Professor of Allied Health, nutrition scientist and dietitian, with expertise in health services research, nutrition and healthy aging, micronutrients, Mediterranean diet and chronic disease
High consumption of soft drinks and other sugary drinks are associated with a number of health pr... more High consumption of soft drinks and other sugary drinks are associated with a number of health problems, including overweight and obesity, type 2 diabetes, osteoporosis and dental caries. In Australia, soft drinks are the most commonly consumed sugary beverage and have been singled out for specific attention as a target of obesity prevention programs. Soft drinks are well-known, readily available and marketed extensively, especially to adolescents. They have no nutritional value other than sugar and fluid, and are identified in the Australian Guide to Healthy Eating as an ‘extra’ food – one that should be consumed only occasionally and in small amounts.
Monitoring key food habits of children is important for planning and improving health services in... more Monitoring key food habits of children is important for planning and improving health services in New South Wales. The NSW Health Department conducts the NSW Health survey program using Computer Assisted Telephone Interviews (CATI). This survey includes questions for monitoring food habits of children aged 0-16 years. In this report, we recommend survey questions to be used in the NSW Health survey for this purpose, which meet a range of criteria for good survey questions about nutrition and food habits.
Short-term trials indicate inorganic nitrate and nitrate-rich vegetables may have vascular health... more Short-term trials indicate inorganic nitrate and nitrate-rich vegetables may have vascular health benefits. However, few observational studies have explored the relationship between nitrate intake and long-term cardiovascular disease (CVD) outcomes. The primary aim of this study was to investigate the association of nitrate intake from vegetables with CVD mortality in a sample of older Australians. A subgroup of participants without diabetes or major CVD at baseline (1992-1994) were included from the Blue Mountains Eye Study, a population-based cohort study of men and women aged ≥ 49 years. Diets were evaluated using a validated food frequency questionnaire at baseline, 5 years and 10 years of follow-up. Vegetable nitrate intake was estimated using a comprehensive vegetable nitrate database. Cox proportional hazard regression was used to explore the association between vegetable nitrate intake and CVD mortality. During 14 years of follow-up, 188/2229 (8.4%) participants died from CV...
The American journal of clinical nutrition, Jan 6, 2018
The majority of research performed to date has examined the effects of commonly known antioxidant... more The majority of research performed to date has examined the effects of commonly known antioxidants such as vitamins C, E, and A and carotenoids on age-related macular degeneration (AMD) risk and progression. To date, there is limited research on promising phytochemicals with antioxidant and anti-inflammatory properties, including flavonoids. In this exploratory study, we aimed to assess the independent associations between dietary intake of total flavonoids and common flavonoid classes with the prevalence and 15-y incidence of AMD. In this population-based cohort study, 2856 adults aged ≥49 y at baseline and 2037 followed up 15 y later were included in prevalence and incidence analyses, respectively. Dietary intake was assessed by using a semiquantitative food-frequency questionnaire (FFQ). Estimates of the flavonoid content of foods in the FFQ were assessed by using the USDA Flavonoid, Isoflavone, and Proanthocyanidin databases. AMD was assessed from retinal photographs. In cross-s...
European journal of clinical nutrition, Mar 1, 2018
To report on the reliability and validity of a Diet Quality Index (DQI) to assess preschoolers di... more To report on the reliability and validity of a Diet Quality Index (DQI) to assess preschoolers dietary patterns using a short food frequency questionnaire (sFFQ) and 3-day food records (3d-FR). Seventy-seven preschool carers/parents completed a telephone interview on preschoolers (2-5-year olds) dietary habits in metropolitan Sydney. Agreement in scores was assessed using intraclass correlation (ICC) and paired t-tests for repeated sFFQ-DQI scores and Bland-Altman methods and paired t-tests for sFFQ-DQI and 3d-FR-DQI scores. Mean-total sFFQ-DQI ICC scores was high = 0.89, 95% CI (0.81, 0.93). There was weak agreement between sFFQ-DQI and 3d-FR-DQI scores (r = 0.36, p < 0.01). The 3d-FR-DQI scores were positively associated with carbohydrate, folate, ß-carotene, magnesium, calcium, protein, total fat and negatively associated with sugar, starch, niacin, vitamin C, phosphorus, polyunsaturated fat, and monounsaturated fat. The sFFQ-DQI demonstrated good reliability but weak validity...
