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SDG 2

Chemical and physical characteristics of grain related to variability in energy and amino acid availability in pigs: a review
17 October 2007
University of Sydney

van Barneveld, Robert

To optimise pig production, there is a need to define the variation in the available energy and amino acid content of feed grains and to understand those factors that influence nutritive value. Differences of up to 3.7 MJ/kg dry matter (DM) in digestible energy (DE) content were observed following a review of data for more than 70 cultivars of wheat. Similarly, analysis of data for more than 125 cultivars of barley revealed a range in DE estimates from 11.7 to 16.0 MJ/kg DM. Differences of this magnitude are economically significant to pig producers. Cultivar has a minimal effect on the availability of energy and amino acids in cereals, although this variation is larger in legumes, particularly lupins. The cultural conditions and agronomic practices (e.g. fertiliser rate) have a greater influence on amino acid and energy availability than the growing region or the growing year. Many factors are shown to influence the availability of energy and amino acids in feed grains, including protein source and type, starch characteristics, fat source and type, non-starch polysaccharide components, and anti-nutritional factors. Although all of these factors can influence the nutritive value of a feed grain for pigs in some way, the availability of energy and amino acids will ultimately depend on the particular combination of these components in a grain and how they behave in the presence of nutrients from other feed ingredients. For this reason, an understanding of the factors that influence the nutritive value of feed grains is more likely to eventuate when multiple regressions of grain components are made against the availability of energy and amino acids.
Genotype and environment effects on feed grain quality
01 April 2008
University of Sydney

O'Brien, L

The extent of genotype and location effects on chemical composition and nutritive value of grains fed to animals was surveyed. The review covered the winter cereals (wheat, barley, oats, and triticale), the summer cereals (sorghum and maize), and the pulses (field pea, lupins, faba beans, and chickpea) when fed to cattle, sheep, poultry, pigs, rats, and mice. The bulk of the literature does not meet the statistical criteria required to differentiate genotype and environment effects. When the criteria were satisfied, significant genotype differences were shown to exist for chemical composition in wheat, barley, triticale, and sorghum, for nutritive value as determined by methods in vitro in wheat, barley, oats, triticale, and sorghum and in vivo for wheat, barley, triticale, sorghum and maize. Valid comparisons across grain species are few, but in vitro gas production ranks wheat > oats > barley. Significant location, year, genotype × location, genotype × year, and genotype × location × year effects were reported for nutritive value for some grains. Wheat feeding trials with poultry indicate that environment can affect apparent metabolisable energy (AME) as much as, if not more than, genotype. A greater range in nutritive value appears to exist in barley than in wheat. The information is unclear in the case of triticale, where despite some reports claiming that grain of this species has high lysine content, the difference does not appear to translate to improved performance in animals. Insufficient studies exist for oats despite it being one of the most widely used on-farm feed grains. No examples could be found of studies with rye. The most thoroughly researched grain has been sorghum, which is principally grown in developed countries for feeding to livestock. Here, some definitive studies have been conducted to define the extent of genotype, location, and genotype × environment interaction effects. Scope exists to enhance the nutritive value of sorghum by breeding through modification of endosperm composition, tannin content, and improved protein digestibility. Variation in endosperm composition in maize due to simply inherited mutations provides the opportunity to improve its nutritive value. This review indicates that before any plant breeding is undertaken for feed grain quality, a better understanding of what determines nutritive value and the relative importance of genotype and environment in modulating these factors is required.
Cereal structure and composition
01 April 2008
University of Sydney

Evers, A. D;Blakeney, A. B;O'Brien, L

Cereals are cultivated grasses that are grown throughout the world. As well as providing food for man, they, or fractions derived from processing them, make an important contribution to the diets of farm stock. Cereal grains have a long storage life under favourable conditions because they are harvested at a relatively low moisture content and comprise stable components. The principal energy sources within the grains are protected from infestation by outer coverings that are difficult to penetrate and in some cases unpalatable components in the coverings discourage predation by wild populations. The largest morphological component of all grains is the starchy endosperm, and approximately 80% of this is starch, occurring as microscopical granules with forms characteristic of the species. Also characteristic of the species are the storage proteins, which make the next largest contribution to endosperm dry weight. Proteins are important both as nutrients and by virtue of the fact that the class includes enzymes which, although making a small contribution to grain weight, can have a marked effect on grain quality and hence price. Other chemical components present as minor contributors, but with potential for exerting significant nutritional influence, are phytates and tannins, and current knowledge of these is briefly discussed. The walls of endosperm cells comprise a complex mixture of polysaccharides including cellulose, arabinoxylans, and β-glucans, as well as proteins and esterified phenolic acids. Attention is drawn to the difficulty in defining ‘fibre’ as it is method- or function-dependent and includes contributions from the endosperm cell wall components as well as the lignified walls of cells in the outer protective pericarp and the contents and cuticle of the testa.
Chemical and physical characteristics of grains related to variability in energy and amino acid availability in poultry
01 April 2008
University of Sydney

Hughes, R. J;Choct, M

Grains such as wheat and barley, combined with legumes and oilseed meals, provide not only the bulk of essential nutrients for commercial poultry production and reproduction, but are also the prime source of anti-nutritive components, which are likely to have significant bearing on how effectively all dietary components are utilised by poultry. Sources of variation in the physical and chemical characteristics of grains used in poultry diets include variety, seasonal effects, and growth sites, crop treatment and grain fumigants, and post-harvest storage conditions and period of storage. The available energy and protein contents of grains fed to poultry, which best represent nutritive value, are extremely wide and in consequence there is an urgent need to develop rapid and objective tests for the assessment of nutritive value prior to including grains in poultry diets. Variation in the available energy and protein content of grains can be attributed to a wide range of anti-nutritive factors such as non-starch polysaccharides (NSP), enzyme activity, tannins, alkyl resorcinols, protease inhibitors, α-amylase inhibitors, phytohaemagglutinins, alkaloids, saponins, and lathyrogens. The relative importance of such factors will also differ according to the type of grain in question. However, NSP seem to be the predominant factor in Australia over the past few years given the volume of published literature on this topic. This argument is strongly supported by the fact that NSP-degrading enzymes are routinely used in monogastric diets with great success throughout the world. Numerous attempts over a long period have failed to provide unequivocal evidence that nutritive value in grains for poultry can be predicted with sufficient accuracy and precision by simple, low-cost physico-chemical measurements used singly or in combination. Nevertheless, it is highly desirable to continue to explore these simple measurements in the expectation that useful statistical relationships with more complex measurements will emerge, or that simple measurements can be used to fine-tune prediction equations based on more powerful techniques such as near infrared spectrophotometry. Finally, the nutritive value of grains for poultry will be determined not only by the chemical and physical properties of grains but also by the way that these interact with the processes of ingestion, digestion, absorption, and metabolism in birds. For this reason it is imperative that plant and animal scientists join forces to improve the nutritive value of plant material as feed for animals for the benefit of grain growers and producers of livestock.
Processing cereal grains for animal feeding
01 April 2008
University of Sydney

Rowe, J. B;Choct, M;Pethick, D. W

This review concentrates on factors influencing the nutritive value of cereal grains for animals and strategies, in particular processing and storage, which may be used to optimise fermentation and digestion. The main focus is on the utilisation of starch in cereal grains by ruminants. Extensive comparisons have been made between grains and between animals to understand the reasons for differences in pattern of fermentation and/or intestinal digestion in response to a range of processing techniques. In addition, differences between the animal species have been reviewed to understand further the factors critical for maximising post-ruminal starch digestion.
Methods for the analysis of premium livestock grains
01 April 2008
University of Sydney

Petterson, D. S;Harris, D. J;Rayner, C. J;Blakeney, A. B;Choct, M

The literature contains a wide range of reported values for the content of most chemical constituents of feed grains and meals. It is not possible to assess accurately how much of this variation is due to genotypic and environmental factors and how much to differences in methodologies between laboratories. We have reviewed the literature for the preparation and analysis of feed grains (cereals, legumes, and oilseeds) and made recommendations for procedures considered to give the most accurate and reliable results. Recommendations are also made for a quality assurance scheme, an inter-laboratory evaluation program, and the use of reference materials. Australia-wide adoption of these practices should ensure that any future variations observed can be ascribed to genotype and/or environment. This review is part of a national premium feed grains quality project which, in turn, is part of a program to provide more accurate and reliable information about the true value of our feed grains to the domestic and international feeds industries.
Increasing the utilisation of grain when fed whole to ruminants
01 April 2008
University of Sydney

Kaiser, A. G

Feeding grain whole to cattle generally results in a lower digestibility than that obtained with processed grain. If this problem could be overcome, feeding with whole grain would reduce processing costs, and the slower rate of starch digestion in the rumen could improve fibre digestion with potential beneficial effects on intake and animal production. Two strategies are available to increase the digestibility of whole grain. The first, longer term strategy relies on the selection or breeding of feed grains that are efficiently digested by cattle when fed whole. The review considers the chemical and physical properties of grains likely to increase the degree of grain damage during mastication, and increase the digestibility of the seed coat fraction. Research is required to determine the feasibility of selecting feed grains with these characteristics. The second strategy is to treat whole grain with chemicals or enzymes to increase digestibility of the seed coat and consequently whole grain digestion within the rumen. Considerable research has been conducted on the sodium hydroxide (NaOH) treatment of grain, and there is sufficient evidence from cattle experiments to indicate that digestibility, liveweight gain, and milk production on NaOH-treated whole grain can be similar to that on rolled grain, provided sufficient NaOH is applied. However, a number of practical and commercial considerations have limited the more widespread adoption of this technology on farms. Although ammonia treatment offers a more practical alternative to NaOH, digestibility and animal production responses have been highly variable, and research is required to identify effective ammoniation procedures. The increased availability of enzymes for livestock feeding has potentially provided another grain treatment option. The application of fibrolytic enzymes to whole grain prior to high-moisture storage or feeding, and their subsequent effect on grain digestibility, require research. The impact of grain characteristics, both physical and chemical, on the response to alkali or enzyme treatment also requires research.
Associative effects between forages and grains: consequences for feed utilisation
01 April 2008
University of Sydney

Dixon, R. M;Stockdale, C. R

Intake of metabolisable energy (ME) when forages and grains are fed together to ruminants may, due to digestive and metabolic interactions, be lower or higher than expected from feeding these components separately. These interactions, or associative effects, are due primarily to changes in the intake and/or the digestibility of the fibrous components of forage. Effects on voluntary forage intake (substitution effects) are usually much larger than on the digestibility of fibrous components, although the changes in forage intake may be a consequence of changes in the rate of digestion of the fibrous components. Positive associative effects, where grains increase voluntary intake and/or digestion of forage, are usually due to the provision of a limiting nutrient (eg. nitrogen, phosphorus) in the grain which is deficient in the forage. Negative associative effects, where grains decrease voluntary intake and/or digestion of forage, occur frequently and can cause low efficiency of utilisation of grain. Rate of substitution of grain for forage is related to forage intake, forage digestibility, the proportion of grain in the diet, and the maturity of the animal. Substitution rates are usually high in ruminants consuming high intakes of forage of high digestibility, probably due to the metabolic mechanisms which control voluntary intake reducing forage intake. Substitution rates are often low when animals are consuming forage of low to medium digestibility. Since voluntary intake of such forages is most likely determined by the capacity of the rumen to accommodate and pass to the lower gastrointestinal tract undigested forage residues, and of the rate of forage fibre digestion in the rumen, substitution is likely to be determined by changes in these processes. Reduced rate of fibre digestion in the rumen is often due to low rumen pH and/or an insufficiency of essential substrates for rumen microorganisms. Use of grains for lactating dairy cows involves an additional constraint since dietary grain may severely reduce milk fat content. Negative associative effects can be alleviated by ensuring supply of essential microbial substrates, feeding management, and modification of grain to minimise their adverse effects on fibre digestion, while ensuring satisfactory digestion of the grain and efficient microbial protein production.
Potential methodologies and strategies for the rapid assessment of feed-grain quality
01 April 2008
University of Sydney

Wrigley, C. W

The efficient use of grains for animal feed requires the use of analytical methods that can provide rapid indications of the suitability of the grain for animal nutrition. Ideally, these methods need to be applied at the site of grain receival within the tight time and cost confines of grain delivery. In addition, methods are needed in plant breeding to efficiently screen for target aspects of feed-grain quality to facilitate the development of genotypes with improved nutritional quality. This review describes a range of techniques that can fulfil these analytical requirements. These include visual examination of grain samples for species identification and for recognition of defects and contaminants. This long-standing approach is rapid, but it is subjective and dependent on the expertise of the operator. The newer technology of image analysis offers the prospect of providing similar information automatically and quantitatively, without the risk of operator bias. Near-infrared (NIR) analysis is already in general use for grain analysis at many receival depots in wheat-growing countries, mainly for the determination of moisture and protein content. There are promising indications that NIR can be extended to the determination of many other aspects of grain composition, both the positive aspects that contribute to feed quality, as well as components such as beta-glucan content that have negative contributions for non-ruminants. Furthermore, NIR is being developed to provide a direct indication of metabolisable energy for a range of grain types. Whereas NIR is primarily suited to the determination of quantitatively major components of the grain, without the requirement of significant sample preparation, immunological analyses are appropriate for the determination of specific and minor components, such as mycotoxins, lectins, alkaloids, and pesticide residues. These and other methods, suited for on-site analysis, need to be combined with effective sampling to ensure that the results of testing are representative of the whole of the grain consignment, and also integrated into a systematic strategy to ensure cost-effective testing.
Comparison of methods used to predict the in vivo digestibility of feeds in ruminants
01 April 2008
University of Sydney

Kitessa, S;Flinn, P. C;Irish, G. G

Digestibility is a very useful index of the energy content of ruminant feeds, but cheaper and quicker laboratory methods are required as an alternative to the ultimate measure of in vivo digestibility using animals. These methods involve either prediction of digestibility from chemical composition or in vitro and in situ simulation of the digestion process. This review presents a range of chemical and in vitro techniques for predicting digestibility, together with an assessment of their advantages and limitations, particularly the degree to which they account for the sources of variation in in vivo digestibility in ruminants. In situ digestion of feed samples in the actual rumen environment is probably the most accurate of the non in vivo procedures, but is not suitable for routine application. Thein vitro gas production technique offers no advantages in prediction of total tract digestibility, but is useful for screening cereal grains for rate of starch hydrolysis in the rumen. The preferred procedure for routine laboratory prediction of digestibility is the pepsin-cellulase technique, provided amylase is included or high temperature digestion is used for samples high in starch content. Prediction of digestibility from chemical composition is not recommended. The optical technique of near infrared reflectance spectroscopy can be calibrated against any of the methods outlined in this review, and is unsurpassed in terms of speed and repeatability. Direct NIR prediction of in vivo digestibility is also possible, but is limited by the lack of adequate numbers of feed samples with known in vivo values. Future work should be aimed at filling this gap and also improving the accuracy of laboratory methods for predicting the digestibility of low quality feeds
An assessment by in vivo methods of grain quality for ruminants
01 April 2008
University of Sydney

Hogan, J. P;Flinn, P. C

For the purpose of this review, grain quality refers to the efficiency with which a grain supports growth in cattle fed diets which contain grain as a major component. Grains are fed as concentrated sources of energy. Their quality depends on the energy content of the grain, the amount eaten, and the efficiency, both of extraction of nutrients from the diet and of conversion of nutrients to weight gain. This paper briefly describes the fermentative and digestive processes involved in releasing energy from grain and in ensuring an adequate supply of other essential nutrients to the animal. Methods are then described for measuring net energy storage, nutrient release in various sections of the tract, and storage of energy and protein both directly and indirectly in studies of growth. It is recommended that in vivo assessment of the energy content of grains for ruminants be conducted in stages. Digestibility in the whole tract should be used to rank a range of grains, then comparisons made between grains using growth studies. Discrepancies arising from these assessments should then be investigated using more detailed measurements, particularly starch digestion in the stomach and intestines.
A review of methods for assessing the protein value of grain fed to ruminants
01 April 2008
University of Sydney

White, Colin;Ashes, John

The protein value of feed grains for ruminant rations is currently described in modern feeding systems in terms of total protein, potentially degradable protein, and potentially undegradable protein. Progress is being made towards full standardisation of methods to measure these components, although it is a goal yet to be achieved. Whereas in the future it is desirable that protein value be defined in terms of individual amino acid availability at the intestine, in the immediate term it can best be described by the rate and extent of degradability of protein in the rumen and the availability in the intestine of the rumen undegraded protein. Refining the methodology for measuring these characteristics is important, but it is equally important that the existing methods be validated using in vivo experimentation.
In vitro techniques for the assessment of the nutritive value of feed grains for pigs: a review
01 April 2008
University of Sydney

Moughan, Paul

The philosophy inherent in developing in vitro digestibility assays for dietary energy and protein is reviewed and an historical account is given of the development of such assays for the pig. General principles to be considered in the development of in vitro digestibility assays are discussed, as are limitations of the in vitro approach. The importance of choosing the most appropriate in vivo measures of digestibility for the evaluation of in vitro assays is stressed. For protein sources that do not contain anti-nutritional factors or plant fibre, ‘true’ ileal digestibility should be the in vivo baseline, while plant proteins should be tested against ‘real’ ileal digestibility. There is a dearth of adequately conducted validation studies for in vitro digestibility assays. It appears that the 3-step (pepsin, pancreatin, Viscozyme) closed in vitro system to allow prediction of organic matter and gross energy digestibility in the pig has particular promise for practical feed evaluation. Similarly based protein digestibility assays may require further development before they can be applied with confidence.
Amino acid availability in poultry - in vitro and in vivo measurements
01 April 2008
University of Sydney

