment

• Height, weight, waist circumference, hip circumference, skinfolds
• Important to establish weight status, body mass index (BMI) and waist-to-hip ratio (waist:hip)

Biochemical Assessment

• Includes blood tests, urine samples
• Used to assess body stores (e.g. iron stores, sodium concentrations, etc.)
• Levels are compared to normal values for a similar population (medical clinics almost always aren’t comparing to specific population instead using entire population)
• Important for detection of nutrient deficiency
• Uncovers early signs before symptoms appear
• Can also confirm suspicions raised by other assessment tools

Clinical Assessment

• Uses a number of physical signs that are known to be associated with malnutrition and deficiency of vitamins and micronutrients
• Physical examination of the body can provide clues to poor nutrition
• Clues can be found by looking at: Hair Eyes Skin Posture Tongue Finger nails
• E.G. the most appropriate type of nutritional assessment to detect night blindness

Dietary Assessment

Food Recall Methods

1. 24h Recall: recall of food and fluid intake over a specified period of time
   • https://asa24.nci.nih.gov/demo/
2. Dietary History: interview to determine the usual food and fluid pattern of an individual over the previous two to three month period. involves a recall of the usual eating pattern and a crosscheck in the form of a detailed list of foods.
3. Food Frequency Questionnaire: self-administered questionnaire to ascertain how frequently common foods are consumed. The questionnaire is limited to selected foods and food quantity may or may not be considered.
   • Limits on recording intake based on seasonality
4. Food Records: recording their current intake over a period of one to seven days. The food intake may be recorded based on weights, household measures or general description or estimated after consuming the meal *not reying on long term reacll.

In a food database, the brand name of the food is needed to analyse the food.

Validity & Realibility

Understanding Food Intake Behaviours

Need to convert dietary information into nutrient information

Scientists often tend to think in their own area of knowledge, but it is important when investigating food intake behaviour to consider different scientific areas to try to understand, predict and change human food choices and other eating behaviours. Understanding the science of behaviour is not just about looking at numbers and associations, but rather about understanding these associations and mechanisms which underlie these.

Observational & Experimental Study Designs Used in Nutritional & Food Sciences Research

There are two major types of study designs used in nutritional and food sciences research: experimental and observational.

Observational investigates behaviour with no intervention (minimises impact on participants’ lives)

*order = from weakest to strongest

• Ecological: A cross-sectional study that investigates exposures and health outcomes at the group rather than the individual level to identify trends over time. They are unable to determine causality but are useful for developing hypothesises and associations between an exposure and disease/outcome.
  • E.G.A study is examining the relationship between Vitamin D intake and rickets among children in Australia, Canada, Ireland, China and Thailand.
• Cross-Sectional: a descriptive study involving the measurement of exposures and outcomes at one point in time providing a snapshot to gather data on large groups. E.G. The Australian Health Survey.
  • E.G. A study is examining the relationship between soft drink intake and obesity from an online survey completed on 1 August 2018.
• Case-Control: Involves individuals with disease (cases) being identified and compared with individuals who do not have a disease (controls). The exposure of the two groups to a factor of interest is compared.
  • E.G. A study is examining whether exposure to processed meats during early childhood is related to a rare form of cancer in adulthood. The participants with the cancer were identified as adults and have been matched to participants without the cancer.
  • Conducted retrospectively
• Cohort: Identifying a group/cohort of disease-free people who are followed over time. Baseline information is collected on exposures of interest and participants who subsequently develop a disease are identified. The rates of disease are compared to those exposed to x condition vs those not exposed.
  • E.G. A study is examining whether children raised as vegetarians have lower rates of cancer as adults compared with those raised eating meat. The participants were recruited as children and followed over time into adulthood.

Experimental studies expose groups to different interventions.

Randomised controlled trial (RCT): 

• Participants are randomly assigned to an intervention group (e.g. where lifestyle is changed – medicine/supplement) and a control group and followed and compared to identify the development of x outcome.
• Minimises selection bias
• Determines causality

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Nutrient Reference Values (NRVs)

Week 3

• NRVs were developed in 2006 by the National Health and Medical Research Council
• Provides a framework for determining adequacy of nutrient intake to prevent deficiency and for chronic disease risk reduction.
• They help to set nutrient targets for healthy individuals
• Data based on healthy populations who don’t have deficiencies or illnesses 
• https://www.nrv.gov.au/home

Includes:

• Estimated Average Requirement (EAR)
  • A daily nutrient level estimated to meet the requirements of half the healthy individuals in a particular life stage and gender group
• Recommended Dietary Intake (RDI)
  • The average daily dietary intake level that is sufficient to meet the nutrient requirements of nearly all (97–98 per cent) healthy individuals in a particular life stage and gender group
• Adequate Intake (AI)
  • The average daily nutrient intake level based on observed or experimentally-determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate
• Acceptable Macronutrient Distribution Range (AMDR)
  • The AMDR is an estimate of the range of intake for each macronutrient for individuals (expressed as per cent contribution to energy), which would allow for an adequate intake of all the other nutrients whilst maximising general health outcome
• Upper Level of Intake (UL)
  • The highest average daily nutrient intake level likely to pose no adverse health effects to almost all individuals in the general population. As intake increases above the UL, the potential risk of adverse effects increases
• Estimated Energy Requirement (EER)
  • The average dietary energy intake that is predicted to maintain energy balance in a healthy adult of defined age, gender, weight, height and level of physical activity, consistent with good health. In children and pregnant and lactating women, the EER is taken to include the needs associated with the deposition of tissues or the secretion of milk at rates consistent with good health
• Suggested Dietary Target (SDT)
  • A daily average intake from food and beverages for certain nutrients that that may help in prevention of chronic disease. Average intake may be based on the mean or median depending on the nutrient and available data
• *nothing based on optimal

Estimated Average Requirement (EAR)

EAR is the requirement of a nutrient that supports a specific function in the body for the needs of 50% of the healthy population. *used commonly at population level

Person C has a greater nutrient X requirement than Persons A and B

Recommended Dietary Intake (RDI)

RDI uses the EAR as a base and includes sufficient daily amounts of nutrients to meet the known nutrient needs of practically all (98%) of the healthy population and is always higher than the EAR. *used commonly at individual level

Population vs Individual Comparisons

• When comparing intakes of a population they say to compare it to the EAR because it’s more likely to capture the true intake and requirements of a given population.
• When you look at an individual you look at the RDI because if the individual is reaching above the RDI there is a very high likelihood that they are meeting the reqirements its also going to capture the individuals who are more likely to have a higher individual requirement.

I would use EAR for both in order to raise up the standard of health from the population-based level.

Adequate Intake

• The same as RDI but used in situations where there isn’t enough evidence to set an RDI and EAR.
• The average daily nutrient intake level based on approximations of intake in apparently healthy people that are assumed to be adequate.
• The AI value is based on observed or experimentally determined approximations
• Use it in place of RDI, as there is not enough evidence to set an RDI or EAR.
• e.g. 60 µg/day for vitamin K in adult women

Upper Level of Intake (UL)

• The highest average daily nutrient intake level likely to pose no adverse health effects to almost all individuals in the general population. As intake increases, potential risk of adverse effects increases like toxcity.
• e.g. 80 µg (micrograms)/day for vitamin D in all individuals (increased blood calcium and calcification in the blood) [1 IU = 0.025 mcg]
  • = 3200IU as a UL. Taken with Vitamin K nullifies this + thousands of health practioners use much higher dosages in patients with great succes.
• e.g. 2 sodium 2000 µg p/d can increase blood volume and BP.

*See PowerPoint slide for nutrient reference tables for more vitamins and minerals*

SDT = suggested dietary target

Energy: Macronutrients

Estimated Energy Requirement (EER)

• The average dietary energy intake that is predicted to maintain energy balance
• In children and pregnant and lactating women, the EER is taken to include the needs associated with growth and development

Acceptable Macronutrient Distribution Range (AMDR)

• An estimate of the range of intake for each macronutrient for individuals (expressed as per cent contribution to energy), which would allow for an adequate intake of all the other nutrients whilst maximising general health outcome.

