Long-term conditions (LTC) such as diabetes, cardiovascular disease (CVD), overweight and obesity have a significant impact in Aotearoa (New Zealand). Māori communities are disproportionately affected, making LTCs a critical equity issue for the country(1). These inequities are not incidental but reflect the direct legacy of colonisation. An intervention shown to have a positive impact across a range of LTCs is a plant-based diet(2), yet nutrition trials in Aotearoa are limited. No published controlled nutrition trials consider a Māori worldview of kai (food) or acknowledge that for Māori, weight may not be the best anthropometric measure. Nutrition is a key determinant of improving health outcomes. To enable equitable health outcomes, research must value Western science alongside mātauranga Māori (Māori knowledge) and incorporate traditional food sources. The purpose of this project is therefore to determine the impact of an Aotearoa-specific nutrition approach with a Māori worldview of kai and prioritising plants. The study is a non-randomised, mixed-methods, single-arm pilot in Gisborne with 11 participants (82% were Māori), guided by Kaupapa Māori methodology (a Māori methodology). The research upholds tino rangatiratanga (Māori sovereignty), ensures Māori governance and oversight, and honours Te Tiriti o Waitangi (the Treaty of Waitangi) principles. Outcome measures will be performed at baseline and 12 weeks, including quality of life using a Kaupapa Māori questionnaire and semi-structured interviews, and metabolic health markers (HbA1c, lipids, blood pressure, weight, waist-to-hip ratio). Adherence is not assessed by monitoring energy intake, but rather supported with recipes, meal plans, weekly check-ins, and a Facebook group to encourage kōrero, pātai, and whanaungatanga. The programme focuses on sustainable lifestyle changes responsive to whānau needs. Kai ā Nuku is a nutrition programme, integrating mātauranga Māori and nutrition science. Approximately 90% of food is sourced from seasonal plants. Core principles include daily beans or lentils, fermented foods (sauerkraut, kimchi, apple cider vinegar), sourdough bread, and unprocessed grains (quinoa, buckwheat, black rice). Limitations include red meat for special occasions, eggs fewer than three per week, no dairy except goat products, no added sugar, and limited processed foods, alcohol, and caffeine. Māori kai practices are integrated: fish and kaimoana three times per week, rewena bread as sourdough, karengo (seaweed), and kaanga pirau and toroi (traditional fermented foods). The themes constructed from this research suggest that Kaupapa Māori health interventions, grounded in whānau-centred (family-centred) approachesand te ao Māori (Maori worldview) understandings of health, remain fundamental for Māori whānau. Participants’ experiences also indicate that hinengaro (mental and emotional well-being) and quality of life are critical markers of health. The quantitative findings demonstrated improvements in hinengaro scores (16.2 ± 4 v 18.4 ± 3.6; p < 0.05), total Kaupapa Māori quality of life scores (20.8 ± 5.7 v 22.25 ± 5.1; p < 0.05), total cholesterol (4.7 ± 1 v 3.9 ± 0.7; p < 0.05), low-density lipoprotein cholesterol (2.7 ± 0.7 v 2.1 ± 0.2; p < 0.05), body weight (99.9 ± 17.1 v 93.8 ± 13.5; p < 0.05), and waist circumference (109 ± 9.4 v 101.2 ± 9; p < 0.01). The Kai ā Nuku study demonstrates that dietary and lifestyle interventions grounded in both evidence-based science and mātauranga can enhance the health and well-being of whānau. The findings from this study support the need for continued investigation, including well-designed randomised controlled trials.

Food literacy is a distinct and complementary concept to nutrition literacy, and both are predictors for health outcomes, including for chronic disease. The food literacy status of people living in Aotearoa New Zealand is unknown. Current food literacy assessments do not encompass concepts of a te ao Māori (Māori) worldview of health such as collective wellbeing, engagement with whānau (family), the environment, spiritual and cultural aspects. Staff from He Toa Taua (Harbour Sport), delivering Green Prescription and Active Families programmes, indicated providing nutrition education is constrained by not knowing what clients need or want. Identifying the skills, knowledge, and confidence people have about food would support better provision of nutrition education. The aim of this work was to develop a food literacy assessment tool that included concepts aligned with a Māori worldview for use in the Aotearoa NZ context. The conceptual model of food literacy by Vidgen and Gallegos(1) outlines four domains pertaining to skills, knowledge and attitudes, and was used as a foundation for this tool. Co-designed with four Māori staff from He Toa Taua, and with contributions from seven Māori dietitians/nutritionists, concepts from Te Whāre Tapa Whā(2) were also considered. The tool was styled after the Hua Oranga(3,4) wellbeing checklist. Twenty whānau engaged with He Toa Taua also had input to the tool development. The completed tool included 20 items under the four domains of Plan and manage, Select, Prepare, and Eat. Following completion, 38 clients and staff from six community services trialled the tool. A five-point Likert scale identified the level of agreement for statements describing the tool use. Twenty-three clients provided feedback and there were high levels of agreement that the tool was dignifying, mana-enhancing, highlighted topics of importance, was easy to understand and helped to identify support. Suggestions for improvement were to include items more relevant to people living alone and capture more detailed information. Nine staff completed feedback and indicated the checklist was quick to complete, increased staff confidence to support a person with food/nutrition needs, invited kōrero (conversation) and was strengths focused. Involvement of whānau and practitioners in the development of this tool was a critical factor to ensure it was relevant to the needs of both people seeking and providing nutrition information and guidance. The contributions of co-designers, whānau, and Māori nutrition practitioners resulted in a checklist that can be used to help clients and staff identify the areas where support is needed and appropriate. Further refinement of the tool and testing in more community settings is warranted, but the evaluation completed thus far indicated the tool was acceptable in the Aotearoa NZ context, facilitates opportunity to explore what is important and meaningful for people, and enables activating appropriate support.

