Browsing by Author "Mackay S"

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    2021 Assessment of New Zealand district health boards' institutional healthy food and drink policies: the HealthY Policy Evaluation (HYPE) study
    (Pasifika Medical Association Group (PMAG), 2022-08-19) Gerritsen S; Kidd B; Rosin M; Shen S; Mackay S; Te Morenga L; Mhurchu CN
    AIM: To assess adoption of the voluntary National Healthy Food and Drink Policy (NHFDP) and the alignment of individual institutional healthy food and drink policies with the NHFDP. METHOD: All 20 district health boards (DHBs) and two national government agencies participated. Policies of those organisations that had not fully adopted the NHFDP were assessed across three domains: nutrition standards; promotion of a healthy food and beverages environment; and policy communication, implementation and evaluation. Three weighted domain scores out of 10, and a total score out of 30 were calculated. RESULTS: Nine of the 22 organisations reported adopting the NHFDP in full. Of the remaining 13, six referred to the NHFDP when developing their institutional policy and three were working toward full adoption of the NHFDP. Mean scores (SD) were 8.7 (1.0), 6.1 (2.6) and 3.8 (2.2) for the three domains, and 18.6 (4.8) in total. Most individual institutional policies were not as comprehensive as the NHFDP. However, some contained stricter/additional clauses that would be useful to incorporate into the NHFDP. CONCLUSION: Since a similar policy analysis in 2018, most DHBs have adopted the NHFDP and/or strengthened their own nutrition policies. Regional inconsistency remains and a uniform mandatory NHFDP should be implemented that incorporates improvements identified in individual institutional policies.
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    Awareness, support, and opinions of healthy food and drink policies: a survey of staff and visitors in New Zealand healthcare organisations.
    (BioMed Central Ltd, 2024-08-12) Gerritsen S; Rosin M; Te Morenga L; Jiang Y; Kidd B; Shen S; Umali E; Mackay S; Ni Mhurchu C
    Background In 2016, a voluntary National Healthy Food and Drink Policy (hereafter, “the Policy”) was released to encourage public hospitals in New Zealand to provide food and drink options in line with national dietary guidelines. Five years later, eight (of 20) organisations had adopted it, with several preferring to retain or update their own institutional-level version. This study assessed staff and visitors’ awareness and support for and against the Policy, and collected feedback on perceived food environment changes since implementation of the Policy. Methods Cross-sectional electronic and paper-based survey conducted from June 2021 to August 2022. Descriptive statistics were used to present quantitative findings. Free-text responses were analysed following a general inductive approach. Qualitative and quantitative findings were compared by level of implementation of the Policy, and by ethnicity and financial security of participants. Results Data were collected from 2,526 staff and 261 visitors in 19 healthcare organisations. 80% of staff and 56% of visitors were aware of the Policy. Both staff and visitors generally supported the Policy, irrespective of whether they were aware of it or not, with most agreeing that “Hospitals should be good role models.” Among staff who opposed the Policy, the most common reason for doing so was freedom of choice. The Policy had a greater impact, positive and negative, on Māori and Pacific staff, due to more frequent purchasing onsite. Most staff noticed differences in the food and drinks available since Policy implementation. There was positive feedback about the variety of options available in some hospitals, but overall 40% of free text comments mentioned limited choice. 74% of staff reported that food and drinks were more expensive. Low-income staff/visitors and shift workers were particularly impacted by reduced choice and higher prices for healthy options. Conclusions The Policy led to notable changes in the healthiness of foods and drinks available in NZ hospitals but this was accompanied by a perception of reduced value and choice. While generally well supported, the findings indicate opportunities to improve implementation of food and drink policies (e.g. providing more healthy food choices, better engagement with staff, and keeping prices of healthy options low) and confirm that the Policy could be expanded to other public workplaces.
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    Barriers and facilitators to implementation of healthy food and drink policies in public sector workplaces: a systematic literature review.
