Sara Grafenauer - Academia.edu (original) (raw)

Papers by Sara Grafenauer

Research paper thumbnail of Developing pre-clinical skills in dietetics students in an acute care setting using a volunteer feeding assistance program

Nutrition & Dietetics, 2016

Vitamin D deficiency has been identified as a worldwide issue with potential to adversely affect ... more Vitamin D deficiency has been identified as a worldwide issue with potential to adversely affect an individual's health. To date, no research has been conducted into the Vitamin D knowledge and practices of Australian Dietitians. The purpose of this study was to survey Dietitians on their knowledge and practices regarding Vitamin D intake, sources, supplementation, and affect on disease state. An online survey was disseminated to members of the Dietitians Association Australia (responses n = 134) via online national newsletters. Descriptive statistics were used to analyse the results. Where respondents made comments, answers were coded and placed into corresponding categories. Z‐scores were used to compare between responses. 29% of respondents identified that endogenous production contributes 90–100% of total Vitamin D. 42% of respondents correctly identified the recommendation of 10–15 minutes of sun exposure at low UV times to prevent deficiency. 31% of respondents correctly i...

Research paper thumbnail of The slow rise of sourdough: a nutrition audit of the bread category highlights whole grain

International Journal of Food Sciences and Nutrition, Apr 3, 2023

Research paper thumbnail of Systematic review of nutritional interventions for people admitted to hospital for alcohol withdrawal

Nutrition & Dietetics, Dec 4, 2019

Aim: Aim: The aim of this review is to describe the nature of nutritional interventions for peopl... more Aim: Aim: The aim of this review is to describe the nature of nutritional interventions for people admitted to hospital for alcohol withdrawal reported in the scientific literature and the health outcomes achieved. Methods: Methods: The review protocol was registered with PROSPERO (CRD42017081884). The following databases were systematically searched following the PRISMA protocol: CINAHL, MEDLINE, PsycARTICLES, PsycINFO, Scopus and Web of Science. Eligible studies were those published in English, in a hospital inpatient setting with the primary reason for admission being alcohol withdrawal. Studies of patient populations with the diagnosis of pancreatitis or liver cirrhosis were excluded. Studies were screened for eligibility, and data were extracted and descriptively analysed. Identified articles were assessed using the Quality Criteria Checklist for Primary Research produced by the Academy of Nutrition and Dietetics. Results: Results: Fourteen studies met the inclusion criteria. Given the heterogeneity of studies, only a descriptive analysis of interventions could be achieved. Nutrition interventions included supplementation with thiamine, multivitamins, amino acids, antioxidant compounds, probiotics, magnesium or were educational interventions. Outcome measures included memory function, biochemical and anthropometrical indices, withdrawal symptoms, bowel flora levels and nutrition knowledge. However, the overall body of evidence was limited, particularly as there was a wide variation in participant age, study designs and duration of interventions. Conclusions: Conclusions: A wide range of nutrition interventions were identified, mostly involving nutrient supplements ameliorating inadequacies. Future research might also consider total dietary interventions as well as studies on the perspectives of people undergoing alcohol withdrawal.

Research paper thumbnail of Lupins and Health Outcomes: A Systematic Literature Review

Nutrients

Lupins have a unique nutrient profile among legumes and may have beneficial health effects when i... more Lupins have a unique nutrient profile among legumes and may have beneficial health effects when included in the diet. The aim of this systematic review was to investigate the effects of lupin on a range of health outcome measures. Databases included MEDLINE, Embase and CINAHL, and focused on controlled intervention studies on healthy adults and those with chronic disease such as type 2 diabetes, cardiovascular disease and overweight. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed. Investigated intervention diets utilised whole lupin, lupin protein or lupin fibre, and outcomes were measured by markers of chronic disease, body weight and satiety. Quality assessment of results was performed using the Cochrane revised risk of bias tool. Overall, 21 studies with 998 participants were included: 12 using whole lupin, four used lupin protein and five lupin fibre. Beneficial changes were observed in 71% of studies that measured blood pressure, 83...