Mental health is a leading health concern for rangatahi (young people) in Aotearoa (New Zealand), especially rangatahi Māori. Symptoms of depression doubled between 2012-2019 among rangatahi (young) Māori, and mental health inequities have unacceptably widened during this time(1). The role of nutrition in promoting mental wellbeing is an emerging area of research; however, it is primarily grounded in Western paradigms. Limited research explores the relationship between kai (food) and mental wellbeing seen through a te ao Māori lens. The aim of this research is to conceptualise the role of kai in supporting mental wellbeing among rangatahi Māori who have experienced mental health challenges. This project is grounded in Participatory Action Research methodologies informed by kaupapa Māori principles of whanaungatanga (relationships), manaakitanga (respect) and tino rangatiratanga (self-determination). Researchers partnered with The Kindness Institute, an organisation with the aspirations to empower marginalised communities and support wellbeing through kaupapa Māori-aligned programs. Rangatahi who had previous engagement with The Kindness Institute were eligible to participate. Photovoice methodology was utilised to explore rangatahi perspectives, values and beliefs around kai and their mental wellbeing in response to three key questions - “what does kai mean to you?”, “what role does kai play in your mental wellbeing?” and “what helps you or makes it hard for you when it comes to kai?”. Five wāhine (female) Māori took part in this study. Participants then engaged in a focus group to discuss their photographs more deeply. Reflexive Thematic Analysis was used to develop themes based on the focus group that explore rangatahi perspectives. Themes were generated based on the overarching theme of ‘Nā te kai ka ora’, through kai, there is wellbeing. This captures the concept that there is more to kai than just the food and nutrients we consume. Within this notion, key themes that were developed included ‘Kai hei Haerenga, Kai hei Oranga’ (Kai as a journey, kai as wellbeing), ‘Ko te Kai he Taura Here’ (Kai as the Binding Cord), Kai i te Ao Matihiko’ (Kai in the Digital World) and ‘He ara kai, He ara hinengaro’ (Kai as a pathway to mental wellbeing). By learning from the lived experiences of wāhine rangatahi, this research helps to build a deeper understanding of what is important for the hauora and mental wellbeing of rangatahi Māori in the kai and nutrition field. We hope to create a foundation from which approaches utilising kai can be used for healing, centring and valuing Māori culture and beliefs to support mental wellbeing.

Pacific women’s accounts of weight stigma in healthcare settings highlight longstanding harms that have been overlooked within both health services and research. Internationally, weight stigma has been shown to contribute to many adverse health outcomes ranging from impact on clinical markers of health risk to healthcare avoidance(1). Pacific women experience the compounded effects of weight stigma, racism and gender bias in healthcare, making their perspectives particularly important to understand(2). This study aimed to explore their experiences of weight stigma in healthcare, its impact, and their recommendations for change from a Pacific perspective. Using the Talanoa research method(3) (a Pacific indigenous research methodology), 10 interviews were conducted with Pacific women aged 28–65 years who had experienced weight stigma in their interactions with health professionals. Talanoa was held face-to-face and guided by the principles of the Fonofale model to capture the multifaceted impact of this phenomenon(4). Interviews were audio-recorded, transcribed automatically via Zoom, checked for accuracy, and then coded manually. A reflexive thematic analytic approach was used to identify key themes. Key themes generated relating to the weight stigma experienced by Pacific women in healthcare settings were(1) experiences of dismissal and stigma in healthcare(2) healthcare for women transcends clinical spaces, extending into family, cultural identity, spirituality and self-worth,(3) underlying systemic and interpersonal biases must be addressed(4) racism intersects with gender and weight stigma undermining trust in health professionals and (5) impacts of weight stigma on health behaviours. Pacific women’s stories highlight weight stigma as a structural issue, compounded by ethnicity and gender, that undermines equitable healthcare. The women of this study recommend that to address this healthcare professionals receive meaningful cultural safety training in recognising and addressing weight bias, to ensure respectful and culturally safe care for Pacific peoples.

Dairy proteins are widely considered the benchmark for high-quality dietary protein, owing to their balanced amino acid (AA) composition, high digestibility, and substantial essential amino acid (EAA) content(1). Recent years have seen a rise in consumer demand for protein resulting in the “proteinification” of the food environment. The dairy industry in New Zealand produces large quantities of proteins that are utilised as ingredients in a wide range of consumer products globally, while these products all originate from raw milk, they differ in their AA profiles as they are fractionated into different product streams to optimise their functionality for a variety of applications. Previously, the data pool for the AA content of various dairy powders was limited with unverified accuracy. This study addresses some of these gaps in the data and explains the variation in AA profiles between a variety of dairy powders. AA content was determined by high performance liquid chromatography. Products examined included whole milk powder (WMP), skim milk powder (SMP), cheese whey protein concentrate (WPC-C), lactic acid casein whey protein concentrate (WPC-L), high-fat whey protein concentrate (WPC-HF), hydrolysed whey protein concentrate (WPH), whey protein isolate (WPI), and demineralised whey protein (D90). The AA content for WMP and SMP were different between 12 of the 18 AAs measured (p < 0.05), attributed to milk fat globular membrane proteins present in the WMP samples. WPC-C and WPC-L comparison indicated higher levels of threonine (MD (95% C.I.) = 22.92 (21.96, 23.88); p<0.001), serine (MD (95% C.I.) = 9.33 (8.41, 10.24); p<0.001), glutamic acid (MD (95% C.I.) = 11.73 (9.58, 13.88); p<0.001), and proline (MD (95% C.I.) = 18.27 (17.29, 19.24); p<0.001) in WPC-C but lower levels of tyrosine (MD (95% C.I.) = -3.67 (-4.24, -3.09); p<0.001), phenylalanine (MD (95% C.I.) = −3.71 (-4.22, -3.20); p<0.001), and tryptophan (MD (95% C.I.) = -4.74 (-5.30, -4.18); p<0.001), attributed to the different methods of separation from casein proteins. WPI and WPC-HF varied in all AAs except histidine (MD (95% C.I.) = -0.33 (-0.75, 0.09); p=0.113) due to minor protein components. D90 and WPC-C demonstrated significant differences (p<0.05) in all but three AAs, Proline (MD (95% C.I.) = -1.63 (-6.28, 3.02); p=0.467), Tyrosine (MD (95% C.I.) = -3.39 (-7.00, 0.22); p=0.064) and Arginine (MD (95% C.I.) = -1.19 (-2.61, 0.24); p=0.096) due to filtering and demineralisation processes. Protein sources originating from the same raw material can end up with significantly different AA profiles due to fractionation and extraction processes. Understanding that these differences exist increases awareness of the need to formulate protein rich foods based on total protein and AA content to ensure the key benefits of protein are being delivered to the consumer.

