Karen Joy Murphy

Background: Behaviour-change outcomes are often incompletely reported in multidomain trials. We evaluated behaviour change during a 12-month Mediterranean diet (MedDiet) and physical activity (PA) intervention.Participants and Setting: Adults aged 60 to 90 years without cognitive impairment, independently living in two Australian cities.Methods: n=83 participants (MedWalk group) were supported over 12 months to consume a MedDiet and engage in at least 150 minutes of moderate to vigorous PA (MVPA) per week. Control group participants (n=73) maintained habitual diet and PA. Four validated measures (MedWalk MedDiet Adherence Screener (MW-MEDAS), MedDiet Score, accelerometry-derived MVPA and MET minutes by International Physical Activity Questionnaire-elderly) were analysed separately and combined into a total adherence score to determine change in behaviour from baseline. Differences within and between groups were analysed at baseline, 6-months and 12-months using linear mixed effect modelling, controlling for predictors of attrition and baseline group differences.Results: Participants were 74% female, with a mean±SD age of 74.9 ± 5.9 years. After 12 months, MW-MEDAS had increased by an average of 3.3/14 points, and total adherence score by 1.4/8 points in the MedWalk group (p<.001), with no significant change in the control group. There were no significant changes in dietary behaviours in the control group, and MVPA declined in both groups at 6 months.Conclusions: The MedWalk intervention improved overall adherence among older adults over 12 months, driven by an increase in MedDiet adherence. PA did not increase, potentially due to high baseline PA or challenges in changing PA behaviours.

Background/Objectives: Malnutrition among older adults, particularly those in aged care, is a major contributor to morbidity and healthcare costs. Reduced visual contrast sensitivity, common with ageing and dementia, may impair the ability to distinguish food from tableware, potentially leading to decreased intake. This systematic review examined whether enhancing visual contrast in the dining environment improves dietary intake in older adults. Methods: Following PRISMA guidelines, five databases were searched from inception to March 2025. Studies were eligible if they involved adults aged ≥65 years and used visual contrast interventions (e.g., coloured tableware, lighting adjustments) aimed at improving food or fluid intake. A narrative synthesis was conducted, and study quality was assessed using the Mixed Methods Appraisal Tool. Results: Of 2901 records screened, four studies (five reports) met the inclusion criteria, involving a total of 64 participants. All studies implemented visual contrast enhancements, including high-contrast dishware and environmental modifications. Most reported increases in food or liquid intake, though statistical significance varied. Some studies also evaluated mealtime behaviours, functional abilities, and food waste, with mixed findings. Methodological limitations, including small sample sizes, short interventions, and inconsistent reporting limited the strength of evidence. Conclusions: Limited and low-quality evidence suggests a possible effect of modifying the dining environment to improve visual contrast for enhancing dietary intake in older adults, with visual contrast sensitivity, particularly those with dementia. However, the evidence gap is large and remains inconclusive. Future well-powered trials with standardised interventions and outcome measures are needed to determine whether these strategies can meaningfully reduce malnutrition in aged care settings.

INTRODUCTION: Healthful dietary patterns may attenuate dementia risk by preserving cerebrovascular health. Prior work has focused on systemic arterial stiffness, but cerebrovascular measures may be more sensitive to neuroprotective effects of diet. We examined associations between Mediterranean diet adherence, prefrontal cortex (PFC) arterial elasticity, and cognition in older adults. METHODS: Participants were 198 older adults (58% female; mean age 65.6 years) from the Newcastle ACTIVate cohort. Mediterranean Diet (MedDiet) scores were derived from the Australian Eating Survey food frequency questionnaire. Pulse Relaxation Function (PReFx), an index of PFC arterial elasticity, was measured using pulse Diffuse Optical Tomography. Cognition was assessed with CANTAB and a cued task-switching paradigm. RESULTS: Higher MedDiet was associated with higher PFC arterial elasticity. MedDiet was not associated with cognition, and PReFx did not mediate diet-cognition associations. DISCUSSION: Greater Mediterranean diet alignment was cross-sectionally associated with PFC arterial elasticity, suggesting a pathway through which diet may influence brain health in ageing.

There is growing evidence that optimising dietary quality and engaging in physical activity (PA) can reduce dementia and cognitive decline risk and improve psychosocial health and quality of life (QoL). Multimodal interventions focusing on diet and PA are recognised as significant strategies to tackle these behavioural risk factors; however, the cost-effectiveness of such interventions is seldom reported. A limited cost consequence based on a 12-month cluster-randomised Mediterranean diet (MedDiet) and walking controlled trial (MedWalk) was undertaken. In addition, QoL data were analysed. Programme costs ($AUD2024) covered staff to deliver the MedWalk programme and foods to support dietary behaviour change. The primary outcome measure of this study was change in QoL utility score, measured using the Assessment of Quality of Life (AQoL-8D). Change scores were compared for the groups using general linear models while controlling for demographic factors associated with baseline group differences and attrition. Change in QoL (decreased, maintained or improved) was determined using a cross-tabulation test. MedWalk programme costs were estimated at $2695 AUD per participant and control group cost at $165 per person – a differential cost of $2530. Mean change in utility scores from baseline to 12 months was not statistically significant between groups. Nevertheless, the MedWalk group was significantly less likely to experience a reduction in their QoL (20·3 % MedWalk v . 42·6 % control group) ( P = 0·020). A MedDiet and walking intervention may have a role in preventing decline in QoL of older Australians; however, longer-term follow-up would be beneficial to see if this is maintained.