Research paper thumbnail of Dietitians’ Attitudes and Understanding of the Promotion of Grains, Whole Grains, and Ultra-Processed Foods

Nutrients

NOVA is a food-classification system based on four levels of processing, from minimally processed... more NOVA is a food-classification system based on four levels of processing, from minimally processed to ultra-processed foods (UPFs). Whole-grain-containing commercial breads and ready-to-eat breakfast cereals are considered ultra-processed within NOVA, despite being considered core foods in the Australian Dietary Guidelines. These food categories contribute the greatest quantities of whole grain in the Australian diet, although consumption is less than half of the 48 g/day daily target intake. Dietitians are key to disseminating messages about nutrition and health; therefore, an accurate understanding of whole grains and the effects of processing is critical to avoid the unnecessary exclusion of nutritionally beneficial foods. The aim was to utilise an online structured questionnaire to investigate dietitians’ attitudes to the promotion of grains and whole grains and understand their level of knowledge about and attitudes towards NOVA and the classification of specific whole-grain foo...

Research paper thumbnail of Legumes—A Comprehensive Exploration of Global Food-Based Dietary Guidelines and Consumption

Nutrients

Despite the well-known human and planetary health benefits of legumes, consumption is often low. ... more Despite the well-known human and planetary health benefits of legumes, consumption is often low. This scoping review aimed to evaluate the inclusion of legumes in global food-based dietary guidelines (FBDG), and to review consumption data against global food group classifications for legumes. The review of FBDG from 94 countries identified legume-based key messaging, the key terms used to define legumes, recommended serving size and frequency of consumption and the classification of legumes into food groups as depicted by food guides. The 2018 Global Dietary Database isolated consumption data of legumes and beans using individual-level, nationally representative dietary survey data for matched countries. Food-based dietary guidelines from 40/94 countries most often identified legumes utilising the term legumes, followed by beans (n = 13), pulses (n = 10), or as beans, peas and lentils (n = 5). The serving size recommendations for legume consumption varied widely, and there was no co...

Research paper thumbnail of Consumer Understanding of the Australian Dietary Guidelines: Recommendations for Legumes and Whole Grains

Nutrients

Dietary guidelines provide evidence-based guidance for healthy individuals to improve dietary pat... more Dietary guidelines provide evidence-based guidance for healthy individuals to improve dietary patterns, although they are most often based on individual foods or food groups. Legumes are a class of food included in current Australian Dietary Guidelines (ADG), mentioned in two of the five food groups, as a vegetable and as an alternative to meat. Whole grain consumption is encouraged in ADG via the statement focused on cereal grains due to their health-promoting properties. Despite their prominence in guidelines, average legume and whole grain consumption in Australia remains lower than recommendations outlined in the ADG. This exploratory study aimed to understand consumer perspectives of wording utilised in dietary guidelines specifically focused on legumes and whole grains. Based on the analysis, there was a significant preference for the statement “each day, consume at least one serve of legumes either as a serve of vegetables or as an alternative to meat” (p < 0.05), which pr...

Research paper thumbnail of Nutrition economics: Four analyses supporting the case for whole grain consumption

Journal of Cereal Science, 2022

Research paper thumbnail of OUP accepted manuscript

Alcohol And Alcoholism, 2020

Aim The aim of this study was to describe the characteristics and the nutritional approaches impl... more Aim The aim of this study was to describe the characteristics and the nutritional approaches implemented with patients undergoing alcohol withdrawal. Methods A retrospective analysis of medical records for patients admitted to a tertiary hospital for alcohol withdrawal was completed over a 5-year period 2013–2017. Data on nutrition-related assessment and management were extracted and descriptively analysed. Results A total of 109 medical records were included (M = 73, F = 36), with the mean age of patients 47.3 years (SD ± 11.2, range 22–70). The average length of stay was 3.7 days (SD ± 3.9, range 0.70–27.8). Approaches towards nutritional care emerged from micronutrient assessment and supplementation and/or dietetic consultation. Nutrition-related biochemistry data was available for most patients, notably serum levels of sodium, urea and creatinine (102 patients; 93.5%) and magnesium and phosphate (66 patients, 60.5%). There was evidence of some electrolyte abnormalities on admiss...