    (19/06/2023) Rosin M; Mackay S; Gerritsen S; Te Morenga L; Terry G; Ni Mhurchu C
    CONTEXT: Many countries and institutions have adopted policies to promote healthier food and drink availability in various settings, including public sector workplaces. OBJECTIVE: The objective of this review was to systematically synthesize evidence on barriers and facilitators to implementation of and compliance with healthy food and drink policies aimed at the general adult population in public sector workplaces. DATA SOURCES: Nine scientific databases, 9 grey literature sources, and government websites in key English-speaking countries along with reference lists. DATA EXTRACTION: All identified records (N = 8559) were assessed for eligibility. Studies reporting on barriers and facilitators were included irrespective of study design and methods used but were excluded if they were published before 2000 or in a non-English language. DATA ANALYSIS: Forty-one studies were eligible for inclusion, mainly from Australia, the United States, and Canada. The most common workplace settings were healthcare facilities, sports and recreation centers, and government agencies. Interviews and surveys were the predominant methods of data collection. Methodological aspects were assessed with the Critical Appraisal Skills Program Qualitative Studies Checklist. Generally, there was poor reporting of data collection and analysis methods. Thematic synthesis identified 4 themes: (1) a ratified policy as the foundation of a successful implementation plan; (2) food providers' acceptance of implementation is rooted in positive stakeholder relationships, recognizing opportunities, and taking ownership; (3) creating customer demand for healthier options may relieve tension between policy objectives and business goals; and (4) food supply may limit the ability of food providers to implement the policy. CONCLUSIONS: Findings suggest that although vendors encounter challenges, there are also factors that support healthy food and drink policy implementation in public sector workplaces. Understanding barriers and facilitators to successful policy implementation will significantly benefit stakeholders interested or engaging in healthy food and drink policy development and implementation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021246340.
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    Concentration of 12 Oligosaccharides in the Milk of New Zealand Breastfeeding Women
    (MDPI (Basel, Switzerland), 2023-03-23) Jia LL; Brough L; Weber JL; Smith C; Mackay S; Jalili-Moghaddam S; Gibbs M
    Human milk oligosaccharides (HMOs) are the third most abundant component in breast milk. HMOs benefit infant gut health, modulate immune responses, and promote brain development. The profile and concentration of HMOs vary considerably among breastfeeding women, and are reported to be associated with genetic, maternal, and environmental factors as well as feeding practices. One reason for the diversity in HMO concentration is the secretor gene, which determines the presence of an enzyme responsible for the synthesis of 2′-FL and LNFP-I. To date, there is no report about HMO concentration or profile in the New Zealand population. Our objective was to investigate 12 HMO concentrations in a small sample of New Zealand women. Sixty-eight breastfeeding mothers (mean age 32 years, 77% Caucasian) of singleton infants (median age [Q1, Q3] 108 [70, 166] days) were included, with 65% exclusively breastfeeding and 54% who had two or more children. Concentrations of 12 HMOs were measured by UHPLC with fluorescence detection. Overall, 68% of mothers were secretors, which was defined by the presence of 2′-FL in the milk. HMO profiles varied widely; total HMO concentration varied 4.2-fold between women; and individual HMOs varied from 4.8-fold to >100-fold. The median of total HMO concentration (Q1, Q3) of the secretors and non-secretors were 6774.9 (6395.4, 8245.6) mg/L and 7128.0 (6093.1, 7880.1) mg/L respectively. Significant differences in concentration of 2′-FL, 3-FL, A-Tet, LNFP-I, LNFP-II, LNFPV, and LNnT between secretors and non-secretors were found by Mann–Whitney tests. However, there was no significant difference in concentrations of LNFP-III, LNnFP, 3′-SL, 6′-SL, LNT, or total HMOs between the secretors and the non-secretors. HMO concentrations vary broadly between breastfeeding women. A longitudinal cohort of a larger sample size is required to fully investigate HMO profiles at different lactation stages of New Zealand women and to further explore the influence of maternal and environmental factors on HMO concentration.
