Publications by authors named "Clare Hughes"

94 Publications

Extracellular Matrix Deposition and Remodeling after Corneal Alkali Burn in Mice.

Int J Mol Sci 2021 May 27;22(11). Epub 2021 May 27.

College of Optometry, University of Houston, Houston, TX 77204, USA.

Corneal transparency relies on the precise arrangement and orientation of collagen fibrils, made of mostly Type I and V collagen fibrils and proteoglycans (PGs). PGs are essential for correct collagen fibrillogenesis and maintaining corneal homeostasis. We investigated the spatial and temporal distribution of glycosaminoglycans (GAGs) and PGs after a chemical injury. The chemical composition of chondroitin sulfate (CS)/dermatan sulfate (DS) and heparan sulfate (HS) were characterized in mouse corneas 5 and 14 days after alkali burn (AB), and compared to uninjured corneas. The expression profile and corneal distribution of CS/DSPGs and keratan sulfate (KS) PGs were also analyzed. We found a significant overall increase in CS after AB, with an increase in sulfated forms of CS and a decrease in lesser sulfated forms of CS. Expression of the CSPGs biglycan and versican was increased after AB, while decorin expression was decreased. We also found an increase in KS expression 14 days after AB, with an increase in lumican and mimecan expression, and a decrease in keratocan expression. No significant changes in HS composition were noted after AB. Taken together, our study reveals significant changes in the composition of the extracellular matrix following a corneal chemical injury.
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http://dx.doi.org/10.3390/ijms22115708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199272PMC
May 2021

The Contribution of Foods Prepared Outside the Home to the Diets of 18- to 30-Year-Old Australians: The MYMeals Study.

Nutrients 2021 May 21;13(6). Epub 2021 May 21.

Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW 2006, Australia.

Young adults are the highest consumers of food prepared outside home (FOH) and gain most weight among Australian adults. One strategy to address the obesogenic food environment is menu labelling legislation whereby outlets with >20 stores in one state and >50 Australia-wide must display energy content in kJ. The aim of this study was to assess the contribution of FOH to the energy and macronutrients, saturated fat, total sugars and sodium intakes of young Australians. One thousand and one 18 to 30-year-olds (57% female) residing in Australia's most populous state recorded all foods and beverages consumed and the location of preparation for three consecutive days using a purpose-designed smartphone application. Group means for the daily consumption of energy, percentage energy (%E) for protein, carbohydrate, total sugars, total and saturated fats, and sodium density (mg/1000 kJ) and proportions of nutrients from FOH from menu labelling and independent outlets were compared. Overall, participants consumed 42.4% of their energy intake from FOH with other nutrients ranging from 39.8% (sugars) to 47.3% (sodium). Independent outlets not required to label menus, contributed a greater percentage of energy (23.6%) than menu labelling outlets (18.7%, < 0.001). Public health policy responses such as public education campaigns, extended menu labelling, more detailed nutrition information and reformulation targets are suggested to facilitate healthier choices.
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http://dx.doi.org/10.3390/nu13061761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224325PMC
May 2021

Chondroitin Sulfate as a Potential Modulator of the Stem Cell Niche in Cornea.

Front Cell Dev Biol 2020 12;8:567358. Epub 2021 Jan 12.

Structural Biophysics Group, School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom.

Chondroitin sulfate (CS) is an important component of the extracellular matrix in multiple biological tissues. In cornea, the CS glycosaminoglycan (GAG) exists in hybrid form, whereby some of the repeating disaccharides are dermatan sulfate (DS). These CS/DS GAGs in cornea, through their presence on the proteoglycans, decorin and biglycan, help control collagen fibrillogenesis and organization. CS also acts as a regulatory ligand for a spectrum of signaling molecules, including morphogens, cytokines, chemokines, and enzymes during corneal growth and development. There is a growing body of evidence that precise expression of CS or CS/DS with specific sulfation motifs helps define the local extracellular compartment that contributes to maintenance of the stem cell phenotype. Indeed, recent evidence shows that CS sulfation motifs recognized by antibodies 4C3, 7D4, and 3B3 identify stem cell populations and their niches, along with activated progenitor cells and transitional areas of tissue development in the fetal human elbow. Various sulfation motifs identified by some CS antibodies are also specifically located in the limbal region at the edge of the mature cornea, which is widely accepted to represent the corneal epithelial stem cell niche. Emerging data also implicate developmental changes in the distribution of CS during corneal morphogenesis. This article will reflect upon the potential roles of CS and CS/DS in maintenance of the stem cell niche in cornea, and will contemplate the possible involvement of CS in the generation of eye-like tissues from human iPS (induced pluripotent stem) cells.
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http://dx.doi.org/10.3389/fcell.2020.567358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835413PMC
January 2021

Defining unhealthy food for regulating marketing to children-What are Australia's options?

Nutr Diet 2021 Jan 7. Epub 2021 Jan 7.

Cancer Prevention and Advocacy Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia.

Aim: To compare six nutrient profiling models for suitability in food marketing to children regulation.

Methods: Products (n = 220) advertised at transport hubs were classified as eligible/ineligible to be advertised to children using an Australian government developed guide (Council of Australian Governments), the Health Star Rating system before and after the modifications made in 2020, World Health Organization Western Pacific Region and Europe nutrient profile criterion and the NOVA food classification system. Agreement between models was determined using Cohen's Kappa.

Results: The Council of Australian Governments' guide was able to classify more products than the other models (n = 210) and was easy to use as it did not require nutrition information. It agreed most closely with NOVA (moderate agreement). The proportion of foods classified as eligible to be marketed (most strict) was lowest for NOVA (10%), similar for Council of Australian Governments and the World Health Organisation models (16%-17%) and highest for Health Star Rating models (26%-28%).