Activity Multiplier: PAL (Physical Activity Multipler)

• Sedentary = BMR x 1.2 (little or no exercise, desk job)
• Lightly active = BMR x 1.375 (light exercise/ sports 1-3 days/week)
• Moderately active = BMR x 1.55 (moderate exercise/ sports 6-7 days/week)
• Very active = BMR x 1.725 (hard exercise every day, or exercising 2 xs/day)
• Extra active = BMR x 1.9 (hard exercise 2 or more times per day, or training for
  marathon, or triathlon, etc.

Protein Requirements for Muscle Maintenance

EXAM: Might be required to know x0.84 RDI

NHMRC, Nutrient Reference Values for Australia and New Zealand, 2006

“Requirements were estimated using the factorial method including estimates of the amount needed for growth and maintenance on a fat-free mass basis. An overall CV of 12% was used to derive the RDIs.” FLAW: for growth and maintenance? they’re two different things that require two different ranges – are these active people or sedentary? weight train? 

AI for Fatty Acids

*no value on total fat intake *total fatty acid intake very low

“Acceptable” Macronutrient Distribution Range (AMDR)

• To reduce risk of chronic disease recommended 20-35% total energy from fat
• Total fat should not be below 15% for women
• Saturated fat should not exceed 10% total energy intake

No explanation of how or why*

Carbohydrate

To reduce risk of chronic disease a diet containing 45-65% total energy from carbohydrates is suggested

What about other disease? How does changing that distribution mean you’re at a high risk of CD? What about metabolic health? 

Dietary fibre

Water

Relationship of NRVs to Other Countries Public Health Nutrition Tools

Food selection guides (click here to see Australia’s version); click country links below to see examples from around the world) are often based on NRVs (or similar nutrient recommendations) and assist the general population in making healthy food choices. When considering nutritional requirements from the consumer’s point of view, health messages are more easily understood when expressed in terms of foods rather than nutrients. For instance, the message “eat more vegetables and fruit” is easier to follow than “eat more vitamins B and C”.

Food selection guide examples:

• Japan – Japanese Food Guide Spinning Top
• China – Food Guide Pagoda for Chinese Residents
• United Kingdom – Eatwell Guide
• Finland – Finnish Food Triangle and Finnish Food Plate
• Germany – German Nutrition Circle
• Dominican Republic – Mortar of Food
• Canada – Canada’s Fo

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Food for Health: Dietary Guidelines & Australian Health Surveys (2013)

Week 4

https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/serve-sizes

https://www.eatforhealth.gov.au/guidelines

“The target audience for the Guidelines includes health professionals (such as dietitians, nutritionists, general practitioners, nurses and lactation consultants), educators, government policy makers, the food industry and other interested parties. The Guidelines are not specifically meant for use by the general population. The AGHE is a resource that can be used by the same audience as for the Guidelines as well as the wider population.”

• The Australian Dietary Guidelines are based on whole foods, rather than individual nutrients
• ‘Mostly’ = 50% of the food  group (e.g. ‘Enjoy milk, yoghurt, cheese  and/or alternatives, mostly  reduced fat’

5 Food Groups of the Australian Guide to Healthy Eating:

1. Fruits
2. Vegetables
3. Grains
4. Lean Meats
5. Dairy

Australian Serving Sizes

EXAM: Know some knowledge on what a standard serve of each main food group is.

What is a serve of vegetables?

What is a serve of fruit?

What is a serve of grain* (cereal) food?

How much is a serve of lean meat and poultry, fish, eggs, nuts and seeds, and legumes/beans?

How much is a serve of milk*, yoghurt*, cheese* and/or alternatives?

What is a serve of discretionary choices?

Infant Feeding Guidelines

https://www.nhmrc.gov.au/about-us/publications/infant-feeding-guidelines-information-health-workers

• “…is to support optimum infant nutrition by providing a
  review of the evidence and clear guidance on infant feeding for health workers. Guidance is based on evidence from the Australian Dietary Guidelines literature review and
  additional reviews specific to infant feeding.”
• Relevant to healthy, term infants of normal
  birth weight (>2500g)
• “Encourage, support and promote exclusive breastfeeding to around 6 months of age and explain that infants do not require fluids other than breast milk for the first 6 months.” [massive benefits to 6-24 months in my notes]
• “As long as iron-rich foods are included as first foods, foods can be introduced in any order and at a rate that suits the infant.”

Australian National Nutrition Surveys

Some countries like Germany and USA do yearly surveys but Australis seldom does them:

1995 National Nutrition and Physical Activity Survey (NNPAS)

• • Ages 2+ years
  • 13,858 participants
  • 3,007 aged 2-18 years
  • 1 x 24hr dietary recall
  • 2-4 years proxy (parent); 5-11 years adult assisted
  • Subsample with second 24hr dietary recall
  • Food frequency questionnaire
  • Questionnaire on eating habits and patterns

2007 Children’s Nutrition and Physical Activity Survey

• • Also known as “Kids Eat Kids Play”
  • Aged 2-16 years
  • 4,487 children
  • 2 x 24hr dietary recall
  • Food habit questions
  • First Australian national survey to measure food and activity patterns in the same group

2011-2013 Australian Health Survey

• • Largest, most comprehensive survey
  • Residents in private dwellings, urban & rural
  • One adult, one child from each dwelling
  • Nutrition, physical activity, anthropometry, biochemical data
  • Staggered release of data
  • Final results include data from 32,000 people
• 2+ Years Old

5 phases in the multiple-pass method used to collect dietary data in the National Nutrition and Physical Activity Survey (NNPAS)

2013 NHS Results: disease prevalence

General health
0.9% kidney disease
3.5% osteoporosis
5.1% diabetes
5.2% heart disease
7.1% high cholesterol
11.3% hypertension
17.5% mental and behavioural conditions

Vegetable consumption – adolescents

 

non discretionary = raw form

40-60% of the adult (18 years or older) population usually ate 2 or more serves of fruit per day

Protein consumption

• Protein intakes compared to EAR (=
• 99% Australians met requirements (EAR = 37g female adult / 52g male adult so of course they’re all meeting the requirements because they’re so abysmally LOW!)
• 14% males and 4% females over 71 years did not

Fat consumption

• No EAR to compare to
• Male (9-50 yrs) median fat intake 79-89g/d
• Top 25% males at least 94g fat/ day
  • 7 tablespoons of spreads (butter, margarine etc.) or 5 tablespoons oil
• Female (9-50 yrs) median fat intake 64-69g/d
• Top 25% females 76g fat/ day
• 6 tablespoons of spreads (butter, margarine etc.) or 4 tablespoons oil

Carbohydrate consumption

• No EAR to compare to
• Top 25% of population had a usual intake of 100g of total
  • sugars per day
  • Three cans of soft drink
  • Two medium sized banana cupcakes
  • Five apples
• Intake of sugars was higher in adolescents that adults
  over 30 years
• Males had higher usual intakes than females in most age
  groups

Free sugars

Average of 60 grams of free sugars per day (equivalent to 14 teaspoons of white sugar)

~12 teaspoons (~52g) from added sugars
~7g from honey and juice

Highest among teenage males (14-18 yrs)
– average 92g per day

top 10% usually consumed >160 grams (~38 teaspoons) of free sugars per day

Alcohol

5% out of 2000 calories p/d = 100 calories (7 calories per gram of alcohol (standard drink = 10g) = 14.2 standard drinks (= 100 calories)

Folate

• Folate important in pregnancy because its linked to development diseases and deformities
• Mandatory fortification of wheat flour for bread making introduced in Australia in 2009
• Approximately one in eleven (9%) adult females (≥19 yrs) did not meet requirements
• Almost all males met requirements (2% with inadequate intakes)
• Blood tests for folate in National Health Measures Survey

Folate, Thiamin & Iodine

• Folate fortification – 2009 (prevention of neural tube defects)
• Thiamin fortification – 1991 (alcoholics)
• Mandatory Iodine fortification of some cereal products by manufacturers – 2009 (re-emergence of iodine deficiency)
• ~9% adult females did not meet folate requirements (foods)
• ~7% of males and 16% of females inadequate thiamin intakes
• 2% of males and 8% of females (≥2 yrs) did not meet iodine
requirements
• 13% of males and 6% of females aged 2-3 years exceeded the UL for iodine

Consequences of Iodine Deficiency

Iodine deficiency during pregnancy is very serious as it impairs the physical and mental development of the foetus. In adults, it causes hypothryroidism, which means the thyroid gland is underactive and fails to secrete enough hormones into the bloodstream. Iodine-poor soils, dairy farmers no longer using iodine to sterilise milking equipment and a reduction in the use of iodised salt are to blame. Iron deficiency in women and vitamin D deficiency in the elderly are examples of other common nutrient deficiencies in Australia that public health measures are yet to correct.