The consumption of hemp derived protein has shown potential to improve cardiovascular disease risk factors(1) For example, Samsamikor et al.(2) showed the efficacy of hemp seed protein in ameliorating high blood pressure in adults with hypertension. However, the effects of hemp seed protein consumption on arterial stiffening have not, to our knowledge, been investigated in humans. The present study aimed to investigate the effects of New Zealand hemp seed protein on blood pressure and measures of arterial stiffness in adults. Inclusion criteria were one or more risk factor for cardiovascular disease; a waist circumference greater than 102 cm (male) or 88 cm (female), fasting triglycerides ≥150mg/dL, high density lipoprotein cholesterol <40mg/dL (male) or <50mg/dL (female), SBP ≥130 mmHg and/or DBP ≥85 mmHg, fasting glucose greater than 110 mg/dL. A randomised control trial was conducted with 33 participants for 16 weeks in which the experimental group consumed 28 g of hemp seed protein extract for 5 days each week while 15 participants acted as a control group instructed to keep their regular daily diet over the experimental period. Blood pressure and arterial stiffness were measured at weeks 1, 8 and 16 using a SphygmoCor Excel device. A linear mixed model was used to analyse the repeated measures for affect differences between weeks, featuring Welches T-Test for uneven variance and an ANOVA test for p-values of the fixed effects. The model included a covariate analysis of the baseline measurement and used Tukey post hoc analysis for pairwise comparisons within and between the experimental and control groups. Results showed that compared to the control group, the experimental group decreased central systolic blood pressure -5.1 ± 2.4 mmHg (mean ± SE, 95% CI [-9.8, -0.3], p <0.05), mean arterial pressure -6.0 ± 2.3 mmHg (95% CI [-10.5, -1.5], p <0.05) ), augmentation index at 75 bpm -11.8 ± 1.8 mmHg (95% CI [-15.8, -7.9], p <0.05) augmented pressure -4.1 ± 0.6 mmHg (95% CI [-5.3, -3.0], p <0.05), and reflection magnitude -7.2 ± 1.7% (95% CI [-10.6, -3.8], p <0.05). However, no significant changes were observed in brachial blood pressures. These results suggest that hemp seed protein improves central arterial health in at risk adults after 16 weeks of supplementation.

Red clover (Trifolium pratense) and lucerne (Medicago sativa) seeds are promising alternative protein sources due to their high crude protein content and rich nutrient profile(1). However, their potential is limited by the presence of anti-nutritional factors (ANFs) such as phytic acid, trypsin inhibitors, and chymotrypsin inhibitors(2). These compounds interfere with protein digestion, thereby reducing protein bioavailability(3). Lactobacillus fermentation has been proposed as a strategy to improve the nutritional quality of plant-based ingredients by enhancing protein hydrolysis, increasing the availability of bioactive compounds, and reducing ANFs. This study aimed to evaluate the effect of Lactobacillus fermentation on ANFs and protein digestion. Red clover and lucerne seed flours were fermented using three Lactobacillus strains, including L. plantarum, L. acidophilus and L. casei. ANFs, including phytic acid, trypsin inhibitory activity (TIA), and chymotrypsin inhibitory activity (CIA), were quantified using standard colorimetric assays. The INFOGEST protocol was used to evaluate in vitro protein hydrolysis (digestion), which was quantified by the o-phthaldialdehyde (OPA) method at three stages: before digestion, after the gastric phase, and after the intestinal phase. All the experiments were replicated three times (n=3) and the results were expressed as mean ± standard deviation. Statistical analysis was performed by SAS 9.4 using a two-way analysis of variance (ANOVA) with 4 legume seed samples x 4 treatments (three Lactobacillus cultures and one unfermented) on antinutritional factors and protein digestion. Fermentation significantly reduced (p < 0.05) all measured ANFs in both seed types. For example, TIA decreased by 33–82% depending on the Lactobacillus strain and seed type. Before in vitro digestion, fermented samples exhibited an average four-fold increase (p < 0.05) in protein hydrolysis compared to unfermented controls. Furthermore, the gastric and intestinal protein hydrolysis values were significantly higher (p < 0.05) in the fermented samples, indicating improved digestibility compared to the unfermented controls. Lactobacillus fermentation significantly enhanced the nutritional profile of lucerne and red clover seeds, reducing ANFs and improving protein bioavailability. The findings of this study suggest the potential application of Lactobacillus fermentation in developing nutritionally enhanced plant-based protein products using lucerne and red clover seeds.