Conclusions: The Council of Australian Governments' guide provides simple, easy to use profiling criteria aligned with Australian dietary advice. Political will is now required to incorporate a profiling model within government-endorsed food marketing regulation.
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http://dx.doi.org/10.1111/1747-0080.12658DOI Listing
January 2021

Effects of HER Family-targeting Tyrosine Kinase Inhibitors on Antibody-dependent Cell-mediated Cytotoxicity in HER2-expressing Breast Cancer.

Clin Cancer Res 2021 Feb 29;27(3):807-818. Epub 2020 Oct 29.

National Institute for Cellular Biotechnology, Dublin City University, Dublin, Leinster, Ireland.

Purpose: Antibody-dependent cell-mediated cytotoxicity (ADCC) is one mechanism of action of the monoclonal antibody (mAb) therapies trastuzumab and pertuzumab. Tyrosine kinase inhibitors (TKIs), like lapatinib, may have added therapeutic value in combination with mAbs through enhanced ADCC activity. Using clinical data, we examined the impact of lapatinib on HER2/EGFR expression levels and natural killer (NK) cell gene signatures. We investigated the ability of three TKIs (lapatinib, afatinib, and neratinib) to alter HER2/immune-related protein levels in preclinical models of HER2-positive (HER2) and HER2-low breast cancer, and the subsequent effects on trastuzumab/pertuzumab-mediated ADCC.

Experimental Design: Preclinical studies (proliferation assays, Western blotting, high content analysis, and flow cytometry) employed HER2 (SKBR3 and HCC1954) and HER2-low (MCF-7, T47D, CAMA-1, and CAL-51) breast cancer cell lines. NCT00524303 provided reverse phase protein array-determined protein levels of HER2/pHER2/EGFR/pEGFR. RNA-based NK cell gene signatures (CIBERSORT/MCP-counter) post-neoadjuvant anti-HER2 therapy were assessed (NCT00769470/NCT01485926). ADCC assays utilized flow cytometry-based protocols.

Results: Lapatinib significantly increased membrane HER2 levels, while afatinib and neratinib significantly decreased levels in all preclinical models. Single-agent lapatinib increased HER2 or EGFR levels in 10 of 11 (91%) tumor samples. NK cell signatures increased posttherapy ( = 0.03) and associated with trastuzumab response ( = 0.01). TKI treatment altered mAb-induced NK cell-mediated ADCC , but it did not consistently correlate with HER2 expression in HER2 or HER2-low models. The ADCC response to trastuzumab and pertuzumab combined did not exceed either mAb alone.

Conclusions: TKIs differentially alter tumor cell phenotype which can impact NK cell-mediated response to coadministered antibody therapies. mAb-induced ADCC response is relevant when rationalizing combinations for clinical investigation.
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http://dx.doi.org/10.1158/1078-0432.CCR-20-2007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854527PMC
February 2021

Vascular dimorphism ensured by regulated proteoglycan dynamics favors rapid umbilical artery closure at birth.

Elife 2020 09 10;9. Epub 2020 Sep 10.

Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, United States.

The umbilical artery lumen closes rapidly at birth, preventing neonatal blood loss, whereas the umbilical vein remains patent longer. Here, analysis of umbilical cords from humans and other mammals identified differential arterial-venous proteoglycan dynamics as a determinant of these contrasting vascular responses. The umbilical artery, but not the vein, has an inner layer enriched in the hydrated proteoglycan aggrecan, external to which lie contraction-primed smooth muscle cells (SMC). At birth, SMC contraction drives inner layer buckling and centripetal displacement to occlude the arterial lumen, a mechanism revealed by biomechanical observations and confirmed by computational analyses. This vascular dimorphism arises from spatially regulated proteoglycan expression and breakdown. Mice lacking aggrecan or the metalloprotease ADAMTS1, which degrades proteoglycans, demonstrate their opposing roles in umbilical vascular dimorphism, including effects on SMC differentiation. Umbilical vessel dimorphism is conserved in mammals, suggesting that differential proteoglycan dynamics and inner layer buckling were positively selected during evolution.
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http://dx.doi.org/10.7554/eLife.60683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529456PMC
September 2020

Changes in nutrition content and health claims post-implementation of regulation in Australia.

Public Health Nutr 2020 08 27;23(12):2221-2227. Epub 2020 Apr 27.

Cancer Prevention and Advocacy Division, Cancer Council NSW, Woolloomooloo, NSW2011, Australia.

Objective: To determine whether there were changes in the prevalence or healthiness of products carrying claims post-implementation of Standard 1.2.7: Nutrition, Health and Related Claims in the Australia New Zealand Food Standards Code.

Design: Observational survey of claims on food packages in three categories: non-alcoholic beverages, breakfast cereals and cereal bars. Nutrient profiling was applied to products to determine their eligibility to carry health claims under Standard 1.2.7. The Standard came into effect in 2013. The proportion of products carrying claims and the proportion of those not meeting the nutrient profiling criteria were calculated. A comparative analysis was conducted to determine changes between 2011 and 2016.

Setting: Three large metropolitan stores from the three major supermarket chains in Sydney, Australia were surveyed in 2011 and 2016.

Participants: All claims on all available products in 2016 (n 1737). Nutrition composition and ingredients were collected from the packaging.

Results: Overall in 2016, 76 % of products carried claims and there were 7367 claims identified in the three food categories. Of products in 2016 with health claims, 34 % did not meet nutrient profiling criteria. These may breach Standard 1.2.7. Comparison of 2011-2016 showed a significant increase in the number of products carrying claims (66 v. 76 %, P < 0·001).

Conclusions: The proportion of products carrying claims that do not meet nutrient profiling and consumers' tendency to infer health benefits from nutrition content claims warrants the regulation of all claims using the nutrient profiling. This will ensure consumers are not misled by claims on unhealthy food products.
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http://dx.doi.org/10.1017/S1368980019004890DOI Listing
August 2020

Children's trips to school dominated by unhealthy food advertising in Sydney, Australia.

Public Health Res Pract 2020 Mar 10;30(1). Epub 2020 Mar 10.

Early Start, School of Health and Society, University of Wollongong, NSW, Australia.