Ravindran, V;Bryden, W. L

Methodology to evaluate the protein quality or amino acid availability in feed ingredients for poultry using in vitro (enzymic, chemical, or microbiological assays), indirect in vivo (plasma amino acid assays), or direct in vivo (growth or digestibility assays) measurements has been reviewed. The specific applications and limitations of these methods are examined. In vitro assays are useful in providing information on heat damage in selected protein sources under defined conditions, and on relative ranking of different samples, but they cannot form the basis of practical feed formulations. While growth assays remain the only direct means of confirming nutritional relevance of values obtained by other procedures, in vivo digestibility assays appear to be most useful, at present, to estimate amino acid availability. Amino acid digestibility assays in poultry should be based on the analysis of digesta from the terminal ileum rather than excreta, because of the variable and modifying effects of hindgut microflora. Techniques used to estimate endogenous amino acid losses in poultry are discussed. The needs for correction of endogenous losses in amino acid digestibility calculations and the relative merits of apparent and true digestible amino acid systems are still being debated. It is, however, clear that both digestible amino systems are superior to the total amino acid system currently employed to formulate practical diets. Digestible amino acid values are likely to form the basis of poultry feed formulations in the future. In particular, there is an urgent need for more precise information on the variation in digestible amino acid contents of locally grown ingredients and on the factors causing this variation (e.g. variety, location, season, agronomic practices, processing, etc.).
Chemical and physical characteristics of grains related to variability in energy and amino acid availability in ruminants: a review
01 April 2008
University of Sydney

van Barneveld, Samantha

This paper reviews the carbohydrate, protein, lipid, anti-nutritional, and physical characteristics of grains that determine the variability in their nutritional quality for ruminant animals. The amount, rate, and extent of starch fermentation in the rumen have been the subject of many studies, with large variation found between and within grain species. Electron microscopy scanning techniques have shown that the protein matrix limits the microbial colonisation of starch granules in some grain species, whereas in others it may be the structural carbohydrates that affect colonisation. The composition of the different fibre fractions of grains and their interaction with non-fibre carbohydrates requires investigation, since it has been shown that non-starch polysaccharides, including neutral detergent fibre and acid detergent fibre, may not be specific enough to predict animal response to grain. Fermentation patterns of the non-starch polysaccharide components of legumes are also poorly understood and hence require further investigation. Different varieties of grain and different seasonal conditions show variation in the protein fractions of the kernel. Since these fractions display different solubility and degradation rates in the rumen, rumen solubility values cannot be generalised for grains. The variability in solubility caused by rumen flow rate and pH is a further complication. Finally, the lipid content of grains varies greatly, with high-oil grains potentially contributing to the energy level of the diet, but possibly negatively affecting rumen fermentation. Due to the degree of variability of characteristics discussed in this review, it is clear that the nutritional quality of grains cannot be assessed in a single rapid assay.
Nutritional value of cereal grains for animals
02 April 2008
University of Sydney

Black, J. L

The energy value of cereal grains for livestock varies widely between grains and animal species. For example, the digestible energy content for pigs of wheat and barley grain ranges from 13.3 to 17.0 MJ/kg and 11.7 to 16.0 MJ/kg, respectively. However, the digestible energy content of sorghum grain for pigs shows little variation from 17.0 to 18.0 MJ/kg. Hughes & Choct reported a similar wide range across some grains in apparent metabolisable energy (AME) values for broiler chickens, being from 10.4 to 15.9 MJ/kg for wheat, 10.4 to 13.5 MJ/kg for barley and 8.6 to 16.6 MJ/kg for triticale. The chicken AME values for sorghum and maize, again, show a small range from only 15.6 to 16.1 MJ/kg, with a similar small range for oat grain (11.8 to 12.4 MJ/kg). Significant variation exists between grains in the digestibility of starch within the rumen of cattle, being 0.92 for oat grain, 0.65 for maize and 0.62 for sorghum starch. There are also striking differences between animal species in their capacity to digest cereal starch. The digestibility of sorghum starch across the whole digestive tract of poultry is extremely high (0.99) compared with 0.87 for cattle and 0.30 for horses. Reasons for these observed differences in the energy value of cereal grains are discussed.
The nutritive value of frosted wheat for sheep
28 July 2008
University of Sydney

Richardson, E. C;Kaiser, A. G;Piltz, J. W

The effect of frosting on the nutritive value of wheat grain was determined in a digestibility experiment with sheep. Thirty-six Merino wethers were maintained on diets of lucerne chaff (30%) and whole wheat grain (70%) which was sourced from either severely frosted (SF), lightly frosted (LF) or unfrosted (UF) crops. The experiment was conducted in a repeated balance study with 8 replications per treatment diet for each of the 7 treatment diets, new animals were assigned to the chaff control (treatment diet 8). The diets were offered at the liveweight maintenance level of feeding and the digestibility of the wheat component was calculated by adjusting for the digestibility of the lucerne component. Frosting had a relatively small effect on the nutritive value of wheat grain for sheep. Dry matter digestibility for UF, LF and SF wheats did not differ significantly (0.886, 0.854 and 0.839, respectively), although the SF wheat had a lower digestibility than the UF wheat at P<0.10. The organic matter digestibility, digestible organic matter in the dry matter and estimated metabolisable energy (ME) content were all significantly (P<0.05) lower for SF compared with UF wheat grain (0.856v. 0.908, 0.859v. 0.915 and 13.5v. 14.3 MJ/kg DM respectively). This study demonstrated that wheat from the severely frosted wheat crop had a lower estimated ME content of about 1 MJ/kg DM (equivalent to about 6% less ME) than wheat from the unfrosted crop fed in this study. However, the resultant ME of all samples fed fell within the normal observed ME range for wheat.
Increasing the frequency of breakfast consumption
12 October 2011
University of Sydney

Kothe, Emily Jane;Mullan, Barbara A

Purpose – A number of interventions aimed at increasing breakfast consumption have been designed and implemented in recent years. This paper seeks to review the current research in this area with the aim of identifying common features of successful interventions and strengths and weaknesses in the current research methodology. Design/methodology/approach – A systematic review of interventions aimed at increasing breakfast-eating frequency in a non-clinical sample was conducted. Findings – A total of 11 interventions were identified and reviewed; of these, only three resulted in an increase in breakfast consumption at follow-up. The three studies that were successful in changing breakfast consumption all included a psychosocial component that was successful in increasing positive attitudes towards nutrition in the intervention protocol. Many of the breakfast-eating interventions included in this review have methodological weaknesses, including difficulties in implementing interventions, small sample sizes, and selection biases, which future researchers should consider when designing and evaluating their own interventions. Research limitations/implications – These findings highlight the importance of including psychosocial components in interventions designed to increase breakfast consumption, while also signalling issues that should be addressed when designing and reporting future interventions. Originality/value – This review was the first to investigate the efficacy of interventions aimed at increasing breakfast consumption. The identification of weaknesses in the current body of research, and of successful and unsuccessful intervention practices is an important step in developing successful interventions in the future.
Response Rate and Reinforcement Rate in Pavlovian Conditioning
20 October 2011
University of Sydney

Harris, Justin A

Four experiments used delay conditioning of magazine approach in rats to investigate the relationship between the rate of responding, R, to a conditioned stimulus (CS) and the rate, r, at which the CS is reinforced with the unconditioned stimulus (US). Rats were concurrently trained with four variable-duration CSs with different rs, either as a result of differences in the mean CS-US interval or in the proportion of CS presentations that ended with the US. In each case, R was systematically related to r, and the relationship was very accurately characterized by a hyperbolic function, R = Ar/(r+c). Accordingly, the reciprocal of these two variables – response interval, I (=1/R), and CS-US interval, i (=1/r) – were related by a simple affine (straight line) transformation, I = mi+b. This latter relationship shows that each increment in the time that the rats had to wait for food produced a linear increment in the time they waited between magazine entries. We discuss the close agreement between our findings and the Matching Law (Herrnstein, 1970), and consider their implications for both associative theories (e.g., Rescorla & Wagner, 1972) and non-associative theories (Gallistel & Gibbon, 2000) of conditioning.
An Extension of the Theory of Planned Behavior to Predict Immediate Hedonic Behaviors and Distal Benefit Behaviors
04 June 2012
University of Sydney

Collins, Anna;Mullan, Barbara

The importance of understanding different behaviortypes is fundamental to changing patterns of dietary consumption toward optimal health. This study investigates fruit and vegetable (F&V) consumption as a distalbenefitbehavior and snacking as an immediatehedonicbehavior, within the framework of the theory of plannedbehavior (TPB; Ajzen, 1991). The model was extended to examine the predictive value of past behavior and self-regulatory ability across these two dietary behaviors. A total of 190 undergraduate students from an Australian university were administered two online questionnaires over two measurement points with 1-week interval. At time one, participants completed TPB questionnaires and a behavioral measure of self-regulation. At time two, self-reported dietary behavior was measured. Multiple and hierarchical regression analyses showed that the TPB model significantly predicted intention to perform both dietary behaviors and intention significantly predicted both behaviors. However consistent with hypotheses, there was a large intention-behavior gap and the predictive value of the TPB differed depending on whether the behavior had immediate vs. distal rewards. When past behavior was added to the model, intention was a significant predictor for the hedonicbehavior, but not for the distalbehavior. Differences in the predictive variables for the two behavior types suggest that the distalbenefitbehavior vs. immediatehedonicbehavior distinction may be useful when designing interventions by considering the temporal element of health decision-making.
Consumer food-safety education for the domestic environment: a systematic review
05 June 2012
University of Sydney

Milton, Alyssa;Mullan, Barbara

Purpose Despite the recognised importance of food-safety, a large number of consumers do not practice adequate food-safety in the home. Many studies have recommended that education is a key step in preventing food borne illness in the domestic environment. However, few educational or psychosocial interventions have been designed and implemented to improve food-safety knowledge, attitudes and behaviours. Even fewer of these studies have been subject to rigorous appraisal. A systematic review of studies that described and evaluated a food-safety intervention in a non-clinical adult sample was conducted. Design/methodology/approach A total of ten studies met the criteria for inclusion in the systematic review. Outcomes of interest included food-safety behaviour, behavioural intention, attitudes, knowledge, microbial transfer and the use of Social Cognition Models. Findings The evidence regarding the effectiveness of the reviewed interventions on these food-safety outcomes was somewhat positive, however, many gaps remained. For example, of the 5 self-report behaviour change studies all reported some significant improvement post intervention. However, the percentage of specific behaviours that significantly changed within each study varied between 0.04 to 100%. There were methodological flaws in many of the studies which complicated the interpretation of these results and indicate a need for more research. Research limitations/implications Future research should include better defined outcomes, longer follow-up, more rigorous reporting of results and intervention design, the use of randomised controlled trial protocols, and utilising health models to have a greater theoretical underpinning to the studies. Originality/value This is the first systematic review examining the effect of psychosocial food-safety interventions on behaviour, attitudes and knowledge.
A pilot evaluation of appetite-awareness training in the treatment of childhood overweight and obesity
26 June 2012
University of Sydney

Bloom, Taryn;Sharpe, Louise;Mullan, Barbara;Zucker, Nancy

Objective: The aim of this study was to conduct a preliminary evaluation of Children’s Appetite Awareness Training (CAAT), a treatment for childhood obesity which encourages overweight children to eat in response to internal appetite cues. Method: Overweight children (ages 6 – 12 years old) were randomized to either the CAAT treatment group (N=23), to receive one-hour treatment sessions over six weeks, or a wait-list group (N=24). Weight and height of children and parents in both groups were assessed at pre- and post-treatment (or equivalent time for wait-list control) and at a six-month follow-up for those in the CAAT group. Results: The intervention had a significant, short-term effect on the BMI of children who participated. Although at six-month follow-up, children’s BMI has not increased significantly, the difference between pre-treatment and follow-up BMI was no longer significant. Discussion: These results are encouraging for the use of CAAT with overweight children. Long-term effectiveness could be enhanced through increasing the duration of the program, adding booster sessions and increased involvement of parents.
Predicting adolescents' safe food handling using an extended theory of planned behavior
17 October 2012
University of Sydney

Mullan, Barbara A;Wong, Cara;Kothe, Emily Jane

The aim of this study was to investigate whether the Theory of Planned Behavior (TPB) with the addition of risk perception could predict safe food handling in a sample of adolescents from the UK and Australia over and above the explanatory power of knowledge. It was hypothesized that knowledge would predict both intention to prepare food safely and self-reported food hygiene behavior. It was expected that attitudes, subjective norm, perceived behavioral control and risk perception would predict intentions over and above knowledge. It was hypothesized that intentions and PBC would significantly predict food hygiene behavior over and above the influence of knowledge. Participants were recruited from secondary schools in Australia and the UK (n=205). Knowledge alone predicted 4% of intention and 1.4% of behaviour. TPB variable with the addition of risk perception accounted for an additional 60% of the variance in intention. PBC and intention accounted for an additional 24% of the variance in behavior. Knowledge was not a significant predictor of intention or behaviour once other variables were added to the model these results provide further support for criticisms of interventions that have targeted food safety through knowledge based interventions. The results provide further support for the utility of the TPB in predicting safe food handling. The addition of risk perception added to the predictive utility of the model, suggesting that researchers may want to incorporate that factor into future considerations of food hygiene using the TPB.
A Framework For Monitoring Overweight And Obesity In NSW
12 November 2012
University of Sydney

Espinel, Paola;King, Lesley

Monitoring of population weight status is valuable in order to track changes and identify likely causes and implications, and to adjust policy and program priorities. A monitoring framework sets out what information should be collected, when and how it should be collected, and systems for the reporting of this information. The framework covers dietary behaviours, physical activity and sedentary behaviours, food environment factors, physical activity environment factors, socio-demographic and other factors.
Measuring Rural Food Environments Within Murrumbidgee Health Network, NSW: Methodology.
12 November 2012
University of Sydney

Boylan, Sinead;Innes-Hughes, Christine;Lobb, Elizabeth;King, Lesley

This document supplements the report on Measuring rural food environments within Murrumbidgee Local Health Network. This study has generated tools and protocols that can be disseminated and used in other locations, as well as information for the three study towns.
Measuring Rural Food Environments Within Murrumbidgee Health Network, NSW.
12 November 2012
University of Sydney

Innes-Hughes, Christine;Boylan, Sinead;Lobb, Elizabeth;King, Lesley

This report presents the results of a study which mapped food availability in three small rural towns in New South Wales on the topic of Food Fairness in disadvantaged towns. This small study designed and tested simple, specifically-designed tools for assessing food availability, and has generated tools and protocols that can be disseminated and used in other locations, as well as information for the three study towns.
A Junk Food Index for Children and Adolescents: Secondary Analysis of the NSW SPANS 2010
12 November 2012
University of Sydney

Grunseit, Anne;Hardy, Louise;King, Lesley;Rangan, Anna

The purpose of this report is to document the methodology used to develop a Junk Food Index for Children and Adolescents from data collected in the 2010 NSW Schools Physical Activity and Nutrition Survey (SPANS).
Magazine approach during a signal for food depends on Pavlovian, not instrumental, conditioning
08 May 2013
University of Sydney

Harris, Justin A;Andrew, Benjamin J;Kwok, Dorothy

In the conditioned magazine approach paradigm, rats are exposed to a contingent relationship between a conditioned stimulus (CS) and the delivery of food (the unconditioned stimulus, US). As the rats learn the CS-US association, they make frequent anticipatory head entries into the food magazine (the conditioned response, CR) during the CS. Conventionally, this is considered to be a Pavlovian paradigm because food is contingent on the CS and not on the performance of CRs during the CS. However, because magazine entries during the CS are reliably followed by food, the increase in frequency of those responses may involve adventitious (“superstitious”) instrumental conditioning. The existing evidence, from experiments using an omission schedule to eliminate the possibility of instrumental conditioning (Farwell & Ayres, 1979; Holland, 1979), is ambiguous: rats acquire magazine CRs despite the omission schedule, demonstrating that the response does not depend on instrumental conditioning, but the response rate is greatly depressed compared with that of rats trained on a yoked schedule, consistent with a contribution from instrumental conditioning under normal (non-omission) schedules. Here we describe experiments in which rats were trained on feature-positive or feature-negative type discriminations between trials that were reinforced on an omission schedule versus trials reinforced on a yoked schedule. The experiments show that the difference in responding between omission and yoked schedules is due to suppression of responding under the omission schedule rather than an elevation of responding under the yoked schedule. We conclude that magazine responses during the CS are largely or entirely Pavlovian CRs.
Purine-Rich Foods Intake and Recurrent Gout Attacks
31 January 2014
University of Sydney

Zhang, Yuqing;Chen, Clara;Choi, Hyon;Chaisson, Christine E;Hunter, David J.;Niu, Jingbo;Neogi, Tuhina

OBJECTIVE: To examine and quantify the relation between purine intake and the risk of recurrent gout attacks among gout patients. METHODS: The authors conducted a case-crossover study to examine associations of a set of putative risk factors with recurrent gout attacks. Individuals with gout were prospectively recruited and followed online for 1 year. Participants were asked about the following information when experiencing a gout attack: the onset date of the gout attack, clinical symptoms and signs, medications (including antigout medications), and presence of potential risk factors (including daily intake of various purine-containing food items) during the 2-day period prior to the gout attack. The same exposure information was also assessed over 2-day control periods. RESULTS: This study included 633 participants with gout. Compared with the lowest quintile of total purine intake over a 2-day period, OR of recurrent gout attacks were 1.17, 1.38, 2.21 and 4.76, respectively, with each increasing quintile (p for trend <0.001). The corresponding OR were 1.42, 1.34, 1.77 and 2.41 for increasing quintiles of purine intake from animal sources (p for trend <0.001), and 1.12, 0.99, 1.32 and 1.39 from plant sources (p=0.04), respectively. The effect of purine intake persisted across subgroups by sex, use of alcohol, diuretics, allopurinol, NSAIDs and colchicine. CONCLUSIONS: The study findings suggest that acute purine intake increases the risk of recurrent gout attacks by almost fivefold among gout patients. Avoiding or reducing amount of purine-rich foods intake, especially of animal origin, may help reduce the risk of gout attacks.
Gender differences in plasma ghrelin and its relations to body composition and bone – an opposite-sex twin study
18 March 2014
University of Sydney

Makovey, Joanna;Naganathan, Vasi;Seibel, Markus;Sambrook, Philip

Backgrond Ghrelin, a peptide hormone that plays a role in the regulation of appetite and body adiposity, may also play a role in bone metabolism. Objectives We used the opposite-sex twin model to study associations of plasma ghrelin levels with measures of bone mass and body composition, and determine how such associations were influenced by gender and age. Patients and measurements We measured total plasma ghrelin by radioimmunoassay (RIA) and bone mass/body composition parameters by dual energy X-ray absorptiometry in 79 pairs of opposite sex twins (n = 158 subjects). To examine the effect of age, the study population was divided by median age into two groups: under 51.2 years (38 pairs) and over 51.2 years (41 pairs). Results Women had higher plasma ghrelin levels than men (median 1063 vs. 869 ng/l, P 30) no significant gender differences in plasma ghrelin were found. Plasma ghrelin levels were not significantly associated with bone mineral density (BMD) generally, except for hip BMD in younger women (r = -0.39). Conclusion Plasma ghrelin levels are associated with age, gender, alcohol intake and fat mass measures but only weakly to bone mass measures.
It’s a dog’s life when man’s best friend becomes his fattest
06 August 2014
University of Sydney

Degeling, C

A study published this morning in Nature offers further insight into how dogs became domesticated. The comparative analysis of human, canine and wolf genomes suggests that humans and dogs have evolved in parallel as a response to the increasingly starchy diets on offer after the agricultural revolution. Such a wholesale change in diet has not necessarily been benign for either species. As our waistlines have expanded, so have those of our pet animals. In fact, the rising incidence of obesity in humans and dogs seems to be linked; people at high risk of obesity are more likely to own and care for an overweight canine companion.
Because we can, does it mean we should? The ethics of GM foods
08 September 2014
University of Sydney