Sodium

Children were more likely than adults to exceed the UL (2300mg) for sodium!

See slides for Vitamin A, B1, Calcium, Iron, 

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Food Choice: Influences of Food Behaviour

Week 5

Food choice is the product of multiple conscious and subconscious evaluations

Why is it important to consider food choice?

• Each individual is different
• There is no “one size fits all” approach
• Most people are not meeting the guidelines, and we need to understand why

Difference between Canadian and Australian food guide is Canada takes into consideration food HABITS and BEHAVIOURS which is extremely important. HOW to eat not just WHAT to eat.

Canada’s Food Guide:

Factors that influence food choice

1. Individual Factors

Taste & Physiology

• Detection of non-volatile foods components (or nutrients) on the tongue
• Differentiated by smell which is the detection of volatile food components (gases) via the nasal cavity
• Two kinds of tastes: appetitive taste (promote food intake e.g. sweet) and aversive taste (inhibit intake e.g. off food or highly bitter/acidic)
• Not everyone tastes the same – some people are more sensitive to certain tastes than others
• Variation in sensitivity has been shown to impact on what we eat and how much we eat

Taste sensitivity & dietary intake

• Sensitivity to different tastes can influence how much we like a food
• People who are more sensitive to PROP (a compound used to test food sensitivity) find vegetables more bitter and unpleasant, and therefore consume less (Dinehart et al., 2006)
• Some tastes regulated by genes, some regulated by environment/diet
• Adding salt to vegetables masks the bitter taste and increases consumption in children and adults (Bouhlal et al., 2011; 2013) e.g. salt added to dark chocolate to mitigate bitter taste 

Liking

• Liking is pleasure derived from oro-sensory stimulation of food
• This is distinct from wanting, which is the motivation to engage in eating (Mela, 2006)
• You might like something but do not want to eat it
• You might like pasta but you do not want to eat it because you have just had lunch
• You might like meat but do not want to eat it because you consider it unethical

Liking, dietary intake & health indices

• Food liking has been noted as an important determinant of food acceptance, food rejection and potentially dietary intake and health indices.
• Based on the assumption that, over time, we tend to eat what we like and avoid what we do not. Which is why wide exposure to food from a young age is important.

Satiety

• Satiety is the overall feeling of fullness or sustenance (opposite of hunger)
• Sensory-specific satiety is the declining desire to eat foods of a certain sensation throughout an eating event AKA declining desire to continuing eating the same food.
  • A valuable sensory phenomena because it helps force food variety.  Helps your body eat a varied diet
  • The more you eat of a particular food, the less appealing a food becomes
  • E.g. After dinner, you might not feel like eating
    more savoury food, but you always seem to
    have room for desert
• Energy-dense foods tend to be less satiating – this is our body’s way of encouraging macronutrient intake
• People who are more sensitive to certain tastes reach satiety quicker than those who are less sensitive

Learning

• Flavour-nutrient learning – Associating the flavour of a food with the positive consequences of nutrient ingestion or satiety (Yeomans et al., 2008)
• In essence, after you eat certain foods, you feel sated
• Flavour-flavour learning – Associating the flavour of a food with another flavour.
  • E.G. associating and learning to like coffee and sugar together instead of just coffee.
  • E.G.2 eating an off-food can create a temporary-chornic aversion.

Exposure

• Early exposure to a food leads to liking (Cooke & Fildes, 2011)
• This includes in utero exposure, breastfeeding and early childhood. Some research showing in utero and during breastfeeding exposure to food can stimulate a likeness for that food once born/ during infancy.
• Frequent repeated exposures to a food to combat neophobia (fear of anything new); mostly researched in children but also effective in adults (Cooke, 2007)
• Learning and exposure are much better promoters of healthy food choices in children than rewarding
  or forcing

Disinhibition

Dietary restraint is defined as a tendency to consciously restrict or control food intake, whereas dietary disinhibition is defined as a tendency to overeat in the presence of palatable foods or other disinhibiting stimuli, such as emotional stress or alcohol.

Level of Education

• Higher level of education is associated with greater diet quality (Hiza et al., 2013)
• This may be due to increased knowledge of nutrition, or an increased ability to understand nutritional guidelines and promotions [BUT it may also be due to wealth, socio-economic status influencing decision making, a better circle of influence of healthy people that generally comes with higher socio-economic status.

Income

• Families with higher income tend to consume more fruit, vegetables and wholegrains, but also consume more sodium (Hiza et al., 2013)
• May be due to access to healthy foods (fast food density, healthy food options) (Milmers et al., 2012)
• Greatest perceived barrier for low income families is inability to afford fresh fruit and vegetables
• Income and education are linked

Ability & Desire to Cook

• Preparing food at home is associated with healthier diet (Larson et al., 2006; Wolfson & Bleich, 2015)
• Proportion of US adults who cook at home (Virudachalam et al., 2013):
  • 18-25 years: 37%
  • 26-45 years: 49%
  • 46-65 years: 48%
  • >65 years: 60%

Perceived barriers include:

• Cooking skills
• Time
• Money to buy food
• Enjoyment of cooking/shopping

Health Status

Social Factors

• Social norms are factors that influence how we eat based on societal determinants
  • Why do we eat breakfast, lunch and dinner? Why do we eat them at specified times?
  • Why do we eat so much at Christmas?
• There are many social norms that we do not think about, but have an impact on what foods we eat and how much we eat
  • Would you eat raw fish for breakfast?
  • Distinction between healthy and unhealthy food
  • Body image and social approval
• Jerry has been raised in a culture that does not eat beef due to religious beliefs. Jerry is not religious, but still refrains from eating beef. His behaviour is a result of social norms.

Body Image

• Adolescents, especially females, are concerned about their body image (Wardle et al., 2004)
• Likely due to social pressure, media, etc.
• Poor body image is associated with inappropriate dietary resections and poor nutritional choices
• Estimates of ‘dieting’ prevalence amongst adolescent girls is between 77% (Hill et al., 1992; Butter et al., 1996; Roberts et al., 1999)

Social facilitation

• Social facilitation – eating more when other people are present (de Castro, 1997)
• Social facilitation can be influenced by other social factors
• Obese eat less in the presence of lean people (Luca & Spigelman, 1979)
• Females eat less with a male they consider attractive (Mori et al 1987)
• Social facilitation is most likely due to the time we spend eating; when eating in larger groups we tend to eat for longer duration

Modelling

• Modelling – eating similar foods and food quantities to others
• People are more likely to consume greater quantities if people around them are eating large quantities (Conger et al., 1980)
• This effect persists even if a person is full or hungry; healthy weight or obese, etc. (Goldman et al., 1991)
• Has been investigated extensively in child-parent eating habits
• Children are more likely to accept a new food that they see a parent eating (Brown & Ogden, 2004)
• Children are also likely to pick up bad eating habits from parents

Environmental Factors

Food Context

• For example, ambient lighting and music can enhance the liking of a meal, leading to a greater consumption. Contrarily, loud distracting noises can reduce liking of a meal.
• foods within a small proximity tend be to consumed at a higher rate than foods within a larger proximity due to the perceived effort involved.
• Focusing on external stimuli whilst eating a meal can lead to passive over-consumption of food. For example, consumption of a meal whilst watching television has a marked effect on food consumption.