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http://dx.doi.org/10.17061/phrp3012005DOI Listing
March 2020

Advertising Placement in Digital Game Design Influences Children's Choices of Advertised Snacks: A Randomized Trial.

J Acad Nutr Diet 2020 03 28;120(3):404-413. Epub 2019 Dec 28.

Background: Children are inhabitants of a media-rich environment rife in extensive, sophisticated, and persistent techniques that are used to market unhealthy food. Exposure is known to influence children's attitudes, choices, and consumption, yet further research is required to explore the influence of contemporary techniques within online games.

Objective: To explore the influence of modern advertising on children's attitudes, choices, and consumption, techniques (ie, banner advertising, advergame, and rewarded video advertising) were used to promote an unfamiliar confectionery brand within an online game.

Design: A between-subjects randomized experimental study.

Participants/setting: Children (aged 7 to 12 years [n=156]) were recruited in New South Wales, Australia, between September and November 2017.

Intervention: Children were required to play a 4-minute online game, complete some questionnaires, and choose one snack to consume afterward. Children were randomly assigned to one of four conditions: a control group with no advertising, and three experimental conditions that promoted an unfamiliar confectionery brand via a banner advertisement, advergame, or rewarded video advertisement.

Main Outcome Measures: Questionnaires included the assessment of attitudes to the test brand before and after the game, enjoyment of the game, and children's awareness of advertising. Food choice was recorded and food consumption was measured by weighing the snack in grams, which was translated into kilocalories.

Statistical Analyses Performed: Statistical tests included analyses of variance, Kruskal-Wallis test, and χ test.

Results: Attitudes toward the perception of fun (P=0.06) and taste (P=0.21) of the test brand were not influenced by condition. Children who were exposed to the rewarded video advertising chose the test brand significantly more than children in the other three conditions (P<0.002). Condition did not influence overall energy intake measured in grams (P=0.78) or kilocalories (P=0.46).

Conclusions: Children's choice of the test brand was significantly influenced by the rewarded video advertising condition (compared with control, banner advertising, and advergame conditions). This technique is prevalent across online and application games that children play yet the effects of using rewarded video advertising to promote food brands have not been explored from a public health perspective. This study contributes to the understanding of modern strategies used to market unhealthy foods to children.
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http://dx.doi.org/10.1016/j.jand.2019.07.017DOI Listing
March 2020

Nutrient composition of Australian fast-food and fast-casual children's meals available in 2016 and changes in fast-food meals between 2010 and 2016.

Public Health Nutr 2019 11 12;22(16):2981-2988. Epub 2019 Sep 12.

Nutrition Unit, Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia.

Objective: A quarter of Australian children are overweight or obese. Research conducted in 2010 found that fast-food children's meals were energy-dense and nutrient-poor. Since then, menu labelling and self-regulation of marketing have been introduced in Australia. The present study aimed to: (i) investigate the nutrient composition of children's meals offered at fast-food chains; (ii) compare these with children's daily requirements and recommendations and the food industry's own criteria for healthier children's meals; and (iii) determine whether results have changed since last investigated in 2010.

Design: An audit of nutrition information for fast-food children's meals was conducted. Meals were compared with 30 % (recommended contribution for a meal) and 100 % of children's daily recommendations and requirements. A comparative analysis was conducted to determine if the proportion of meals that exceeded meal requirements and recommendations, and compliance with the food industry's own criteria, changed between 2010 and 2016.

Setting: Large Australian fast-food chains.

Participants: All possible children's meal combinations.

Results: Overall, 289 children's meals were included. Most exceeded 30 % of daily recommendations and requirements for a 4-year-old's energy, saturated fat, sugars and Na. Results were also substantial for 8- and 13-year-olds, particularly for Na. When compared with mean energy and nutrient contents from 2010, there were minimal changes overall.

Conclusions: Children's meals can provide excess energy, saturated fat, sugar and Na to children's diets. Systematic reformulation of energy, saturated fat, sugars and Na would improve the nutrient composition of the meals.
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http://dx.doi.org/10.1017/S1368980019001897DOI Listing
November 2019

Skin Conductance Responses Indicate Children are Physiologically Aroused by Their Favourite Branded Food and Drink Products.

Int J Environ Res Public Health 2019 08 21;16(17). Epub 2019 Aug 21.

Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.

Children's favourite food and beverage brands use various tactics to foster positive associations and loyalty. This brand-consumer dynamic is frequently influenced by the use of implicit techniques and emotional appeals. Few studies have used physiological methods to examine the connections that brands build with children and the influence this has on their automatic responses. These techniques are potentially less prone to bias than behavioural or cognitive methods. This is the first study to explore the implicit response that children have to images of their favourite food and beverage brands using skin conductance responses as a marker of arousal. Australian children aged 8-11 years ( = 48) were recruited. Images of the participants' favourite branded food and beverage products, alongside images of the same products unpackaged, their family and friends, and neutral objects were presented in a randomised order with a standard timed interval between images. Children were significantly more aroused by branded images of their favourite food and beverage products than by their unpackaged counterparts ( < 0.042, = 0.4). The physiological response to the branded products was similar to the response to the children's family and friends ( = 0.900, = -0.02). These findings suggest that children may have an implicit connection to their favourite branded products.
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http://dx.doi.org/10.3390/ijerph16173014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747165PMC
August 2019

Children's Exposure to Television Food Advertising Contributes to Strong Brand Attachments.

Int J Environ Res Public Health 2019 07 3;16(13). Epub 2019 Jul 3.

Cancer Council NSW, Sydney, NSW 2011, Australia.