Mayes, C

Food is cultural, social and deeply personal, so it’s no surprise that modifications to the way food is produced, distributed and consumed often lead to ethical debates. Developments in the genetic modification (GM) of foods and crops has resulted in a raft of controversies. Ethics can help here. While science determines whether we can safely modify the genetic makeup of certain organisms, ethics asks whether we should. Ethics tries to move beyond factual statements about what is, to evaluative statements about the way we should act towards ourselves, each other and the environment we inhabit. But things are not always so clear-cut. Three areas of ethics can help frame some of the concerns with GM food and crops: virtue, moral status and consequences.
Big Food with a regional flavour: how Australia’s food lobby works
08 October 2014
University of Sydney

Mayes, C;Kaldor, J

Criticism of the food industry has itself become a niche industry. But the tendency to embrace a US-centric conception of how the industry works risks masking local variants and inhibiting a targeted response in other countries. Since the 2001 book Fast Food Nation, a spate of books, films and documentaries on the American food industry have helped to shape the popular idea of “Big Food”. The food industry is depicted as a highly organised set of multinational food and beverage lobbyists peddling the global diet of sugary drinks and highly processed, energy-dense salty foods – akin to tobacco industry lobbyist Nick Naylor in the 2005 film Thank You For Smoking. But although it is highly globalised, the food industry is far from homogeneous. Big Food in Australia is not the same as the industry in the United States, where much of the popular media has come from. Still, that doesn’t mean Australian food and beverage lobbying is benign. Responding to the threat posed by the food industry to public health locally requires a clear understanding of food industry tactics in the context of Australia’s political and lobbying culture.
An Agrarian Imaginary in Urban Life: Cultivating Virtues and Vices Through a Conflicted History.
28 January 2015
University of Sydney

Mayes, C

This paper explores the influence and use of agrarian thought on collective understandings of food practices as sources of ethical and communal value in urban contexts. A primary proponent of agrarian thought that this paper engages is Paul Thompson and his exceptional book, The Agrarian Vision. Thompson aims to use agrarian ideals of agriculture and communal life to rethink current issues of sustainability and environmental ethics. However, Thompson perceives the current cultural mood as hostile to agrarian virtue. There are two related claims of this paper. The first argues that contrary to Thompson’s perception of hostility, agrarian thought is popularly and commercially mobilized among urban populations. To establish this claim I extend Charles Taylor’s notion of a social imaginary and suggest that urban agriculture can be theorized as an agrarian imaginary. Entwined with the first claim is the second, that proponents selectively use agrarian history to overemphasis a narrative of virtue while ignoring or marginalizing historical practices of agrarian violence, exclusion and dispossession. I do not discount or deny the significance of agrarian virtue. By situating agrarian thought within a clearer virtue ethics framework and acknowledging potential manifestation of agrarian vice, I suggest that the idea of agrarian virtue is strengthened. Keywords: Agrarian, Social imaginary, Urban agriculture, Virtue, Vice, Charles Taylor
Iwaidja Jurtbirrk songs: bringing language and music together
12 April 2015
University of Sydney

Barwick, Linda;Birch, Bruce;Evans, Nicholas

Song brings language and music together. Great singers are at once musi- cians and wordsmiths, who toss rhythm, melody and word against one another in complex cross-play. In this paper we outline some initial findings that are emerg- ing from our interdisciplinary study of the musical traditions of the Cobourg region of western Arnhem Land, a coastal area situated in the far north of the Australian continent 350 kilometres northeast of Darwin. We focus on a set of songs called Jurtbirrk, sung in Iwaidja, a highly endangered language, whose core speaker base is now located in the community of Minjilang on Croker Island. We bring to bear analytical methodologies from both musicology and linguistics to illuminate this hitherto undocumented genre of love songs.
Governing through choice: Food labels and the confluence of food industry and public health discourse to create ‘healthy consumers’
01 March 2016
University of Sydney

Mayes, C

Food industry and public health representatives are often in conflict, particularly over food labelling policies and regulation. Food corporations are suspicious of regulated labels and perceive them as a threat to free market enterprise, opting instead for voluntary labels. Public health and consumer groups, in contrast, argue that regulated and easy-to-read labels are essential for consumers to exercise autonomy and make healthy choices in the face of food industry marketing. Although public health and food industry have distinct interests and objectives, I argue that both contribute to the creation of the food label as a governmental strategy that depends on free-market logics to secure individual and population health. While criticism of ‘Big Food’ has become a growth industry in academic publishing and research, wider critique is needed that also includes the activities of public health. Such a critique needs to address the normalizing effect of neoliberal governmentality within which both the food industry and public health operate to reinforce individuals as ‘healthy consumers’. Drawing on Michel Foucault’s lectures at the Collège de France, I examine the food label through the lens of governmentality. I argue that the rationale operating through the food label combines nutrition science and free-market logics to normalize subjects as responsible for their own health and reinforces the idea of consumption as a means to secure population health from diet-related chronic diseases.
Movement of IS26-Associated Antibiotic Resistance Genes Occurs via a Translocatable Unit That Includes a Single IS26 and Preferentially Inserts Adjacent to Another IS26
07 March 2016
University of Sydney

Harmer, Christopher J;Moran, Robert A;Hall, Ruth M

TheinsertionsequenceIS26playsakeyroleindisseminatingantibioticresistancegenesinGram-negativebacteria, forming regions containing more than one antibiotic resistance gene that are flanked by and interspersed with copies of IS26. A model presented for a second mode of IS26 movement that explains the structure of these regions involves a translocatable unit consisting of a unique DNA segment carrying an antibiotic resistance (or other) gene and a single IS copy. Structures resembling class I transposons are generated via RecA-independent incorporation of a translocatable unit next to a second IS26 such that the ISs are in direct orientation. Repeating this process would lead to arrays of resistance genes with directly oriented copies of IS26 at each end and between each unique segment. This model requires that IS26 recognizes another IS26 as a target, and in transpo- sition experiments, the frequency of cointegrate formation was 60-fold higher when the target plasmid contained IS26. This re- action was conservative, with no additional IS26 or target site duplication generated, and orientation specific as the IS26s in the cointegrates were always in the same orientation. Consequently, the cointegrates were identical to those formed via the known mode of IS26 movement when a target IS26 was not present. Intact transposase genes in both IS26s were required for high- frequency cointegrate formation as inactivation of either one reduced the frequency 30-fold. However, the IS26 target specificity was retained. Conversion of each residue in the DDE motif of the Tnp26 transposase also reduced the cointegration frequency.
The A to Z of A/C Plasmids
11 March 2016
University of Sydney

Harmer, Christopher J;Hall, Ruth M

Plasmids belonging to incompatibility groups A and C (now A/C) were among the earliest to be associated with antibiotic resistance in Gram-negative bacteria. A/C plasmids are large, conjugative plasmids with a broad host range. The prevalence of A/C plasmids in collections of clinical isolates has revealed their importance in the dissemination of extended-spectrum β-lactamases and carbapenemases. They also mobilize SGI1-type resistance islands. Revived interest in the family has yielded many complete A/C plasmid sequences, revealing that RA1, designated A/C1, is different from the remainder, designated A/C2. There are two distinct A/C2 lineages. Backbones of 128-130 kb include over 120 genes or ORFs encoding proteins of at least 100 amino acids, but very few have been characterized. Genes potentially required for replication, stability and transfer have been identified, but only the replication system of RA1 and the regulation of transfer have been studied. There is enormous variety in the antibiotic resistance genes carried by A/C2 plasmids but they are usually clustered in larger regions at various locations in the backbone. The ARI-A and ARI-B resistance islands are always at a specific location but have variable content. ARI-A is only found in type 1 A/C2 plasmids, which disseminate blaCMY-2 and blaNDM-1 genes, whereas ARI-B, carrying the sul2 gene, is found in both type 1 and type 2. This review summarizes current knowledge of A/C plasmids, and highlights areas of research to be considered in the future.
Association of farm soil characteristics with ovine Johne's disease in Australia
11 April 2016
University of Sydney

Dhand, Navneet K.;Eppleston, Jeff;Whittington, Richard J.;Toribio, Jenny-Ann L.M.L.

Speculation about the association of soil characteristics with the expression of ovine Johne’s disease (OJD) prompted this cross-sectional study. We enrolled 92 sheep flocks in Australia during 2004-05 and in each enrolled flock collected pooled faecal samples from an identified cohort (group of same age and sex) of sheep and soil samples from the paddocks grazed by this cohort of sheep. Faecal pools were cultured to create three outcome variables: positive or negative status of faecal pools (pool OJD status, binary); the log number of viable Mycobacterium avium subsp. paratuberculosis (MAP) organisms per gram of faeces (log pool MAP number, continuous); and the prevalence of faecal shedders (cohort OJD prevalence level, ordinal: low 10%). Separate statistical models were then developed to investigate the association between soil characteristics and each outcome variable. Sheep raised on soils with a higher percentage of organic carbon and clay had a higher OJD prevalence whereas, sheep grazing on soils with a higher content of sand and nitrogen had a lower OJD prevalence. Iron content of the soil was positively associated with OJD infection but the association between soil pH and OJD was inconclusive. Parent soil type, the only farm level factor, was not significant in any of the final models. Study results indicate a higher risk of OJD in sheep raised on soils with greater organic matter and clay content. We hypothesise that this is due to adsorption of MAP to clay and the consequent retention of the bacteria in the topsoil, thus making them available in higher numbers to grazing sheep. Keywords: risk factors, paratuberculosis, mycobacterium, cross-sectional study, organic carbon, clay, sand, pH, iron.
Economic losses occurring due to brucellosis in Indian livestock populations.
11 April 2016
University of Sydney

Singh, B. B.;Dhand, Navneet K.;Gill, J. P. S.

Brucellosis is a serious public health issue in India. Estimation of economic losses occurring due to brucellosis is required to help formulate prevention and control strategies, but has not been done in India. We estimated economic losses due to brucellosis by sourcing prevalence data from epidemiological surveys conducted in India. Data for livestock populations were obtained from official records. Probability distributions were used for many of the input parameters to account for uncertainty and variability. The analysis revealed that brucellosis in livestock is responsible for a median loss of US $ 3.4 billion (5th–95th percentile 2.8–4.2 billion). The disease in cattle and buffalo accounted for 95.6% of the total losses occurring due to brucellosis in livestock populations. The disease is responsible for a loss of US$ 6.8 per cattle, US$18.2 per buffalo, US$ 0.7 per sheep, US$ 0.5 per goat and US$ 0.6 per pig. These losses are additional to the economic and social consequences of the disease in humans. The results suggest that the disease causes significant economic losses in the country and should be controlled on a priority basis. Keywords: bovine brucellosis; ovine brucellosis; porcine brucellosis; economic loss; India; developing countries; zoonoses; partial budgeting Highlights • This is the first systematic analysis of the economic losses occurring due to brucellosis in livestock populations in India. • The analysis revealed that brucellosis in livestock is responsible for a median loss of US $ 3.4 billion (5th–95th percentile 2.8–4.2 billion). • There is urgent need to formulate intervention policies for prevention and control of this disease in India.
Attachment accuracy of a novel prototype robotic rotary and investigation of two management strategies for incomplete milked quarters
12 April 2016
University of Sydney

Kolbach, R.;Kerrisk, K. L.;García, S. C.;Dhand, Navneet K.

Throughout 2009 and 2010, FutureDairy (Camden, NSW, Australia) was involved in testing a novel prototype robotic rotary (RR). The commercial version RR is expected to be capable of carrying out 90 milkings per hour. To achieve the high throughput the rotary rotates the cow to the cup attachment robot and then around the platform in a stop–start fashion. The robot does not remain with the cow during the entire milking process. When not all teat cups are attached during a milking session there is an opportunity for cows to be sent back to the waiting yard for a second milking attempt. The study presented here was designed to test whether or not the extension of the interval to a second milking attempt improved milking success of incompletely milked cows. It was expected that with an increased milking interval between the two subsequent milkings the changes to the udder conformation could positively affect the attachment success at the second attempt. The 1 h milking interval treatment (1 h) simulated cows being drafted directly back to the pre-milking waiting yard, whilst the 3 h milking interval treatment (3 h) was designed to simulate cows being drafted back after accessing post-milking supplementary feed on a feedpad. The results presented in this manuscript showed no significant difference between the frequencies of successful attachment in the second attempt between the 1 h and 3 h treatments indicating that a reasonable level of flexibility exists with management of incompletely milked cows and dairy layout designs. Milk production level affected the probability of success at second attempt, which was about 7.5 times higher in cows with an average milk production level greater than 19.3 kg than those with less than 10.8 kg. When looking at the total proportion of cows successfully milked after two attempts, it was found that successful milking was more likely in multiparous cows compared to primiparous cows. Highlights • We studied management options for incompletely milked cows on a robotic rotary. • Firstly cows returned to waiting yard with approx. 1 h interval between attempts. • Secondly cows returned to waiting yard via feed pad – approx. 3 h between attempts. • No difference found between 1 and 3 h intervals on attachment success. • Level of flexibility exists with management of incompletely milked cows. Keywords: Success-rate; Pasture based; Automatic milking system; Robotic rotary; Dairy
Factors affecting reproductive performance of dairy cows in a pasture-based, automatic milking system research farm: a retrospective, single-cohort study
12 April 2016
University of Sydney

Talukder, S;Celi, P;Kerrisk, K. L.;Garcia, S. C.;Dhand, Navneet K.

A retrospective single cohort study was conducted to identify production and health factors associated with reproductive performance in a pasture-based automatic milking system research farm. The calving system of this herd shifted from split calving to year round calving gradually during the study period. Data from 365 cows with 798 lactations were analysed in the study. Reproductive outcome variables of interest were intervals from calving to first oestrus, to first insemination, and to conception as well as number of inseminations per conception, probability of submission for insemination by 80 days in milk, probability of conception by 100 days in milk and probability of conception at first insemination. Production factors (milk yield and its composition; milking frequency), record of periparturient disease, parity and season of calving were considered as predictor variables. The associations between predictor and outcome variables were assessed by multivariable linear regression, logistic regression and survival analyses for quantitative, binary and time-to-event outcomes, respectively. Average milk yield and milking frequency during 100 days in milk were not significantly associated with any of the reproductive measures. The likelihood of conception by 100 days in milk decreased gradually with year of automatic milking systems commissioning. Cows calved in autumn were 43% (hazard ratio: 1.43, P < 0.05) more likely to conceive compared to cows that calved in summer. Multiparous cows were more likely (P < 0.05) to be recorded for oestrus compared to primiparous cows. Twinning was negatively associated with the reproductive outcomes measured in the automatic milking systems research herd. Milk yield and milking frequency during 100 days in milk had no effect on reproductive measures in the pasture-based automatic milking system research herd. Key words: Reproduction, Automatic Milking System, Pasture-Based System
Risk factors for congenital chondrodystrophy of unknown origin in beef cattle herds in south-eastern Australia
13 April 2016
University of Sydney

White, P. J.;Windsor, P. A.;Dhand, Navneet K.;Toribio, Jenny-Ann L.M.L.

A case control study was conducted on 46 farms in south eastern Australia with a recent history of congenital chondrodystrophy of unknown origin (CCUO) between 2002 and 2007. For each farm data was collected using face-to-face interviews concerning the management of case and control mobs during the gestation period in which affected calves were born. Data concerning the paddocks in which gestating cattle were maintained was also collected for analysis. Three separate multivariable models were constructed using generalised linear mixed models (GLMM). The first model was based on the dichotomous outcome of mob status (affected/not affected) and included explanatory variables for management and environment factors. The second model used a novel approach, taking into account the number of cases in affected mobs in order to utilise available data. The outcome events/ trials was used where the numerator was equal to the number of affected calves in a mob, and the denominator was equal to the total number of calves in the mob. The third model used the dichotomous outcome paddock status and included environmental and soil variables for paddocks involved with case and control mobs. Confounding for dam age and year affected was included in the mob outcome models, and random effects for paddock and farm were incorporated into the models. The birth of CCUO calves was associated with dams grazing native pastures on hilly terrain during gestation. Low levels of pasture were also associated with the outcome. The two models used for the mob outcome were similar in many respects. The events/trial model included the use of supplemental feed and an interaction term. This study demonstrates an association between a maternal nutritional disturbance and the occurrence of CCUO. Keywords: Risk factors, congenital chondrodystrophy, case control study, epidemiology, Australia
Biological variation and reference change values of feline plasma biochemistry analytes.
19 April 2016
University of Sydney

Baral, Randolph M.;Dhand, Navneet K.;Freeman, Kathleen P.;Krockenberger, Mark B.;Govendir, Merran

This is the first report concerning biological variation and reference change values of feline plasma biochemistry components in the peer-reviewed literature. Biological variation refers to inherent physiological variation of analytes. The ratio of individual biological variation to group biological variation is referred to as an analyte's index of individuality. This index determines the suitability of an analyte to be assessed in relation to population- or subject-based reference intervals. A subject-based reference interval is referred to as a reference change value or critical difference, and is calculated from individual biological variation. Fourteen cats were sampled for plasma biochemistry analysis once weekly for 6 weeks. Samples were stored and then tested at the same time. Results were assessed in duplicate and coefficients of variation for each analyte were isolated to distinguish variation within each subject, between all subjects and by the analyser. From these results, an index of individuality and reference change values were determined for each analyte. Five plasma biochemistry analytes (alkaline phosphatase, alanine aminotransferase, cholesterol, creatinine and globulin) had high individuality and, therefore, subject-based reference intervals are more appropriate; only one analyte (sodium) had low individuality, indicating that population-based reference intervals are appropriate. Most analytes had intermediate individuality so population-based reference intervals should be assessed in relation to subject-based reference intervals. The results of this study demonstrate high individuality for most analytes and, therefore, that population-based reference intervals are of limited utility for most biochemical analytes in cats.
Demographics and husbandry of pet cats living in Sydney, Australia: results of cross-sectional survey of pet ownership
02 May 2016
University of Sydney

Toribio, Jenny-Ann L. M. L.;Norris, J. M.;White, J. D.;Dhand, Navneet K.;Hamilton, S. A.;Malik, R

Our aim was to collect baseline data on the age, gender, breed, reproductive status and husbandry (housing, diet, vaccination, veterinary attention) of pet cats living in Sydney. Accordingly, a cross-sectional survey of 2768 households was conducted using a postal questionnaire. The 2006 Sydney residential phone book was used as the sampling frame. Non-responders were re-mailed the questionnaire on two further occasions, two and four weeks after the first postings. Completed questionnaires were received from 884 households. No pets were kept by 387 (43.8%) respondents. Dogs and cats were owned by 295 (33.4%) and 198 (22.5%) of households, respectively, with 7.8% of households having both cat(s) and dog(s). Fish and birds were the next most popular pets. Of the 198 cat-owning households, 54.0% kept only cat(s), while 46.5% kept cats with other pets. The distribution of cat ownership across Sydney was non-uniform. Each cat-owning household kept 1.3 cats on average, with the majority keeping one (75.8% households) or two (18.7%). For the 260 cats, the mean age was 7.1 years, the median 6 years, with a range of 3 months to 22 years. There were significantly more female (143; 55%) than male cats (117; 45%). Only 7 cats (2.7%) were sexually entire, and these were all ≤ 6-years. Crossbred cats outnumbered pedigree cats by a ratio of 3.3:1. The Burmese was the most common breed, followed by the Persian. The median age of pedigree cats (5.5 years) was significantly lower than for domestic crossbred cats (7.0 years). Most cats were housed both indoors and outdoors (72.6%), with 19.7% being restricted to indoors and/or “pet park enclosures”. Pedigree cats were significantly more likely than crossbreds to be housed indoors. Most cat owners fed their cats a combination of commercial dry and canned food (38.1%), although fresh meat was popular also and either fed alone (1.6%) or in combination with dry food (14.4%), tinned food (1.6%) or canned and dry food (25.8%). A diet consisting of dry food alone was fed to cats in 13.4% of households. Ninety percent of cats had been vaccinated at least once, while 72.2% received a vaccination in the last three years. Older cats were less likely to have been vaccinated recently than younger cats. Only 5.8% of cats had never visited a veterinarian. For the 243 cats that had received veterinary attention, the average number of years since the last visit was 1.5. Keywords: cat, age, breed, gender, population, cross-sectional study, survey, Australia
A Survey of Dog Owners in Remote Northern Australian Indigenous Communities to Inform Rabies Incursion Planning
02 May 2016
University of Sydney

Hudson, Emily G.;Dhand, Navneet K.;Dürr, Salome;Ward, Michael P.