Environmental Concerns

• Energy: Some foods require more energy to produce such as grain feed vs grass fed.
• Biodiversity: Production of some foods may harm local wildlife
• Waste: Packaging of foods is often not biodegradable or recyclable

Ethical Concerns

Ethical concerns also influence food choice:

• Animal welfare: Are animals treated humanely?
• Fair trade: Fair distribution of wealth and working conditions for food growers, particularly from developing countries

Marketing

• Marketing can include advertisements, labelling, branding, ambient sensations (e.g. a bakery smelling like vanilla)
• TV advertisements increase purchase intent, liking and consumption of food, especially in children
• One study found that children consumed more food immediately following viewing of a food advertisement on TV (Halford et al., 2004)

Branding

• Known brands increase preference for a food
• In one study, children had a greater preference for foods that were branded with McDonald’s logos than foods that were unbranded, even though the foods were exactly the same (Robinson et al., 2007)
• Even carrots!

Packaging

• Food packaging that uses bright colours and cartoon characters appeals more to children
• Natural colours (wood brown and leaf green) appeal more to health conscious adults (Simmonds & Spence, 2017)

Labelling

• Labels can influence consumer choices when shopping (e.g. health claims, nutrition information panels, accreditation logos)
• Healthy labels can sometimes negatively impact sales

One study provided a soup to participants accompanied with different health labels

• The reduced salt and heart foundation labels decreased expected liking and salt intensity, and actual perceived liking and salt intensity, despite being the same soup [because placebo/nocebo is real]
• When participants were allowed to add their own salt, they added more salt to the ‘reduced salt’ labelled soup

Specialised Diets

• A specialised diet is a dietary pattern that is the product of one or more factors that influence food choice
• Much more robust than discrete food choices; it affects overall eating patterns and behaviour

Common specialised diets include:

• Vegetarianism/veganism & other low-meat diets
• Allergen-free diets
• Religious diets (e.g. Halal, Kosher)
• Many, many, many others

Something to consider – Can specialised diets meet the recommendations of the Australian Dietary Guidelines?

Palaeolithic diet includes More Vitamin C

Vegetarianism & Low-Meat Diets

• Vegetarian and low-meat diets are associated with reduced risk of coronary heart disease, type 2 diabetes and cancer (McEvoy et al., 2012)
• Vegetarian diets have not shown adverse health effects, but important to consider nutritional adequacy in vulnerable groups (e.g. pregnant women, children)
• Health effects likely due to increased fruit and vegetable intake

Consider: What are some factors that might influence someone to follow a vegetarian or low-meat diet?

Allergen-Free Diets

Most common allergies amongst Australian school children (Sasaki et al., 2018):

• Peanut 2.7%
• Tree nut 2.3%
• Egg 0.5%
• Cow’s milk 0.2%
• Sesame 0.2%
• Fish 0.2%

Intolerances among adults in the US (self-reported):

• Wheat sensitivity 14.9% (Potter et al., 2018)
• Symptomatic dairy avoiders 11.0% (Yantcheva et al., 2016)

Personalised Nutrition

• Individuals vary in their nutrient metabolism and response to diet
• The same diet followed by multiple people may have slightly different outcomes for each person
• Personalised nutrition is a unique diet plan for an individual based on their physiological needs
• Precision nutrition seeks to develop effective approaches based on the combination of an individual’s genetic, environmental and lifestyle factors (Betts & Gonzalez, 2016)

 

• Our understanding of genes is currently not sufficient to be able to formulate an individual diet plan [debatable – nutragenemics is rapidly emerging]
• Our genes aren’t the only consideration – humans have approximately 23,000 genes while our microbiome has somewhere between 1-4 million genes (Qin et al., 2010)

The Future of Personalised
Nutrition

Individual measures of food responses (e.g. glycaemic response) are widely varied from person to person even with the same food

Mendes-Soares et al. Assessment of a Personalized Approach to Predicting Postprandial Glycemic Responses to Food Among Individuals Without Diabetes. JAMA Network Open. 2019 Feb 1;2(2):e188102-.

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The Health of Australians

Week 6

Australian Institute of Health and Welfare 2018. Australia’s health 2018: In brief. Cat. No. AUS 222. Canberra: AIHW.

Life Expectancy

• Life expectancy differs by about 8-9 years for Indigenous versus non-Indigenous Australians
• Non-Indigenous Australians (born in 2015-2017):
  • Males 80.2 years
  • Females 83.4 years
• Indigenous Australians (born in 2015-2017):
  • Males 71.6 years
  • Females 75.6 years

Causes of Death in Australia

Leading Causes of Death

In 2012-2016, for Indigenous Australians:

• CHD
• Diabetes
• COPD
• Lung cancer
• Suicide

Burden of Disease in Australia

Chronic Conditions

It is estimated that 50% of Australian’s have at least 1/8 common chronic conditions.

Health Perception Association With Age

National Health Survey: First Results, 2014-15

Measuring the perception of health status relative to age groups. There is clearly a disconnect between the actual reality of one’s health and their perception. This is proven by statistics of the majority of the population having some type of health conditions (comorbidity) or neurological/GI issue.

Health Perception and Disadvantage Perception Association

First Quintile = lowest disadvantage group 

There is a relationship between perceived disadvantage and health.

Health Perception Among Indigenous Australians

Adult weight status

In 2014-15, 63% of Australian adults were overweight or obese.

If you compare this graph to the perception of health status graph will see a stark contradiction that people often report better health status then they actually are in reality. You can’t have 60% of the population in 25-34 be overweight or obese and 65% of the population between 25-34 assess their health status as excellent/very good. There’s about 25% of you fuckers who are lying to yourself or are getting lied too. 

Yes the sample sizes may have been slightly different, but they’re both from the same year and performed by the Australian Bureau of Statistics and appears to both be from the same 2014-15 National Health Survey. That should give us enough confidence to reliability compare and highlight this contradiction between perception and reality.

Moral of the story: we will all be faced with the reality of our health. You can choose the hard way and perform an honest self-reflection of yourself and why you are the way you are OR you can choose the really hard way and let illness and death be your teacher.

Adult weight status over the years

Adult waist circumference & All-Cause Mortality Risk

Child weight status

Child weight status over the years

Across all age groups 1/4 children are overweight or obese.

What if…

Australian Institute of Health and Welfare 2018. Australia’s health 2018: In brief. Cat. No. AUS 222. Canberra: AIHW.

Cardiovascular Disease

Cardiovascular disease (CVD) includes all diseases and conditions of the heart and blood vessels

Main types include:

• Coronary Heart Disease (CHD)
• Stroke
• Heart failure
• Rheumatic heart disease
• Congenital heart disease

Main cause is atherosclerosis = build up of fatty deposits in
arteries which cause blockages

Coronary Heart Disease (CHD)

Also known as Ischemic Heart Disease (IHD)

Two forms of CHD:

Heart attacks (mycocardial infarction – occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle) and angina (chest pain or discomfort caused when your heart muscle gets a temporary reduction in oxygen-rich blood)

Risk factors include smoking, high blood pressure, high cholesterol, diabetes, overweight, physically inactive, depression

Stroke

Artery supplying blood to the brain is blocked or begins to bleed

Two types:

• ischaemic: artery that supplies blood to the brain is blocked by a blood clot or fatty buildup, called plaque
• haemorrhagic: blood from an artery begins bleeding into the brain)

Health risk factors

CVD

• $5.0 billion in 2012-2013 (11.1% of total health
  expenditure)
• CVD causes largest number of ‘lost years’ through death in males >75yrs (premature mortality)
• 3.4 million Australian’s have one or more long term diseases of the circulatory system
• Of these, 1.4 million report having disability that led to mild to profound restriction on core activities such as lose of speech

CVD in Indigenous Australians

• 13% of Indigenous Australians had CVD (2012-2013)
• CVD 1.2 times more common compared with non- Indigenous people
• Leading cause of death (24%)
• CHD (Coronary heart disease) is the leading cause of CVD deaths
• Death rate for Indigenous people 1.6 times higher than for non-Indigenous people