Children's exposure to unhealthy food marketing is one factor contributing to childhood obesity. The impact of marketing on children's weight likely occurs via a cascade pathway, through influences on children's food brand awareness, emotional responses, purchasing and consumption. Thus, building emotional attachments to brands is a major marketing imperative. This study explored Australian children's emotional attachments to food and drink brands and compared the strength of these attachments to their food marketing exposure, using television viewing as a proxy indicator. A cross-sectional face-to-face survey was conducted with 282 Australian children (8-12 years). Children were asked to indicate their agreement/disagreement with statements about their favourite food and drink brands, as an indicator of the strength and prominence of their brand attachments. Questions captured information about minutes/day of television viewing and the extent that they were exposed to advertising (watched live or did not skip through ads on recorded television). For those children who were exposed to advertisements, their age and commercial television viewing time had significant effects on food and drink brand attachments ( = 0.001). The development of brand attachments is an intermediary pathway through which marketing operates on behavioural and health outcomes. Reducing children's exposure to unhealthy food marketing should be a policy priority for governments towards obesity and non-communicable disease prevention.
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http://dx.doi.org/10.3390/ijerph16132358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6651128PMC
July 2019

How effective is food industry self-substantiation of food-health relationships underpinning health claims on food labels in Australia?

Public Health Nutr 2019 06 4;22(9):1686-1695. Epub 2019 Mar 4.

2Cancer Programs Division,Cancer Council NSW,Woolloomooloo,New South Wales,Australia.

Objective: The Food Standards Code regulates health claims on Australian food labels. General-level health claims highlight food-health relationships, e.g. 'contains calcium for strong bones'. Food companies making claims must notify Food Standards Australia New Zealand (FSANZ) and certify that a systematic literature review (SLR) substantiating the food-health relationship has been conducted. There is no pre- or post-notification assessment of the SLR, potentially enabling the food industry to make claims based on poor-quality research. The present study assessed the rigour of self-substantiation.

Design: Food-health relationships notified to FSANZ were monitored monthly between 2013 and 2017. These relationships were assessed by scoping published literature. Where evidence was equivocal/insufficient, the relevant government food regulatory agency was asked to investigate. If not investigated, or the response was unsatisfactory, the project team conducted an independent SLR which was provided to the government agency.

Setting: Australia.ParticipantsSelf-substantiated food-health relationships.

Results: There were sixty-seven relationships notified by thirty-eight food companies. Of these, thirty-three relationships (52 %) from twenty companies were deemed to have sufficient published evidence. Four were excluded as they originated in New Zealand. Three relationships were removed before investigations were initiated. The project initiated twenty-seven food-health relationship investigations. Another six relationships were withdrawn, and three relationships were awaiting government assessment.

Conclusions: To ensure that SLR underpinning food-health relationships are rigorous and reduce regulatory enforcement burden, pre-market approval of food-health relationships should be introduced. This will increase consumer and public health confidence in the regulatory process and prevent potentially misleading general-level health claims on food labels.
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http://dx.doi.org/10.1017/S1368980018004081DOI Listing
June 2019

Evaluation of the Cancer Council NSW Eat It To Beat It Healthy Lunch Box Sessions: A short intervention to promote the intake of fruit and vegetables among families of primary school children in NSW Australia.

Health Promot J Austr 2019 Jan 28;30(1):102-107. Epub 2017 Dec 28.

Prevention Research Collaboration, Sydney Medical School & Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.

Issue Addressed: Children and adults in Australia are not eating the recommended amounts of fruits and vegetables. Our objective was to assess the effectiveness of a health promotion intervention to improve fruit and vegetable intake among primary school children and their families in NSW.

Methods: The Cancer Council New South Wales Healthy Lunch Box sessions were a 25-minute session delivered to parents of primary school-aged children. The sessions provided information and resources about fruit and vegetables and healthy school lunch boxes. The evaluation is a quantitative uncontrolled pre-post design. Data were collected using three questionnaires, pre-intervention, 1 week post-intervention and 6 months post-intervention.

Results: A total of 204 parents completed all three evaluation questionnaires to 6 months. Knowledge of recommended intakes and serving sizes of fruit and vegetables improved significantly after the intervention. There was an increase in parents reporting packing vegetables (often/always) in the child's lunch box at 1 week (47%) and 6 months post-intervention (40%) compared to pre-intervention (32%). The proportion of parents reporting that they were confident in packing a healthy lunch box increased from 45% pre-intervention to 62% after the intervention.

Conclusion: The Healthy Lunch Box sessions were effective in improving parental knowledge and practices related to fruit and vegetables and parental confidence with packing a healthy lunch box. SO WHAT?: This short intervention could be a useful component of a portfolio of interventions to support parents with knowledge and resources to pack a healthy lunch box for their children.
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http://dx.doi.org/10.1002/hpja.23DOI Listing
January 2019

Sustained impact of energy-dense TV and online food advertising on children's dietary intake: a within-subject, randomised, crossover, counter-balanced trial.

Int J Behav Nutr Phys Act 2018 04 12;15(1):37. Epub 2018 Apr 12.

Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia.

Background: Policies restricting children's exposure to unhealthy food marketing have been impeded by the lack of evidence showing a direct link between food advertising exposure and children's energy intake and body weight. Food advertising exposure increases children's immediate food consumption, but whether this increased intake is compensated for at later eating occasions is not known; consequently the sustained effect on diets remains unclear.

Methods: We conducted a within-subject, randomised, crossover, counterbalanced study across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017. Children (7-12 years, n = 160) were recruited via local schools, email networks and social media. Two gender- and age-balanced groups were formed for each camp (n = 20), randomised to either a multiple- or single- media condition and exposed to food and non-food advertising in an online game and/or a television cartoon. Children's food consumption (kilojoules) was measured at a snack immediately after exposure and then at lunch later in the day. Linear mixed models were conducted to examine relationships between food advertising exposure and dietary intake, taking into account gender, age and weight status.

Results: All children in the multiple-media condition ate more at a snack after exposure to food advertising compared with non-food advertising; this was not compensated for at lunch, leading to additional daily food intake of 194 kJ (95% CI 80-308, p = 0.001, d = 0.2). Exposure to multiple-media food advertising compared with a single-media source increased the effect on snack intake by a difference of 182 kJ (95% CI 46-317, p = 0.009, d = 0.4). Food advertising had an increased effect among children with heavier weight status in both media groups.