To assess if there is a difference in salt intake (24 h urine collection and dietary recall) and ... more To assess if there is a difference in salt intake (24 h urine collection and dietary recall) and dietary sources of salt (Na) on weekdays and weekend days. A cross-sectional study of adults who provided one 24 h urine collection and one telephone-administered 24 h dietary recall. Community-dwelling adults living in the State of Victoria, Australia. Adults (n 598) who participated in a health survey (53·5 % women; mean age 57·1 (95 % CI 56·2, 58·1) years). Mean (95 % CI) salt intake (dietary recall) was 6·8 (6·6, 7·1) g/d and 24 h urinary salt excretion was 8·1 (7·8, 8·3) g/d. Mean dietary and 24 h urinary salt (age-adjusted) were 0·9 (0·1, 1·6) g/d (P=0·024) and 0·8 (0·3, 1·6) g/d (P=0·0017), respectively, higher at weekends compared with weekdays. There was an indication of a greater energy intake at weekends (+0·6 (0·02, 1·2) MJ/d, P=0·06), but no difference in Na density (weekday: 291 (279, 304) mg/MJ; weekend: 304 (281, 327) mg/MJ; P=0·360). Cereals/cereal products and dishes, m...
To update the estimate of mean salt intake for the Australian population made by the Australian H... more To update the estimate of mean salt intake for the Australian population made by the Australian Health Survey (AHS). A secondary analysis of the data collected in a cross-sectional survey was conducted. Estimates of salt intake were made in Lithgow using the 24 h diet recall methodology employed by the AHS as well as using 24 h urine collections. The data from the Lithgow sample were age- and sex-weighted, to provide estimates of daily salt intake for the Australian population based upon (i) the diet recall data and (ii) the 24 h urine samples. Lithgow, New South Wales, Australia. Individuals aged ≥20 years residing in Lithgow and listed on the 2009 federal electoral roll. Mean (95 % CI) salt intake estimated from the 24 h diet recalls was 6·4 (6·2, 6·7) g/d for the Lithgow population compared with a corresponding figure of 6·2 g/d for the Australian population derived from the AHS. The corresponding estimate of salt intake for Lithgow adults based upon the 24 h urine collections wa...
Salt reduction is a public health priority but there are few studies testing the efficacy of plau... more Salt reduction is a public health priority but there are few studies testing the efficacy of plausible salt reduction programs. A multi-faceted, community-based salt reduction program using the Communication for Behavioral Impact framework was implemented in Lithgow, Australia. Single 24-h urine samples were obtained from 419 individuals at baseline (2011) and from 572 at follow-up (2014). Information about knowledge and behaviors relating to salt was also collected. Survey participants were on average 56 years old and 58 % female. Mean salt intake estimated from 24-h urine samples fell from 8.8 g/day (SD = 3.6 g/day) in 2011 to 8.0 (3.6) g/day in 2014 (-0.80, 95 % confidence interval -1.2 to -0.3;p < 0.001). There were significant increases in the proportion of participants that knew the recommended upper limit of salt intake (18 % vs. 29 %; p < 0.001), knew the importance of salt reduction (64 % vs. 78 %; p < 0.001) and reported changing their behaviors to reduce their sa...
Despite the potential of declared serving size to encourage appropriate portion size consumption,... more Despite the potential of declared serving size to encourage appropriate portion size consumption, most countries including Australia have not developed clear reference guidelines for serving size. The present study evaluated variability in manufacturer-declared serving size of discretionary food and beverage products in Australia, and how declared serving size compared with the 2013 Australian Dietary Guideline (ADG) standard serve (600 kJ). Serving sizes were obtained from the Nutrition Information Panel for 4466 packaged, discretionary products in 2013 at four large supermarkets in Sydney, Australia, and categorised into fifteen categories in line with the 2013 ADG. For unique products that were sold in multiple package sizes, the percentage difference between the minimum and the maximum serving size across different package sizes was calculated. A high variation in serving size was found within the majority of food and beverage categories – for example, among 347 non-alcoholic be...
ObjectiveTo compare two front-of-pack nutrition labelling systems for the assessment of packaged ... more ObjectiveTo compare two front-of-pack nutrition labelling systems for the assessment of packaged foods and drinks with Australian Dietary Guidelines.DesignA cross-sectional nutrient profiling assessment. Food and drink products (n20 225) were categorised into scoring levels using criteria for the Institute of Medicine (IOM) three-star system and the five-star Australian Health Star Rating (HSR). The effectiveness of these systems to categorise foods in accordance with Australian Dietary Guidelines was explored.SettingThe study was conducted in Australia, using a comprehensive food database.SubjectsPackaged food and drink products (n20 225) available in Australia.ResultsUsing the IOM three-star system, the majority (55 %) of products scored the minimum 0 points and 25·5 % scored the maximum 3 points. Using HSR criteria, the greatest proportion of products (15·2 %) scored three-and-a-half stars from a possible five and 12·5 % received the lowest rating of a half-star. Very few product...