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    Exogenous Carbohydrate as an Ergogenic Aid: Recent Advances in Dose and Form and Format
    (MDPI (Basel, Switzerland), 2019-03-05) Rowlands DS; Rachel Brown; Mackay S; Eyles H
    Performance nutrition is as wide and complex topic as the number and diversity of sports available for human endeavor. Nevertheless, over 100 years of evidenced-based outcomes founded upon the science of energy-substrate metabolism provide a body of evidence providing almost certain support for the use of carbohydrate prior to and during most prolonged maximal efforts to enhance performance. This presentation will provide a summary of some of our recent research contributing to the refinements and translation of this general ergogenic theme. Topics covered will include: maximal exogenous-carbohydrate dose response; optimal fructose:glucose/maltodextrin ratio for gut comfort, oxidation rate, and performance; new data on the role of sucrose and very long-chain glucose polymers in glycogen recovery; effects of solid, gel, and drink format; training of the gut, new technologies in sports drinks- the Sub2/Maurten story, and inferences from lab vs in-competition field clinical trials.
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    Is a voluntary healthy food policy effective? evaluating effects on foods and drinks for sale in hospitals and resulting policy changes
    (BioMed Central Ltd, 2025-12-01) Ni Mhurchu C; Rosin M; Shen S; Kidd B; Umali E; Jiang Y; Gerritsen S; Mackay S; Te Morenga L
    Background: Healthy food and drink guidelines for public sector settings can improve the healthiness of food environments. This study aimed to assess the implementation and impact of the voluntary National Healthy Food and Drink Policy (the Policy) introduced in New Zealand in 2016 to encourage provision of healthier food and drink options for staff and visitors at healthcare facilities. Methods: A customised digital audit tool was used to collate data on foods and drinks available for sale in healthcare organisations and to systematically classify items as green (‘healthy’), amber (‘less healthy’), or red (‘unhealthy’) according to Policy criteria. On-site audits were undertaken between March 2021 and June 2022 at 19 District Health Boards (organisations responsible for providing public health services) and one central government agency. Forty-three sites were audited, encompassing 229 retail settings (serviced food outlets and vending machines). In total, 8485 foods/drinks were classified according to Policy criteria. The primary outcome was alignment with Policy guidance on the availability of green, amber, and red category food/drink items (≥ 55% green and 0% red items). Secondary outcomes were proportions of green, amber, and red category items, promotional practices, and price. Chi-square tests were used to compare results between categorical variables. Results: No organisation met the criteria for alignment with the Policy. Across all sites, 38.9% of food/drink items were rated red (not permitted), 39.0% were amber, and 22.1% were green. Organisations that adopted the voluntary Policy offered more healthy foods/drinks than those with their own organisational policy, but the proportion of red items remained high: 32.3% versus 47.5% (p < 0.0001). About one-fifth (21.3%) of all items were promoted, with red (24.6%) and amber (22.2%) items significantly more likely to be promoted than green items (14.0%) (p < 0.001). Green items were also significantly more costly on average (NZ$6.00) than either red (NZ$4.00) or amber (NZ$4.70) items (p < 0.0001). Conclusions: Comprehensive and systematic evaluation showed that a voluntary Policy was not effective in ensuring provision of healthier food/drink options in New Zealand hospitals. The adoption of a single, mandatory Policy, accompanied by dedicated support and regular evaluations, could better support Policy implementation.