Research paper thumbnail of Legume Intake Is Associated with Potential Savings in Coronary Heart Disease-Related Health Care Costs in Australia

Nutrients

Legume intake has been associated with lower risk for a number of chronic disorders of high finan... more Legume intake has been associated with lower risk for a number of chronic disorders of high financial burden, and is advocated by dietary guidelines as an important part of healthy dietary patterns. Still, the intake of legumes generally falls short of the recommended levels in most countries around the world despite their role as an alternative protein source. The aim of this study was to assess the potential savings in costs of health care services that would follow the reduction in incidences of coronary heart disease (CHD) when adult consumers achieve a targeted level of 50 g/day of legumes intake in Australia. A cost-of-illness analysis was developed using estimates of current and targeted legumes intake in adults (age 25+ y), the estimated percent reduction in relative risk (95% CI) of CHD following legumes intake, and recent data on health care costs related to CHD in Australia. A sensitivity analysis of ‘very pessimistic’ through to ‘universal’ scenarios suggested savings in...

Research paper thumbnail of Healthcare Cost Savings Associated with Increased Whole Grain Consumption among Australian Adults

Nutrients, 2021

Many dietary guidelines emphasise “mostly” whole grain food choices as part of an overall healthy... more Many dietary guidelines emphasise “mostly” whole grain food choices as part of an overall healthy eating pattern based on evidence for enhancing nutritional status and reducing chronic disease. Still, countries including Australia fall short of their consumption targets. Furthermore, healthcare cost savings associated with increasing the consumption of whole grains in alignment with the Daily Target Intake (DTI) recommendation of 48 g are unknown. The aim of this study was to assess the potential savings in costs of healthcare and lost productivity associated with a reduction in the incidence of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD) through meeting the 48 g DTI recommendation for whole grains among the Australian adult population (>20 years). A three-step cost-of-illness analysis was conducted using input parameters from: 1) estimates of proportions of consumers (5%, 15%, 50%, and 100%) who would increase their current intake of whole grains to meet the...

Research paper thumbnail of Whole Grain Intakes Are Associated with Healthcare Cost Savings Following Reductions in Risk of Colorectal Cancer and Total Cancer Mortality in Australia: A Cost-of-Illness Model

Nutrients, 2021

Whole grain consumption has been associated with the reduced risk of several chronic diseases wit... more Whole grain consumption has been associated with the reduced risk of several chronic diseases with significant healthcare monetary burden, including cancer. Colorectal cancer (CRC) is one of the most common cancers globally, with the highest rates reported in Australia. Three servings of whole grains provide a 15% reduction in total cancer and 17% reduction in CRC risk; however, 70% of Australians fall short of this level of intake. The aim of this study was to assess the potential savings in healthcare costs associated with reductions in the relative risk of CRC and total cancer mortality following the whole grain Daily Target Intake (DTI) of 48 g in Australia. A three-step cost-of-illness analysis was conducted using input parameters from: (1) estimates of current and targeted whole grain intakes among proportions (5%, 15%, 50%, and 100%) of the Australian adult (≥20 years) population; (2) estimates of reductions in relative risk (with 95% confidence intervals) of CRC and total ca...

Research paper thumbnail of Leveraging partnerships to amplify whole grain messaging

Journal of Cereal Science, 2022

Research paper thumbnail of Lupins and Health Outcomes: A Systematic Literature Review

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Whole Grain Consumption and Inflammatory Markers: A Systematic Literature Review of Randomized Control Trials

Nutrients, 2022

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

Research paper thumbnail of Oat and Barley in the Food Supply and Use of Beta Glucan Health Claims

Nutrients, 2021

Beta glucan is a type of soluble dietary fibre found in oats and barley with known cholesterol-lo... more Beta glucan is a type of soluble dietary fibre found in oats and barley with known cholesterol-lowering benefits. Many countries globally have an approved beta glucan health claim related to lowering blood cholesterol, an important biomarker for cardiovascular disease. However, the use of these claims has not been examined. The aim of this study was to explore the range and variety of oat and barley products in the Australian and global market within a defined range of grain food and beverage categories and examine the frequency of beta glucan health claims. Australian data were collected via a recognised nutrition audit process from the four major Australian supermarkets in metropolitan Sydney (January 2018 and September 2020) and Mintel Global New Product Database was used for global markets where a claim is permitted. Categories included breakfast cereals, bread, savoury biscuits, grain-based muesli bars, flour, noodles/pasta and plant-based milk alternatives and information coll...