Conclusion: Online ('advergame') advertising combined with TV advertising exerted a stronger influence on children's food consumption than TV advertising alone. The lack of compensation at lunch for children's increased snack intake after food advertising exposure suggests that unhealthy food advertising exposure contributes to a positive energy-gap, which could cumulatively lead to the development of overweight.

Trial Registration: Australian New Zealand Clinical Trials Registry, number ACTRN12617001230347 (Retrospectively registered).
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http://dx.doi.org/10.1186/s12966-018-0672-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897936PMC
April 2018

Children's self-regulation of eating provides no defense against television and online food marketing.

Appetite 2018 06 26;125:438-444. Epub 2018 Feb 26.

Prevention Research Collaboration, School of Public Health, University of Sydney, NSW, 2006, Australia.

Exposure to unhealthy food marketing stimulates children's food consumption. A child's responsiveness is influenced by individual factors, resulting in an increased vulnerability to advertising effects among some children. Whether these differential responses may be altered by different parental feeding behaviours is unclear. The purpose of this study was to determine the relationship between parental feeding practices and children's food intake responses to food advertising exposure. A randomised, crossover, counterbalanced, within subject trial was conducted across four, six-day holiday camps in New South Wales, Australia between April 2016 and January 2017 with 160 children (7-12 years, n = 40/camp). Children were randomised to either a multiple media (TV and Internet) or single media (TV) condition and exposed to food (3 days) and non-food (3 days) advertising in an online game and/or a cartoon. Children's food consumption (kilojoules (kJ)) was measured at a snack immediately after advertising exposure and then at lunch later in the day. Parents completed the Child Feeding Questionnaire, and 'restriction' and 'pressure to eat' subscale scores were calculated. While food advertising affected all children in the multiple media condition, there was an increased effect on snack intake among children whose parents reported pressuring them to eat, with children consuming an additional 356 kJ after food advertising compared with non-food advertising. This was 209 kJ more than children whose parents did not pressure them to eat. In the single media condition, only children whose parents reported restrictive feeding practices ate more at lunch on food advertising days than non-food advertising days (240 kJ). These data highlight an increased susceptibility to food advertising among children whose parents report controlling feeding practices.
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http://dx.doi.org/10.1016/j.appet.2018.02.026DOI Listing
June 2018

Lost in translation - the role of prospective partners within the perioperative setting.

Authors:
Clare Hughes

J Perioper Pract 2018 Mar;28(3):40

Midwifery Lecturer (Education), MBC Reception, Queens University Belfast, Belfast.

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http://dx.doi.org/10.1177/1750458918755966DOI Listing
March 2018

Examining the Frequency and Contribution of Foods Eaten Away From Home in the Diets of 18- to 30-Year-Old Australians Using Smartphone Dietary Assessment (MYMeals): Protocol for a Cross-Sectional Study.

JMIR Res Protoc 2018 Jan 26;7(1):e24. Epub 2018 Jan 26.

Nutrition and Dietetics Group, School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia.

Background: Young Australians aged between 18 and 30 years have experienced the largest increase in the body mass index and spend the largest proportion of their food budget on fast food and eating out. Frequent consumption of foods purchased and eaten away from home has been linked to poorer diet quality and weight gain. There has been no Australian research regarding quantities, type, or the frequency of consumption of food prepared outside the home by young adults and its impact on their energy and nutrient intakes.

Objectives: The objective of this study was to determine the relative contributions of different food outlets (eg, fast food chain, independent takeaway food store, coffee shop, etc) to the overall food and beverage intake of young adults; to assess the extent to which food and beverages consumed away from home contribute to young adults' total energy and deleterious nutrient intakes; and to study social and physical environmental interactions with consumption patterns of young adults.

Methods: A cross-sectional study of 1008 young adults will be conducted. Individuals are eligible to participate if they: (1) are aged between 18 and 30 years; (2) reside in New South Wales, Australia; (3) own or have access to a smartphone; (4) are English-literate; and (5) consume at least one meal, snack, or drink purchased outside the home per week. An even spread of gender, age groups (18 to 24 years and 25 to 30 years), metropolitan or regional geographical areas, and high and low socioeconomic status areas will be included. Participants will record all food and drink consumed over 3 consecutive days, together with location purchased and consumed in our customized smartphone app named Eat and Track (EaT). Participants will then complete an extensive demographics questionnaire. Mean intakes of energy, nutrients, and food groups will be calculated along with the relative contribution of foods purchased and eaten away from home. A subsample of 19.84% (200/1008) of the participants will complete three 24-hour recall interviews to compare with the data collected using EaT. Data mining techniques such as clustering, decision trees, neural networks, and support vector machines will be used to build predictive models and identify important patterns.

Results: Recruitment is underway, and results will be available in 2018.

Conclusions: The contribution of foods prepared away from home, in terms of energy, nutrients, deleterious nutrients, and food groups to young people's diets will be determined, as will the impact on meeting national recommendations. Foods and consumption behaviors that should be targeted in future health promotion efforts for young adults will be identified.
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http://dx.doi.org/10.2196/resprot.9038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807621PMC
January 2018

Monitoring the changes to the nutrient composition of fast foods following the introduction of menu labelling in New South Wales, Australia: an observational study.

Public Health Nutr 2018 04 21;21(6):1194-1199. Epub 2017 Dec 21.

1Cancer Programs Division,Cancer Council NSW,153 Dowling Street,Woolloomooloo,NSW 2011,Australia.

Objective: The present study examined the energy (kilojoule) content of Australian fast-food menu items over seven years, before and after introduction of menu board labelling, to determine the impact of the introduction of the legislation.

Design: Analysis of the median energy contents per serving and per 100g of fast-food menu items. Change in energy content of menu items across the years surveyed and differences in energy content of standard and limited-time only menu items were analysed.

Setting: Five of Australia's largest fast food chains: Hungry Jack's, KFC, McDonald's, Oporto and Red Rooster.