Small intestinal bacterial overgrowth (SIBO) is a condition characterised by an increased concentration of bacteria in the small intestine, leading to fermentation and subsequent gas production. SIBO symptoms are similar to those reported by athletes who experience exercise-associated gastrointestinal symptoms (Ex-GIS), including abdominal bloating and pain, and abnormal defecation (1). A low fermentable oligo-, di-, monosaccharide and polyol (FODMAP) diet has previously been shown to reduce the incidence and severity of Ex-GIS (1). This case-series explored the efficacy of a low-FODMAP diet in trained athletes with SIBO who become symptomatic during exercise. Three recreational to elite-level athletes who were retrospectively diagnosed with SIBO, and experienced severe recurrent Ex-GIS, volunteered to participate. Athletes were encouraged to implement their typical nutrition and hydration strategies 48-h before and during a gastrointestinal assessment during exercise (GastroAxEx). During the GastroAxEx, athletes ran on a motorised treadmill (average ± SD, 9.2 ± 2.7 km/h) for 3-h in temperate ambient conditions (19.7 ± 0.8°C, 64 ± 10% RH), with physiological strain and Ex-GIS outcomes measured. To determine orocaecal transit time, athletes consumed a 150 mL solution containing 20 g of lactulose 30 min into the final hour of exercise. Breath samples were collected at baseline and every 15 minutes during recovery to measure breath hydrogen (H2) and methane (CH4). Following the GastroAxEx, individualised therapeutic intervention and management strategies based on collected data and best-practice guidelines were recommended, including the implementation of a 48-h high-carbohydrate low-FODMAP (HC-LFOD) diet before endurance exercise sessions (>3-h). Follow-ups were conducted to facilitate compliance. This enabled anecdotal feedback on the efficacy of the strategies. During the GastroAxEx, athletes consumed approximately 450 mL/h (range: 242-693 mL/h) of fluid and 43 g/h (12-100 g/h) of carbohydrate, resulting in a 1.8% (1.6-2.4%) body mass loss. Loose stools were the predominant severe symptom (rated 10/10) experienced before (n=1), during (n=3/3) and the recovery period after exercise (n=3/3). Baseline breath H2 and CH4 concentrations were 24 ppm (3-45 ppm) and 34 ppm (13-74 ppm), respectively. Orocaecal transit time was normal (45-60 min) for all athletes. All athletes successfully implemented a 48-h HC-LFOD diet [(carbohydrate 9.2 g/kg/d (8.6-9.8 g/kg/d) FODMAP 3.5 g/d (2.6-5.1 g/d)] before a prolonged endurance event. In response to a 48-h HC-LFOD diet, athletes reported improved performance and reduced incidence and severity of Ex-GIS, including total gut discomfort, total-GIS, upper- and lower-GIS, nausea, dizziness and stitch, during an endurance event. No athletes experienced loose stools. The most severe symptom reported was belching (5/10), experienced by one athlete. Athletes with SIBO who implemented a 48-h HC-LFOD diet reported reduced incidence and severity of Ex-GIS, which may have favourable performance implications, warranting further investigation.

Globally, macadamia nut production generates substantial amounts of by-products such as macadamia husk, which is rich in phenolic compounds known for their antioxidant and health benefits(1). In this study, we encapsulated a phenolic-rich extract from macadamia green husk into soy-lecithin liposomes and applied a chitosan biopolymer coating to protect phenolic integrity, enhance physical stability(2), and improve delivery for food applications(3), as the phenolic compounds are often unstable and susceptible to environmental conditions such as heat, light, enzymes, and pH. Liposomes were prepared in aqueous media by high-pressure homogenization (2,000 MPa) and subsequently coated with 0.4% (w/v) chitosan. Particle size, ζ-potential, and polydispersity index (PDI) were measured by dynamic light scattering, morphology was assessed by transmission electron microscopy (TEM), and encapsulation efficiency (EE) was determined by quantifying free total phenols (unencapsulated phenolics). In vitro bioaccessibility was evaluated by measuring total phenolic content during an in vitro simulated gastrointestinal digestion. Empty and extract-loaded liposomes had mean diameters ranging between ~77 to 112 nm. Chitosan coating increased vesicle size (empty: 523 nm; loaded: 501 nm) and produced a broader size distribution (PDI = 0.41). Uncoated liposomes were strongly anionic (ζ = −62 mV empty; −43 mV loaded); chitosan coating reversed the surface charge to strongly positive values of +48 mV for empty and +50 mV for loaded liposomes, indicating successful adsorption of the cationic polymer. TEM confirmed largely spherical vesicles with sizes consistent with those measured by dynamic light scattering. Coated liposomes achieved higher encapsulation efficiency (91.15%) than uncoated liposomes (81.50%). Simulated digestion showed that liposomal encapsulation provided good protection under gastric (low pH) conditions but lost membrane integrity under intestinal conditions, releasing the phenolic compounds. The release of phenolic compound from coated liposomes was lower than uncoated liposomes. These results demonstrate that chitosan-coated liposomes improve the stability and in vitro bioaccessibility of macadamia husk-derived phenolics and provide practical design guidance for the development of liposomal delivery systems in food and pharmaceutical applications.