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    Maternal plasma selenium and the occurrence of infection symptoms among women at six and twelve months postpartum
    (MDPI (Basel, Switzerland), 2023-04-03) Jin Y; Coad J; Brough L; Smith C; Mackay S; Jalili-Moghaddan S
    Selenium is essential for human health because it produces selenoproteins, which have antioxidant and anti-inflammatory roles. Recently published data have suggested high selenium status (high hair selenium concentration) improved outcomes in patients with COVID-19 infections. Our objective was to investigate the occurrence of infectious symptoms and selenium status among postpartum women. This is a secondary analysis of data collected in the Mother and Infant Nutrition Investigation—an observational, longitudinal cohort study spanning the first postpartum year of mother and infant pairs (n = 87) in Palmerston North, New Zealand. Plasma selenium was measured in women at six months postpartum (6MPP), and the validated Carr Infection Symptom Checklist (CISC) measured the type and frequency of infection symptoms experienced at 6MPP and twelve months postpartum (12MPP). The checklist contains 30 symptoms of infection; each symptom is scored from 0 (no symptoms) to 4 (severe symptoms), thus the possible total score ranges from zero to 120. The data were expressed as the median (q25, q75). The median maternal plasma selenium was 105.8 (95.6, 115.3) µg/L, with 41% of women meeting the criteria for the maximum expression of selenoprotein P (>110 µg/L). The median CISC scores were 12 (8, 18) at 6MPP and 13 (8, 21) at 12MPP, which were weakly correlated (r = 0.363, p = 0.002). Plasma selenium levels among women with a low CISC score ≤ 15 (n = 56) at 6MPP were significantly higher (110.05 µg/L) than those women with a high score of symptoms of infection (score > 15, n = 23) at 102.18 µg/L (p = 0.048, Mann–Whitney U test). Further research is warranted to investigate whether higher plasma selenium levels contribute to a lower rate of maternal infection during the postpartum period. The association between wider selenium biomarkers and maternal immune function should be determined by examining inflammatory markers or immunoglobulin concentrations
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    Slow and steady-small, but insufficient, changes in food and drink availability after four years of implementing a healthy food policy in New Zealand hospitals
    (BioMed Central Ltd, 2024-12) Mackay S; Rosin M; Kidd B; Gerritsen S; Shen S; Jiang Y; Te Morenga L; Ni Mhurchu C
    BACKGROUND: A voluntary National Healthy Food and Drink Policy (the Policy) was introduced in public hospitals in New Zealand in 2016. This study assessed the changes in implementation of the Policy and its impact on providing healthier food and drinks for staff and visitors in four district health boards between 1 and 5 years after the initial Policy introduction. METHODS: Repeat, cross-sectional audits were undertaken at the same eight sites in four district health boards between April and August 2017 and again between January and September 2021. In 2017, there were 74 retail settings audited (and 99 in 2021), comprising 27 (34 in 2021) serviced food outlets and 47 (65 in 2021) vending machines. The Policy's traffic light criteria were used to classify 2652 items in 2017 and 3928 items in 2021. The primary outcome was alignment with the Policy guidance on the proportions of red, amber and green foods and drinks (≥ 55% green 'healthy' items and 0% red 'unhealthy' items). RESULTS: The distribution of the classification of items as red, amber and green changed from 2017 to 2021 (p < 0.001) overall and in serviced food outlets (p < 0.001) and vending machines (p < 0.001). In 2021, green items were a higher proportion of available items (20.7%, n = 815) compared to 2017 (14.0%, n = 371), as were amber items (49.8%, n = 1957) compared to 2017 (29.2%, n = 775). Fewer items were classified as red in 2021 (29.4%, n = 1156) than in 2017 (56.8%, n = 1506). Mixed dishes were the most prevalent green items in both years, representing 11.4% (n = 446) of all items in 2021 and 5.5% (n = 145) in 2017. Fewer red packaged snacks (11.6%, n = 457 vs 22.5%, n = 598) and red cold drinks (5.2%, n = 205 vs 12.5%, n = 331) were available in 2021 compared to 2017. However, at either time, no organisation or setting met the criteria for alignment with the Policy (≥ 55% green items, 0% red items). CONCLUSIONS: Introduction of the Policy improved the relative healthiness of food and drinks available, but the proportion of red items remained high. More dedicated support is required to fully implement the Policy.