Subjects: All standard and limited-time only menu items available at each fast-food chain, collected annually for seven years, 2009-2015.

Results: Although some fast-food chains/menu item categories had significant increases in the energy contents of their menus at some time points during the 7-year period, overall there were no significant or systematic decreases in energy following the introduction of menu labelling (P=0·19 by +17 kJ/100 g, P=0·83 by +8 kJ/serving). Limited-time only items were significantly higher in median energy content per 100 g than standard menu items (+74 kJ/100 g, P=0·002).

Conclusions: While reformulation across the entire Australian fast-food supply has the potential to positively influence population nutrient intake, the introduction of menu labelling legislation in New South Wales, Australia did not lead to reduced energy contents across the five fast-food chains. To encourage widespread reformulation by the fast-food industry and enhance the impact of labelling legislation, the government should work with industry to set targets for reformulation of nutrient content.
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http://dx.doi.org/10.1017/S1368980017003706DOI Listing
April 2018

"Keeping it on your radar"-assessing the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood: A qualitative study from the early detection of type 1 diabetes in youth study.

Endocrinol Diabetes Metab 2018 Jan 18;1(1):e00008. Epub 2017 Dec 18.

Division of Population Medicine Cardiff University Cardiff UK.

Aims: The aim of this study was to explore from the perspectives of key stakeholders involved in the pathway to diagnosis, the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood.

Methods: Qualitative interviews and free-text analyses were undertaken in 21 parents with a child diagnosed with type 1 diabetes, 60 parents without a child diagnosed with type 1 diabetes, 9 primary healthcare professionals, 9 teachers and 3 community diabetes liaison nurses Data were analysed thematically and 30% double coded.

Results: Two key themes were identified, namely the importance of widespread awareness and knowledge and seeking healthcare professional help Parents with a child diagnosed with type 1 diabetes described seeking opinions from a number of individuals prior to seeking health professional help. Healthcare professionals recognized the rarity of the condition and the need for it to be kept on their "radar", to ensure they considered it when examining an unwell child. The process of obtaining a primary healthcare appointment was identified as potentially playing a crucial role in the diagnostic process. However, most parents with a child diagnosed with type 1 diabetes described receiving an appointment on the day they sought it.

Conclusions: Knowledge and awareness of type 1 diabetes in childhood remain limited in the general population and misconceptions persist relating to how children present with this serious condition. An effective community-based intervention to raise awareness amongst key stakeholders is required to ensure children receive a timely diagnosis once symptomatic.
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http://dx.doi.org/10.1002/edm2.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373827PMC
January 2018

Support for food policy initiatives is associated with knowledge of obesity-related cancer risk factors.

Public Health Res Pract 2017 Dec 7;27(5). Epub 2017 Dec 7.

Cancer Council New South Wales, Sydney, Australia.

Objectives: To investigate community support for government-led policy initiatives to positively influence the food environment, and to identify whether there is a relationship between support for food policy initiatives and awareness of the link between obesity-related lifestyle risk factors and cancer.

Methods: An online survey of knowledge of cancer risk factors and attitudes to policy initiatives that influence the food environment was completed by 2474 adults from New South Wales, Australia. The proportion of participants in support of seven food policy initiatives was quantified in relation to awareness of the link between obesity, poor diet, insufficient fruit and vegetable consumption, and physical inactivity with cancer and other health conditions.

Results: Overall, policies that involved taxing unhealthy foods received the least support (41.5%). Support was highest for introducing a colour-coded food labelling system (85.9%), restricting claims being made about the health benefits of foods which are, overall, unhealthy (82.6%), displaying health warning labels on unhealthy foods (78.7%) and banning unhealthy food advertising that targets children (72.6%). Participants who were aware that obesity-related lifestyle factors are related to cancer were significantly more likely to support food policy initiatives than those who were unaware. Only 17.5% of participants were aware that obesity, poor diet, insufficient fruit and vegetable consumption, and physical inactivity are linked to cancer.

Conclusions: There is strong support for all policies related to food labelling and a policy banning unhealthy food advertising to children. Support for food policy initiatives that positively influence the food environment was higher among those who were aware of the link between cancer and obesity-related lifestyle factors than among those who were unaware of this link. Increasing awareness of the link between obesity-related lifestyle factors and cancer could increase community support for food policy initiatives, which, in turn, support the population to maintain a healthy weight.
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http://dx.doi.org/10.17061/phrp27341703DOI Listing
December 2017

Do model polymer therapeutics sufficiently diffuse through articular cartilage to be a viable therapeutic route?

J Drug Target 2017 Nov - Dec;25(9-10):919-926. Epub 2017 Sep 21.

c Department of Pharmaceutical, Chemical and Environmental Sciences, Faculty of Engineering and Science , University of Greenwich , Kent , UK.

The ability of a polymer therapeutic to access the appropriate subcellular location is crucial to its efficacy and is defined to a large part by the many and complex cellular biological and biochemical barriers such that a construct must traverse. It is shown here that model dextrin conjugates are able to pass through a cartilaginous extracellular matrix into chondrocytes, with little perturbation of the matrix structure, indicating that targeting of potential therapeutics through a cartilaginous extracellular matrix should be proven possible. Rapid chondrocytic targeting of drugs which require intra cellularisation for their activity and uniform extracellular concentrations of drugs with an extracellular target, is thus enabled though polymer conjugation.
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http://dx.doi.org/10.1080/1061186X.2017.1378660DOI Listing
June 2018

Tyrosine kinase inhibitors as modulators of trastuzumab-mediated antibody-dependent cell-mediated cytotoxicity in breast cancer cell lines.

Cell Immunol 2017 Sep 15;319:35-42. Epub 2017 Jul 15.

National Institute for Cellular Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland; Department of Medical Oncology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.