Australia is underprepared for a rabies incursion due to a lack of information about how a rabies outbreak would spread within the susceptible canine populations and which control strategies would be best to control it. The aim of this study was to collect information to parameterize a recently developed dog rabies spread model as well as use this information to gauge how the community would accept potential control strategies. Such information–together with model outputs–would be used to inform decision makers on the best control strategies and improve Australia’s preparedness against a canine rabies incursion. The parameters this study focussed on were detection time, vaccination rates and dog-culling and dog movement restriction compliance. A cross-sectional survey of 31 dog-owners, using a questionnaire, was undertaken in the five communities of the Northern Peninsular Area (NPA) in northern Australia regarding community dog movements, veterinary visits, reporting systems, perceptions of sick dogs and potential human behaviours during hypothetical rabies outbreaks. It highlighted the significant shortfalls in veterinary care that would need to be vastly improved during an outbreak, who educational programs should be targeted towards and which dog movements should be restricted. The results indicate that men were significantly more likely than women to allow their dogs to roam and to move their dogs. The current low vaccination rate of 12% highlighted the limited veterinary services that would need to be substantially increased to achieve effective rabies control. Participation in mass vaccination was accepted by 100% of the respondents. There was lower acceptance for other possible rabies control strategies with 10–20% of the respondents stating a resistance to both a mass culling program and a ban on dog movements. Consequently, movement bans and mass dog culling would have limited effectiveness as a control strategy in the NPA community. More than half of the respondents said that they would report their sick dogs within a week. This would lead to a much more optimistic rabies detection time than observed in other regions with recent dog rabies outbreaks. Findings from this study can be used to parameterize a recently developed dog rabies spread model as well as to develop informed policies for managing a future rabies incursion, thus improving Australia’s preparedness against a canine rabies incursion. Author Summary Australia is underprepared for a rabies incursion due to limited information about how a rabies outbreak would behave and which control strategies would be best to control it. A disease spread model of rabies has been developed to help policy-makers decide on the best response to a rabies incursion. However, data to inform this model are lacking. Therefore, the aim of this study was to gather information to parameterize the existing rabies spread model and to gauge how the community would accept potential control strategies. A survey of dog-owners, using a questionnaire, was undertaken in five remote, indigenous communities in northern Australia. We found that compared to women, men were more likely to allow their dogs to roam and to move their dogs. The current vaccination rates in these dog populations are low due to limited veterinary services. This would make delivery of vaccine in the event of a rabies incursion potentially challenging. However, compliance of dog owners with mass vaccination campaigns would be high. However, compliance with movement control of dogs might be problematic, as would the mass culling of dogs, although, rabies detection following an incursion could optimistically occur within a week.
The management of children with Spinal Muscular Atrophy Type 1 in Australia
16 May 2016
University of Sydney

Tassie, B;Isaacs, D;Kilham, H;Kerridge, I

Aims: To (1) estimate the prevalence of Spinal Muscular Atrophy Type 1 (SMA 1); (2) describe what practices characterise end-of-life care of patients with SMA 1; (3) ascertain whether a consistent approach to the management of these patients exists in Australia. Methods: An audit of the Australasian pathology laboratories offering the diagnostic SMN1 deletion test was conducted for patients diagnosed with SMA in Australia for 2010 and 2011. In addition, a retrospective clinical audit was conducted in eight major Australian paediatric hospitals of the end-of-life care provided to children with confirmed SMA 1 from 2005 to 2010. Results: 35 children were included in the clinical audit, accounting for an estimated 61% of children diagnosed with SMA 1 from 2005-2010. 26% were ventilated invasively, only two of whom were intubated after the diagnosis was confirmed. No children were ventilated long-term (>90 days) or had a tracheostomy performed. Nasogastric tube feeding was a common measure to support adequate nutritional intake. Total parenteral nutrition, gastrostomy and fundoplication were not provided for any children. Conflict over end-of-life care decisions was documented in one instance, without the involvement of a guardianship tribunal. Conclusion: There appears to be a consistent approach in the management of children with SMA 1 in Australia, which can be characterised as ‘actively managed dying.’ This study could contribute to the development of Australian consensus guidelines for the management of these children. These results also highlight a number of ethical issues related to the management of children with SMA 1.
Osteoblasts mediate the adverse effects of glucocorticoids on fuel metabolism
20 July 2016
University of Sydney

Brennan-Speranza, Tara C.;Henneicke, Holger;Gasparini, Sylvia J.;Blankenstein, Katharina I.;Heinevetter, Uta;Cogger, Victoria C.;Svistounov, Dmitri;Zhang, Yaqing;Cooney, Gregory J.;Buttgereit, Frank;Dunstanl, Colin R.;Gundberg, Caren;Zhou, Hong;Seibel, Markus J.

Long-term glucocorticoid treatment is associated with numerous adverse outcomes, including weight gain, insulin resistance, and diabetes; however, the pathogenesis of these side effects remains obscure. Glucocorticoids also suppress osteoblast function, including osteocalcin synthesis. Osteocalcin is an osteoblast-specific peptide that is reported to be involved in normal murine fuel metabolism. We now demonstrate that osteoblasts play a pivotal role in the pathogenesis of glucocorticoid-induced dysmetabolism. Osteoblast-targeted disruption of glucocorticoid signaling significantly attenuated the suppression of osteocalcin synthesis and prevented the development of insulin resistance, glucose intolerance, and abnormal weight gain in corticosterone-treated mice. Nearly identical effects were observed in glucocorticoid-treated animals following heterotopic (hepatic) expression of both carboxylated and uncarboxylated osteocalcin through gene therapy, which additionally led to a reduction in hepatic lipid deposition and improved phosphorylation of the insulin receptor. These data suggest that the effects of exogenous high-dose glucocorticoids on insulin target tissues and systemic energy metabolism are mediated, at least in part, through the skeleton.
Changes in the distribution of response rates across the CS-US interval: Evidence that responding switches between two distinct states.
15 August 2016
University of Sydney

Harris, Justin A

Two experiments used the peak procedure to examine timing of conditioned responses in a magazine approach paradigm with rats. A conditioned stimulus (CS) was reinforced with food on 50% of trials. Food was delivered at a fixed time, either 20 s, 30 s or 40 s into the CS presentation. Response rates were recorded during non-reinforced CS presentations that extended well beyond the scheduled time of food delivery. The mean response rate (averaged over many trials) increased during the CS, peaking at the expected time of reinforcement, and decreased again. Detailed analyses of the frequency distribution of response rates showed that responding was described by two distinct distributions, consistent with the rat being in a low response state on some trials and in a high response state on other trials. Modeling of these frequency distributions showed that the systematic rise and fall in response rate across a trial was primarily explained by a change in the proportion of time that the rat spent in the low versus high response state. However, the change in responding was also explained in part by a continuous shift in the high response state, such that responding in that state increased and then decreased gradually across the trial. These results support accounts that describe response timing as an abrupt change from low to high responding during the CS, but also provide evidence for a continuous change in conditioning strength across the duration of the CS. The implications of these findings for timing and associative theories of conditioning are discussed.
The major plant-derived cannabinoid 9-tetrahydrocannabinol promotes hypertrophy and macrophage infiltration in adipose tissue
24 August 2016
University of Sydney

Wong, Alexander;Gunasekaran, Nathan;Hancock, D. P.;Denyer, Gareth;Meng, Luxi;Radford, Jane;McGregor, Iain;Arnold, J. C.

Synthetic cannabinoid receptor agonists activate lipoprotein lipase and the formation of lipid droplets in cultured adipocytes. Here we extend this work by examining whether Δ(9)-tetrahydrocannabinol (THC), a major plant-derived cannabinoid, increases adipocyte size in vivo. Further, possibly as a consequence of hypertrophy, we hypothesize that THC exposure promotes macrophage infiltration into adipose tissue, an inflammatory state observed in obese individuals. Rats repeatedly exposed to THC in vivo had reduced body weight, fat pad weight, and ingested less food over the drug injection period. However, THC promoted adipocyte hypertrophy that was accompanied by a significant increase in cytosolic phosphoenolpyruvate carboxykinase (PEPCK-C) expression, an enzyme important in packaging triglycerides. We also showed that THC induced macrophage infiltration and increased expression of the inflammatory cytokine tumor necrosis factor alpha (TNF-α) in adipose tissue but did not induce apoptosis as measured by TUNEL staining. That THC increased adipocyte cell size in the absence of greater food intake, body weight and fat provides a unique model to explore mechanisms underlying changes in adipocyte size associated with a mild inflammatory state in fat tissue.
PDZK1 and NHERF1 Regulate the Function of Human Organic Anion Transporting Polypeptide 1A2 (OATP1A2) by Modulating Its Subcellular Trafficking and Stability
16 September 2016
University of Sydney

Zheng, Jian;Chan, Ting;Cheung, Florence Shin Gee;Zhu, Ling;Murray, Michael;Zhou, Fanfan

The human organic anion transporting polypeptide 1A2 (OATP1A2) is an important membrane protein that mediates the cellular influx of various substances including drugs. Previous studies have shown that PDZ-domain containing proteins, especially PDZK1 and NHERF1, regulate the function of related membrane transporters in other mammalian species. This study investigated the role of PDZK1 and NHERF1 in the regulation of OATP1A2 in an in vitro cell model. Transporter function and protein expression were assessed in OATP1A2-transfected HEK-293 cells that co-expressed PDZK1 or NHERF1. Substrate (estrone-3-sulfate) uptake by OATP1A2 was significantly increased to ,1.6- (PDZK1) and ,1.8- (NHERF1) fold of control; this was dependent on the putative PDZ-binding domain within the C-terminus of OATP1A2. The functional increase of OATP1A2 following PDZK1 or NHERF1 over-expression was associated with increased transporter expression at the plasma membrane and in the whole cell, and was reflected by an increase in the apparent maximal velocity of estrone-3-sulfate uptake (Vmax: 138.964.1 (PDZK1) and 181.4616.7 (NHERF1) versus 55.563.2 pmol*(mg*4 min)21 in control; P,0.01). Co-immunoprecipitation analysis indicated that the regulatory actions of PDZK1 and NHERF1 were mediated by direct interaction with OATP1A2 protein. In further experiments PDZK1 and NHERF1 modulated OATP1A2 expression by decreasing its internalization in a clathrin-dependent (but caveolin-independent) manner. Additionally, PDZK1 and NHERF1 enhanced the stability of OATP1A2 protein in HEK-293 cells. The present findings indicated that PDZK1 and NHERF1 regulate the transport function of OATP1A2 by modulating protein internalization via a clathrin-dependent pathway and by enhancing protein stability.
Functional Analysis of Novel Polymorphisms in the Human SLCO1A2 Gene that Encodes the Transporter OATP1A2
19 September 2016
University of Sydney

Zhou, Fanfan;Zheng, Jian;Zhu, Ling;Jodal, Andreas;Cui, Pei H.;Wong, Mark;Gurney, Howard;Church, W. Bret;Murray, Michael

The solute carrier organic anion transporting polypeptide 1A2 (OATP1A2, SLCO1A2) is implicated in the cellular influx of a number of drugs. We identified five novel single nucleotide polymorphisms (SNPs) in coding exons of the SLCO1A2 gene in a cohort of subjects: G550A, G553A, G673A, A775C, and G862A, that encoded the OATP1A2 variants E184K, D185N, V255I, T259P, and D288N, respectively. The function and expression of these variant transporters were assessed in HEK-293 cells. We found that the novel variants, E184K, D185N, T259P, and D288N, were associated with impaired estrone-3-sulfate, imatinib, and methotrexate transport (∼20-50% of wild-type control); function was retained by OATP1A2-V255I. From biotinylation assays, the decreased function of these variants was due, at least in part, to impaired plasma membrane expression. The four loss-of-function variants were studied further using mutagenesis to produce variants that encode residues with different charges or steric properties. From immunoblotting, the replacement of negatively charged residues at amino acid positions 184 and 185 impaired membrane expression, while either a positive or negative charge at residue 288 supported the correct membrane targeting of OATP1A2. Replacement of T259 with bulky residues disrupted transporter stability. From molecular models, E184, D185, and D288 were located near several charged residues such that intramolecular ionic interactions may stabilize the transporter structure. Individuals who carry these novel SNPs in the SLCO1A2 gene may be at risk from impaired efficacy or enhanced toxicity during treatment with drugs that are substrates for OATP1A2.
Iron supplement use in pregnancy – are the right women taking the right amount?
08 December 2016
University of Sydney

Chatterjee, Rahul;Shand, Antonia W.;Nassar, Natasha;Walls, Mariyam;Khambalia, Amina Z.

Objectives: To examine the prevalence and determinants of iron supplement use and the amount of iron consumed from iron-containing supplements. Methods: A cross-sectional survey was performed in antenatal clinics in two tertiary hospitals in Sydney, Australia between January and March 2014. Results: Of 612 (91% response rate) pregnant women, 589 with complete data were analysed. The overall prevalence of iron-containing supplement use was 88.0%, of which 70.1% was MV only, 7.2% was iron-only and 22.2% was both. Use of iron-containing supplements was associated with increased gestational age, a diagnosis of anaemia or iron deficiency (ID) in the current pregnancy and pre-pregnancy use of an iron-containing supplement. Several risk factors for ID or anaemia such as on-red meat eating and previous miscarriage were not associated with current iron supplement use. About 65% of women diagnosed with ID, and 62.3% of women diagnosed with anaemia were taking an iron-only supplement, with or without a MV. The proportion of women consuming low (<30), preventative (30-99) and treatment (≥100) mg/day doses were 36.8%, 45.4%, and 17.8%, respectively. Only 46.7% of women diagnosed with ID were taking ≥100 mg/day iron from supplements, while 23.3% were taking <30 mg/day. Conclusion: Women are consuming varying doses of iron and some high-risk women are taking inadequate doses of iron to prevent or treat ID or iron deficiency anaemia. Healthcare professionals are best positioned to advise women on iron supplement use in pregnancy and should educate women individually about the type and dose of supplement best suited to their needs.
Neuropeptide Y Knockout Mice Reveal a Central Role of NPY in the Coordination of Bone Mass to Body Weight
03 January 2017
University of Sydney

Baldock, PA;Lee, NJ;Driessler, F;Lin, S;Allison, SJ;Stehrer, B;Lin, EJD;Zhang, L;Enriquez, RF;Wong, IPL;McDonald, MM;During, M;Pierroz, DD;Slack, K;Shi, Y;Yulyaningsih, E;Aljianova, A;Little, DG;Ferrari, SL;Sainsbury, Amanda;Eisman, JA;Herzog, H

Changes in whole body energy levels are closely linked to alterations in body weight and bone mass. Here, we show that hypothalamic signals contribute to the regulation of bone mass in a manner consistent with the central perception of energy status. Mice lacking neuropeptide Y (NPY), a well-known orexigenic factor whose hypothalamic expression is increased in fasting, have significantly increased bone mass in association with enhanced osteoblast activity and elevated expression of bone osteogenic transcription factors, Runx2 and Osterix. In contrast, wild type and NPY knockout (NPY −/−) mice in which NPY is specifically over expressed in the hypothalamus (AAV-NPY+) show a significant reduction in bone mass despite developing an obese phenotype. The AAV-NPY+ induced loss of bone mass is consistent with models known to mimic the central effects of fasting, which also show increased hypothalamic NPY levels. Thus these data indicate that, in addition to well characterized responses to body mass, skeletal tissue also responds to the perception of nutritional status by the hypothalamus independently of body weight. In addition, the reduction in bone mass by AAV NPY+ administration does not completely correct the high bone mass phenotype of NPY −/− mice, indicating the possibility that peripheral NPY may also be an important regulator of bone mass. Indeed, we demonstrate the expression of NPY specifically in osteoblasts. In conclusion, these data identifies NPY as a critical integrator of bone homeostatic signals; increasing bone mass during times of obesity when hypothalamic NPY expression levels are low and reducing bone formation to conserve energy under ‘starving’ conditions, when hypothalamic NPY expression levels are high.
Macrophage Inhibitory Cytokine 1 (MIC-1/GDF15) Decreases Food Intake, Body Weight and Improves Glucose Tolerance in Mice on Normal & Obesogenic Diets
03 January 2017
University of Sydney

Macia, L;Tsai, VWW;Nguyen, AD;Johnen, H;Kuffner, T;Shi, YC;Lin, S;Herzog, H;Brown, DA;Breit, SN;Sainsbury, Amanda

Food intake and body weight are controlled by a variety of central and peripheral factors, but the exact mechanisms behind these processes are still not fully understood. Here we show that that macrophage inhibitory cytokine-1 (MIC-1/GDF15), known to have anorexigenic effects particularly in cancer, provides protection against the development of obesity. Both under a normal chow diet and an obesogenic diet, the transgenic overexpression of MIC-1/GDF15 in mice leads to decreased body weight and fat mass. This lean phenotype was associated with decreased spontaneous but not fasting-induced food intake, on a background of unaltered energy expenditure and reduced physical activity. Importantly, the overexpression of MIC-1/GDF15 improved glucose tolerance, both under normal and high fat-fed conditions. Altogether, this work shows that the molecule MIC-1/GDF15 might be beneficial for the treatment of obesity as well as perturbations in glucose homeostasis.
Y1 and Y5 Receptors Are Both Required for the Regulation of Food Intake and Energy Homeostasis in Mice
03 January 2017
University of Sydney

Nguyen, AD;Mitchell, NF;Lin, S;Macia, L;Yulyaningsih, E;Baldock, PA;Enriquez, RF;Zhang, L;Shi, YC;Zolotukhin, S;Herzog, H;Sainsbury, Amanda

