Objective: To examine how socio-demographic characteristics and diet quality vary with consumption of ultra-processed foods (UPF) in a cross-sectional nationally representative survey of Australian adults.Design: Using a 24-h recall, this cross-sectional analysis of dietary and socio-demographic data classified food items using the NOVA system, estimated the percentage of total energy contributed by UPFs and assessed diet quality using the Dietary Guideline Index (DGI–2013 total and components). Linear regression models examined associations between socio-demographic characteristics and diet quality with percentage of energy from UPF.Setting: Australian Health Survey 2011–2013.Participants: Australian adults aged ≥ 19 years (n 8209).Results: Consumption of UPF was higher among younger adults (aged 19–30 years), adults born in Australia, those experiencing greatest area-level disadvantage, lower levels of education and the second lowest household income quintile. No significant association was found for sex or rurality. A higher percentage of energy from UPF was inversely associated with diet quality and with lower DGI scores related to the variety of nutritious foods, fruits, vegetables, total cereals, meat and poultry, fish, eggs, nuts and seeds, legumes/beans, water and limits on discretionary foods, saturated fat and added sugar.Conclusions: This research adds to the evidence on dietary inequalities across Australia and how UPF are detrimental to diet quality. The findings can be used to inform interventions to reduce UPF consumption and improve diet quality.

Plant-based dietary patterns are comprised of a range of foods, and increasingly, diet quality indices are used to assess them and their associations with health outcomes. As the design of these indices varies, a review of existing indices is necessary to identify common features, strengths, and considerations. This scoping review aimed to synthesize the literature on plant-based diet quality indices by examining their 1) basis for development, 2) scoring methodology, and 3) validation approaches. MEDLINE, CINAHL, and Global Health databases were systematically searched from 1980 to 2022. Observational studies were included if they assessed plant-based diets in adults, using an a priori methodology with food-based components. Studies conducted among pregnant/lactating people were excluded. Thirty-five unique plant-based diet quality indices were identified in 137 included articles published between 2007 and 2022. Indices were developed to reflect epidemiological evidence for associations between foods and health outcomes (n = 16 indices), previous diet quality indices (n = 16), country-specific dietary guidelines (n = 9), or foods from traditional dietary patterns (n = 6). Indices included 4 to 33 food groups, with fruits (n = 32), vegetables (n = 32), and grains (n = 30) the most common. Index scoring comprised of population-specific percentile cutoffs (n = 18) and normative cutoffs (n = 13). Twenty indices differentiated between healthy and less healthy plant-based foods when scoring intakes. Validation methods included construct validity (n = 26), reliability (n = 20), and criterion validity (n = 5). This review highlights that most plant-based diet quality indices were derived from epidemiological research, the majority of indices differentially scored healthy and unhealthy plant and animal foods, and indices were most often evaluated for construct validity and reliability. To ensure best practice use and reporting of plant-based dietary patterns, researchers should consider the basis for development, methodology, and validation when identifying appropriate plant-based diet quality indices for use in research contexts.

Novel plant-based meat and dairy alternatives are designed to mimic and replace animal sourced products, yet their nutritional composition differs to traditional alternatives such as legumes and beans. The nutritional impacts of switching from animal sourced to traditional or novel plant-based alternatives remains unclear. To model the impact of partial and complete substitution of animal sourced meat and dairy products with traditional or novel plant-based alternatives on diet quality and nutrient adequacy in a nationally representative sample of Australian adults. Dietary data (one 24-hour recall) from the Australian Health Survey 2011-2013 (n=9115; ≥19 years) were analysed. Four models simulated partial or complete substitution of animal sourced meat and dairy with traditional or novel plant-based alternatives. Diet quality was assessed using the Dietary Guideline Index (DGI), and nutrient adequacy was determined using age and sex-specific nutrient reference values. Modelled diets were compared to a baseline diet using survey weighted paired t-tests. DGI scores improved by between 0.3% to 6.0% for all models across all sex and age groups compared to baseline. Improvements in diet quality were greatest for the complete substitution to traditional alternatives (5.1% average increase in DGI). Overall, inclusion of plant-based alternatives (complete or partial) decreased saturated fat and increased dietary fibre. Long-chain n-3 polyunsaturated fatty acids decreased to below adequate intakes for all complete substitution models. Substitution with traditional alternatives deceased sodium and increased calcium, while substitution with novel alternatives increased sodium and decreased calcium. All models using traditional alternatives, and the partial substitution using novel alternatives showed small but statistically significant improvements in diet quality. Nutrient adequacy varied between models, with nutrients including saturated fat, sodium, calcium, and long-chain fatty acids implicated. Findings highlight the importance of informed choices when switching to traditional or novel plant-based alternatives to prevent sub-optimal dietary intake.