Type 2 Diabetes

• Lifestyle disease
• Associated with high blood pressure, high cholesterol and weight gain (especially around waist)
• 85-90% of people with diabetes have type 2 diabetes
• Cells don’t respond to insulin properly and over time a build up of glucose occurs in the blood and can cause damage to parts of the body
• Frequently undiagnosed
• Among top 10 leading causes of death in developed world
• Australia 4.1% total population
• Type 2 diabetes is projected to become the leading cause of disease burden by 2023

Diabetes in Indigenous Australians

• 13% of adults
• 3.5 times more likely than among non-Indigenous adults
• Affects Indigenous people at a younger age
• Second leading cause of death in Indigenous Australians
• Death rate 5.2 times higher than for non-Indigenous Australians

Diabetes/High Sugar Levels

Diabetes/High Sugar Levels by Area

Cancer

• Disease of the body’s cells
• Cells normally grow and multiply in a controlled way. Cancer causes cells to multiply in an uncontrolled way.
• If damaged cells spread into surrounding areas of the body = malignant
• If damaged cells stay in the same area and do not spread = benign
• 1 in 3 men, 1 in 4 women diagnosed with cancer in their first 75 years
  • 1 in 2 men and 1 in 3 women by 85 yrs
• Most common cancers in Australia are prostate, colorectal (bowel), breast, melanoma, lung
  • Men: prostate
  • Women: breast
• Leading cause of cancer deaths: lung
• 69% of people diagnosed with cancer are alive 5 years later.

Cancer in Indigenous Australians

More common in Indigenous people than non-Indigenous:

• Lung and other smoking-related cancers
• Cervical cancer and cancer of the uterus (women)
• Liver cancer
• Head and neck cancers

Less common or similar in Indigenous people compared
with non-Indigenous:

• Breast cancer (women)
• Prostate cancer (men)
• Bowel cancer

Deaths higher for Indigenous than non-Indigenous people

How do we establish a relationship?

Challenging, several approaches

Epidemiological studies

• Comparison between countries
• Migration studies

Case-control

Look at people with and without disease (chicken and egg problem)

Longitudinal studies (prospective)

Follow up over time and look at disease states

Intervention studies

Change diet: does disease rate change?

Dietary Fat

• Early work: Ancel Keys 1980: 7 countries study (since debunked)
• Relationship between total fat and mortality
• Stronger relationship saturated fat and mortality
• Additionally showed that with high saturated
  fat other risk factors more dangerous
• For many decades there was a prevailing view that sat fat was the leading cause of CHD and since this study has been heavily criticised for its bias not including countries that didn’t support his linear relationship model and many other studies have shown fat to not meaningfully increase CHD. It is not as simple as more fat = more CHD.

Sodium

• Hypertension: 25% men, 20% women
• Intersalt study: 1988 52 centres worldwide, 10,079
• A positive relationship between NA secretion and systolic BP.
• Intersalt study found 2300mg sodium (~6g of salt) (1tsp) increased blood pressure
  • 3-6mmHg Systolic Blood pressure
  • 0-3mmHg Diastolic Blood pressure

Meta-analysis (J Hum Hyper 2002;16:761)

~2300mg reduction sodium reduced blood pressure by 5mmHg SBP and 3mmHg DBP

Study BMJ 2007

Lowering salt also reduces chance of CVD by 20%

Fruits & Vegetables

• 11% cancers attributable to inadequate F&V
• Important for prevention of stroke, overweight/obesity
• 26% reduction stroke with >5 serves/day

Note the pooled relative risk is <1.0 for 5+ is 26% reduction in stroke compared to <3 servings p/d.

Alcohol

BMI and Mortality

Diet patterns and health

Vegetarian diets: ↓ risk dying heart disease

Meta-Analysis: 5 studies, 8,300 deaths,76,000 subjects

• 24% reduction in mortality from Ischemic Heart Disease
• Lower blood pressure, body weight
• (but: less likely to smoke, are more active, often spiritual base – AKA the healthy user bias)

And Cancers (2009)

• 61,566 (20,000 veg). 12 yr follow-up:
• 36% ↓stomach, 70% ↓ovarian, 47% ↓bladder, 55% ↓lymphatic cancers

Micronutrient concerns in Australia

See slides for iodine and folate average intakes.

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Global Health

Week 7

USA: Over 70 million adults in U.S. are obese (35 million men and 35 million women). 99 million are overweight (45 million women and 54 million men). NHANES 2016 statistics showed that about 39.6% of American adults were obese.

So why is Latin and south America higher than US in obesity %?

Malnutrition

• Is an umbrella term that describes the health disorders with too little food or overnutrition.
• Malnutrition means “bad nutrition”
• Globally, the FAO (Food and Agriculture Organization of the United Nations) estimates there were 821 million undernourished people in 2017. The number of undernourished people was on a steady decline in the first part of the 21st century, but has been increasing since 2014.
• Nearly every country suffers from malnutrition
• 2-3 billion people are malnourished
• 1/9 of the worlds population is undernourished 
• Approximately 1/3rd of the proportion of elderly patients admitted to hospital in Australia are malnourished

Can be:

Overnutrition: (trouble breathing due to overweight/obesity)

Undernutrition:

• Undernutrition denotes insufficient intake of energy and nutrients to meet an individual’s growth and development and maintain healthy immune system to resist infections.  (children living in famine appear to be skin and bones)
• In developing countries, most deaths of children under five years of age are attributable to undernutrition

Nutrition paradox: The coexistence of undernutrition and over-nutrition in the same region

Micronutrient deficiency

•  The most common micronutrient deficiency on a global scale = Iron (most common cause of anemia)
  • Other common deficienies: Vit A (fruits & veg, organ meats), Iodine (poor soil), Zinc (dairy, legumes, potatoes)
• infants who don’t survive until their 1st birthday due to poor diet, poor feeding practises, infectious diseases)

Protein-energy malnutrition (PEM)

• an overall lack of energy and PRO in the diet to maintain growth and maintenance of muscle.
• Can cause wasting (rapid weight loss – low weight for height = when a child is thin for their age but not necessarily short),
• In Australia, protein energy malnutrition (PEM) is most prevalent in the elderly.
  • Stunting (develops over a longer period of time – insufficient nutrition – low weight and short = when a child is both short and thin for their age)
• marasmus and kwashiorkor are growth infections due to trauma which put increased nutritional demands on the body
  • Kwashikor: caused by moderate energy deficit with severe PRO deficit
  • Marasmus: caused by severe energy deficit with severe PRO deficit

Kwashikor

Overnutrition

• Over-consumption of nutrients and food to the point at which health is adversely affected
• Affects both developed and developing countries, even in countries where hunger is prevalent
• Obesogenic environment spreading to other nations e.g. China: 5000+ KFC restaurants (2018) and one opening almost everyday
• Income inequality seen – some can afford food beyond their needs and others not enough
• Increasing numbers of poor people overweight due to high caloric foods (processed/fast foods) being more affordable

Trends in weight status worldwide (females)

Trends in weight status worldwide (males)

Trends in weight status in Australia

Worldwide childhood overweight and obesity

• 42 million children worldwide under 5 years overweight in 2016 out of 1.9~ billion children in 2010~ (0-14)
• Almost half of all overweight children under 5
  lived in Asia and one quarter lived in Africa.

Consequences of obesity

Cardiovascular Disease

• 17.3 million deaths from CVD – 30% of all global deaths
• Approximately half from stroke and half from
  CHD
• Large percentage of these due to smoking tobacco, low levels of PA, obesity and unhealthy diets
• Early detection needed for those at high risk

Type 2 Diabetes

• 387 million people had diabetesin 2015 – Of this, 90% have type 2 diabetes
• Caused 5.1 million deaths in 2013
• Is preventable

Diabetes with age

Cancer

• Second leading cause of death globally, and is responsible for an estimated 9.6 million deaths in 2018. Globally, about 1 in 6 deaths is due to cancer.
• Around one third of deaths from cancer are due to the 5 leading behavioural and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use.
• Most common cancers in MEN: lung, prostate, colorectal, stomach, liver
• Most common cancers in WOMEN: breast, colorectal, lung, cervix, thyroid

Abdominal/Central Obesity

Double burden of malnutrition and overnutrtion

It is quite possible to have overnutrition and
nutrient deficiencies in the same person. Can have high energy (kilojoule) intake but inadequate micronutrient intake (eg, dietary fibre, iron, folate, and vitamin C).