Background/Objectives: Determining whether dietary fatty acids and the use of fat spreads are associated with cardiovascular risk factors is difficult due to the multicollinearity of fatty acids and the consumption of multiple spread types. Methods: We applied clustering methodologies using data on 31 different fatty acids and 5 different types of fat spreads (high fat: butter, blended butters, and margarines; lower fat: polyunsaturated and monounsaturated) and investigated associations with blood pressure, serum lipid patterns and insulin resistance in the Raine Study Gen2 participants in Western Australia, at 20 and 22 years of age. Results: Amongst n = 785 participants, there were eight distinct clusters formed from the fatty acid data and ten distinct clusters formed from the fat spread data. Male participants had higher systolic blood pressure than females (122.2 ± 11.6 mmHg versus 111.7 ± 10.3, p < 0.001 at age 20 and 123.4 ± 10.6 versus 113.9 ± 9.8, p < 0.001 at age 22). Males consuming exclusively butter as a fat spread had significantly higher SBP (+4.3 mmHg) compared with males not using spreads. Males consuming a high intake of margarine had significantly higher SBP (+6.6 mmHg), higher DBP (+3.4 mmHg) and higher triglycerides (+30.5%). Amongst females, four patterns of fatty acid intake were associated with lower levels of HDL cholesterol compared with the low-saturated-fat/high n-3 reference group (p = 0.017 after adjustment for relevant confounders, range = −10.1% to −16.0%, p = 0.017). There were no associations between clusters and HOMA-IR or other serum lipids for males or females. Conclusions: Compared to using no fat spreads, amongst males, a high intake of margarine was characterised by higher systolic and diastolic blood pressure and higher serum triglycerides, whilst the use of butter also was associated with higher SBP. Diets low in n-3s or high in trans fats were associated with sub-optimal HDL levels amongst females.

Purpose: Inadequate reporting of nutrition data can hinder the success of nutrition health policies. CONSORT provides guidance for reporting of randomised controlled trials (RCTs) and is required by most journals today, yet reporting of nutrition interventions may benefit from a more tailored approach. A Federation of European Nutrition Societies working group was created to improve quality and completeness of reporting of nutrition trials, and our work to date features a proposal for a CONSORT extension specific to nutrition RCTs. The present manuscript describes a Delphi survey conducted to gather opinion from a wider panel of nutrition and health experts and related interest-holders on our proposal. Methods: We invited 138 potentially eligible participants to take part in the Delphi survey from a representative spread of expertise and geography. We employed a Likert scale with comments for our 32-item proposal in round 1, and a dichotomous scale with comments for our 29-item proposal in round 2. Threshold for agreement was set at ≥ 80% for both rounds. Results: Forty-seven potentially eligible participants responded to our invitation, 38 completed the first round and 36 completed the second. N = 23 (72%) items achieved ≥ 80% in round 1, and 100% of items in round 2. Three items were dropped or merged following round 1. A third Delphi round was not required to obtain consensus. Conclusions: This Delphi expert consensus proposes a 29-item checklist specific to the reporting of nutrition RCTs and will inform further development of guidance through forthcoming consensus meetings.

Malnutrition and frailty are preventable and reversible. However, a significant proportion of aged care residents live with malnutrition and frailty which have associated complications such as increased falls, hospitalizations, infections, and decreased quality of life. Nutrition and dietary interventions can prevent these issues, however, there a few interventions conducted in this setting and no consensus on the most utilized interventions to improve health outcomes. In a crude literature search, we identified 65 nutrition-related randomized controlled trials worldwide in the aged care setting from 2000 to 2024. Most interventions were conducted in Europe and were oral nutrition supplementation or dietary supplements and/or food fortification. With few published studies, progressing nutrition interventions in aged care may be assisted by the mapping and identification of the key barriers and challenges related to engagement and collaboration with stakeholders and participants and the logistics of the aged care environment including staffing workload and kitchen capacity. Nutrition researchers should consider using process evaluations and qualitative research to map barriers and enablers to implementation in hopes to improve future research.

Background: Healthy dietary patterns can support the maintenance of cognition and brain health in older age and are negatively associated with cardiometabolic risk. Cardiometabolic risk factors are similarly important for cognition and may play an important role in linking diet to cognition. Aim: This study aimed to explore the relationship between dietary patterns and cognition and to determine whether cardiometabolic health markers moderate these relationships in older adulthood. Design: A cross-sectional analysis of observational data from the baseline of the ACTIVate study. Participants: The cohort included 426 cognitively normal adults aged 60–70 years. Methods: The Australian Eating Survey (AES) Food Frequency Questionnaire was used to collect data on usual dietary intake, along with additional questions assessing intake of dietary oils. Principal component analysis (PCA) was applied to reduce the dimensionality of dietary data. Cardiometabolic risk was quantified using the metabolic syndrome severity score (MetSSS). Tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were used to derive composite scores on four cognitive domains: processing speed, executive function, short-term memory, and long-term memory. Results: Three dietary patterns were identified using PCA: a plant-dominant diet, a Western-style diet, and a meat-dominant diet. After controlling for age, sex, total years of education, energy intake, and moderate-to-vigorous physical activity (MVPA), there was a small, negative association between the meat-dominant diets and long-term memory. Subsequent moderation analysis indicated that MetSSS significantly moderated this relationship. Conclusions: Findings highlight the link between diet, cardiometabolic health, and cognitive function in older, cognitively healthy adults. However, longitudinal studies are needed to confirm observations and evaluate the dynamics of diet, cardiometabolic health, and cognitive function over time.