Atherosclerosis in the blood vision and common eye diseases do not support any adverse vessels of... more Atherosclerosis in the blood vision and common eye diseases do not support any adverse vessels of the eye has been in non-institutionalised residents, associations between high proposed as a possible 49 years or older, living in Blue intakes of dietary fats or mechanism underlying macular Mountains area, west of Sydney. sub-types of fats and the degeneration, which has raised Dietary
High consumption of soft drinks and other sugary drinks are associated with a number of health pr... more High consumption of soft drinks and other sugary drinks are associated with a number of health problems, including overweight and obesity, type 2 diabetes, osteoporosis and dental caries. In Australia, soft drinks are the most commonly consumed sugary beverage and have been singled out for specific attention as a target of obesity prevention programs. Soft drinks are well-known, readily available and marketed extensively, especially to adolescents. They have no nutritional value other than sugar and fluid, and are identified in the Australian Guide to Healthy Eating as an ‘extra’ food – one that should be consumed only occasionally and in small amounts.
Monitoring key food habits of children is important for planning and improving health services in... more Monitoring key food habits of children is important for planning and improving health services in New South Wales. The NSW Health Department conducts the NSW Health survey program using Computer Assisted Telephone Interviews (CATI). This survey includes questions for monitoring food habits of children aged 0-16 years. In this report, we recommend survey questions to be used in the NSW Health survey for this purpose, which meet a range of criteria for good survey questions about nutrition and food habits.
Short-term trials indicate inorganic nitrate and nitrate-rich vegetables may have vascular health... more Short-term trials indicate inorganic nitrate and nitrate-rich vegetables may have vascular health benefits. However, few observational studies have explored the relationship between nitrate intake and long-term cardiovascular disease (CVD) outcomes. The primary aim of this study was to investigate the association of nitrate intake from vegetables with CVD mortality in a sample of older Australians. A subgroup of participants without diabetes or major CVD at baseline (1992-1994) were included from the Blue Mountains Eye Study, a population-based cohort study of men and women aged ≥ 49 years. Diets were evaluated using a validated food frequency questionnaire at baseline, 5 years and 10 years of follow-up. Vegetable nitrate intake was estimated using a comprehensive vegetable nitrate database. Cox proportional hazard regression was used to explore the association between vegetable nitrate intake and CVD mortality. During 14 years of follow-up, 188/2229 (8.4%) participants died from CV...
The American journal of clinical nutrition, Jan 6, 2018
The majority of research performed to date has examined the effects of commonly known antioxidant... more The majority of research performed to date has examined the effects of commonly known antioxidants such as vitamins C, E, and A and carotenoids on age-related macular degeneration (AMD) risk and progression. To date, there is limited research on promising phytochemicals with antioxidant and anti-inflammatory properties, including flavonoids. In this exploratory study, we aimed to assess the independent associations between dietary intake of total flavonoids and common flavonoid classes with the prevalence and 15-y incidence of AMD. In this population-based cohort study, 2856 adults aged ≥49 y at baseline and 2037 followed up 15 y later were included in prevalence and incidence analyses, respectively. Dietary intake was assessed by using a semiquantitative food-frequency questionnaire (FFQ). Estimates of the flavonoid content of foods in the FFQ were assessed by using the USDA Flavonoid, Isoflavone, and Proanthocyanidin databases. AMD was assessed from retinal photographs. In cross-s...
European journal of clinical nutrition, Mar 1, 2018
To report on the reliability and validity of a Diet Quality Index (DQI) to assess preschoolers di... more To report on the reliability and validity of a Diet Quality Index (DQI) to assess preschoolers dietary patterns using a short food frequency questionnaire (sFFQ) and 3-day food records (3d-FR). Seventy-seven preschool carers/parents completed a telephone interview on preschoolers (2-5-year olds) dietary habits in metropolitan Sydney. Agreement in scores was assessed using intraclass correlation (ICC) and paired t-tests for repeated sFFQ-DQI scores and Bland-Altman methods and paired t-tests for sFFQ-DQI and 3d-FR-DQI scores. Mean-total sFFQ-DQI ICC scores was high = 0.89, 95% CI (0.81, 0.93). There was weak agreement between sFFQ-DQI and 3d-FR-DQI scores (r = 0.36, p < 0.01). The 3d-FR-DQI scores were positively associated with carbohydrate, folate, ß-carotene, magnesium, calcium, protein, total fat and negatively associated with sugar, starch, niacin, vitamin C, phosphorus, polyunsaturated fat, and monounsaturated fat. The sFFQ-DQI demonstrated good reliability but weak validity...