Background: Trastuzumab is an anti-HER2 monoclonal antibody (mAb) therapy capable of antibody-dependent cell-mediated cytotoxicity (ADCC) and used in the treatment of HER2+ breast cancer. Through interactions with FcƴR+ immune cell subsets, trastuzumab functions as a passive immunotherapy. The EGFR/HER2-targeting tyrosine kinase inhibitor (TKI) lapatinib and the next generation TKIs afatinib and neratinib, can alter HER2 levels, potentially modulating the ADCC response to trastuzumab. Using LDH-release assays, we investigated the impact of antigen modulation, assay duration and peripheral blood mononuclear cell (PBMC) activity on trastuzumab-mediated ADCC in breast cancer models of maximal (SKBR3) and minimal (MCF-7) target antigen expression to determine if modulating the ADCC response to trastuzumab using TKIs may be a viable approach for enhancing tumor immune reactivity.

Methods: HER2 levels were determined in lapatinib, afatinib and neratinib-treated SKBR3 and MCF-7 using high content analysis (HCA). Trastuzumab-mediated ADCC was assessed following treatment with TKIs utilising a colorimetric LDH release-based protocol at 4 and 12h timepoints. PBMC activity was assessed against non-MHC-restricted K562 cells. A flow cytometry-based method (CFSE/7-AAD) was also used to measure trastuzumab-mediated ADCC in medium-treated SKBR3 and MCF-7.

Results: HER2 antigen levels were significantly altered by the three TKIs in both cell line models. The TKIs significantly reduced LDH levels directly in SKBR3 cells but not MCF-7. Lapatinib and neratinib augment trastuzumab-related ADCC in SKBR3 but the effect was not consistent with antigen expression levels and was dependent on volunteer PBMC activity (vs. K562). A 12h assay timepoint produced more consistent results. Trastuzumab-mediated ADCC (PBMC:target cell ratio of 10:1) was measured at 7.6±4.7% (T12) by LDH assay and 19±3.2 % (T12) using the flow cytometry-based method in the antigen-low model MCF-7.

Conclusions: In the presence of effector cells with high cytotoxic capacity, TKIs have the ability to augment the passive immunotherapeutic potential of trastuzumab in SKBR3, a model of HER2+ breast cancer. ADCC levels detected by LDH release assays are extremely low in MCF-7; the flow cytometry-based CFSE/7-AAD method is more sensitive and consistent for the determination of ADCC in HER2-low models.
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http://dx.doi.org/10.1016/j.cellimm.2017.07.005DOI Listing
September 2017

Consumers' responses to health claims in the context of other on-pack nutrition information: a systematic review.

Nutr Rev 2017 04;75(4):260-273

Z. Talati and S. Pettigrew are with the School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia. B. Neal is with The George Institute for Global Health, Sydney, New South Wales, Australia. H. Dixon is with the Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia. C. Hughes is with the Cancer Council, Sydney, New South Wales, Australia. B. Kelly is with the School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia. C. Miller is with the South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia. C. Miller is with the University of Adelaide, Adelaide, South Australia, Australia.

Context: The presence of health claims on food packaging can positively bias consumers' evaluations of foods. This review examined whether cognitive biases endure when other sources of nutrition information [the nutrition facts panel (NFP) and front-of-pack labels] appear on-pack with health claims. The following databases were searched: Web of Science, Ovid, Google Scholar, ScienceDirect, Scopus, ProQuest, and Wiley Online Library. The search terms ("health claim*" OR "nutri* claim") AND ("food label*" OR "front of pack") were used to identify studies. Twenty-four studies that examined health claims and front-of-pack labels or the NFP were included. The NFP can reduce bias, but only if consumers view it and interpret it correctly, which often does not occur. Front-of-pack labels show greater promise in reducing bias created by health claims. These findings are relevant to policymakers who are considering the effectiveness of mandating an NFP and/or a front-of-pack label alongside health claims.
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http://dx.doi.org/10.1093/nutrit/nuw070DOI Listing
April 2017

Exploring perceptions and beliefs about the cost of fruit and vegetables and whether they are barriers to higher consumption.

Appetite 2017 06 2;113:310-319. Epub 2017 Mar 2.

School of Life and Environmental Science in Charles Perkins Centre, University of Sydney, Sydney, Australia. Electronic address:

Background: Fruit and vegetable (F&V) consumption is below recommendations, and cost may be a barrier to meeting recommendations. Limited evidence exists on individual perceptions about the cost, actual spending and consumption of F&V. This study investigated perceptions and beliefs about cost of F&V and whether this is a barrier to higher consumption.

Methods: An online survey of Australian adults (n = 2474) measured F&V consumption; expenditure on F&V and food; and perceived barriers to consumption. Multivariable logistic regression examined associations between participants' responses about cost of F&V and demographic factors, and with actual consumption and expenditure on F&V.

Results: Cost was identified as a barrier for 29% of people not meeting recommended fruit servings and for 14% of people not meeting recommendations for vegetables. Cost was a more common barrier for those on lower incomes (fruit aOR 1.89; 95% CI 1.20-2.98 and vegetables aOR 2.94; 95% CI 1.97-4.39) and less common for older participants (fruit aOR 0.33; 95% CI 0.17-0.62 and vegetables aOR 0.31; 95% CI 0.18-0.52). There was no association between the perceived barriers and actual F&V spending. Twenty percent of participants said F&V were not affordable; 39% said cost made it difficult to buy F&V, and for 23% the cost of F&V meant they bought less than desired.

Conclusions: A minority reported F&V were not affordable where they shopped and that cost was a barrier to higher consumption. However, it is apparent that young adults and those on low incomes eat less than they would like because of cost. Strategies that remove financial impediments to consumption are indicated for these population sub-groups.
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http://dx.doi.org/10.1016/j.appet.2017.02.043DOI Listing
June 2017

Improving patient safety through the introduction of a formal triage process.

Emerg Nurse 2017 Feb;24(9):19-25

Medway NHS Foundation Trust, Gillingham, Kent, England.