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History of Food and Australian Food Culture

Week 8

Food History

Hominid Evolution/Paleolithic Era (4,000,000 – 250,000 years ago)

• Application of Heat to Raw Foods
• Homo erectus (upright man)  first deliberately applied heat to food

Neolithic/Agricultural Revolution/End of Paleolithic Era (12,500 years ago)

• A wide-scale transition of many human cultures during the Neolithic period from a lifestyle of hunting and gathering to one of agriculture, farming and settlement ( 2nd century BCE to the 18th century).
• Paleolithic and neolithic revolutions are two key historical periods when protein foods were considered important

World Trade (3,000 years ago)

• Role of Food in Human Culture
• The Silk Road was the most important trade route in world history and linked China and the Middle East with Europe.

Industrial Revolution (200 years ago)

• A defining feature of the IR is the emergence of national cuisines
• food preservation become more advanced and widespread

Scientific Revolution (now)

From Local to Global: Changes to the Food Supply

Artificial Man-Made Ingredients

Vegetable Gum: Non-starch polysaccharides commonly used as thickeners.

Food Acid: Commonly used for preservation and flavour enhancement. 

Food Culture

Cuisine

• Cuisine is a style or manner of cooking
• Regional cuisines exist, not national cuisines because nations are too diverse to have an entire cuisine (Sidney Mintz)
• Cuisines grow by adopting new ingredients or old ingredients in new ways

Regionality

• Terroir = A combination of natural and human factors
• Together these factors create a unique character of a small agricultural locality and the food and drink raised, made and cooked there.

Regionality of cheese in France

• North – Cheeses are mellower due to sweet foliage
• South – Cheeses are stronger due to drier fodder
  • Foliage/Fodder: plant matter domestic animals consume
• Differences within north and south due to traditions and practises of cultivation

Australian Food Culture

Before Europeans arrived

Indigenous people occupied Australia for up to 60,000 years before Europeans arrived in 1788

Food culture was characterised by:

• Local hunting and gathering
• Intimate knowledge of habits and seasonal patterns
• Seasonal sharing
• Feast and famine
• Food variety
• Limited food preservation methods
• High fibre, low fat diet (meat + several hundred veg) – FOOD VARIETY

Coolamon was used to carry food

Indigenous regionality

Example: Honey Ant (aboriginals would pick them from their colony) Honey bees and some wasps, collect and store liquid for use at a later date. However, these insects store their food within their nest or in combs. Honey ants are unique in using their own bodies as living storage, used later by their fellow ants when food is otherwise scarce. When the liquid stored inside a honeypot ant is needed, the worker ants stroke the antennae of the honeypot ant, causing the honeypot ant to regurgitate the stored liquid from its crop

New settlers (Late 1700s – early 1800s)

E.G. rabbits were brought in to tackle the prickly pear plant but rabbits multiplied too rapidly they destroyed the natural habitat.

Urbanisation (1800s – early 1900s)

• 1881~ 63% of homes in Brunswick Melbourne owned poultry
• 1941 41% of homes produced food for themselves
  • How much has changed know and how reliant we are on others for food security.
• First Melbourne restaurant in 1840~

The War Years (Early – Mid 1900s)

War had a large effect on Australian food industries. Canning became more efficient and so did freezing and packaging. Canned and frozen foods, wheat, butter, meat and fruits were sent to Britain and other countries in the British Empire to assist the war effort. In 1916, an increase in the amount of land that had been planted with wheat produced a large surplus, which was bought by the British government to offset an expected fall in production of wheat in America.

Prices of food rose during the war as well as the wages and the number of people working in the food industry. Food exports reached record heights. Due to wheat selling well during the war, governments were encouraged by farmers to open land previously considered to be too dry for wheat farming.

The decade following World War I was one of great promise. Australians had more contact with European culture due partly to movement of Australian troops in Europe. Soldiers came home with stories about French food and wine. In the 1920s, a trickle of European immigrants and refugees settled in Melbourne and Sydney. A few restaurants offering European food sprang up near theatres, drawing a crowd of theatre goers and theatrical stars.

Australian interests began to swing towards the United States, although ties with Britain remained strong. American firms such as Kellogg’s and Kraft established themselves in Australia during this time and the first soda fountain was opened in Sydney in 1921. This interest in the American way of life brought an increased awareness of the power of advertising. Slogans, which equated food with health or national pride, became important; brand names were far less important at this time as packaging was minimal or generic.

It was in this part of the century, however, that the foundation of modern Australian merchandising and packaging was laid. As we will see in the case study for this topic, many of these changes in technology, packaging and marketing are reflected in the history of Vegemite.

During World War II, France was a battleground whose once lush green cattle-grazed fields were occupied by the Germans. The farmers were restricted in what they could do and much of the produce (milk and meat) was used by the invading army; the farmers could not produce the cheeses they used to. Equipment for making and storing cheese was destroyed.

The local cheese industry was decimated, and what was known as the golden age of cheese was over. Parallel to this, in the United States, farmers enlisted in the armed services and went overseas to fight the enemy – it was left to the women to run the farms and make the cheese, but equipment and machinery for cheesemaking was not important during war years, and local cheesemaking operations were soon in trouble as equipment was run down.

After the war, a group of returned servicemen decided to invest in a cheesemaking factory they could all use. Milk from surrounding farms would be sent to a central operation for processing – this was the first co-op. The idea gained momentum, and local cheeses were starting to diminish as the co-ops took hold. Today the co-ops produce the cheese we see in supermarkets and, while small cheese producers exist, the golden age of cheese was effectively over at the start of World War II.

It was to take another ten years after the end of World War II for cooking styles to change and show European (not British) influence. In 1948 when the Australian Women’s Weekly held a national cookery competition, not one of the recipes included olive oil and only one mentioned garlic. In the 1950s and 1960s, European migrants had an effect on Australian food habits. Olive groves and vineyards were planted for commercial purposes, and tomatoes, beans and garlic were grown in backyards.

Many migrants took jobs in markets and food retailing, and as European communities grew, business people from those communities began to import food and wine from their former homes. As demand increased, many of these products were grown or made in Australia. Take cheese for example: three decades ago, Australia’s primary manufactured cheese was cheddar, but now manufacturers produce everything from feta to brie, mozzarella to parmesan. The culinary landscape continues to evolve, with Asian migrants having a similar influence on the Australian diet in recent years.

Compared with the Australian-born population, European migrants may have lower rates of death and other disease risk factors

Post War (Mid – late 1900s)

European migration 1947-1950 had 20,000 Europeans arrive which stimulated a second culinary revolution 

Modern Cuisine (21st Century)

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Sustainability of the Food Supply

Week 9

Short history

Hunter-gatherers -> Consumers

Major revolutions

• Agricultural revolution: from small scale to large scale monocultures (the agricultural practice of producing or growing a single crop, plant, or livestock species)
• Industrial revolution: from manual labour to machines, freezers
• Scientific revolution
  • Chemical revolution: from short shelf life to long
    shelf life, pesticides
• Transport revolution: from local to global

Current issues with food sustainability

1. Widespread malnutrition/hunger

2. High global food prices

3. Falling biodiversity

• 75% of the worlds agricultural diversity was lost in the 20th century. 
• 12 species provide 90% of animal protein globally and 5 crops provide 60% of plant-based food energy.