Dietary patterns examine the combinations, types and quantities of foods consumed in the diet. Compared to individual nutrients, dietary patterns may be better associated with cancer-related malnutrition, low muscle mass and sarcopenia. This scoping review identified associations between dietary patterns, assessed using data-driven methods (i.e., statistical methods used to derive existing dietary patterns) and hypothesis-orientated methods (i.e., adherence to diet quality indices), and malnutrition, low muscle (lean) mass and sarcopenia. MEDLINE, Embase and CINAHL databases were searched up to September 2021. Of the 3341 studies identified, seven studies were eligible for review. Study designs included experimental (n = 5) and observational (n = 2), and people with prostate, ovarian and endometrial, bladder, breast, and gastrointestinal cancers. One study used data-driven methods to derive dietary patterns, finding adherence to a ‘fat and fish’ diet was associated with lower odds of low muscle mass. Two studies examined adherence to hypothesis-orientated methods including the Mediterranean Diet Adherence Screener and Healthy Eating Index 2010 and four studies used ‘non-traditional’ approaches to analyse dietary patterns. Hypothesis-orientated dietary patterns, developed to improve general health and prevent chronic disease, and ‘non-traditional’ dietary patterns demonstrated inconsistent effects on muscle (lean) mass. All studies investigated muscle (lean) mass, omitting malnutrition and sarcopenia as cancer-related outcomes. This scoping review highlights the limited research examining the effect of dietary patterns on cancer-related outcomes.

Background: Plant-based diets are associated with favourable cardiovascular health markers. Although increasingly consumed among younger demographics, it is unclear how plant-based diet quality tracks from adolescence to young adulthood, and how this impacts cardiovascular health later in life. Thus, this study aimed to explore trajectories of plant-based dietary patterns from adolescence to young adulthood and investigate associations with cardiometabolic health markers in young Australian adults. Methods: Longitudinal data from 417 participants from the Raine Study were included. Semi-quantitative food frequency questionnaires conducted at 14, 20, and 27 years of were used to derive three plant-based diet quality index scores: an overall plant-based diet (PDI), a healthy plant-based diet (hPDI), and a less healthy plant-based diet (uPDI). Markers of cardiometabolic health included waist circumference, blood lipids, and blood pressure obtained at 14 and 28 years of age. Group-based trajectory modelling was used to describe plant-based diet quality trajectory groups from adolescence to young adulthood. Multivariate linear regression models were used to investigate associations with cardiovascular health markers. Results: Plant-based diet quality trajectory groups were different by sex, but remained relatively stable over the life stages, with participants remaining either above or below average diet quality at all time points. Associations with cardiovascular health outcomes differed between the sexes, with the hPDI having the greatest number of associations for females, and the uPDI for males. Being female with a higher hPDI score was associated with lower insulin (β = -1.11 (95% CI -2.12, -0.09)), HOMA-IR (β = -0.25 (95% CI -0.48, -0.01)), systolic blood pressure (β = -2.75 (95% CI -5.31, -0.19)), and hs-CRP (β = -1.53 (95% CI -2.82, -0.23)), and higher HDL-cholesterol (β = 0.13 (95% CI -0.03, 0.23)) compared to females with lower hPDI scores. Being male in the higher scoring uPDI group was associated with higher waist circumference (β = 3.12 (95% CI 0.61, 5.63)), waist-to-height ratio (β = 0.02 (95% CI 0.01, 0.03)), insulin (β = 1.54 (95% CI 0.33, 2.76)), HOMA-IR (β = 0.35 (95% CI 0.07, 0.63)), and hypertension status (β = 6.60 (95% CI 1.04, 42.00)) when compared to the lower scoring uPDI group. Conclusions: This study provides new insights into how plant-based diets track across adolescence into adulthood, impacting on cardiometabolic risk factors differently for males and females. Findings highlight the importance of early sex-specific interventions in adolescence to reduce future risk of cardiovascular-disease.