Neuropeptide Y (NPY) acting in the hypothalamus is one of the most powerful orexigenic agents known. Of the five known Y receptors, hypothalamic Y1 and Y5 have been most strongly implicated in mediating hyperphagic effects. However, knockout of individual Y1 or Y5 receptors induces late-onset obesity – and Y5 receptor knockout also induces hyperphagia, possibly due to redundancy in functions of these genes. Here we show that food intake in mice requires the combined actions of both Y1 and Y5 receptors. Germline Y1Y5 ablation in Y1Y5−/− mice results in hypophagia, an effect that is at least partially mediated by the hypothalamus, since mice with adult-onset Y1Y5 receptor dual ablation targeted to the paraventricular nucleus (PVN) of the hypothalamus (Y1Y5Hyp/Hyp) also exhibit reduced spontaneous or fasting-induced food intake when fed a high fat diet. Interestingly, despite hypophagia, mice with germline or hypothalamus-specific Y1Y5 deficiency exhibited increased body weight and/or increased adiposity, possibly due to compensatory responses to gene deletion, such as the decreased energy expenditure observed in male Y1Y5−/− animals relative to wildtype values. While Y1 and Y5 receptors expressed in other hypothalamic areas besides the PVN – such as the dorsomedial nucleus and the ventromedial hypothalamus – cannot be excluded from having a role in the regulation of food intake, these studies demonstrate the pivotal, combined role of both Y1 and Y5 receptors in the mediation of food intake.
TGF-b Superfamily Cytokine MIC-1/GDF15 Is a Physiological Appetite and Body Weight Regulator
03 January 2017
University of Sydney

Tsai, VWW;Macia, L;Johnen, H;Kuffner, T;Manadhar, R;Beck Jorgensen, S;Lee-Ng, KKM;Zhang, HP;Wu, L;Marquis, CP;Jiang, L;Husaini, Y;Lin, S;Herzog, H;Brown, DA;Sainsbury, Amanda;Breit, SN

The TGF-b superfamily cytokine MIC-1/GDF15 circulates in all humans and when overproduced in cancer leads to anorexia/cachexia, by direct action on brain feeding centres. In these studies we have examined the role of physiologically relevant levels of MIC-1/GDF15 in the regulation of appetite, body weight and basal metabolic rate. MIC-1/GDF15 gene knockout mice (MIC-1−/−) weighed more and had increased adiposity, which was associated with increased spontaneous food intake. Female MIC-1−/− mice exhibited some additional alterations in reduced basal energy expenditure and physical activity, possibly owing to the associated decrease in total lean mass. Further, infusion of human recombinant MIC-1/GDF15 sufficient to raise serum levels in MIC-1−/− mice to within the normal human range reduced body weight and food intake. Taken together, our findings suggest that MIC-1/GDF15 is involved in the physiological regulation of appetite and energy storage.
The Anorectic Actions of the TGFb Cytokine MIC-1/GDF15 Require an Intact Brainstem Area Postrema and Nucleus of the Solitary Tract
03 January 2017
University of Sydney

Tsai, VWW;Manadhar, R;Jorgensen, SB;Lee-Ng, KK;Zhang, HP;Marquis, CP;Jiang, L;Husaini, Y;Lin, S;Sainsbury, Amanda;Sawchenko, PE;Brown, DA;Breit, SN

Macrophage inhibitory cytokine-1 (MIC-1/GDF15) modulates food intake and body weight under physiological and pathological conditions by acting on the hypothalamus and brainstem. When overexpressed in disease, such as in advanced cancer, elevated serum MIC-1/GDF15 levels lead to an anorexia/cachexia syndrome. To gain a better understanding of its actions in the brainstem we studied MIC-1/GDF15 induced neuronal activation identified by induction of Fos protein. Intraperitoneal injection of human MIC-1/GDF15 in mice activated brainstem neurons in the area postrema (AP) and the medial (m) portion of the nucleus of the solitary tract (NTS), which did not stain with tyrosine hydroxylase (TH). To determine the importance of these brainstem nuclei in the anorexigenic effect of MIC-1/GDF15, we ablated the AP alone or the AP and the NTS. The latter combined lesion completely reversed the anorexigenic effects of MIC-1/GDF15. Altogether, this study identified neurons in the AP and/or NTS, as being critical for the regulation of food intake and body weight by MIC-1/GDF15.
Anorexia/cachexia of chronic diseases: a role for the TGF-β family cytokine MIC-1/GDF15
03 January 2017
University of Sydney

Tsai, VWW;Husaini, YC;Manadhar, R;Lee-Ng, M;Zhang, HP;Harriott, K;Jiang, L;Lin, S;Sainsbury, Amanda;Brown, DA;Breit, SN

Anorexia/cachexia is a common and currently mostly untreatable complication of advanced cancer. It is also a feature of a number of chronic diseases and can also occur as part of the normal ageing process. Over recent years, two different, but sometimes overlapping, processes have been identified to mediate anorexia/cachexia: those that act primarily on muscle reducing its mass and function, and processes that decrease nutrition leading to loss of both fat and muscle. In the case of at least some cancers, the latter process is sometimes driven by marked overexpression of macrophage inhibitory cytokine-1/growth differentiation factor 15 (MIC-1/GDF15). MIC-1/GDF15 is a transforming growth factor beta (TGF-β) family cytokine that is found in the serum of all normal individuals at an average concentration of about 0.6 ng/ml. Its increased expression in both cancers and other diseases can result in 10–100-fold or more elevation of its serum levels. In experimental animals, serum MIC-1/GDF15 levels at the lower end of this range induce anorexia by direct actions of the circulating cytokine on feeding centres in the brain. Mice with tumours overexpressing MIC-1/GDF15 display decreased food intake, loss of lean and fat mass and cachexia. That this process also mediates anorexia/cachexia in humans is suggested by the fact that there is a direct correlation between the degree of serum MIC-1/GDF15 elevation and the amount of cancer-related weight loss, the first such relationship demonstrated. Further, in experimental animals, weight loss can be reversed by neutralisation of tumour-produced MIC-1/GDF15 with a specific monoclonal antibody, suggesting the possibility of effective therapy of patients with the devastating complication of anorexia/cachexia.
Accuracy of hands v. household measures as portion size estimation aids
03 January 2017
University of Sydney

Gibson, AA;Hsu, MSH;Rangan, A;Lee, CMY;Das, A;Seimon, RV;Sainsbury, Amanda

Accurate estimation of food portion size is critical in dietary studies. Hands are potentially useful as portion size estimation aids; however, their accuracy has not been tested. The aim of the present study was to test the accuracy of a novel portion size estimation method using the width of the fingers as a ‘ruler’ to measure the dimensions of foods (‘finger width method’), as well as fists and thumb or finger tips. These hand measures were also compared with household measures (cups and spoons). A total of sixty-seven participants (70 % female; age 32·7 (sd 13·7) years; BMI 23·2 (sd 3·5) kg/m2) attended a 1·5 h session in which they estimated the portion sizes of forty-two pre-weighed foods and liquids. Hand measurements were used in conjunction with geometric formulas to convert estimations to volumes. Volumes determined with hand and household methods were converted to estimated weights using density factors. Estimated weights were compared with true weights, and the percentage difference from the true weight was used to compare accuracy between the hand and household methods. Of geometrically shaped foods and liquids estimated with the finger width method, 80 % were within ±25 % of the true weight of the food, and 13 % were within ±10 %, in contrast to 29 % of those estimated with the household method being within ±25 % of the true weight of the food, and 8 % being within ±10 %. For foods that closely resemble a geometric shape, the finger width method provides a novel and acceptably accurate method of estimating portion size.
Glycyrrhizic Acid Can Attenuate Metabolic Deviations Caused by a High-Sucrose Diet without Causing Water Retention in Male Sprague-Dawley Rats
03 January 2017
University of Sydney

Fernando, HA;Chandramouli, C;Rosli, D;Lam, YL;Yong, ST;Yaw, HP;Ton, SH;Kadir, K;Sainsbury, Amanda

Glycyrrhizic acid (GA) ameliorates many components of the metabolic syndrome, but its potential therapeutic use is marred by edema caused by inhibition of renal 11β-hydroxysteroid dehydrogenase 2 (11β-HSD2). We assessed whether 100 mg/kg per day GA administered orally could promote metabolic benefits without causing edema in rats fed on a high-sucrose diet. Groups of eight male rats were fed on one of three diets for 28 days: normal diet, a high-sucrose diet, or a high-sucrose diet supplemented with GA. Rats were then culled and renal 11β-HSD2 activity, as well as serum sodium, potassium, angiotensin II and leptin levels were determined. Histological analyses were performed to assess changes in adipocyte size in visceral and subcutaneous depots, as well as hepatic and renal tissue morphology. This dosing paradigm of GA attenuated the increases in serum leptin levels and visceral, but not subcutaneous adipocyte size caused by the high-sucrose diet. Although GA decreased renal 11β-HSD2 activity, it did not affect serum electrolyte or angiotensin II levels, indicating no onset of edema. Furthermore, there were no apparent morphological changes in the liver or kidney, indicating no toxicity. In conclusion, it is possible to reap metabolic benefits of GA without edema using the current dosage and treatment time.
Continuous exercise but not high intensity interval training improves fat distribution in overweight adults
03 January 2017
University of Sydney

Keating, S;Machan, E;O'Connor, H;Gerofi, J;Sainsbury, Amanda;Caterson, I;Johnson, NL

Objective. The purpose of this study was to assess the effect of high intensity interval training (HIIT) versus continuous aerobic exercise training (CONT) or placebo (PLA) on body composition by randomized controlled design. Methods. Work capacity and body composition (dual-energy X-ray absorptiometry) were measured before and after 12 weeks of intervention in 38 previously inactive overweight adults. Results. There was a significant group × time interaction for change in work capacity (P < 0.001), which increased significantly in CONT (23.8 ± 3.0%) and HIIT (22.3 ± 3.5%) but not PLA (3.1 ± 5.0%). There was a near-significant main effect for percentage trunk fat, with trunk fat reducing in CONT by 3.1 ± 1.6% and in PLA by 1.1 ± 0.4%, but not in HIIT (increase of 0.7 ± 1.0%) (P = 0.07). There was a significant reduction in android fat percentage in CONT (2.7 ± 1.3%) and PLA (1.4 ± 0.8%) but not HIIT (increase of 0.8 ± 0.7%) (P = 0.04). Conclusion. These data suggest that HIIT may be advocated as a time-efficient strategy for eliciting comparable fitness benefits to traditional continuous exercise in inactive, overweight adults. However, in this population HIIT does not confer the same benefit to body fat levels as continuous exercise training.
The Ethics of Menu Labelling
10 January 2017
University of Sydney

Carter, SM

In this commentary, I explore the ethically relevant dimensions of menu labelling. The evidence that menu labelling changes purchasing or consumption behaviour is contentious and inconclusive; there is some suggestion that menu labelling may preferentially influence the behaviour of healthier and wealthier citizens. Some suggest that menu labelling is unjust, as it fails to direct resources towards those who most need them. An alternative is to see menu labels as just one of a set of strategies that can increase people’s real opportunities to be healthy. Complementing strategies will be necessary to ensure that all citizens can consider and value food choices, which may include becoming a more critical consumer in the food marketplace. Menu labels may also have the potential to (i) shift our attention from people to food, (ii) reallocate (some) responsibility in the food environment and (iii) facilitate structural change. It would be a mistake to expect too much of menu labels alone: rather, they should be integrated into a broader programme that supports health opportunities, especially for the least well off.
Exercise and diet in the management of nonalcoholic fatty liver disease
20 February 2017
University of Sydney

Mahady, Suzanne E;George, Jacob

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver condition worldwide, and is projected to become the leading cause for liver transplantation in the United States as early as 2020. The mainstay of treatment remains lifestyle modification with diet and exercise recommendations, as although some pharmacological treatments such as glitazones and Vitamin E have shown benefit, there are concerns regarding long term safety. The evidence base for dietary interventions in NAFLD such as the Mediterranean diet, omega-3 polyunsaturated fatty acids and coffee is mainly derived from observational data with questionable validity. Where trials exist, they have shown benefit for surrogate outcomes such as hepatic steatosis and insulin resistance, but no trials have been conducted with salient clinical outcomes such as reduction in progression to chronic liver disease. Benefit in surrogate outcomes has also been seen for aerobic, anaerobic and combined modality exercise but it remains unclear if one type is superior. Furthermore, a reduction in sedentary time appears equally important. To provide a sound evidence base for lifestyle recommendations to people with NAFLD, longer duration trials of standardized dietary or exercise interventions, and testing various doses, types and with liver related outcomes, are essential.
Dietary vitamin, mineral and herbal supplement use: a cross-sectional survey of before and during pregnancy use in Sydney, Australia.
22 March 2017
University of Sydney

Shand, Antonia W.;Walls, Mariyam;Chatterjee, Rahul;Nassar, Natasha;Khambalia, Amina Z.

AIM: To describe use of dietary vitamin, mineral and herbal supplements before and during pregnancy. METHODS: Pregnant women attending antenatal care at two tertiary Sydney hospitals between January and March 2014 completed an anonymous survey. Information on general maternal and pregnancy characteristics and the use of dietary and herbal supplements, including type, duration, and sources of information was collected. Frequency and contingency tabulations were performed. RESULTS: 612 women agreed to participate (91% response rate). 23 were excluded due to incomplete data. Of 589 women included in the analysis, the mean gestational age at the time of survey was 28.5 weeks (SD 8.3), 55% had no children, and 67% were tertiary educated. Overall 62.9% of women reported taking a multivitamin (MV) and/or folic acid (FA) supplement in the 3 months pre-pregnancy. At the time of the survey 93.8% of women were taking at least one supplement (median 2, range 1-13). During pregnancy 79.1% of women were taking MVs, including 59.2% taking MV only and 19.9% taking MV and FA. The 5 most common supplements outside of a MV were FA (31%), iron (30%), vitamin D (23%), calcium (13%) and fish oil (12%). CONCLUSION: Use of folic acid and MVs and other supplements during and pre-pregnancy is relatively high, although pre-pregnancy FA supplementation rates could still be improved. Further research on the actual dosages and dietary intakes consumed are needed to examine whether pregnant women have adequate intake of nutrients, regardless of supplement use.
Nephrotoxicity-induced proteinuria increases biomarker diagnostic thresholds in acute kidney injury.
15 May 2017
University of Sydney

Mohamed, F;Buckley, Nicholas A.;Pickering, JW;Wunnapuk, K;Dissanayake, S;Chathuranga, U;Gawarammana, I;Jayamanne, S;Endre, ZH

BACKGROUND: Paraquat ingestion is frequently fatal. While biomarkers of kidney damage increase during paraquat-induced acute kidney injury (AKI), significant concurrent proteinuria may alter diagnostic thresholds for diagnosis and prognosis to an unknown extent. This study evaluated the effect of albuminuria on biomarker cutoffs for diagnosis and outcome prediction. METHODS: This was a multi-centre prospective clinical study of patients following acute paraquat self-poisoning in 5 Sri Lankan hospitals. Biomarker concentrations were quantified using ELISA and microbead assays and correlated with urinary albumin. Functional-AKI was defined by the Acute Kidney Injury Network serum creatinine definition and alternatively by a ≥50% increase in serum cystatin C. Albuminuria was defined as albumin-creatinine ratio >30 mg/g. The study outcomes were compared with a retrospective analysis of a pre-clinical study of paraquat-induced nephrotoxicity with appropriate controls. RESULTS: Albuminuria was detected in 34 of 50 patients, and increased with functional-AKI severity. The concentrations of uNGAL, uCysC, uClusterin, uβ2M, and uKIM-1 were higher in albuminuric compared to non-albuminuric patients (p 0.6, p < 0.01) and was associated with death (p = 0.006). Optimal biomarker cutoffs for prediction of death were higher in the albuminuric group. Similar outcomes with more detailed analysis were obtained in experimental paraquat nephrotoxicity. CONCLUSION: Albuminuria was associated with paraquat-induced nephrotoxicity and increased excretion of low-molecular weight protein biomarkers. AKI biomarker cutoffs for diagnosis, outcome prediction and AKI stratification increased in the presence of albuminuria. This may lead to over-diagnosis of AKI in conditions independently associated with proteinuria.
Assessing the public acceptability of proposed policy interventions to reduce the misuse of antibiotics in Australia: A report on two community juries
05 July 2017
University of Sydney

Degeling, C;Johnson, J;Iredell, J;Nguyen, KA;Norris, J;Turnidge, J;Dawson, A;Carter, SM;Gilbert, GL

Objective To elicit the views of well-informed community members on the acceptability of proposed policy interventions designed to improve community use of antibiotics in Australia. Design Two community juries held in 2016. Setting and participants Western Sydney and Dubbo communities in NSW, Australia. Twenty-nine participants of diverse social and cultural backgrounds, mixed genders and ages recruited via public advertising: one jury was drawn from a large metropolitan setting; the other from a regional/rural setting. Main outcome measure Jury verdict and rationale in response to a prioritization task and structured questions. Results Both juries concluded that potential policy interventions to curb antibiotic misuse in the community should be directed towards: (i) ensuring that the public and prescribers were better educated about the dangers of antibiotic resistance; (ii) making community-based human and animal health-care practitioners accountable for their prescribing decisions. Patient-centred approaches such as delayed prescribing were seen as less acceptable than prescriber-centred approaches; both juries completely rejected any proposal to decrease consumer demand by increasing antibiotic prices. Conclusion These informed citizens acknowledged the importance of raising public awareness of the risks, impacts and costs of antibiotic resistance and placed a high priority on increasing social and professional accountability through restrictive measures. Their overarching aim was that policy interventions should be directed towards creating collective actions and broad social support for changing antibiotic use through establishing and explaining the need for mechanisms to control and support better prescribing by practitioners, while not transferring the burdens, costs and risks of interventions to consumers.
The effect of a high-egg diet on cardiovascular risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) study-a 3-mo randomized controlled trial
08 February 2018
University of Sydney

Fuller, N.;Caterson, I.;Sainsbury, Amanda;Denyer, G.;Fong, M.;Gerofi, J.;Baqleh, K.;Williams, K.;Lau, N.;Markovic, TP