4. Environmental challenges

• arable land (decreasing farmable land)
• soil (infertile soil/nutrient deficient)
• water
• Using underground water increases salinity concentrations of soil which can cause soil degradation

Sustainability in the Next 20-40 Years Exacerbated by…

1. Increasing world population

• The world’s population is expected to increase by 2 billion persons in the next 30 years, from 7.7 billion currently to 9.7 billion in 2050
• More than half of the growth will take place in 9 countries (India, Pakistan, Nigeria, DRC, Ethiopia, Tanzania, Indonesia, Egypt, USA)
• Projected in 2027 India will take over China as the most populous country 
• There will be a need for a 50% increase in food production to meet need by 2030 (UN, 2008)
• More than 70% of the increase by 2050 is expected to be in urban areas (FAO, 2009)

Median = assumes a decline of fertility for countries where large families are still prevelent as well as a slight increase in fertility in several countries with fewer than 2 children per women on average.

High = Assumes an extra 0.5 of a child per women on average compared to the median.

Low = Assumes 0.5 less of a child per women on average compared to the median.

The difference of 0.5 average in fertility rate has DRAMATIC consequences from a systemic level.

Projected world population growth

2. Arable Land

Land that can be used for the production of food.

• Humans cause 10x normal erosion
  • The risk of erosion is exacerbated by agriculture due to overgrazing of animals (hence how regenerative agriculture can help aid this)
• It takes 500 years for 2.5cm of topsoil to form (which is the nutrient-rich component of soil)

 

Water Availability

Fresh water availability per head of world population

Total world water demands are predicted to increase by over 30% by 2030

2. Increasing urbanisation and income (particularly in Asia)

• In 2008, for the first time, more than half the world’s population became urban
• Increasing urbanisation leads to increased food demand due to land use and transport needs

Urbanisation and Income Growth

With income growth, will have lower demand for grains and higher demands for meat, fish, dairy, vegetables and fruit
e.g. meat intake doubled in China in 1990’s (Horrigan 2009)

3. Increasing energy demand

• Currently about 2-2.5% of energy is directly used in agriculture in developed countries, about ½ directly and ½ fertiliser and pesticides (Pimental 2010)
• The food production system uses about 12%-17% of energy in total due to transport, food processing, and packing www. atrra.org

• There will be an increased demand for energy (30% by 2050, especially oil)
• Oil production will be reduced as reserves are reduced
• Conventional farming is highly energy intensive – can’t replace oil currently for pesticides

Biofuels

• Examples of biofuels include ethanol (often made from corn in the United States and sugarcane in Brazil), biodiesel (from vegetable oils and liquid animal fats), green diesel (derived from algae and other plant sources) and biogas (methane derived from animal manure and other digested organic material).
• Increased production of biofuels will make the food situation worse because it ferments food like corn to make ethanol.
• Bioofuels are not an ideal solution to increased energy demands because they divert edible crops away from being consumed as food
• Biofules need pesticides, oil and fertiliser to create fuel. Is that more efficient than fossil fuels?

4. Climate Change

Will have many effects on future agricultural production,
including:

• More CO2
• Changing rainfall
• Increased weeds, pests, diseases
• More common extreme weather events (droughts and
  floods)
• Estimated reduced output in Africa and increased output in temperate zone
• Fertilisers require the highest amount of energy out of packaging, transport and pesticides

How has our ability to measure atmospheric CO2 retrospectively vs currently changed the accuracy of the data?

Projected 2080 affected by climate change relative to argiculture producitvity: 

Green = increases in food productivity / Red = opposite

Current Solutions For Food Production NOT Sustainability or Environmentally Effective

• Monocropping
• New machinery
• Fertilizers/Pesticides
• Deforest to produce more land for farming
• Larger farms
• More production and transport

Sustainability of the Food Supply New Solutions?

1. More local production, less food transport (food miles), reduce food wastage
2. Use of GMO crops to be less vulnerable to pests and disease resulting in increases in supply without needing to draw on the resources of land as much. E.G. Drought resistent wheat.
3. Organic/sustainable agriculture
4. Shift in food choices – Vegetarianism (or less meat),
   eating insects
5. ME: REGENERATIVE ARGICULTURE & GROWING VEGETABLES, HERBS & FRUITS IN HOMES

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Food Production: Producing Enough Food in the Future

Week 10

Agriculture History

• The movement to planned food production can be traced back to 9,000–7,000 BCE in the ‘fertile crescent’ of southwest Asia (Iraq region) where farmers grew the cereal grasses wheat and barley. Agriculture appeared in central and south America approximately 8,000 years ago where maize, beans and tomatoes were harvested. (These basic ingredients are still the foundation of Mexican and South American cookery today.)
• Grapes, figs, olives, and cereal/grains were early crops of the Mediterranean region; as was millet in Saharan Africa and palm and starchy tubers such as yam and taro in Southeast Asia and tropical regions of Africa. Over time, with trade and cultural exchange between nations, crops have spread around the world, many becoming staples in regions far from where they originated.
• With crops and farming came the need for domestication of animals. Early agriculturalists found that animals were not only a valuable source of food (e.g. meat, milk, eggs) but were also a tremendous help in terms of labour.
• Development of agriculture was the beginning of organised societies and civilisations; it not only influenced the food people ate but how they lived. Demographic changes occurred. Rather than living and travelling in small nomadic groups, people began to settle in densities near to the large food sources, and populations quickly grew to form cities. Agriculture and large-scale production of food is thought to have emerged to even out and prevent food shortages, but in many ways these changes exacerbated the problem: the human diet became more dependent on single staple foods, and the reduced variety in the diet sometimes lead to nutritional imbalance. In the 1840s, the Irish Potato Famine left thousands starving because the population was so reliant on a single food source.
• Agriculture brought about many changes in the social structure of human societies as having a controlled food stock meant power and ownership. Food and the land from which it was grown were valuable commodities, used as currency for barter and for political influence and power. Many early invasions and battles are based on trying to win or defend land suitable for cultivation and food production. Today, land and produce are still vital for survival and the economy, but improved transport has made access to variety easier.

Sustainability of the Food Supply

New Solutions

1. More local production, less food transport (food miles)
2. Use of GMO crops
3. Organic/sustainable agriculture – REGENERATIVE AGRICULTURE
4. Shifts in food choices

Solution 1: More local production

Relocalisation of Food Systems

• Industrialised agriculture is truly globalised
  • For example, we can eat Alaskan salmon in Melbourne
• Farmers markets and locally produced foods and seasonal fruits and vegetables are gaining increased prominence
• The paradox is that purchasing local made foods is often more expensive than many imported goods (why?)

Is Local Food Always Better?

The program showed you advantages of being a ‘locavore’, but it is important to think about whether this also has disadvantages

• Need heated greenhouses thus need more energy
• May need to use lots of fertilisers
• Storage for keeping for long periods of time
• Often more expensive because the process is more labour intensive and therefore not as efficient as globalised methods

Food Distribution

Coles (2006) suggested that trucks are more efficient than cars relative to the same tonnage of food delivered: “in terms of vehicle-km, cars accounted for 48% of the pie and LGVs (large goods vehicle) only 19%. After all, it takes almost 1,000 cars to carry the contents of one 40-tonne truck home from the supermarket”

Food Waste

• In 2011, FAO presented the estimate that around 1/3 of the world’s food was lost or wasted every year. 1.3 billion tonnes of food costing $240 billion each year. 
• In developing countries, mainly due to poor storage post-harvest and lack of refrigeration
• The majority of food waste happening in developed countries occurs via home and municipal waste

In developed countries, mainly (both supermarkets and consumers):

• desire for ‘perfect’ food
• misunderstanding of ‘use by’ dates
• cheap food

In Australia, 35% of the average household bin is food waste.

Best By Date vs Use By Date

Use by dates indicate when a product may no longer be safe to eat. You should not eat, cook, or freeze it after the date displayed, even if it looks or smells fine.

Best before dates are an indication of quality rather than safety and indicate quality such as taste and texture is more likely to degrade at this point.