Research paper thumbnail of Back in Time for Breakfast: An Analysis of the Changing Breakfast Cereal Aisle

Breakfast cereal improves overall diet quality yet is under constant scrutiny with assertions tha... more Breakfast cereal improves overall diet quality yet is under constant scrutiny with assertions that the category has not improved over time. This study aimed to comprehensively analyse the category of breakfast cereals, the nutritional values, and health claims across eight distinct sub-categories at four time points (2013, 2015, 2018, and 2020). An audit of products from four major supermarkets in metropolitan Sydney (Aldi, Coles, IGA, and Woolworths) collected ingredient lists, nutrition information, claims and Health Star Rating (HSR) for biscuits and bites; brans; bubbles, puffs, and flakes; granola and clusters; hot cereal flavoured; hot cereal plain; muesli; breakfast biscuits. The median (IQR) were calculated for energy, protein, fat, saturated fat, carbohydrate, sugars, dietary fibre, and sodium for comparisons over time points by nutrient. Data from 2013 was compared with 2020 (by sub-category and then for a sub-section of common products available at each time point). Produ...

Research paper thumbnail of Beyond nutrients: classification of foods to identify dietary patterns for weight management

Research paper thumbnail of Fortification of grain foods and NOVA: the potential for altered nutrient intakes while avoiding ultra-processed foods

European Journal of Nutrition, 2021

NOVA is a food classification system describing a hierarchy from minimally processed to ultra-pro... more NOVA is a food classification system describing a hierarchy from minimally processed to ultra-processed foods (UPF). Research has associated intake of UPF with chronic diseases. In Australia, the primary sources of grains, both refined and whole, are breads and breakfast cereals, which are typically fortified. Most are classified as UPF, yet are recommended core foods according to the Australian Dietary Guidelines (ADG). This research aimed to identify if avoidance of ultra-processed grain foods would alter nutrient intakes in an Australian population and whether sample diets using substitute (non-UPF) foods would be likely to meet nutrient requirements. Quantitative analysis of usual nutrient intake from the National Nutrition and Physical Activity Survey 2011–12 (n = 12,153) for all foods including and excluding UPF. Dietary modelling examined the nutritional adequacy of sample diets aligned with the ADG and another containing replacements for UPF. We particularly focused on grain foods and meeting whole-grain intake targets. There was a significant decrease (all p < 0.05) in modelled intake of key nutrients when UPF were excluded, specifically, thiamin, folate and iodine, as substitutions are rarely fortified. Diets with no UPF, where substitutes are carefully chosen, have the potential to meet Nutrient Reference Values, but deviation from customary food choices may mean adoption of substitutes is unlikely. Exclusion of UPF may result in lowered intakes of key nutrients of particular concern for at risk groups (including women of child-bearing age), negating gains made by public health policy of fortification. Substitutions may not be realistic in these at-risk populations.

Research paper thumbnail of The Changing Landscape of Legume Products Available in Australian Supermarkets

Nutrients, 2021

Evidence supports regular dietary inclusion of legumes due to their positive effects on both huma... more Evidence supports regular dietary inclusion of legumes due to their positive effects on both human and planetary health. Intake within Australia is suboptimal, with consumer data suggesting that an inability to integrate legumes into usual dietary patterns is a barrier to consumption. This places the food industry in a unique position to offer Australians the ability to incorporate legumes into usual dietary patterns via innovative new products. The aim of this study was to explore the legume category and compare nutrition product data and the use of nutrition and health claims between 2019 and 2021. An audit of legume products from four major metropolitan Sydney supermarkets (Aldi, Coles, IGA, Woolworths) collected ingredient lists, nutrition information and on-pack claims for baked beans, legume dips, legume flours, legume snacks (including subcategories of legume chips and whole legume snacks), canned legumes, dried legumes, frozen legumes, and pulse pasta. The total number of le...