Functional dyspepsia (FD) is a chronic upper gastrointestinal disorder marked by abdominal symptoms without a structural cause. It includes two subtypes: epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). FD affects up to 30% of adults worldwide, impairs quality of life (QoL), yet effective treatment options are limited, leaving many seeking alternative treatments. Mānuka honey has unique bioactive compounds, such as Lepteridine™(1), that may improve digestive symptoms. While used anecdotally for managing digestive disorders, its efficacy in FD has not been studied clinically. Seventy-five adults with mild-moderate symptoms of FD participated in a three-arm, randomised controlled feasibility trial. Participants consumed 10g of mānuka honey containing 10 (L10) or 25 (L25) mg/kg of Lepteridine™, or a honey-flavoured maple syrup control, twice daily for six weeks. Primary feasibility outcomes examined the initial effect of Lepteridine™ standardised mānuka honey on FD symptoms and QoL using the Nepean Dyspepsia Index (NDI)(2). Secondary outcomes included examining changes in Patient-Reported Outcomes Management Information System (PROMIS) scores for gastrointestinal symptoms, anxiety, and depression. Differences in changes in NDI and PROMIS scores between intervention groups were examined using general linear models that included baseline values. Prespecified subgroup analyses were performed in participants with EPS or PDS, using linear models that included main effect (with/without subtype), interaction term (treatment*subtype) and baseline values. Post-hoc pairwise comparisons were conducted to assess the effects of each intervention. After six weeks, compared with the control, FD symptom scores decreased by -7.01 (95%CI: -19.74, 5.72, p=0.275) and -7.04 (95%CI: -19.60, 5.51, p=0.267) points in L10 and L25 groups, respectively (overall treatment p=0.438). QoL scores increased by 3.72 (95%CI: -3.42, 10.85, p=0.302) and 2.01 (95%CI: -4.97, 8.99, p=0.568) points in L10 and L25 groups, respectively compared with the control (overall treatment p=0.586). There was a suggestion that participants with EPS had a greater treatment response in symptom scores (interaction p=0.062) and QoL scores (interaction p=0.036) than those without EPS. In participants with EPS, symptom scores decreased by -12.29 (-26.09, 1.51; p=0.080) and -16.99 (-31.09, -2.90, p=0.019) points and QoL scores increased by 7.99 (-0.12, 16.10; p=0.053) and 8.30 (0.65, 15.95, p=0.034) in L10 and L25 groups, respectively, compared to control. No significant differences were observed in PROMIS scores at week six (p>0.05). Although this feasibility study showed no statistically significant improvements in overall FD symptoms or QoL with Lepteridine™ standardised mānuka honey in the overall FD cohort, the confidence intervals of the differences in symptom severity include potentially clinically meaningful benefits. Subtype analyses suggest Lepteridine™ standardised mānuka honey may improve symptoms and QoL in participants with EPS subtype of FD. These feasibility data will support the design of future randomised controlled trials.

Observational evidence suggests that increasing fruit and vegetable (FV) intake has the potential to improve children’s cognitive function and mental well-being(1,2), but this has not yet been empirically tested in intervention research. This study assessed the feasibility and acceptability of a multi-component FV intervention, informed by behaviour change science, which measures mental and cognitive health outcomes in children. The ‘Feel Good Study’ was a cluster-randomised wait-list controlled feasibility study conducted in four New Zealand primary schools, with equal allocation of schools to intervention and wait-list control arms. The intervention group received a 10-week FV intervention which included a programme informed by behavioural theory. designed to improve FV availability and acceptance. The wait-list control group received a simplified 5-week version of the intervention. Dietary, cognitive, and mental health outcomes were completed by children and parents/caregivers at the start and end of the 10-week study period. Primary outcomes of this feasibility study were recruitment, retention, and data collection rates. Process evaluation captured measures of intervention fidelity and dose, acceptability, reach, and barriers or facilitators to implementation. Seventy children were recruited (79% recruitment rate), with an average retention rate of 89%. Diet, cognitive, and mental health data collection procedures were feasible, with all data valid for analysis except for 6% of children’s dietary questionnaires. All intervention components were delivered (100% dose delivered), with high levels of fidelity (82% - 100% of components implemented as planned). All teachers and parents strongly agreed that they would recommend other schools/families to take part in the study, indicating high levels of acceptability. The process evaluation revealed areas for refinement, including more cohesive connections between school- and home-based intervention components, enhancing or adding new intervention components, and simplifying enrolment procedures with extended recruitment periods. The key feasibility and acceptance measures in the Feel Good Study were met. We recommend refining the intervention and progression to a definitive trial. This will allow for the first evaluation of the impact of increased FV intake on children’s mental health and cognitive function.

Climate change is one of the most serious global health threats of the 21st century. The modern food system is accelerating climate change through greenhouse gas emissions, deforestation, biodiversity loss, excessive water and energy use, soil erosion, and pollution(1). Environmental degradation, in turn, is fuelling climate change worry, defined as a persistent fear of ecological catastrophe, particularly affecting youth and young adults(2). Environmentally friendly diets, such as those low in animal products and high in seasonal and local produce, are known to benefit both planetary and human health(1). However, little is known about how young adults in Aotearoa New Zealand understand and engage in sustainable eating behaviours, and how this relates to climate change worry. The Food, Feelings and the Future project developed and applied a survey to assess knowledge, attitudes, and behaviours (KAB) towards environmentally-friendly diets, and examined the relationship between climate change worry and dietary behaviours among young adults (18–35 years) in Aotearoa New Zealand. Our study employed a mixed-methods, cross-sectional online questionnaire guided by the KAB framework. The 60-item questionnaire included Likert-scale and open-ended questions, which was reviewed by an expert panel for content validity and piloted for usability prior to dissemination. Participants were recruited using a stepwise convenience sampling approach via the research team’s social media, in-person promotions, and targeted organisational outreach. Quantitative data was analysed descriptively, and qualitative data was analysed using an inductive thematic approach. Two hundred participants (25 ± 5 years; 80% female) completed the survey, with representation from NZ European (57%), Chinese (11%), Māori (7%), Indian (5%), Cook Island Māori (1%) and ‘Other’ (18%) ethnicities. The majority of participants were omnivores (71%), followed by flexitarian/pescatarian (15%) and vegetarian/vegan (14%). Over half of participants strongly agreed or agreed that it is important their food and drink choices are environmentally friendly, only 37% reported following such patterns ‘often’ or ‘always’. The most common barriers for following an environmentally friendly diet were price and convenience. When questioned what an environmentally friendly diet means to them as a young adult living in Aotearoa New Zealand, participants highlighted themes of minimally processed, locally sourced kai (food) with minimal wastage along the food supply chain. Furthermore, climate change worry was widespread: 87% reported experiencing this at least sometimes, and 68% reported that this caused them to feel ‘distressed’ or ‘very distressed’. Participants reported that climate change worry has caused a shift in dietary behaviours, with changes including reduced meat consumption, increased purchase of local/seasonal foods, and avoiding products with excessive packaging. Climate change worry was highly prevalent among young adults in Aotearoa New Zealand and appeared to motivate shifts towards more sustainable eating patterns; however, cost and convenience remain key barriers. Enhancing the affordability and accessibility of locally sourced, minimal processed and environmentally friendly food options would better align environmental values with dietary behaviours, benefiting both planetary and human health.