To assess if there is a difference in salt intake (24 h urine collection and dietary recall) and ... more To assess if there is a difference in salt intake (24 h urine collection and dietary recall) and dietary sources of salt (Na) on weekdays and weekend days. A cross-sectional study of adults who provided one 24 h urine collection and one telephone-administered 24 h dietary recall. Community-dwelling adults living in the State of Victoria, Australia. Adults (n 598) who participated in a health survey (53·5 % women; mean age 57·1 (95 % CI 56·2, 58·1) years). Mean (95 % CI) salt intake (dietary recall) was 6·8 (6·6, 7·1) g/d and 24 h urinary salt excretion was 8·1 (7·8, 8·3) g/d. Mean dietary and 24 h urinary salt (age-adjusted) were 0·9 (0·1, 1·6) g/d (P=0·024) and 0·8 (0·3, 1·6) g/d (P=0·0017), respectively, higher at weekends compared with weekdays. There was an indication of a greater energy intake at weekends (+0·6 (0·02, 1·2) MJ/d, P=0·06), but no difference in Na density (weekday: 291 (279, 304) mg/MJ; weekend: 304 (281, 327) mg/MJ; P=0·360). Cereals/cereal products and dishes, m...
To update the estimate of mean salt intake for the Australian population made by the Australian H... more To update the estimate of mean salt intake for the Australian population made by the Australian Health Survey (AHS). A secondary analysis of the data collected in a cross-sectional survey was conducted. Estimates of salt intake were made in Lithgow using the 24 h diet recall methodology employed by the AHS as well as using 24 h urine collections. The data from the Lithgow sample were age- and sex-weighted, to provide estimates of daily salt intake for the Australian population based upon (i) the diet recall data and (ii) the 24 h urine samples. Lithgow, New South Wales, Australia. Individuals aged ≥20 years residing in Lithgow and listed on the 2009 federal electoral roll. Mean (95 % CI) salt intake estimated from the 24 h diet recalls was 6·4 (6·2, 6·7) g/d for the Lithgow population compared with a corresponding figure of 6·2 g/d for the Australian population derived from the AHS. The corresponding estimate of salt intake for Lithgow adults based upon the 24 h urine collections wa...
Salt reduction is a public health priority but there are few studies testing the efficacy of plau... more Salt reduction is a public health priority but there are few studies testing the efficacy of plausible salt reduction programs. A multi-faceted, community-based salt reduction program using the Communication for Behavioral Impact framework was implemented in Lithgow, Australia. Single 24-h urine samples were obtained from 419 individuals at baseline (2011) and from 572 at follow-up (2014). Information about knowledge and behaviors relating to salt was also collected. Survey participants were on average 56 years old and 58 % female. Mean salt intake estimated from 24-h urine samples fell from 8.8 g/day (SD = 3.6 g/day) in 2011 to 8.0 (3.6) g/day in 2014 (-0.80, 95 % confidence interval -1.2 to -0.3;p < 0.001). There were significant increases in the proportion of participants that knew the recommended upper limit of salt intake (18 % vs. 29 %; p < 0.001), knew the importance of salt reduction (64 % vs. 78 %; p < 0.001) and reported changing their behaviors to reduce their sa...
Despite the potential of declared serving size to encourage appropriate portion size consumption,... more Despite the potential of declared serving size to encourage appropriate portion size consumption, most countries including Australia have not developed clear reference guidelines for serving size. The present study evaluated variability in manufacturer-declared serving size of discretionary food and beverage products in Australia, and how declared serving size compared with the 2013 Australian Dietary Guideline (ADG) standard serve (600 kJ). Serving sizes were obtained from the Nutrition Information Panel for 4466 packaged, discretionary products in 2013 at four large supermarkets in Sydney, Australia, and categorised into fifteen categories in line with the 2013 ADG. For unique products that were sold in multiple package sizes, the percentage difference between the minimum and the maximum serving size across different package sizes was calculated. A high variation in serving size was found within the majority of food and beverage categories – for example, among 347 non-alcoholic be...
ObjectiveTo compare two front-of-pack nutrition labelling systems for the assessment of packaged ... more ObjectiveTo compare two front-of-pack nutrition labelling systems for the assessment of packaged foods and drinks with Australian Dietary Guidelines.DesignA cross-sectional nutrient profiling assessment. Food and drink products (n20 225) were categorised into scoring levels using criteria for the Institute of Medicine (IOM) three-star system and the five-star Australian Health Star Rating (HSR). The effectiveness of these systems to categorise foods in accordance with Australian Dietary Guidelines was explored.SettingThe study was conducted in Australia, using a comprehensive food database.SubjectsPackaged food and drink products (n20 225) available in Australia.ResultsUsing the IOM three-star system, the majority (55 %) of products scored the minimum 0 points and 25·5 % scored the maximum 3 points. Using HSR criteria, the greatest proportion of products (15·2 %) scored three-and-a-half stars from a possible five and 12·5 % received the lowest rating of a half-star. Very few product...
Atherosclerosis in the blood vision and common eye diseases do not support any adverse vessels of... more Atherosclerosis in the blood vision and common eye diseases do not support any adverse vessels of the eye has been in non-institutionalised residents, associations between high proposed as a possible 49 years or older, living in Blue intakes of dietary fats or mechanism underlying macular Mountains area, west of Sydney. sub-types of fats and the degeneration, which has raised Dietary
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