Research paper thumbnail of Developing pre-clinical skills in dietetics students in an acute care setting using a volunteer feeding assistance program

Nutrition & Dietetics, 2016

Vitamin D deficiency has been identified as a worldwide issue with potential to adversely affect ... more Vitamin D deficiency has been identified as a worldwide issue with potential to adversely affect an individual's health. To date, no research has been conducted into the Vitamin D knowledge and practices of Australian Dietitians. The purpose of this study was to survey Dietitians on their knowledge and practices regarding Vitamin D intake, sources, supplementation, and affect on disease state. An online survey was disseminated to members of the Dietitians Association Australia (responses n = 134) via online national newsletters. Descriptive statistics were used to analyse the results. Where respondents made comments, answers were coded and placed into corresponding categories. Z‐scores were used to compare between responses. 29% of respondents identified that endogenous production contributes 90–100% of total Vitamin D. 42% of respondents correctly identified the recommendation of 10–15 minutes of sun exposure at low UV times to prevent deficiency. 31% of respondents correctly i...

Research paper thumbnail of The slow rise of sourdough: a nutrition audit of the bread category highlights whole grain

International Journal of Food Sciences and Nutrition, Apr 3, 2023

Research paper thumbnail of Systematic review of nutritional interventions for people admitted to hospital for alcohol withdrawal

Nutrition & Dietetics, Dec 4, 2019

Aim: Aim: The aim of this review is to describe the nature of nutritional interventions for peopl... more Aim: Aim: The aim of this review is to describe the nature of nutritional interventions for people admitted to hospital for alcohol withdrawal reported in the scientific literature and the health outcomes achieved. Methods: Methods: The review protocol was registered with PROSPERO (CRD42017081884). The following databases were systematically searched following the PRISMA protocol: CINAHL, MEDLINE, PsycARTICLES, PsycINFO, Scopus and Web of Science. Eligible studies were those published in English, in a hospital inpatient setting with the primary reason for admission being alcohol withdrawal. Studies of patient populations with the diagnosis of pancreatitis or liver cirrhosis were excluded. Studies were screened for eligibility, and data were extracted and descriptively analysed. Identified articles were assessed using the Quality Criteria Checklist for Primary Research produced by the Academy of Nutrition and Dietetics. Results: Results: Fourteen studies met the inclusion criteria. Given the heterogeneity of studies, only a descriptive analysis of interventions could be achieved. Nutrition interventions included supplementation with thiamine, multivitamins, amino acids, antioxidant compounds, probiotics, magnesium or were educational interventions. Outcome measures included memory function, biochemical and anthropometrical indices, withdrawal symptoms, bowel flora levels and nutrition knowledge. However, the overall body of evidence was limited, particularly as there was a wide variation in participant age, study designs and duration of interventions. Conclusions: Conclusions: A wide range of nutrition interventions were identified, mostly involving nutrient supplements ameliorating inadequacies. Future research might also consider total dietary interventions as well as studies on the perspectives of people undergoing alcohol withdrawal.

Research paper thumbnail of Lupins and Health Outcomes: A Systematic Literature Review

Nutrients

Lupins have a unique nutrient profile among legumes and may have beneficial health effects when i... more Lupins have a unique nutrient profile among legumes and may have beneficial health effects when included in the diet. The aim of this systematic review was to investigate the effects of lupin on a range of health outcome measures. Databases included MEDLINE, Embase and CINAHL, and focused on controlled intervention studies on healthy adults and those with chronic disease such as type 2 diabetes, cardiovascular disease and overweight. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed. Investigated intervention diets utilised whole lupin, lupin protein or lupin fibre, and outcomes were measured by markers of chronic disease, body weight and satiety. Quality assessment of results was performed using the Cochrane revised risk of bias tool. Overall, 21 studies with 998 participants were included: 12 using whole lupin, four used lupin protein and five lupin fibre. Beneficial changes were observed in 71% of studies that measured blood pressure, 83...