BACKGROUND: Previously published research that examined the effects of high egg consumption in people with type 2 diabetes (T2D) produced conflicting results leading to recommendations to limit egg intake. However, people with T2D may benefit from egg consumption because eggs are a nutritious and convenient way of improving protein and micronutrient contents of the diet, which have importance for satiety and weight management. OBJECTIVE: In this randomized controlled study, we aimed to determine whether a high-egg diet (2 eggs/d for 6 d/wk) compared with a low-egg diet (<2 eggs/wk) affected circulating lipid profiles, in particular high-density lipoprotein (HDL) cholesterol, in overweight or obese people with prediabetes or T2D. DESIGN: A total of 140 participants were randomly assigned to one of the 2 diets as part of a 3-mo weight maintenance study. Participants attended the clinic monthly and were instructed on the specific types of foods and quantities to be consumed. RESULTS: There was no significant difference in the change in HDL cholesterol from screening to 3 mo between groups; the mean difference (95% CI) between high- and low-egg groups was +0.02 mmol/L (-0.03, 0.08 mmol/L; P = 0.38). No between-group differences were shown for total cholesterol, low-density lipoprotein cholesterol, triglycerides, or glycemic control. Both groups were matched for protein intake, but the high-egg group reported less hunger and greater satiety postbreakfast. Polyunsaturated fatty acid (PUFA) and monounsaturated fatty acid (MUFA) intakes significantly increased from baseline in both groups. CONCLUSIONS: High egg consumption did not have an adverse effect on the lipid profile of people with T2D in the context of increased MUFA and PUFA consumption. This study suggests that a high-egg diet can be included safely as part of the dietary management of T2D, and it may provide greater satiety. This trial was registered at the Australia New Zealand Clinical Trials Registry (http://www.anzctr.org.au/) as ACTRN12612001266853.
Glycemic Index and Pregnancy: A Systematic Literature Review
09 February 2018
University of Sydney

Louie, Jimmy CY;Brand-Miller, JC;Markovic, TP;Ross, GP;Moses, RG

Background/Aim. Dietary glycemic index (GI) has received considerable research interest over the past 25 years although its application to pregnancy outcomes is more recent. This paper critically evaluates the current evidence regarding the effect of dietary GI on maternal and fetal nutrition. Methods. A systematic literature search using MEDLINE, EMBASE, CINAHL, Cochrane Library, SCOPUS, and ISI Web of Science, from 1980 through September 2010, was conducted. Results. Eight studies were included in the systematic review. Two interventional studies suggest that a low-GI diet can reduce the risk of large-for-gestational-age (LGA) infants in healthy pregnancies, but one epidemiological study reported an increase in small-for-gestational-age (SGA) infants. Evidence in pregnancies complicated by gestational diabetes mellitus (GDM), though limited (), consistently supports the advantages of a low-GI diet. Conclusion. There is insufficient evidence to recommend a low-GI diet during normal pregnancy. In pregnancy complicated by GDM, a low-GI diet may reduce the need for insulin without adverse effects on pregnancy outcomes. Until larger-scale intervention trials are completed, a low-GI diet should not replace the current recommended pregnancy diets from government and health agencies. Further research regarding the optimal time to start a low-GI diet for maximum protection against adverse pregnancy outcomes is warranted.
Comparison of Very Low Energy Diet Products Available in Australia and How to Tailor Them to Optimise Protein Content for Younger and Older Adult Men and Women
18 February 2018
University of Sydney

Gibson, Alice A.;Franklin, Janet;Pattinson, AL;Cheng, Zilvia G. Y.;Samman, Samir;Markovic, TP;Sainsbury, Amanda

Very low energy diets (VLED) are efficacious in inducing rapid weight loss but may not contain adequate macronutrients or micronutrients for individuals with varying nutritional requirements. Adequate protein intake during weight loss appears particularly important to help preserve fat free mass and control appetite, and low energy and carbohydrate content also contributes to appetite control. Therefore, the purpose of this study was to compare the nutritional content (with a focus on protein), nutritional adequacy and cost of all commercially-available VLED brands in Australia. Nutritional content and cost were extracted and compared between brands and to the Recommended Dietary Intake (RDI) or adequate intake (AI) of macronutrients and micronutrients for men and women aged 19–70 years or >70 years. There was wide variability in the nutritional content, nutritional adequacy and cost of VLED brands. Most notably, even brands with the highest daily protein content, based on consuming three products/day (KicStart™ and Optislim®, ~60 g/day), only met estimated protein requirements of the smallest and youngest women for whom a VLED would be indicated. Considering multiple options to optimise protein content, we propose that adding pure powdered protein is the most suitable option because it minimizes additional energy, carbohydrate and cost of VLEDs.
A large conjugative Acinetobacter baumannii plasmid carrying the sul2 sulphonamide and strAB streptomycin resistance genes
09 March 2018
University of Sydney

Hamidian, Mohammad;Ambrose, Stephanie;Hall, Ruth

Acinetobacter baumannii is an important nosocomial pathogen that often complicates treatment because of its high level of resistance to antibiotics. Though plasmids can potentially introduce various genes into bacterial strains, compared to other Gram-negative bacteria, information about the unique A. baumannii plasmid repertoire is limited. Here, whole genome sequence data was used to determine the plasmid content of strain A297 (RUH875), the reference strain for the globally disseminated multiply resistant A. baumannii clone, global clone 1(GC1). A297 contains three plasmids. Two known plasmids were present; one, pA297-1 (pRAY*), carries the aadB gentamicin, kanamycin and tobramycin resistance gene and another is an 8.7kb cryptic plasmid often found in GC1 isolates. The third plasmid, pA297-3, is 200kb and carries the sul2 sulphonamide resistance gene and strAB streptomycin resistance gene within Tn6172 and a mer mercuric ion resistance module elsewhere. pA297-3 transferred sulphonamide, streptomycin and mercuric ion resistance at high frequency to a susceptible A. baumannii recipient, and contains several genes potentially involved in conjugative transfer. However, a relaxase gene was not found. It also includes several genes encoding proteins involved in DNA metabolism such as partitioning. However, a gene encoding a replication initiation protein could not be found. pA297-3 includes two copies of a Miniature Inverted-Repeat Transposable Element (MITE), named MITE-297, bracketing a 77.5kb fragment, which contains several IS and the mer module. Several plasmids related to but smaller than pA297-3 were found in the GenBank nucleotide database. They were found in different A. baumannii clones and are wide spread. They all contain either Tn6172 or a variant in the same position in the backbone as Tn6172 in pA297-3. Some related plasmids have lost the segment between the MITE-297 copies and retain only one MITE-297. Others have segments of various lengths between two MITE-297 copies, and these can be derived from the region in pA297-3 via a deletion adjacent to IS related to IS26 such as IS1007 or IS1007-like. pA297-3 and its relatives represent a third type of conjugative Acinetobacter plasmid that contributes to the dissemination of antibiotic resistance in this species.
pCERC3 from a commensal ST95 Escherichia coli: A ColV virulence-multiresistance plasmid carrying a sul3-associated class 1 integron
09 March 2018
University of Sydney

Moran, Robert A;Holt, Kathryn E;Hall, Ruth M

The rare sulphonamide resistance gene sul3was found in the commensal Escherichia coli ST95 strain 22.1-R1 that was isolated in 2010 from the faeces of a healthy Australian adult. The genome of 22.1-R1 was sequenced and a 144,344 bp RepFII/FIB plasmid, pCERC3, carrying sul3 was assembled. The sul3 gene is part of a class 1 integron featuring a sul3-containing conserved segment (sul3-CS) that replaced the classic sul1-containing 3′-conserved segment (3′-CS) usually seen in class 1 integrons. The integron contained the cassette array dfrA12-orfFaadA2- cmlA1-aadA1-qacH, conferring resistance to trimethoprim, streptomycin, spectinomycin, chloramphenicol and quaternary ammonium compound. Two additional antibiotic resistance genes, blaTEM (ampicillin resistance) and tetA(B) (tetracycline) were adjacent to the integron, forming a single resistance region. In pCERC3, the sul3-type class 1 integron was flanked by sequence derived from the tnp and mer modules of Tn21 and was in the same location as In2, the sul1-containing In5-type class 1 integron of Tn21. At one end the sequence extends into Tn2670-derived sequence and then into sequence derived from the plasmid NR1 (R100). Examination of the sequences of eleven more complete sul3-containing plasmids in GenBank confirmed the relationship between sul3-associated integrons and Tn21/Tn2670/NR1. This suggests that the events that formed sul3- associated class 1 integrons occurred within the Tn21/Tn2670 context, most likely in NR1 or a related plasmid. The backbone of pCERC3 is most closely related to the backbones of ColV virulence plasmids and contains a complete ColV operon as well as several virulence associated genes and gene clusters. Hence, pCERC3 is both an antibiotic resistance and virulence plasmid.
Compatibility and entry exclusion of IncA and IncC plasmids revisited: IncA and IncC plasmids are compatible
09 March 2018
University of Sydney

Ambrose, Stephanie;Harmer, Christopher John;Hall, Ruth Milne

In an early study, IncA and IncC plasmids that were reported to be compatible were grouped as the “A-C complex” based on similarities and on strong entry exclusion. However, recently, the term IncA/C has been used frequently to describe plasmids belonging to both of these two groups. Granted that the supporting data was not included in the original reports and that the consensus iteron sequences have since been shown to be essentially identical, we have addressed the question again. The original IncA plasmid, RA1, and the IncC plasmid pRMH760, were introduced into the same cell by transformation, and were found to be maintained stably for over 100 generations in the absence of selection for either plasmid, i.e. they were compatible. We conclude that use of the term IncA/C for this important plasmid group is indeed incorrect and it causes unnecessary confusion. Granted the importance of IncC plasmids in the spread of antibiotic resistance genes, we recommend that use of the misleading terms IncA/C, IncA/C1 and IncA/C2 should cease. In addition, RA1 and pRMH760 were shown to each completely prevent entry of the other via conjugative transfer into the cell they reside in.
Evolution and typing of IncC plasmids contributing to antibiotic resistance in Gram-negative bacteria
08 January 2019
University of Sydney

Ambrose, Stephanie J;Harmer, Christopher J;Hall, Ruth M

The large, broad host range IncC plasmids are important contributors to the spread of key antibiotic resistance genes and over 200 complete sequences of IncC plasmids have been reported. To track the spread of these plasmids accurate typing to identify the closest relatives is needed. However, typing can be complicated by the high variability in resistance gene content and various typing methods that rely on features of the conserved backbone have been developed. Plasmids can be broadly typed into two groups, type 1 and type 2, using four features that differentiate the otherwise closely related backbones. These types are found in many different countries in bacteria from humans and animals. However, hybrids of type 1 and type 2 are also occasionally seen, and two further types, each represented by a single plasmid, were distinguished. Generally, the antibiotic resistance genes are located within a small number of resistance islands, only one of which, ARI-B, is found in both type 1 and type 2. The introduction of each resistance island generates a new lineage and, though they are continuously evolving via the loss of resistance genes or introduction of new ones, the island positions serve as valuable lineage-specific markers. A current type 2 lineage of plasmids is derived from an early type 2 plasmid but the sequences of early type 1 plasmids include features not seen in more recent type 1 plasmids, indicating a shared ancestor rather than a direct lineal relationship. Some features, including ones essential for maintenance or for conjugation, have been examined experimentally.
Explaining recent increases in calorie intake in rural india: The role of social policy strengthening
08 August 2019
University of Sydney

Pritchard, Bill;Lahiri-Dutt, Kuntala;Siddiqui, Md Zakaria

During the past decade, considerable research efforts have sought to explain India’s “calorie consumption paradox”, namely, the coexistence of a decline in average per capita calorie intake in rural India alongside increased material living standards. Evidence from the most recent (68th) round of the National Sample Survey (NSS), released in 2014, however, indicates increases in calorie intake, notably among poorer income quintiles. This paper argues that the turnaround in these data is linked to the improved performance of pro-poor social protection measures. Analysis of data suggests a close association between states that have made the greatest improvements in social policy delivery systems, and increased calorie intake for the poorest quintile of rural populations. This conclusion supports wider international evidence on the importance of social protection strengthening for nutrition-sensitive economic growth. © 2019 Taylor & Francis.
Chewing function, general health and the dentition of older Australian men: The Concord Health and Ageing in Men Project
15 August 2019
University of Sydney

Wright, FAC;Law, GG;Milledge, KL;Chu, SK-Y;Valdez, E;Naganathan, V;Hirani, V;Blyth, FM;Le Couteur, DG;Waite, LM;Handelsman, DJ;Seibel, MJ;Cumming, R

Objectives To describe the associations between chewing function with oral health and certain general health characteristics, in a population of community‐dwelling older Australian men. Methods Analysis of data obtained from a cross‐sectional analysis of the 4th wave of the Concord Health and Ageing in Men Project cohort of 614 participants, 524 whom were dentate, aged 78 years and over. Their chewing capacity was assessed using three main indicators: capacity to chew eleven food items ranging from boiled eggs through to fresh carrots and nuts; discomfort when eating; and interruption of meals. Associations with chewing were tested for dentate vs edentate participants, numbers of teeth present, active dental disease and key general health conditions such as disabilities, comorbidities and cognitive status. Log binomial regression models adjusted for age, country of birth, income, education and marital status. Prevalence ratios and 95% confidence intervals were estimated. Results Twenty‐one per cent of participants could not eat hard foods, while 23.1% reported discomfort when eating, and 8.8% reported interrupted meals when eating. There was a threefold difference in the capacity of dentate men to chew firm meat over that of edentulous men (95% CI, 2.0‐4.9); a 2.5 times greater likelihood of edentate men reporting discomfort when eating (95% CI: 1.5‐4.3); and 1.9 times greater likelihood of edentate participants reporting having meals interrupted (95% CI: 1.4‐2.6). Chewing/eating difficulties were associated with both dental status (number of teeth, active dental caries) and self‐rated dental health. Fewer than 20 teeth and the presence of active coronal or root decay were associated with more discomfort when eating. General health conditions associated with chewing function included disability, physical activity, comorbidities, cognitive status and depression. Older men's self‐rated oral health and general health perceptions were also associated with aspects of chewing function. Poorer self‐reported oral health was associated with inability to eat hard foods (95% CI: 1.3‐2.7) and with discomfort when eating (95% CI: 2.6‐5.1), while poorer self‐reported general health was associated with discomfort when eating (95% CI: 1.2‐2.2). Conclusions Falling rates of edentulism may lead to improved chewing and eating function in older men. Maintaining 20 or more natural teeth, and preventing active coronal and root caries should enhance chewing function and promote self‐reported health and oral health. Lower capacity to chew hard foods and a higher reporting of discomfort when eating is associated with co‐morbidity in older Australian men.
Completeness of nutrient declarations and the average nutritional composition of pre-packaged foods in Beijing, China
28 August 2019
University of Sydney

Huang, L;Neal, B;Ma, G;Wu, JHY;Crino, M;Trevena, H

© 2016 The Authors Increasing consumption of pre-packaged foods is likely an important driver of diet-related diseases in China. From January 2013 it became mandatory to provide a standardised nutrient declaration on pre-packaged foods in China. We collected data on pre-packaged foods from large chain supermarkets in Beijing in 2013, examined the completeness of the nutrient declaration of core required nutrients and summarised the average nutritional composition of 14 different major food groups. We also illustrated the potential use of the data by comparing sodium levels. Photos of 14,279 pre-packaged foods were collected from 16 chain supermarkets in Beijing. Data for 11,489 products were included in the evaluation of nutrient declarations and data for 10,048 in the summary analysis of average nutritional composition. Compliant nutrient declarations were displayed by 87% of products with 88% of foods displaying data for each of energy, protein, total fat, carbohydrate and sodium. Nutrients not required by the Chinese regulation were infrequently reported: saturated fat (12%), trans fat (17%) and sugars (11%). Mean sodium levels were higher in Chinese products compared to UK products for 8 of 11 major food categories, often markedly so (e.g. 1417 mg/100 g vs. 304 mg/100 g for convenience foods). There has been substantial uptake of the recently introduced Chinese nutrition labelling regulation which should help consumers to choose healthier foods. As the comparison against corresponding data about sodium from the United Kingdom shows, the nutrient data can also be used to identify broader opportunities for improvement of the food supply.
Protocol for a cluster-randomised trial to determine the effects of advocacy actions on the salt content of processed foods
29 August 2019
University of Sydney

Trevena, H;Thow, AM;Dunford, E;Wu, JHY;Neal, B

Background: Corporate decisions affecting the composition of processed foods are a potent factor shaping the nutritional quality of the food supply. The addition of large quantities of salt to foods is incompatible with Australian Dietary Guidelines and the reformulation of processed foods to have less salt is a focus of non-governmental organisations (NGOs). There is evidence that advocacy can influence corporate behaviour but there are few data to define the effects of NGOs working in the food space. The aim of this study is to quantify the effects of advocacy delivered by a local NGO on the salt content of food products produced or marketed by companies in Australia. Methods/Design: This is a cluster-randomised controlled trial that will be done in Australia from 2013 to 2015 which includes 45 food companies. The 23 companies in the control group will receive no specific intervention whilst the 22 companies in the intervention group will receive an advocacy program based upon an established theory of change model. The primary outcome will be the mean change in sodium content (mg/100 g) of processed foods produced or marketed by intervention compared to control companies assessed at 24 months. Interim outcomes (statements of support, published nutrition policies, level of engagement, knowledge and use of technology to reduce salt, salt reduction plans, and support for national initiatives) will also be assessed and a qualitative evaluation will provide more detailed insight. Discussion: This novel study will provide robust randomised evidence about the effects of advocacy on food company behaviour and the quality of the processed food supply. A finding of improved food company behaviour will highlight the potential for greater investment in advocacy whilst the opposite result will reinforce the importance of government-led initiatives for the improvement of the food supply.
Do health claims and front-of-pack labels lead to a positivity bias in unhealthy foods?
29 August 2019
University of Sydney

Talati, Z;Pettigrew, S;Dixon, H;Neal, B;Ball, K;Hughes, C

Health claims and front-of-pack labels (FoPLs) may lead consumers to hold more positive attitudes and show a greater willingness to buy food products, regardless of their actual healthiness. A potential negative consequence of this positivity bias is the increased consumption of unhealthy foods. This study investigated whether a positivity bias would occur in unhealthy variations of four products (cookies, corn flakes, pizzas and yoghurts) that featured different health claim conditions (no claim, nutrient claim, general level health claim, and higher level health claim) and FoPL conditions (no FoPL, the Daily Intake Guide (DIG), Multiple Traffic Lights (MTL), and the Health Star Rating (HSR)). Positivity bias was assessed via measures of perceived healthiness, global evaluations (incorporating taste, quality, convenience, etc.) and willingness to buy. On the whole, health claims did not produce a positivity bias, while FoPLs did, with the DIG being the most likely to elicit this bias. The HSR most frequently led to lower ratings of unhealthy foods than the DIG and MTL, suggesting that this FoPL has the lowest risk of creating an inaccurate positivity bias in unhealthy foods.
Extracellular allosteric Na+ binding to the Na+,K+-ATPase in cardiac myocytes
10 September 2019
University of Sydney

Garcia, Alvaro;Fry, Natasha A. S.;Karimi, Keyvan;Liu, Chia-chi;Apell, Hans-Jurgen;Rasmussen, Helge H.;Clarke, Ronald J.