Poor mental health symptoms are prevalent amongst young adults in Aotearoa New Zealand, with almost one in four aged 15-24 experiencing high levels of psychological distress in 2023/24(1). There is growing evidence for the link between diet quality and positive mental health outcomes in both observational and intervention contexts(2). However, understanding the holistic and complex determinants of dietary behaviours for wellbeing in young adults with poor mental health has largely been neglected from nutrition research, limiting the development of practical solutions. The ‘Food and Mood’ project aims to explore the determinants of dietary behaviours that support wellbeing in young adults experiencing symptoms of anxiety, depression, and/or stress in Aotearoa New Zealand. A 48-item mixed-methods survey was designed for this project, utilising the COM-B (capability, opportunity, motivation and behaviour) model and the Theoretical Domains Framework (TDF) to inform the survey structure. Young adults aged 18-30y experiencing at least mild symptoms of anxiety, depression, and/or stress according to the DASS-21 were recruited across Aotearoa New Zealand to take part in the cross sectional, anonymous study. Participants were recruited through university channels, community mental health organisations, social media advertising, and flyers. Open-ended questions were analysed through inductive thematic analysis, and Likert scale questions were descriptively analysed. Participants (n=131) were predominantly female (84%) and had a mean age of 23.2 + 4.1 years. Majority of the participants identified as NZ European (76%), with smaller proportions identifying as Māori (14.2%), Chinese (6.3%), Indian (4.7%), and Samoan (2%). Participants demonstrated a high level of psychological capability, where 92% of participants considered it “very” important to eat a diet that supports wellbeing, and 70% agreed that limiting highly processed foods is important for wellbeing. These findings are supported by the key theme of ‘nourishment’ identified in the thematic analysis, where participants highlighted that consuming nourishing foods can support physical wellbeing, which in turn positively influences mental and social health. Although 71% of participants indicated willingness to change their diet if they knew it would improve their mental wellbeing, almost half (48%) reported that they do not have adequate physical capability (e.g., skills and resources) to make these dietary changes. The majority of participants (90%) expressed that their mood influenced the way they eat, where 48% strongly agreed that it is more challenging to eat for wellbeing when mental health is worse. These results are supported by the qualitative theme of ‘emotional barriers’, with participants illustrating that negative emotions such as stress and depression inhibit their ability to engage in behaviours that enhance wellbeing. In conclusion, greater psychological capability appears to support young adults in eating for wellbeing. Poor mental health inhibits automatic motivation, suggesting that nutrition interventions should prioritise addressing emotional barriers to behaviour change.

Mental health conditions such as stress and anxiety are increasingly targeted by nutritional strategies that modulate neurobiological and inflammatory pathways(1,2). Milk fat globule membrane (MFGM) is a complex structure of polar lipids, gangliosides, and glycoproteins that has demonstrated anti-inflammatory, neuroprotective, and gut-modulatory effects in preclinical and human studies(3). However, its effects on adult psychological outcomes have not been systematically synthesised. We conducted a systematic literature search through to September 2025 across multiple databases, including PubMed, Scopus, Web of Science, the Cochrane Library, Google Scholar, ACS Publications, Academic Search Index, BMJ Journals, and BNP Media. The search strategy combined relevant keywords and MeSH terms, with manual reference checks to ensure comprehensiveness. Of the 35 articles initially identified, 12 underwent full-text review after screening for duplicates and relevance. Three3 randomised controlled trials (RCTs, n = 438) met the inclusion criteria: adult participants (≥20 years), bovine MFGM supplementation, a placebo or control group, and outcomes measuring stress, anxiety, or depression. Exclusion criteria included non-RCT designs, special populations, mixed or acute interventions, and studies lacking appropriate controls. The review was conducted and reported according to PRISMA guidelines. A random-effects meta-analysis was performed, calculating standardised mean differences (Hedge’s g) for stress, anxiety, and depression outcomes. Heterogeneity was evaluated with I2 and publication bias was explored with funnel plots and Egger’s test. Two trials contributed two dose arms each, yielding five comparisons for synthesis. MFGM supplementation produced small but statistically significant reductions in stress (SMD = −0.20; 95% CI −0.41 to −0.00; p = 0.0495; I2 = 0%) and anxiety (SMD = −0.22; 95% CI −0.44 to −0.01; p = 0.044; I2 = 0%). Effects on depression were non-significant though directionally favourable (SMD = −0.15; 95% CI −0.37 to 0.07; p = 0.18; I2 = 0%). Risk-of-bias assessments were conducted using Cochrane criteria and indicated low concerns across trials. Funnel plots and Egger’s tests did not indicate clear publication bias, but interpretation is limited by the small number of studies. These findings suggest that bovine MFGM supplementation may confer modest benefits for stress and anxiety in adults, while evidence for depression is inconclusive. Taken together, the results indicate that MFGM could be part of a nutritional strategy to support overall mental well-being.