Research paper thumbnail of Dietitians’ Attitudes and Understanding of the Promotion of Grains, Whole Grains, and Ultra-Processed Foods

Nutrients

NOVA is a food-classification system based on four levels of processing, from minimally processed... more NOVA is a food-classification system based on four levels of processing, from minimally processed to ultra-processed foods (UPFs). Whole-grain-containing commercial breads and ready-to-eat breakfast cereals are considered ultra-processed within NOVA, despite being considered core foods in the Australian Dietary Guidelines. These food categories contribute the greatest quantities of whole grain in the Australian diet, although consumption is less than half of the 48 g/day daily target intake. Dietitians are key to disseminating messages about nutrition and health; therefore, an accurate understanding of whole grains and the effects of processing is critical to avoid the unnecessary exclusion of nutritionally beneficial foods. The aim was to utilise an online structured questionnaire to investigate dietitians’ attitudes to the promotion of grains and whole grains and understand their level of knowledge about and attitudes towards NOVA and the classification of specific whole-grain foo...

Research paper thumbnail of Legumes—A Comprehensive Exploration of Global Food-Based Dietary Guidelines and Consumption

Nutrients

Despite the well-known human and planetary health benefits of legumes, consumption is often low. ... more Despite the well-known human and planetary health benefits of legumes, consumption is often low. This scoping review aimed to evaluate the inclusion of legumes in global food-based dietary guidelines (FBDG), and to review consumption data against global food group classifications for legumes. The review of FBDG from 94 countries identified legume-based key messaging, the key terms used to define legumes, recommended serving size and frequency of consumption and the classification of legumes into food groups as depicted by food guides. The 2018 Global Dietary Database isolated consumption data of legumes and beans using individual-level, nationally representative dietary survey data for matched countries. Food-based dietary guidelines from 40/94 countries most often identified legumes utilising the term legumes, followed by beans (n = 13), pulses (n = 10), or as beans, peas and lentils (n = 5). The serving size recommendations for legume consumption varied widely, and there was no co...

Research paper thumbnail of Consumer Understanding of the Australian Dietary Guidelines: Recommendations for Legumes and Whole Grains

Nutrients

Dietary guidelines provide evidence-based guidance for healthy individuals to improve dietary pat... more Dietary guidelines provide evidence-based guidance for healthy individuals to improve dietary patterns, although they are most often based on individual foods or food groups. Legumes are a class of food included in current Australian Dietary Guidelines (ADG), mentioned in two of the five food groups, as a vegetable and as an alternative to meat. Whole grain consumption is encouraged in ADG via the statement focused on cereal grains due to their health-promoting properties. Despite their prominence in guidelines, average legume and whole grain consumption in Australia remains lower than recommendations outlined in the ADG. This exploratory study aimed to understand consumer perspectives of wording utilised in dietary guidelines specifically focused on legumes and whole grains. Based on the analysis, there was a significant preference for the statement “each day, consume at least one serve of legumes either as a serve of vegetables or as an alternative to meat” (p < 0.05), which pr...

Research paper thumbnail of Nutrition economics: Four analyses supporting the case for whole grain consumption

Journal of Cereal Science, 2022

Research paper thumbnail of OUP accepted manuscript

Alcohol And Alcoholism, 2020

Aim The aim of this study was to describe the characteristics and the nutritional approaches impl... more Aim The aim of this study was to describe the characteristics and the nutritional approaches implemented with patients undergoing alcohol withdrawal. Methods A retrospective analysis of medical records for patients admitted to a tertiary hospital for alcohol withdrawal was completed over a 5-year period 2013–2017. Data on nutrition-related assessment and management were extracted and descriptively analysed. Results A total of 109 medical records were included (M = 73, F = 36), with the mean age of patients 47.3 years (SD ± 11.2, range 22–70). The average length of stay was 3.7 days (SD ± 3.9, range 0.70–27.8). Approaches towards nutritional care emerged from micronutrient assessment and supplementation and/or dietetic consultation. Nutrition-related biochemistry data was available for most patients, notably serum levels of sodium, urea and creatinine (102 patients; 93.5%) and magnesium and phosphate (66 patients, 60.5%). There was evidence of some electrolyte abnormalities on admiss...