Whole cell patch clamp measurements of the current, Ip, produced by the Na+,K+-ATPase across the plasma membrane of rabbit cardiac myocytes show an increase in Ip over the extracellular Na+ concentration range 0 – 50 mM. This is not predicted by the classical Albers-Post scheme of the Na+,K+-ATPase mechanism, where extracellular Na+ should act as a competitive inhibitor of extracellular K+ binding, which is necessary for the stimulation of enzyme dephosphorylation and the pumping of K+ ions into the cytoplasm. The increase in Ip is consistent with Na+ binding to an extracellular allosteric site, independent of the ion transport sites, and an increase in turnover via an acceleration of the rate-determining release of K+ to the cytoplasm, E2(K+)2 → E1 + 2K+. At normal physiological concentrations of extracellular Na+ of 140 mM it is to be expected that binding of Na+ to the allosteric site would be nearly saturated. Its purpose would seem to be simply to optimize the enzyme’s ion pumping rate under its normal physiological conditions. Based on published crystal structures, a possible location of the allosteric site is within a cleft between the α- and β-subunits of the enzyme.
Interaction of N-terminal peptide analogues of the Na+,K+-ATPase with membranes
10 September 2019
University of Sydney

Nguyen, Khoa;Garcia, Alvaro;Sani, Marc-Antoine;Diaz, Dil;Dubey, Vikas;Clayton, Daniel;Dal Poggetto, Giovanni;Cornelius, Flemming;Payne, Richard J.;Separovic, Frances;Khandelia, Himanshu;Clarke, Ronald J.

The Na+,K+-ATPase, which is present in the plasma membrane of all animal cells, plays a crucial role in maintaining the Na+ and K+ electrochemical potential gradients across the membrane. Recent studies have suggested that the N-terminus of the protein’s catalytic α-subunit is involved in an electrostatic interaction with the surrounding membrane, which controls the protein’s conformational equilibrium. However, because the N-terminus could not yet be resolved in any X-ray crystal structures, little information about this interaction is so far available. In measurements utilising poly-L-lysine as a model of the protein’s lysine-rich N-terminus and using lipid vesicles of defined composition, here we have identified the most likely origin of the interaction as one between positively charged lysine residues of the N-terminus and negatively charged headgroups of phospholipids (notably phosphatidylserine) in the surrounding membrane. Furthermore, to isolate which segments of the N-terminus could be involved in membrane binding, we chemically synthesized N-terminal fragments of various lengths. Based on a combination of results from RH421 UV/visible absorbance measurements and solid-state 31P and 2H NMR using these N-terminal fragments as well as MD simulations it appears that the membrane interaction arises from lysine residues prior to the conserved LKKE motif of the N-terminus. The MD simulations indicate that the strength of the interaction varies significantly between different enzyme conformations.
Typical food portion sizes consumed by Australian adults: Results from the 2011-12 Australian National Nutrition and Physical Activity Survey
13 November 2019
University of Sydney

Zheng, M;Wu, JHY;Louie, JCY;Flood, VM;Gill, T;Thomas, B;Cleanthous, X;Neal, B;Rangan, A

Considerable evidence has associated increasing portion sizes with elevated obesity prevalence. This study examines typical portion sizes of commonly consumed core and discretionary foods in Australian adults, and compares these data with the Australian Dietary Guidelines standard serves. Typical portion sizes are defined as the median amount of foods consumed per eating occasion. Sex-and age-specific median portion sizes of adults aged 19 years and over (n = 9341) were analysed using one day 24 hour recall data from the 2011-12 National Nutrition and Physical Activity Survey. A total of 152 food categories were examined. There were significant sex and age differences in typical portion sizes among a large proportion of food categories studied. Typical portion sizes of breads and cereals, meat and chicken cuts, and starchy vegetables were 30-160% larger than the standard serves, whereas, the portion sizes of dairy products, some fruits, and non-starchy vegetables were 30-90% smaller. Typical portion sizes for discretionary foods such as cakes, ice-cream, sausages, hamburgers, pizza, and alcoholic drinks exceeded the standard serves by 40-400%. The findings of the present study are particularly relevant for establishing Australian-specific reference portions for dietary assessment tools, refinement of nutrition labelling and public health policies.
Designing a Healthy Food Partnership: Lessons from the Australian Food and Health Dialogue
13 November 2019
University of Sydney

Jones, A;Magnusson, R;Swinburn, B;Webster, J;Wood, A;Sacks, G;Neal, B

Background: Poor diets are a leading cause of disease burden worldwide. In Australia, the Federal Government established the Food and Health Dialogue (the Dialogue) in 2009 to address this issue, primarily through food reformulation. We evaluated the Dialogue's performance over its 6 years of operation and used these findings to develop recommendations for the success of the new Healthy Food Partnership. Methods: We used information from the Dialogue website, media releases, communiqués, e-newsletters, materials released under freedom-of-information, and Parliamentary Hansard to evaluate the Dialogue's achievements from October 2013 to November 2015, using the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework. We also engaged closely with two former Dialogue members. Our findings update a prior assessment done in October 2013. Results: Little data is available to evaluate the Dialogue's recent achievements, with no information about progress against milestones released since October 2013. In the last 2 years, only one additional set of sodium reduction targets (cheese) was agreed and Quick Service Restaurant foods were added as an area for action. Some activity was identified in 12 of a possible 137 (9 %) areas of action within the Dialogue's mandate. Independent evaluation found targets were partially achieved in some food categories, with substantial variation in success between companies. No effects on the knowledge, behaviours or nutrient intake of the Australian population or evidence of impact on diet-related disease could be identified. Conclusions: The new Healthy Food Partnership has similar goals to the Dialogue. While highly laudable and recognised globally as cost-effective, the mechanism for delivery in Australia has been woefully inadequate. Strong government leadership, adequate funding, clear targets and timelines, management of conflict of interest, comprehensive monitoring and evaluation, and a plan for responsive regulation in the event of missed milestones will be required if the new Healthy Food Partnership is to achieve its urgent public health goals.
Effects of a community-based salt reduction program in a regional Australian population
13 November 2019
University of Sydney

Land, MA;Wu, JHY;Selwyn, A;Crino, M;Woodward, M;Chalmers, J;Webster, J;Nowson, C;Jeffery, P;Smith, W;Flood, V;Neal, B

Background: Salt reduction is a public health priority but there are few studies testing the efficacy of plausible salt reduction programs. Methods: A multi-faceted, community-based salt reduction program using the Communication for Behavioral Impact framework was implemented in Lithgow, Australia. Single 24-h urine samples were obtained from 419 individuals at baseline (2011) and from 572 at follow-up (2014). Information about knowledge and behaviors relating to salt was also collected. Results: Survey participants were on average 56 years old and 58 % female. Mean salt intake estimated from 24-h urine samples fell from 8.8 g/day (SD = 3.6 g/day) in 2011 to 8.0 (3.6) g/day in 2014 (-0.80, 95 % confidence interval -1.2 to -0.3;p < 0.001). There were significant increases in the proportion of participants that knew the recommended upper limit of salt intake (18 % vs. 29 %; p < 0.001), knew the importance of salt reduction (64 % vs. 78 %; p < 0.001) and reported changing their behaviors to reduce their salt intake by using spices (5 % vs. 28 %; p < 0.001) and avoiding eating out (21 % vs. 34 %; p < 0.001). However, the proportions that checked food labels (30 % vs. 25 %; p = 0.02) fell, as did the numbers avoiding processed foods (44 % vs. 35 %; p = 0.006). Twenty-six percent reported using salt substitute at the end of the intervention period and 90 % had heard about the program. Findings were robust to multivariable adjustment. Conclusions: Implementation of this multi-faceted community-based program was associated with a ~10 % reduction in salt consumption in an Australian regional town. These findings highlight the potential of well-designed health promotion programs to compliment other population-based strategies to bring about much-needed reductions in salt consumption.
Population-level interventions in government jurisdictions for dietary sodium reduction
13 November 2019
University of Sydney

McLaren, L;Sumar, N;Barberio, AM;Trieu, K;Lorenzetti, DL;Tarasuk, V;Webster, J;Campbell, NRC

Background: Excess dietary sodium consumption is a risk factor for high blood pressure, stroke and cardiovascular disease. Currently, dietary sodium consumption in almost every country is too high. Excess sodium intake is associated with high blood pressure, which is common and costly and accounts for significant burden of disease. A large number of jurisdictions worldwide have implemented population-level dietary sodium reduction initiatives. No systematic review has examined the impact of these initiatives. Objectives: • To assess the impact of population-level interventions for dietary sodium reduction in government jurisdictions worldwide. • To assess the differential impact of those initiatives by social and economic indicators. Search methods: We searched the following electronic databases from their start date to 5 January 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); Cochrane Public Health Group Specialised Register; MEDLINE; MEDLINE In Process & Other Non-Indexed Citations; EMBASE; Effective Public Health Practice Project Database; Web of Science; Trials Register of Promoting Health Interventions (TRoPHI) databases; and Latin American Caribbean Health Sciences Literature (LILACS). We also searched grey literature, other national sources and references of included studies. This review was conducted in parallel with a comprehensive review of national sodium reduction efforts under way worldwide (Trieu 2015), through which we gained additional information directly from country contacts. We imposed no restrictions on language or publication status. Selection criteria: We included population-level initiatives (i.e. interventions that target whole populations, in this case, government jurisdictions, worldwide) for dietary sodium reduction, with at least one pre-intervention data point and at least one post-intervention data point of comparable jurisdiction. We included populations of all ages and the following types of study designs: cluster-randomised, controlled pre-post, interrupted time series and uncontrolled pre-post. We contacted study authors at different points in the review to ask for missing information. Data collection and analysis: Two review authors extracted data, and two review authors assessed risk of bias for each included initiative. We analysed the impact of initiatives by using estimates of sodium consumption from dietary surveys or urine samples. All estimates were converted to a common metric: salt intake in grams per day. We analysed impact by computing the mean change in salt intake (grams per day) from pre-intervention to post-intervention. Main results: We reviewed a total of 881 full-text documents. From these, we identified 15 national initiatives, including more than 260,000 people, that met the inclusion criteria. None of the initiatives were provided in lower-middle-income or low-income countries. All initiatives except one used an uncontrolled pre-post study design. Because of high levels of study heterogeneity (I2 > 90%), we focused on individual initiatives rather than on pooled results. Ten initiatives provided sufficient data for quantitative analysis of impact (64,798 participants). As required by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) method, we graded the evidence as very low due to the risk of bias of the included studies, as well as variation in the direction and size of effect across the studies. Five of these showed mean decreases in average daily salt intake per person from pre-intervention to post-intervention, ranging from 1.15 grams/day less (Finland) to 0.35 grams/day less (Ireland). Two initiatives showed mean increase in salt intake from pre-intervention to post-intervention: Canada (1.66) and Switzerland (0.80 grams/day more per person. The remaining initiatives did not show a statistically significant mean change. Seven of the 10 initiatives were multi-component and incorporated intervention activities of a structural nature (e.g. food product reformulation, food procurement policy in specific settings). Of those seven initiatives, four showed a statistically significant mean decrease in salt intake from pre-intervention to post-intervention, ranging from Finland to Ireland (see above), and one showed a statistically significant mean increase in salt intake from pre-intervention to post-intervention (Switzerland; see above). Nine initiatives permitted quantitative analysis of differential impact by sex (men and women separately). For women, three initiatives (China, Finland, France) showed a statistically significant mean decrease, four (Austria, Netherlands, Switzerland, United Kingdom) showed no significant change and two (Canada, United States) showed a statistically significant mean increase in salt intake from pre-intervention to post-intervention. For men, five initiatives (Austria, China, Finland, France, United Kingdom) showed a statistically significant mean decrease, three (Netherlands, Switzerland, United States) showed no significant change and one (Canada) showed a statistically significant mean increase in salt intake from pre-intervention to post-intervention. Information was insufficient to indicate whether a differential change in mean salt intake occurred from pre-intervention to post-intervention by other axes of equity included in the PROGRESS framework (e.g. education, place of residence). We identified no adverse effects of these initiatives. The number of initiatives was insufficient to permit other subgroup analyses, including stratification by intervention type, economic status of country and duration (or start year) of the initiative. Many studies had methodological strengths, including large, nationally representative samples of the population and rigorous measurement of dietary sodium intake. However, all studies were scored as having high risk of bias, reflecting the observational nature of the research and the use of an uncontrolled study design. The quality of evidence for the main outcome was low. We could perform a sensitivity analysis only for impact. Authors' conclusions: Population-level interventions in government jurisdictions for dietary sodium reduction have the potential to result in population-wide reductions in salt intake from pre-intervention to post-intervention, particularly if they are multi-component (more than one intervention activity) and incorporate intervention activities of a structural nature (e.g. food product reformulation), and particularly amongst men. Heterogeneity across studies was significant, reflecting different contexts (population and setting) and initiative characteristics. Implementation of future initiatives should embed more effective means of evaluation to help us better understand the variation in the effects.
Implications of thiamine fortification in Cambodian fish sauce
13 November 2019
University of Sydney

Wake, M;Neal, B

The astonishing range of dietary patterns within which humans can thrive contrasts with the precision of human metabolic processes.Nonetheless, reduced food diversity can pose major challenges for child health and more broadly for public health in rich and poor nations alike. How do societies provide the right balance of both food and nutrients—not too much but not too little—to meet immediate health needs? Simultaneously, how can childhood nutrition be optimized for a lifetime of good health, when diseases of aging may be far from the minds of parents and clinicians? How can the greater good be balanced against the possibility of harms for some?And how can these aims be achieved in a culturally acceptable way at a population level?
Developing a national salt reduction strategy for Mongolia
18 November 2019
University of Sydney

Enkhtungalag, B;Batjargal, J;Chimedsuren, O;Tsogzolmaa, B;Anderson, CS;Webster, J

BACKGROUND: The increase in prevalence of risk factors such as hypertension has contributed to an incremental rise in non-communicable diseases (NCDs) in Mongolia over recent decades, such that they now account for 80% of all deaths in the country. Salt reduction is one of the most cost-effective interventions to reduce the burden of NCDs. METHODS: In 2011, the Ministry of Health (MOH) instigated the development of a national salt reduction strategy for Mongolia. As part of a 2-week national consultation and training program on salt reduction, it established an inter-sectoral working party and organized a series of bilateral meetings and visits to factories. Actions arising included a baseline survey of population salt consumption patterns and the implementation of a series of pilot salt reduction initiatives. RESULTS: The results of the baseline assessment revealed that average daily intake of salt, based on 24 hour urine samples from a representative national sample (n=1,027), was 11.06±5.99 g in 2011, more than double the World Health Organization (WHO) five grams recommendation. Moreover, while most participants knew that salt was bad for health, few were taking efforts to reduce intake, and many were consuming highly salty meals and tea; salt in tea alone was estimated to contribute 30% of daily salt intake. A pilot Pinch Salt intervention to reduce salt consumption of factory workers was undertaken in Ulaanbaatar (UB) city between 2012 and 2013, and was associated with a reduction of 2.8 g of salt intake. Ongoing food industry initiatives have led to significant reductions in salt levels in bread, and companies producing processed meat have indicated a willingness to reduce salt. Relevant stakeholders have also supported the campaign by participating in annual World Salt Awareness Week events. The activities to date have demonstrated the potential for action and there is now a need scale these up to a national level to ensure that Mongolia is in a strong position to achieve a 30% reduction in population salt intake by 2025. The main goal of the Mongolian national salt reduction strategy is to create a social, economic and legal environment that supports salt reduction, including by influencing food supply, increasing partnerships between government and relevant stakeholders, and creating an enabling environment to support improved consumer choices. The strategy will be implemented from 2015 to 2025, with an interim review of progress in 2020. CONCLUSIONS: Given that Mongolia has one of the highest rates of stroke in the world, which is strongly associated with population-wide blood pressure (BP) levels, the addition of a population-based stroke surveillance program would provide a reliable direct assessment of the impact of these salt reduction initiatives on the health of the Mongolian people. The results from this research would likely be widely generalizable to other populations experiencing similar lifestyle transitional changes.
Dietary Salt Intake and Discretionary Salt Use in Two General Population Samples in Australia: 2011 and 2014
18 November 2019
University of Sydney

Nowson, C;Lim, K;Grimes, C;O'Halloran, S;Land, MA;Webster, J;Shaw, J;Chalmers, J;Smith, W;Flood, V;Woodward, M;Neal, B

The limited Australian measures to reduce population sodium intake through national initiatives targeting sodium in the food supply have not been evaluated. The aim was, thus, to assess if there has been a change in salt intake and discretionary salt use between 2011 and 2014 in the state of Victoria, Australia. Adults drawn from a population sample provided 24 h urine collections and reported discretionary salt use in 2011 and 2014. The final sample included 307 subjects who participated in both surveys, 291 who participated in 2011 only, and 135 subjects who participated in 2014 only. Analysis included adjustment for age, gender, metropolitan area, weekend collection and participation in both surveys, where appropriate. In 2011, 598 participants: 53% female, age 57.1(12.0)(SD) years and in 2014, 442 participants: 53% female, age 61.2(10.7) years provided valid urine collections, with no difference in the mean urinary salt excretion between 2011: 7.9 (7.6, 8.2) (95% CI) g/salt/day and 2014: 7.8 (7.5, 8.1) g/salt/day (p = 0.589), and no difference in discretionary salt use: 35% (2011) and 36% (2014) reported adding salt sometimes or often/always at the table (p = 0.76). Those that sometimes or often/always added salt at the table and when cooking had 0.7 (0.7, 0.8) g/salt/day (p = 0.0016) higher salt excretion. There is no indication over this 3-year period that national salt reduction initiatives targeting the food supply have resulted in a population reduction in salt intake. More concerted efforts are required to reduce the salt content of manufactured foods, together with a consumer education campaign targeting the use of discretionary salt.
Dietary sodium and iodine in remote Indigenous Australian communities: will salt-reduction strategies increase risk of iodine deficiency? A cross-sectional analysis and simulation study
19 November 2019
University of Sydney

McMahon, E;Webster, J;O'Dea, K;Brimblecombe, J

Background: Excess salt intake is a global issue. Effective salt-reduction strategies are needed, however, as salt is a vehicle for iodine fortification, these strategies may also reduce iodine intake. This study examines the case of the remote Indigenous Australian population; we employed an innovative, objective method to assess sodium and iodine intakes against requirements and modelled the potential effects of salt-reduction strategies on estimated sodium and iodine intakes. Design: Store-sales data were collected from 20 remote Indigenous community stores in 2012–14 representing the main source of food for 2 years for ~8300 individuals. Estimated average sodium and iodine intakes were compared against recommendations (nutrient reference values weighted to age and gender distribution). Linear programming was employed to simulate potential effects of salt-reduction strategies on estimated sodium and iodine intakes. Results: Estimated average sodium intake was 2770 (range within communities 2410–3450) mg/day, far exceeding the population-weighted upper limit (2060 mg/day). Discretionary (added) salt, bread and processed meat were the biggest contributors providing 46 % of all sodium. Estimated average iodine intake was within recommendations at 206 (186–246) μg/day. The following scenarios enabled modelling of estimated average salt intake to within recommendations: 1) 67 % reduction in sodium content of bread and discretionary salt intake, 2) 38 % reduction in sodium content of all processed foods, 3) 30 % reduction in sodium content of all processed foods and discretionary salt intake. In all scenarios, simulated average iodine intakes remained within recommendations. Conclusions: Salt intakes of the remote Indigenous Australian population are far above recommendations, likely contributing to the high prevalence of hypertension and cardiovascular mortality experienced by this population. Salt-reduction strategies could considerably reduce salt intake in this population without increasing risk of iodine deficiency at the population-level. These data add to the global evidence informing salt-reduction strategies and the evidence that these strategies can be synergistically implemented with iodine deficiency elimination programmes. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12613000694718.
Salt reduction in Australia: from advocacy to action
20 November 2019
University of Sydney