A diagnosis of colorectal cancer and its subsequent treatments can have a significant impact on dietary decisions, but what these drivers are in the New Zealand population and what information underpins these decisions requires further investigation. This research aimed to explore whether patients made dietary changes after a diagnosis of colorectal cancer, and what factors influenced these changes. In addition, what dietary information has been provided along the treatment pathway and does this meet the needs of this patient population? A qualitative study method was used to explore the lived experiences of individuals undergoing treatment for colorectal cancer at Christchurch Hospital. Patients were recruited at the Computed Tomography (CT) radiotherapy planning appointment, and semi-structured interviews were conducted in week two or three of their chemoradiotherapy treatment. The interview questions focused on how diet is impacted by diagnosis, treatment side effects, access to information, and personal beliefs. Over five months, 14 patients were recruited, receiving concurrent chemoradiotherapy for Stage 3 & 4 Rectal Cancer. Audio-recorded interviews were transcribed verbatim, coded and analysed using reflexive thematic analysis(1). Participants described varying degrees of dietary change, with treatment side-effects, particularly nausea, fatigue, taste changes, and bowel changes emerging as key drivers of food choice. Many adopted a flexible, reactive approach to eating, often prioritising what was manageable over what was considered nutritionally optimal. Changes included reduced appetite, aversions to certain foods, decreased portion sizes, and a preference for bland or easy-to-prepare meals. Some participants experienced distress or uncertainty navigating treatment-imposed dietary routines (e.g., low-fibre diets or eating with medication), often without adequate support or explanation. Dietary changes were also influenced by personal beliefs (e.g., avoiding sugar, alcohol or processed meats perceived as harmful), and input from family, friends, or online sources. The emotional significance of food, including feelings of guilt around eating, further shaped dietary decisions. Logistical challenges, such as being away from home for treatment and limited access to cooking facilities also influenced participants’ ability to maintain usual eating patterns. Participants reported inconsistent access to dietary guidance, with some receiving timely, helpful input while others felt information was lacking. The findings suggest a need for more personalised colorectal cancer-specific dietary advice and improved integration of nutrition into the cancer care pathway to better support patients' evolving needs.

South Asians experience a disproportionate burden of early and aggressive atherosclerotic cardiovascular disease (ASCVD)(1). Their diets are typically high in refined carbohydrates and saturated fats, and epidemiological evidence suggests a link between high saturated fat intake and increased ASCVD risk(2). This study aimed to explore the knowledge and dietary behaviours related to saturated fat among SAs who self-reported hypercholesterolemia. Twenty South Asian adults who self-reported hypercholesterolemia were recruited through stakeholder engagement and advertisements in cultural and religious organisations. Demographic and dietary information were collected via an online Qualtrics survey (n = 20), and knowledge and behaviours related to saturated fat were explored through semi-structured telephone interviews (n = 19), which were thematically analysed. Participants included 12 of Indian ethnicity (India, Fiji, and NZ-born), five Sri Lankan, two Nepali, and one Afghan. Fourteen were male and six were female, with a mean age of 40 years (SD 9.8). Most expressed concern about their elevated cholesterol levels, particularly concerning family histories of cardiac events. Interview data revealed widespread confusion about whether saturated fats were harmful. Dairy products, particularly milk and yoghurt, were the main sources of saturated fat. Following diagnosis, many participants switched from standard (blue top) to reduced fat (light blue top) milk after receiving general advice from their health professional. Nevertheless, few recognised that frequently consumed yoghurts (e.g., Gopala) were high in saturated fat. Ghee use was also prevalent, motivated either by cultural practices or beliefs that it is a healthier fat. Coconut oil consumption was less common, but coconut milk consumption, especially among Sri Lankan and South Indian participants was widespread, with limited awareness of its saturated fat content. Knowledge of saturated fat sources was generally low, contributing to continued consumption of high-saturated-fat foods. These findings highlight the need for culturally tailored dietary education and resources to improve awareness and reduce ASCVD risk in South Asian populations.

In Aotearoa New Zealand, the landscape of care for youth with type 1 diabetes (T1D) is evolving rapidly with the introduction of public funding for diabetes technologies such as continuous glucose monitors (CGMs), insulin pumps, and automated insulin delivery (AiD) systems(1). Previously, one of the requirements for youth with T1D to meet the Pharmac criteria for funded insulin pumps and consumables was participation in carbohydrate counting education delivered by a multidisciplinary team. However, with universal access now available, there is limited research on how diabetes teams across Aotearoa NZ are now providing nutrition and carbohydrate counting education to meet the needs of youth using diabetes technology. This qualitative study aimed to explore the perspectives of dietitians and diabetes nurses on the evolving role of carbohydrate counting and nutrition education in supporting youth (aged 12 to 24 years) with T1D to optimise their glucose outcomes, particularly in the context of increasing use of newer diabetes technologies. Semi-structured interviews were conducted with 13 participants, including dietitians (n = 8) and diabetes nurses (n = 5), who were purposively sampled to capture experiences from regional diabetes services and rural-based teams across diverse geographical regions of Aotearoa NZ. All participants took part in the study voluntarily and interviews were recorded, transcribed and coded using NVivo. Data were analysed thematically to generate insights relevant to clinical practice, guided by interpretive description methodology(2). Participants acknowledged that advances in diabetes technology, along with the universal funding of diabetes technology for T1D from October 2024, have enabled carbohydrate counting education to become more flexible and accessible for youth living with T1D. Importantly, many emphasised that dietitian input remains critical to achieving optimal diabetes outcomes and supporting overall health. In addition, while increased access to CGM and AiD data enables healthcare professionals to provide tailored follow-up and support, participants described a substantial increase in workload, making it challenging to manage within already limited resources. To address these challenges and improve access to carbohydrate-counting information, some regions reported an increase in the use of group nutrition education sessions as part of their pre-pump training programme. Of note, participants reported mixed results when using this approach (compared to individualised nutrition education), with low attendance to group sessions being a frequent challenge. Participants suggested that flexibility in the way education is provided - via one-on-one consultations, phone, email, and online webinars - has helped enhance access, particularly for vulnerable populations. In conclusion, this qualitative study suggests that healthcare professionals believe that providing carbohydrate counting and nutrition education remains vital to optimising the use of diabetes technology in youth with T1D in Aotearoa New Zealand.