Research paper thumbnail of Legume Intake Is Associated with Potential Savings in Coronary Heart Disease-Related Health Care Costs in Australia

Nutrients

Legume intake has been associated with lower risk for a number of chronic disorders of high finan... more Legume intake has been associated with lower risk for a number of chronic disorders of high financial burden, and is advocated by dietary guidelines as an important part of healthy dietary patterns. Still, the intake of legumes generally falls short of the recommended levels in most countries around the world despite their role as an alternative protein source. The aim of this study was to assess the potential savings in costs of health care services that would follow the reduction in incidences of coronary heart disease (CHD) when adult consumers achieve a targeted level of 50 g/day of legumes intake in Australia. A cost-of-illness analysis was developed using estimates of current and targeted legumes intake in adults (age 25+ y), the estimated percent reduction in relative risk (95% CI) of CHD following legumes intake, and recent data on health care costs related to CHD in Australia. A sensitivity analysis of ‘very pessimistic’ through to ‘universal’ scenarios suggested savings in...

Research paper thumbnail of Healthcare Cost Savings Associated with Increased Whole Grain Consumption among Australian Adults

Nutrients, 2021

Many dietary guidelines emphasise “mostly” whole grain food choices as part of an overall healthy... more Many dietary guidelines emphasise “mostly” whole grain food choices as part of an overall healthy eating pattern based on evidence for enhancing nutritional status and reducing chronic disease. Still, countries including Australia fall short of their consumption targets. Furthermore, healthcare cost savings associated with increasing the consumption of whole grains in alignment with the Daily Target Intake (DTI) recommendation of 48 g are unknown. The aim of this study was to assess the potential savings in costs of healthcare and lost productivity associated with a reduction in the incidence of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD) through meeting the 48 g DTI recommendation for whole grains among the Australian adult population (>20 years). A three-step cost-of-illness analysis was conducted using input parameters from: 1) estimates of proportions of consumers (5%, 15%, 50%, and 100%) who would increase their current intake of whole grains to meet the...

Research paper thumbnail of Whole Grain Intakes Are Associated with Healthcare Cost Savings Following Reductions in Risk of Colorectal Cancer and Total Cancer Mortality in Australia: A Cost-of-Illness Model

Nutrients, 2021

Whole grain consumption has been associated with the reduced risk of several chronic diseases wit... more Whole grain consumption has been associated with the reduced risk of several chronic diseases with significant healthcare monetary burden, including cancer. Colorectal cancer (CRC) is one of the most common cancers globally, with the highest rates reported in Australia. Three servings of whole grains provide a 15% reduction in total cancer and 17% reduction in CRC risk; however, 70% of Australians fall short of this level of intake. The aim of this study was to assess the potential savings in healthcare costs associated with reductions in the relative risk of CRC and total cancer mortality following the whole grain Daily Target Intake (DTI) of 48 g in Australia. A three-step cost-of-illness analysis was conducted using input parameters from: (1) estimates of current and targeted whole grain intakes among proportions (5%, 15%, 50%, and 100%) of the Australian adult (≥20 years) population; (2) estimates of reductions in relative risk (with 95% confidence intervals) of CRC and total ca...

Research paper thumbnail of Leveraging partnerships to amplify whole grain messaging

Journal of Cereal Science, 2022

Research paper thumbnail of Lupins and Health Outcomes: A Systematic Literature Review

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Whole Grain Consumption and Inflammatory Markers: A Systematic Literature Review of Randomized Control Trials

Nutrients, 2022

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

Research paper thumbnail of Oat and Barley in the Food Supply and Use of Beta Glucan Health Claims

Nutrients, 2021

Beta glucan is a type of soluble dietary fibre found in oats and barley with known cholesterol-lo... more Beta glucan is a type of soluble dietary fibre found in oats and barley with known cholesterol-lowering benefits. Many countries globally have an approved beta glucan health claim related to lowering blood cholesterol, an important biomarker for cardiovascular disease. However, the use of these claims has not been examined. The aim of this study was to explore the range and variety of oat and barley products in the Australian and global market within a defined range of grain food and beverage categories and examine the frequency of beta glucan health claims. Australian data were collected via a recognised nutrition audit process from the four major Australian supermarkets in metropolitan Sydney (January 2018 and September 2020) and Mintel Global New Product Database was used for global markets where a claim is permitted. Categories included breakfast cereals, bread, savoury biscuits, grain-based muesli bars, flour, noodles/pasta and plant-based milk alternatives and information coll...