Webster, J;Trieu, K;Dunford, E;Nowson, C;Jolly, KA;Greenland, R;Reimers, J;Bolam, B

Background: As part of its endorsement of the World Health Organization’s Global Action Plan to prevent non-communicable diseases, the Federal Government of Australia has committed to a 30% reduction in average population salt intake by 2025. Currently, mean daily salt intake levels are 8-9 grams, varying by sex, region and population group. A number of salt reduction initiatives have been established over the last decade, but key elements for a co-ordinated population-level strategy are still missing. The objective of this review is to provide a comprehensive overview of existing population-level salt reduction activities in Australia and identify opportunities for further action. Methods: A review of the published literature and stakeholder activities was undertaken to identify and document current activities. The activities were then assessed against a pre-defined framework for salt reduction strategies. Results: A range of initiatives were identified from the review. The Australian Division of World Action on Salt and Health (AWASH) was established in 2005 and in 2007 launched its Drop the Salt! Campaign. This united non-governmental organisations (NGOs), health and medical and food industry organisations in a co-ordinated advocacy effort to encourage government to develop a national strategy to reduce salt. Subsequently, in 2010 the Federal Government launched its Food and Health Dialogue (FHD) with a remit to improve the health of the food supply in Australia through voluntary partnerships with food industry, government and non-government public health organisations. The focus of the FHD to date has been on voluntary reformulation of foods, primarily through salt reduction targets. More recently, in December 2014, the government’s Health Star Rating system was launched. This front of pack labelling scheme uses stars to highlight the nutritional profile of packaged foods. Both government initiatives have clear targets or criteria for industry to meet, however, both are voluntary and the extent of industry uptake is not yet clear. There is also no parallel public awareness campaign to try and influence consumer behaviour relating to salt and no agreed mechanism for monitoring national changes in salt intake. The Victorian Health Promotion Foundation (VicHealth) has recently instigated a State-level partnership to advance action and will launch its strategy in 2015. Conclusions: In conclusion, salt reduction activities are currently being implemented through a variety of different programs but additional efforts and more robust national monitoring mechanisms are required to ensure that Australia is on track to achieve the proposed 30% reduction in salt intake within the next decade.
An Evaluation of the Effects of the Australian Food and Health Dialogue Targets on the Sodium Content of Bread, Breakfast Cereals and Processed Meats
27 November 2019
University of Sydney

Trevena, H;Neal, B;Dunford, E;Wu, JHY

The Australian Food and Health Dialogue set sodium reduction targets for three food categories (breads, ready-to-eat breakfast cereals and processed meats) to be achieved by December, 2013. Sodium levels for 1849 relevant packaged foods on the shelves of Australian supermarkets between 2010 and 2013 were examined. Changes in mean sodium content were assessed by linear mixed models, and the significance of differences in the proportion of products meeting targets was determined using chi-squared or McNemar’s tests. The mean sodium level of bread products fell from 454 to 415 mg/100 g (9% lower, p < 0.001), and the proportion reaching target rose from 42% to 67% (p < 0.005). The mean sodium content of breakfast cereals also fell substantially from 316 to 237 mg/100 g (25% lower, p < 0.001) over the study period. The decline in mean sodium content of bacon/ham/cured meats from 1215 to 1114 mg/100 g (8% lower, p = 0.001) was smaller, but associated with a rise in the proportion meeting the target from 28% to 47%. Declines in mean sodium content did not appreciably differ between companies that did and did not make public commitments to the targets. These data show that the Australian food industry can reduce salt levels of processed foods and provide a strong case for broadening and strengthening of the Food and Health Dialogue (FHD) process.
Drop the Salt! Assessing the impact of a public health advocacy strategy on Australian government policy on salt
27 November 2019
University of Sydney

Webster, J;Dunford, E;Kennington, S;Neal, B;Chapman, S

Objective: In 2007 the Australian Division of World Action on Salt and Health (AWASH) launched a campaign to encourage the Australian government to take action to reduce population salt intake. The objective of the present research was to assess the impact of the Drop the Salt! campaign on government policy. Design: A review of government activities related to salt reduction was conducted and an advocacy strategy implemented to increase government action on salt. Advocacy actions were documented and the resulting outcomes identified. An analysis of stakeholder views on the effectiveness of the advocacy strategy was also undertaken. Settings: Advocacy activities were coordinated through AWASH at the George Institute for Global Health in Sydney. Subjects: All relevant State and Federal government statements and actions were reviewed and thirteen stakeholders with known interests or responsibilities regarding dietary salt, including food industry, government and health organisations, were interviewed. Results: analysis affirmed that AWASH influenced the government's agenda on salt reduction and four key outputs were attributed to the campaign: (i) the Food Regulation Standing Committee discussions on salt, (ii) the Food and Health Dialogue salt targets, (iii) National Health and Medical Research Council partnership funding and (iv) the New South Wales Premier's Forum on Fast Foods. Conclusions: While it is not possible to definitively attribute changes in government policy to one organisation, stakeholder research indicated that the AWASH campaign increased the priority of salt reduction on the government's agenda. However, a coordinated government strategy on salt reduction is still required to ensure that the potential health benefits are fully realised.
Effects of interpretive front-of-pack nutrition labels on food purchases: protocol for the Starlight randomised controlled trial
27 November 2019
University of Sydney

Volkova, E;Neal, B;Rayner, M;Swinburn, B;Eyles, H;Jiang, Y;Michie, J;Ni Murchu, C

Background: Interpretive front-of-pack nutrition labels are better understood than non-interpretive labels. However, robust evidence on the effects of such labels on consumer food purchases in the real-world is lacking. Our aim is to assess the effects of two interpretive front-of-pack nutrition labels, compared with a non-interpretive label, on the healthiness of consumer food purchases. Methods/Design: A five-week (1-week baseline and 4-week intervention) three-arm parallel randomised controlled trial will be conducted using a bespoke smartphone application, which will administer study questionnaires and deliver intervention (Multiple Traffic Light and Health Star Rating) and control (Nutrition Information Panel) labels. To view their allocated nutrition label, participants scan the barcode of packaged food products using their smartphone camera. The assigned label is displayed instantly on the smartphone screen.1500 eligible participants (New Zealand adult smartphone owners who shop in a supermarket at least once a week and are main household shoppers) will be randomised in a 1:1:1 ratio to one of the three nutrition label formats, using computer-generated randomisation sequences. Randomisation will be stratified by ethnicity and interest in healthy eating. Food and beverage purchase data will be collected continuously throughout the study via hard copy till receipts and electronic grocery purchase lists recorded and transmitted using the smartphone application. The primary outcome will be healthiness of food purchases in each trial arm, assessed as mean Food Standards Australia New Zealand nutrient profiling score criterion score for all food and beverages purchased over the intervention period. Secondary outcomes will include saturated fat, sugar, sodium and energy content of food purchases; food expenditure; labelling profile of food purchases (i.e. mean number of Health Star Rating stars and proportion of red, green and amber traffic lights); nutrient profiling score over time and by food categories; purchases of unpackaged foods; self-reported nutrition knowledge and recorded use of assigned labelling system. Discussion: The Starlight randomised, controlled trial will determine the effects of interpretive front-of-pack nutrition labels on the healthiness of consumer food purchases in the real world. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12614000644662 (registered 18 June 2014).
Protocol for developing the evidence base for a national salt reduction programme for India
27 November 2019
University of Sydney

Johnson, C;Mohan, S;Praveen, D;Woodward, M;Maulik, PK;Shivashankar, R;Amarchand, R;Webster, J;Dunford, E;Thout, SR;MacGregor, G;He, F;Reddy, S;Krishnan, A;Prabhakaran, D;Neal, B

Introduction: The scientific evidence base in support of salt reduction is strong but the data required to translate these insights into reduced population salt intake are mostly absent. The aim of this research project is to develop the evidence base required to formulate and implement a national salt reduction programme for India. Methods and analysis: The research will comprise three components: a stakeholder analysis involving government, industry, consumers and civil society organisations; a population survey using an age-stratified and sex-stratified random samples drawn from urban (slum and non-slum) and rural areas of North and South India; and a systematic quantitative evaluation of the nutritional components of processed and restaurant foods. The stakeholder interviews will be analysed using qualitative methods to summarise the main themes and define the broad range of factors influencing the food environment in India. The population survey will estimate the mean daily salt consumption through the collection of 24 h urine samples with concurrent dietary surveys identifying the main sources of dietary sodium/salt. The survey of foods will record the nutritional composition of the chief elements of food supply. The findings from this research will be synthesised and proposals for a national salt reduction strategy for India will be developed in collaboration with key stakeholders. Ethics and dissemination: This study has been approved by the Human Research Ethics Committees of the University of Sydney and the Centre for Chronic Disease Control in New Delhi, and also by the Indian Health Ministry's Screening Committee. The project began fieldwork in February 2014 and will report the main results in 2016. The ﬁndings will be targeted primarily at public health policymakers and advocates, but will be disseminated widely through other mechanisms including conference presentations and peer-reviewed publications, as well as to the participating communities.
Salt intake assessed by 24 h urinary sodium excretion in a random and opportunistic sample in Australia
27 November 2019
University of Sydney

Land, MA;Webster, J;Christoforou, A;Praveen, D;Jeffrey, P;Chalmers, J;Smith, W;Woodward, M;Barzi, F;Nowson, C;Flood, V;Neal, B

Objective: The gold standard method for measuring population sodium intake is based on a 24 h urine collection carried out in a random population sample. However, because participant burden is high, response rates are typically low with less than one in four agreeing to provide specimens. At this low level of response it is possible that simply asking for volunteers would produce the same results. Setting: Lithgow, New South Wales, Australia. Participants: We randomly selected 2152 adults and obtained usable 24 h urine samples from 306 (response rate 16%). Specimens were also collected from a further 113 volunteers. Estimated salt consumption and the costs for each strategy were compared. Results: The characteristics of the ‘random’ and ‘volunteer’ samples were moderately different in mean age 58 (SD 14.6 vs 49(17.7) years, respectively; p<0.001) as well as self-reported alcohol use, tobacco use, history of hypertension and prescription drug use (all p<0.04). Overall crude mean 24 h urinary salt excretion was 8.9(3.6) g/day in the random sample vs 8.5(3.3) g/day for the volunteers (p=0.42). Corresponding age-adjusted and sex-adjusted estimates were 9.2(3.3) and 8.8(3.4) g/day (p=0.29). Estimates for men 10.3(3.8) vs 9.6(3.3) g/day; (p=0.26) and women 7.6(3) vs 7.9(3.2) g/day; (p=0.43) were also similar for the two samples, as was salt excretion across age groups (p=0.72). The cost of obtaining each 24 h urine sample was two times greater for the random compared to volunteer samples ($A62 vs $A31). Conclusions: The estimated salt consumption derived from the two samples was comparable and was not substantively different to estimates obtained from other surveys. In countries where salt is pervasive and cannot easily be avoided, estimates of consumption obtained from volunteer samples may be valid and less costly.
Using mobile technology to support lower-salt food choices for people with cardiovascular disease: protocol for the SaltSwitch randomized controlled trial
27 November 2019
University of Sydney

Eyles, H;McLean, R;Neal, B;Doughty, RN;Jiang, Y;Ni Mhurchu, C

Background: Cardiovascular disease (CVD) is the leading cause of early death worldwide, responsible for an estimated 29% of all global deaths. Reducing salt intake lowers blood pressure and risk of secondary cardiac events. However, identifying low salt foods can be challenging. SaltSwitch is a simple smartphone application (app) that enables shoppers to scan the barcode of packaged foods and receive an immediate, interpretive, traffic light nutrition label on the screen, along with suggestions for healthier lower-salt alternatives. A growing body of evidence suggests mobile technologies can support healthy behaviour change. However, robust evidence for the impact of smartphone interventions is lacking. This manuscript outlines the rationale and methods for a randomized controlled trial designed to determine the effectiveness of SaltSwitch in supporting people with CVD to make lower-salt food choices. Design/Methods: A 6-week, two-arm, parallel, randomized controlled trial is being undertaken in New Zealand (2 weeks baseline and 4 weeks intervention). Three hundred adults aged 40 years and older with CVD and their main household shoppers are recruited from research lists, cardiac rehabilitation clinics, and communities in Auckland. Participants are randomized to receive either the SaltSwitch smartphone app or no intervention (control). Randomisation is stratified by ethnicity and age. The primary outcome is the salt content of household food purchases. Secondary outcomes are the saturated fat and energy content of household food purchases, household food expenditure, use and acceptability of the SaltSwitch app by shoppers, and urinary sodium and blood pressure of participants with CVD. Ambulatory blood pressure and potential longer-term impact (12 weeks) of SaltSwitch will be assessed in sub-studies (n ~ 40 and n ~ 20, respectively). Household purchases of salt and other nutrients will be assessed using till receipt data electronically linked with branded food composition data. Discussion: The results of the SaltSwitch trial will determine the effectiveness, use and acceptability of a smartphone application to support lower salt food choices and secondary prevention of CVD. Trial registration: ACTRN12614000206628. Registered 30 March 2014.
Protein Micropatterns by PEG Grafting on Dewetted PLGA Films
28 November 2019
University of Sydney

Ghezzi, Manuel;Thickett, S.C.;Telford, A.M.;Easton, C.D.;Meagher, L.;Neto, Chiara

The ability to control protein and cell positioning on a microscopic scale is crucial in many biomedical applications, such as single cell studies. We have developed and investigated the grafting of poly(ethylene glycol) (PEG) brushes onto poly(D,L-lactide-co-glycolide) (PLGA) thin films, which can be micro-patterned by exploiting their spontaneous dewetting on top of polystyrene (PS) films. Dense PEG brushes with excellent protein repellence were achieved on PLGA by using cloud point grafting conditions, and selective adsorption of proteins on the micro-patterned substrates was achieved by exploiting the different affinity protein adsorption onto the PEG brushes and the PS holes. PEG-grafted PLGA films showed better resistance against spontaneous degradation in buffer than bare PLGA films, due to passivation by the thin PEG coating. The simplicity of dewetting and subsequent grafting approaches, coupled with the ability to coat and pattern non-planar substrates give rise to possible applications of PEG-grafted PLGA films in single cell studies and cell cultures for tissue engineering.
A proposed approach to monitor private‐sector policies and practices related to food environments, obesity and non‐communicable disease prevention
04 December 2019
University of Sydney

Sacks, G;Swinburn, B;Kraak, V;Downs, S;Walker, C;Barquera, S;Friel, S;Hawkes, C;Kelly, B;Kumanyika, S;L'Abbe, M;Lee, A;Lobstein, T;Ma, J;Macmullan, J;Mohan, S;Monteiro, C;Neal, B;Rayner, M;Sanders, D;Snowdon, W;Vandevijvere, S;INFORMAS

Private‐sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private‐sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private‐sector policies and practices related to food environments, and their influence on obesity and non‐communicable disease (NCD) prevention. A step‐wise approach to data collection is recommended, in which the first (‘minimal’) step is the collation of publicly available food and nutrition‐related policies of selected private‐sector organizations. The second (‘expanded’) step assesses the nutritional composition of each organization's products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third (‘optimal’) step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private‐sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention.
INFORMAS (International Network for Food and Obesity/non‐communicable diseases Research, Monitoring and Action Support): overview and key principles
04 December 2019
University of Sydney

Swinburn, B;Sacks, G;Vandevijvere, S;Kumanyika, S;Lobstein, T;Neal, B;Barquera, S;Friel, S;Hawkes, C;Kelly, B;L'Abbe, M;Lee, A;Ma, J;Macmullan, J;Mohan, S;Monteiro, C;Rayner, M;Sanders, D;Snowdon, W;Walker, C;INFORMAS

Non‐communicable diseases (NCDs) dominate disease burdens globally and poor nutrition increasingly contributes to this global burden. Comprehensive monitoring of food environments, and evaluation of the impact of public and private sector policies on food environments is needed to strengthen accountability systems to reduce NCDs. The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) is a global network of public‐interest organizations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities. The INFORMAS framework includes two ‘process’ modules, that monitor the policies and actions of the public and private sectors, seven ‘impact’ modules that monitor the key characteristics of food environments and three ‘outcome’ modules that monitor dietary quality, risk factors and NCD morbidity and mortality. Monitoring frameworks and indicators have been developed for 10 modules to provide consistency, but allowing for stepwise approaches (‘minimal’, ‘expanded’, ‘optimal’) to data collection and analysis. INFORMAS data will enable benchmarking of food environments between countries, and monitoring of progress over time within countries. Through monitoring and benchmarking, INFORMAS will strengthen the accountability systems needed to help reduce the burden of obesity, NCDs and their related inequalities.
Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed Government Healthy Food Environment Policy Index
05 December 2019
University of Sydney

Swinburn, B;Vandevijvere, S;Kraak, V;Sacks, G;Snowdon, W;Hawkes, C;Barquera, S;Friel, S;Kelly, B;Kumanyika, S;L'Abbe, M;Lee, A;Lobstein, T;Ma, J;Macmullan, J;Mohan, S;Monteiro, C;Neal, B;Rayner, M;Sanders, D;Walker, C;INFORMAS

Government action is essential to increase the healthiness of food environments and reduce obesity, diet‐related non‐communicable diseases (NCDs), and their related inequalities. This paper proposes a monitoring framework to assess government policies and actions for creating healthy food environments. Recommendations from relevant authoritative organizations and expert advisory groups for reducing obesity and NCDs were examined, and pertinent components were incorporated into a comprehensive framework for monitoring government policies and actions. A Government Healthy Food Environment Policy Index (Food‐EPI) was developed, which comprises a ‘policy’ component with seven domains on specific aspects of food environments, and an ‘infrastructure support’ component with seven domains to strengthen systems to prevent obesity and NCDs. These were revised through a week‐long consultation process with international experts. Examples of good practice statements are proposed within each domain, and these will evolve into benchmarks established by governments at the forefront of creating and implementing food policies for good health. A rating process is proposed to assess a government's level of policy implementation towards good practice. The Food‐EPI will be pre‐tested and piloted in countries of varying size and income levels. The benchmarking of government policy implementation has the potential to catalyse greater action to reduce obesity and NCDs.

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