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    Supplement Use during Pregnancy in Aotearoa, New Zealand
    (MDPI (Basel, Switzerland), 2023-03-06) Funnell C; Coad J; Brough L; Smith C; Mackay S; Jalili-Moghaddam S; Gibbs M
    Iodine is an essential micronutrient required for thyroid function, and is essential during pregnancy for growth and development. Manatū Hauora (MoH) recommends an iodine supplement of 150 µg/day during pregnancy and breastfeeding. To reduce the risk of brain and spinal cord birth defects, the MoH also recommends a folic acid (FA) supplement of 800 µg/day preconception (four weeks) and during the first trimester of pregnancy. A self-administered Qualtrics XM survey was designed for pregnant women between 20–23 weeks of gestation and advertised on Facebook between March 2021–June 2021 throughout Aotearoa. The aim of the survey was to ascertain supplement usage during pregnancy, with a particular focus on iodine and FA. In total, one hundred and sixty pregnant women completed the online survey. A total of 50% were of New Zealand/European ethnicity, 11% were Māori, and 3.2% of a Pacific Island ethnicity. Furthermore, 43% were educated to university level, and 80% were in either voluntary and/or paid employment. In addition, 66% consumed iodine-only supplements (Neurotab; 150 µg/day), 44% consumed FA-only supplements (800 µg/day), and 34% consumed multiple-micronutrient (MN) supplements containing iodine and FA, predominately Elevit or Blackmore pregnancy supplements. Concerningly, 11% of participants took no supplements, and only 45% of the FA supplement users reported taking the FA prior to conception. Furthermore, 13% took both folic and an MN supplement, putting them at risk of an intake over the upper level of intake (1000 mg/day). Additionally, 18% of the participants consumed both an iodine-only and an MN supplement. Only 37% of those using an iodine supplement planned to stop taking it when breastfeeding ceased, suggesting that many were not aware of the recommendation for continuation of use. Despite the high educational status, many did not adhere to the supplement use recommendations. Public health strategies are required to ensure that women of childbearing age are aware of these recommendations for supplement use pre-, during, and post-pregnancy.
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    Validity of Quantitative Ultrasound and Bioelectrical Impedance Analysis against Dual X-Ray Absorptiometry for Measuring Bone Quality and Body Composition in Children
    (MDPI (Basel, Switzerland), 2019-03-07) Delshad M; Beck KL; Conlon CA; Mugridge O; Kruger MC; Von Hurst PR; Brown R; Mackay S; Eyles H
    Background: Dual energy X-ray absorptiometry (DXA) is a well-regarded device for primarily measuring bone mineral density (BMD) and body composition. However, its use is limited in children since it is expensive, time-consuming, lacks portability, and exposes children to ionizing radiation. The objective was to examine the validity of quantitative ultrasound (QUS) and bioelectrical impedance analysis (BIA) measurements against DXA for bone quality and body composition in children (8–13 years) living in Auckland, New Zealand. Methods: Whole body bone mineral content (BMC), BMD, and body composition were measured with DXA (QDR Discovery A, Hologic, USA), BMD and calcaneal stiffness index (SI) with QUS (Sahara QUS, Hologic, USA), and BIA measurements on the InBody 230 (Biospace Ltd., Seoul, Korea). Relative validity was assessed using Pearson correlation coefficients, cross-classification, and weighted ĸ-statistic Results: Healthy children (n = 127, 58 boys) were recruited. Positive correlations between QUS -SI and DXA (BMC and BMD) were observed (range = 0.40–0.45) (p < 0.05). QUS-SI correctly classified >50% of participants into the correct tertile and <10% into the opposite tertile when compared with DXA-BMD. Moderate agreement (ĸ = 0.4) was found through weighted ĸ-statistic analysis (between QUS-SI and DXA-BMD). Correlations existed between BIA and DXA for lean mass, fat mass and percentage body fat (range = 0.8–0.97) (p < 0.01). Cross-classification showed a range of 70%–84% of participants were correctly categorized into the same tertile. Weighted ĸ-statistic illustrated good agreement (ĸ = 0.6–0.8) between BIA and DXA variables. Conclusion: We found that the calcaneal QUS-SI appears to be a valid method for identifying children with low BMD as identified by DXA, and BIA is a valid method to assess children’s body composition status since there was a good relative agreement between BIA parameters and DXA values. Our results suggest that calcaneal QUS and BIA could be used to investigate bone health and body composition among children, respectively.