Research paper thumbnail of Back in Time for Breakfast: An Analysis of the Changing Breakfast Cereal Aisle

Breakfast cereal improves overall diet quality yet is under constant scrutiny with assertions tha... more Breakfast cereal improves overall diet quality yet is under constant scrutiny with assertions that the category has not improved over time. This study aimed to comprehensively analyse the category of breakfast cereals, the nutritional values, and health claims across eight distinct sub-categories at four time points (2013, 2015, 2018, and 2020). An audit of products from four major supermarkets in metropolitan Sydney (Aldi, Coles, IGA, and Woolworths) collected ingredient lists, nutrition information, claims and Health Star Rating (HSR) for biscuits and bites; brans; bubbles, puffs, and flakes; granola and clusters; hot cereal flavoured; hot cereal plain; muesli; breakfast biscuits. The median (IQR) were calculated for energy, protein, fat, saturated fat, carbohydrate, sugars, dietary fibre, and sodium for comparisons over time points by nutrient. Data from 2013 was compared with 2020 (by sub-category and then for a sub-section of common products available at each time point). Produ...

Research paper thumbnail of Beyond nutrients: classification of foods to identify dietary patterns for weight management

Research paper thumbnail of Fortification of grain foods and NOVA: the potential for altered nutrient intakes while avoiding ultra-processed foods

European Journal of Nutrition, 2021

NOVA is a food classification system describing a hierarchy from minimally processed to ultra-pro... more NOVA is a food classification system describing a hierarchy from minimally processed to ultra-processed foods (UPF). Research has associated intake of UPF with chronic diseases. In Australia, the primary sources of grains, both refined and whole, are breads and breakfast cereals, which are typically fortified. Most are classified as UPF, yet are recommended core foods according to the Australian Dietary Guidelines (ADG). This research aimed to identify if avoidance of ultra-processed grain foods would alter nutrient intakes in an Australian population and whether sample diets using substitute (non-UPF) foods would be likely to meet nutrient requirements. Quantitative analysis of usual nutrient intake from the National Nutrition and Physical Activity Survey 2011–12 (n = 12,153) for all foods including and excluding UPF. Dietary modelling examined the nutritional adequacy of sample diets aligned with the ADG and another containing replacements for UPF. We particularly focused on grain foods and meeting whole-grain intake targets. There was a significant decrease (all p < 0.05) in modelled intake of key nutrients when UPF were excluded, specifically, thiamin, folate and iodine, as substitutions are rarely fortified. Diets with no UPF, where substitutes are carefully chosen, have the potential to meet Nutrient Reference Values, but deviation from customary food choices may mean adoption of substitutes is unlikely. Exclusion of UPF may result in lowered intakes of key nutrients of particular concern for at risk groups (including women of child-bearing age), negating gains made by public health policy of fortification. Substitutions may not be realistic in these at-risk populations.

Research paper thumbnail of The Changing Landscape of Legume Products Available in Australian Supermarkets

Nutrients, 2021

Evidence supports regular dietary inclusion of legumes due to their positive effects on both huma... more Evidence supports regular dietary inclusion of legumes due to their positive effects on both human and planetary health. Intake within Australia is suboptimal, with consumer data suggesting that an inability to integrate legumes into usual dietary patterns is a barrier to consumption. This places the food industry in a unique position to offer Australians the ability to incorporate legumes into usual dietary patterns via innovative new products. The aim of this study was to explore the legume category and compare nutrition product data and the use of nutrition and health claims between 2019 and 2021. An audit of legume products from four major metropolitan Sydney supermarkets (Aldi, Coles, IGA, Woolworths) collected ingredient lists, nutrition information and on-pack claims for baked beans, legume dips, legume flours, legume snacks (including subcategories of legume chips and whole legume snacks), canned legumes, dried legumes, frozen legumes, and pulse pasta. The total number of le...