Globally, it is reported that 30-40% of food is lost or wasted somewhere along the food supply chain(1). As a member state of the United Nations, New Zealand has a commitment to Sustainable Development Target 12.3 “to halve per capita global food waste at the retail and consumer levels and reduce food losses along production and supply chains, including post-harvest losses” by 2030. In order to track progress against this target, an estimate of the total amount of food loss and waste (FLW) is required. There is no globally accepted definition of FLW which makes comparisons across countries difficult and explains why per capita FLW vary across countries: total FLW is 312 kg/person/year in Australia(2), 111 kg/person/year in the UK(3), and 132 kg/person/year in the European Union(3). In 2023, the Ministry for the Environment developed the first definition of FLW in New Zealand as “ imported or domestically produced food and drink, including inedible parts, which leave the food supply chain from the point that crops and livestock are ready for harvest or slaughter onwards to the point of consumption, to be recycled, recovered or disposed of in Aotearoa New Zealand”. Following this, in 2024, the Ministry for the Environment commissioned the first baseline study of FLW across the food supply chain, as outlined here. The methodological approach for this study was similar to Australia(2), which used a mass balance approach for key food commodities. For example, apples can be consumed as fresh fruit or turned into other foods such as apple juice, while wheat is milled and used to make bread or pasta. The study identified 61 of the most commonly consumed food commodities in New Zealand. Data for any 12-month period between 2015-2022 were obtained from a range of sources including industry reports, government and non-governmental publications, scientific articles, interviews, and FAOSTAT food balances. Six stages of the supply chain were included: primary production (i.e., on farm), processing, wholesale/retail, transport, institutions, hospitality, and household. Of the ~ 30 million tonnes of available food, about 2.3 million tonnes is lost or wasted or 237 kg/person/year. However, there were many data gaps, particularly at primary production, processing, institutions and no data for transport. The majority of FLW occurred at primary production, followed by households, and then processing. Household food waste was 70 kg/person/year, which is comparable to the UK and EU. As a proportion of available food, FLW is lower in New Zealand than the global average; however, the waste of thousands of tonnes of edible food comes with substantial economic, environmental and social costs.

Food insecurity, in children, is associated with poorer health and academic outcomes. Around 27% of New Zealand households have reported food insecurity(1). The Ka Ora, Ka Ako | Healthy School Lunches Programme(2) initiative in New Zealand schools aims to reduce food insecurity(3). This cross-sectional study assesses the nutritional contribution of the government-funded school lunches to daily nutrient intake among adolescents. The study compares nutrient intake during school hours between consumers (students from schools with funded lunch programme who ate during school hours) and non-consumers (students from schools with funded lunch programme who did not consume a funded lunch) and students from schools ineligible for the funded lunch. Dietary data was collected in 2024 via an online 24-hour recall (Intake24) from 390 intermediate and secondary school students in Auckland, Waikato and Bay of Plenty. Demographic data was collected via survey. Nutrient intake from food consumed during the school day (between 9am–3pm) was considered ‘school lunch’ and expressed as a percentage of total daily intake. Students were grouped as consumers (n=95); non-consumers (n=109); and ineligible (n=186). Comparisons between groups were conducted using Kruskal-Wallis tests. The funded school lunch provided an average of 26% of daily energy and contributed proportionally higher amounts of several key nutrients when compared to energy provision, including fibre (31% of daily fibre intake), zinc (30%), and beta-carotene (37%). Consumers had significantly higher nutrient intakes than non-consumers. Nutrient contributions were comparable between consumers and ineligible students, except for total sugars, which were lower in consumers. In 2024, New Zealand’s government-funded school lunches were nutrient-dense and provided better nutritional value than lunches sourced elsewhere from students in eligible schools and similar or better nutritional value than lunches of ineligible students. Findings support continued investment and potential expansion of the programme to improve adolescent nutrition and reduce health inequities.

Post World War II, there have been vast shifts in the global food supply which have influenced the burden of diet-related disease. The objective of this study was to use Food Balance Sheet data from the Food and Agricultural Organization of the United Nations(1) to describe trends in the population supply of main food commodities from 1961 to 2022 in New Zealand (NZ) – a high-income country with a rapid decline in ischaemic heart disease (IHD) mortality since the late 1960s(2) and steadily increasing mean population body mass index, at least since the 1990s. Using Food Balance Sheet Data, which estimates population food supply, we calculated the percentage contribution of total fat from each of the main food commodity groups and also calculated mean population supply of food commodities in g/capita/day, as well as mean population supply of total energy in g/capita/day. For all analyses, we averaged data over 3-4 years. In 1961-63, the commodities ‘butter’ (37.0%) and ‘meat & poultry’ (35.6%) were the leading contributors to population supply of total fat. In 2019-22, ‘vegetable oils’ (23.3%) contributed most to total fat supply, whereas the contribution of butter had decreased to 15.8% and ‘meat & poultry’ to 21.6%. Per capita supply of ‘red meat’ decreased from 303g/day in 1961-63 to 162g/day in 2019-22, whilst per capita supply of poultry increased from 8g/day to 71g/day. In 1961-63, the per capita population supply of energy was 12,329 kJ/day; this had increased to 13,151 kJ/day in 2019-22. The considerable shifts in types of fat in the food supply from 1961 to 2022 have likely contributed significantly to marked decreases in rates of IHD over this time period in NZ. The supply of energy increased by 7% during the same time period, mirroring the increase in mean population body mass index over this time. This analysis underscores the profound importance of a country’s food supply to population health.