Food waste in developed and developing countries

Municipal = grocery store

Solution 2: GMO Crops

Foods that contain novel DNA (genes) or novel proteins using gene technology (e.g. transferring gene from fish to strawberries)

GM whole foods, such as wheat, soybeans, corn and tomatoes NOT allowed in Australia

BUT

GMO modified ingredients are allowed (e.g. soy flour in bread)

Must show on label unless either:

• highly refined (e.g. oil)
• in small amounts
• restaurants/take away

Examples of GM applications

Potential Benefits of GM foods

Food security
• Lower food price, more nutritious
• Reduce toxins and enhance food safety

Environment
• Improve water and soil quality
• Reduce greenhouse gases
• Reduce pesticide, herbicide use

Farmers
• Guaranteed increased crop yields
• Reduced costs and better return

Food Industry
• Enhanced ingredient availability

Consumers
• Health
• Food quality and convenience

Potential Risks of GM foods

• New allergens created – e.g. Brazil nut protein into soy for those with allergies

• Cross-breeding – interbreeding between GM crops and weeds that may result in herbicide resistant weeds

• Encourages increased use of herbicides (e.g. Roundup Ready soy and corn)

• May decrease biodiversity

• Concerns about ownership of genes, seed, and can’t grow crops from seeds

Solution 3: Organic agriculture

Basic Principles of Organic Farming

“… to achieve optimum quantities of quality produce, while enhancing the sustainability of natural agricultural resources”

This is achieved by:

• conservation of energy, soil and water
• avoidance of pollution
• development of soil structure
• organically grown feed and ethical treatment practices for animals

Conventional Farming vs. Organic Farming

Beus and Dunlap (1990) characterised the fundamental difference between the two competing agricultural paradigms

Conventional Farming

• Synthetic chemical fertilizers
• Herbicides, pesticides and fungicides
• Heavy irrigation
• Intensive tillage (agricultural preparation of soil by mechanical agitation such as digging, stirring and overturning)
• Monoculture production
• GM crops
• Mechanisation
• Grazing is NOT a food production method

Organic Farming Practises Include

• Crop rotation (planting different plants that feed the soil or nutrients and take away different nutrients and giving the soil rest)
• Cover crops (reduce erosion of topsoil)
• Legumes (draw nitrogen from the atmosphere to put into the soil)
• Green manure crops
• Animal manure
• Biological pest controls (companion planting such as planting basil and dile next tomato to stop hawn worm)
• No artificial fertiliser or synthetic chemicals
• No GMO

Though conventional farming has helped food price drastically decrease:

Can it produce sufficient quantities of food?

• Maybe sufficient – although generally 20-30% lower on average than inorganic
• May be particularly effective in drought conditions
• 69.8 million hectares of organic land worldwide (2017)
• Almost half of this land located in Australia (35.6m ha) – 2.5% of Australian agricultural land is
  certified organic.
• Australia owns 53% of the worlds organic farmland.

Organic food and health

• Organic food has lower synthetic pesticide residues (but not none)
• May still have organic pesticides which are not necessarily safer than conventional ones

https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2017.4791

• In general, no major difference in nutrition
• Some evidence for increased antioxidants in organic food
• Methods to assess differences between organic and conventional is contentious

Organic Food Sales

Organic Farming Does Improve Soil

• The interrelation between the number of years after conversion from conventional to organic farming and the ATP-content in the soil (Source: Maire et al., 1990). HIgher ATP indicating greater soil fertility
• Compared to traditional practices such as tillage soil is being uplifted and washed away 10-40x faster than it is being replenished worldwide.

Organic Farming vs Conventional Farming

Organic vs. Sustainable Agriculture

• Current industrialised agriculture will not be effective in meeting future needs sustainably – Do we need to be completely organic or are there alternatives? – sustainable intensification?
• Integrated pest management – by careful use of knowledge of insects and weeds, minimise pesticide use
• Integrated waste management of livestock – use manure for fertiliser
• Zero or reduced tillage, mulches, cover crops
• Precision agriculture – only when and where needed for water, fertiliser, pesticide

(Godfray et. al, 2010)

Solution 4: Shift in food choice

Meat (Livestock) Production

• About 30% of ice free-land involved in livestock production
• Majority of corn and soy grown is fed to animals
• About 20% of greenhouse gases (more than transport, mainly from ruminants) due to livestock
• Meat consumption estimated to double by 2050 – remember urbanisation and prosperity
• Highly inefficient (especially red meat) in terms of energy and grain
• on average need to feed 6kg of plant protein to produce 1kg of animal protein

Willett W et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The Lancet. 2019.

What About Being a Vegetarian?

• A lacto-ovo vegetarian diet of equivalent kilojoules would use 33% less fossil fuel energy than an average American (Australian) diet (Pimental et. al., 2008)
• Moving from an average American diet to a lacto-ovo vegetarian diet would have a greater effect on greenhouse gas emissions than changing from an SUV to a Prius (Eshel and Martin, 2006)

Not Everyone Will Become Vegetarian

• Not realistic to expect everyone to become vegetarian
• Small changes in red meat consumption make a difference – if meat reduced
  20% = Camry to Prius for greenhouse gases (Eshel and Martin, 2006)
• Important to reduce in developed countries and slow increase in developing countries – what about equity?
• Chicken better than red meat

EAT-Lancet Planetary Health Diet

• A diet created by the EAT-Lancet Commission that will be able to support a population of 10 billion
• Adherence to the diet would drive the transition toward a sustainable global food system and achieve the goals set by the Paris Agreement
• Flexible diet that is designed to suit most cultures
• High in fruits, vegetables, nuts, and legumes; low in meat and dairy

Cultured Lab Made Meat

Food Miles vs. Meat Reduction?

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Careers in Food and Nutrition Sciences

Week 11

We’re in a bizarre era of personal diet-sharing – you know, if you haven’t written a cookbook crammed full of health advice, are you even a model, actor or chef?

The more individuals that join the chorus of food advice, the more overwhelmed the general public becomes. And the more pivotal the need for a voice of reason to cut through the noise.

That’s where nutritionists and dietitians come in. As qualified specialists with an evidence-based approach to healthful eating they have the capacity to differentiate between fact and fad.

What is the difference between a nutritionist and a dietitian?

• nutritionists work primarily at the population level in broader community settings such as schools and organisations. And dietitians can work one-on-one with clients. But to add a layer of confusion, some nutritionists may advertise that they work in private practice with clients. Dr Milte explains:
• The terms “nutritionist” and “dietitian” are not legally protected, so essentially anyone can call themselves by these names
• Dr Margerison agrees. ‘It’s not to say that any of the other people out there calling themselves a nutritionist or dietitian would necessarily give bad advice – not at all – it’s just a risk. There may be some out there who are not properly qualified.’

Nutritionist

• ‘You can think of nutritionists as “nutrition scientists” who either generate the science themselves or use the established evidence to implement programs or advocate for changes within the food system.
• A nutritionist works in roles where they use nutrition and food knowledge to promote healthy societies – Dr Catherine Milte
• Apply scientific principles and methods to influence: • Broad environment affecting food supply and eating behaviours • Enhance nutritional status and prevent chronic diseases
• Design and implement health interventions for individuals, communities and population

Dietitian

• The clearest way to understand the difference between dietitians and nutritionists is to think of dietetics as a specialisation on top of your nutrition studies. Dietitians have the added qualifications to work one-on-one with patients in a clinical context.
• Clinical training to prescribe diets for medical conditions
• ‘Dietitians can work in any of the areas that nutritionists work but, additionally, they can provide nutrition advice for treatment of a broad range of diseases and health conditions.
• They can work clinically with individuals who have conditions such as diabetes, food allergies, gastrointestinal disorders and they provide nutritional advice to help them manage their conditions
• ‘One of the main differences in terms of training for dietitians is individual counselling,’ says Dr Margerison. ‘In the Master of Dietetics at Deakin there’s 20 weeks of full time placements in hospitals, food service and community nutrition.’ This gives dietitians the expertise to work in hospitals and in private practice, if desired. 
• Can register to be an APD (Australian Practising Dietitian) – protected by law

Registration:

Both Dr Milte and Dr Margerison recognise that nutritionists who are registered with the Nutrition Society of Australia and dietitians who are accredited by the Dietitians Association of Australia have training and expertise that sets them apart.