Emergency departments (EDs) in the UK are facing unprecedented increases in attendance, and the ability to safely assess, diagnose, treat, refer or discharge patients is a national challenge. This article discusses one component of a comprehensive ED strategy created to address serious concerns identified by regulators and develop and improve services in the department at Medway NHS Foundation Trust, Kent.
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http://dx.doi.org/10.7748/en.2017.e1647DOI Listing
February 2017

Advertising to children initiatives have not reduced unhealthy food advertising on Australian television.

J Public Health (Oxf) 2017 12;39(4):787-792

Cancer Programs Division, Cancer Council NSW, Woolloomooloo, 2011 New South Wales, Australia.

Background: In response to rising childhood obesity rates, the Australian food industry implemented two initiatives in 2009 to reduce the marketing of unhealthy food to children. This study evaluated the efficacy of these initiatives on the rate of unhealthy food advertising to children on Australian television.

Methods: The rates of food advertisements on three free-to-air commercial television channels and a youth-oriented digital channel in Sydney, Australia were analysed over 2 weekdays (16 h) and two weekend days (22 h). Advertisements were categorized according to the healthiness of foods advertised (non-core, core, miscellaneous) and signatory status to the food industry advertising initiatives.

Results: Total food advertising rates for the three channels increased from 5.5/h in 2011 to 7.3/h in 2015, due to an increase of 0.8/h for both core and miscellaneous foods. The rate of non-core food advertisements in 2015 (3.1/h) was similar to 2011 (3.0/h). The youth-oriented channel had fewer total food advertisements (3.7/h versus 7.3/h) but similar fast-food advertisement rates (1.3/h versus 1.3/h).

Conclusions: There was no change in the rate of unhealthy food advertising since 2011, suggesting minimal impact of the current food industry initiatives on reducing children's exposure to unhealthy food advertising.
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http://dx.doi.org/10.1093/pubmed/fdx004DOI Listing
December 2017

A systematic review of the use of dosage form manipulation to obtain required doses to inform use of manipulation in paediatric practice.

Int J Pharm 2017 Feb 28;518(1-2):155-166. Epub 2016 Dec 28.

NIHR Medicines for Children Research Network Co-ordinating Centre, Institute of Child Health, University of Liverpool, L12 2AP, United Kingdom; Liverpool Women's Hospital NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, United Kingdom. Electronic address:

This study sought to determine whether there is an evidence base for drug manipulation to obtain the required dose, a common feature of paediatric clinical practice. A systematic review of the data sources, PubMed, EMBASE, CINAHL, IPA and the Cochrane database of systematic reviews, was used. Studies that considered the dose accuracy of manipulated medicines of any dosage form, evidence of safety or harm, bioavailability, patient experience, tolerability, contamination and comparison of methods of manipulation were included. Case studies and letters were excluded. Fifty studies were eligible for inclusion, 49 of which involved tablets being cut, split, crushed or dispersed. The remaining one study involved the manipulation of suppositories of one drug. No eligible studies concerning manipulation of oral capsules or liquids, rectal enemas, nebuliser solutions, injections or transdermal patches were identified. Twenty four of the tablet studies considered dose accuracy using weight and/or drug content. In studies that considered weight using adapted pharmacopoeial specifications, the percentage of halved tablets meeting these specifications ranged from 30% to 100%. Eighteen studies investigated bioavailability, pharmacokinetics or clinical outcomes following manipulations which included nine delayed or modified release formulations. In each of these nine studies the entirety of the dosage form was administered. Only one of the 18 studies was identified where drugs were manipulated to obtain a proportion of the dosage form, and that proportion administered. The five studies that considered patient perception found that having to manipulate the tablets did not have a negative impact on adherence. Of the 49 studies only two studies reported investigating children. This review yielded limited evidence to support manipulation of medicines for children. The results cannot be extrapolated between dosage forms, methods of manipulation or between different brands of the same drug.
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http://dx.doi.org/10.1016/j.ijpharm.2016.12.032DOI Listing
February 2017

Do Health Claims and Front-of-Pack Labels Lead to a Positivity Bias in Unhealthy Foods?

Nutrients 2016 Dec 2;8(12). Epub 2016 Dec 2.

Cancer Council, Sydney, NSW 2150, Australia.

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.
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http://dx.doi.org/10.3390/nu8120787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5188442PMC
December 2016

Health and nutrition content claims on Australian fast-food websites.

Public Health Nutr 2017 03 17;20(4):571-577. Epub 2016 Oct 17.

1Cancer Programs Division,Cancer Council NSW,153 Dowling St,Woolloomooloo,NSW 2011,Australia.

Objective: To determine the extent that Australian fast-food websites contain nutrition content and health claims, and whether these claims are compliant with the new provisions of the Australia New Zealand Food Standards Code ('the Code').

Design: Systematic content analysis of all web pages to identify nutrition content and health claims. Nutrition information panels were used to determine whether products with claims met Nutrient Profiling Scoring Criteria (NPSC) and qualifying criteria, and to compare them with the Code to determine compliance.

Setting: Australian websites of forty-four fast-food chains including meals, bakery, ice cream, beverage and salad chains.

Subjects: Any products marketed on the websites using health or nutrition content claims.

Results: Of the forty-four fast-food websites, twenty (45 %) had at least one claim. A total of 2094 claims were identified on 371 products, including 1515 nutrition content (72 %) and 579 health claims (28 %). Five fast-food products with health (5 %) and 157 products with nutrition content claims (43 %) did not meet the requirements of the Code to allow them to carry such claims.

Conclusions: New provisions in the Code came into effect in January 2016 after a 3-year transition. Food regulatory agencies should review fast-food websites to ensure compliance with the qualifying criteria for nutrition content and health claim regulations. This would prevent consumers from viewing unhealthy foods as healthier choices. Healthy choices could be facilitated by applying NPSC to nutrition content claims. Fast-food chains should be educated on the requirements of the Code regarding claims.
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http://dx.doi.org/10.1017/S1368980016002561DOI Listing
March 2017