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Item Factors associated with ultra processed food intake in children : a systematic review of observational studies : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2025) McArley, SarahBackground Ultra processed food (UPF) makes a substantial and growing contribution to diets globally. UPF intake is associated with adverse health outcomes. Childhood represents an ideal time for interventions to reduce UPF intake as it is when dietary behaviours are established. Understanding factors associated with UPF intake in children will help inform the design of future interventions. The socioecological model provides a framework in which to conceptualise factors contributing to dietary behaviours, such as UPF intake. Aim To synthesise the current body of knowledge on the factors associated with UPF intake in children. Methods A comprehensive literature search of three databases was conducted to identify quantitative evidence of factors associated with UPF intake in children. A total of 3,271 articles were identified. After screening, 32 reports from 20 original studies (18 cross-sectional and two prospective cohort) were included. A narrative synthesis of factors across levels of the socioecological model was performed. Results The majority of studied factors were at the interpersonal and individual levels of the socioecological model. Few factors had been studied at the community level and none at the policy level. Studies have identified positive associations between screen time, screen use during meals and having a parent who smokes and children’s UPF intake, and generally negative associations between breastfeeding duration and UPF intake. Sex, ethnicity, gestational age, birthweight and parents BMI did not tend to be associated with children’s UPF intake. There were inconsistent associations for age, physical activity, socioeconomic status, parents age and family size and children’s UPF intake. A wide range of other factors had been examined in one or two studies. Conclusions Screen use, parental smoking and breastfeeding appear to be related to UPF intake in children, but how these factors influence UPF intake requires further study. There is a paucity of knowledge on how factors at the community and policy levels of the socioecological model influence UPF intake in children. Further research is needed to understand factors associated with UPF intake in children and which interventions are successful, the findings of this review may be used to inform the design of such studies.Item Exploring dietary patterns of a vegan population living in Auckland, New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Auckland, New Zealand(Massey University, 2024) Henderson, PhillipaBackground: The vegan diet is increasing in popularity in New Zealand, however the current literature regarding dietary intake in NZ vegan populations is limited. Overseas studies in vegan populations have focused mostly on nutrient adequacy rather than broader dietary patterns. Dietary patterns can be used to measure diet quality as they look at the whole diet rather than single aspects. Given the diversity within vegan dietary practices, an increasing number of people choosing veganism and the growing market of ultra-processed vegan foods, this study seeks to fill a critical gap by examining the dietary patterns of vegans living in Auckland, New Zealand. Aim: To identify and analyse dietary patterns among vegans living in Auckland, New Zealand, and explore associations with socio-demographic and lifestyle factors. Methods: This study recruited participants as part of the larger Vegan Health Research Program at Massey University. Inclusion criteria were at least 2 years following the vegan diet, not pregnant or breastfeeding and living in Auckland, New Zealand. Dietary intake was assessed using a validated Food Frequency Questionnaire (FFQ) including 196 vegan foods, which were grouped into 34 food groups. Principal component analysis (PCA) was applied to identify common dietary patterns, and associations with socio demographics such as ‘age, gender, education, alcohol consumption and physical activity score’ were examined. Results: Participants (n=212) were 71% female with a mean age of 39.4 (12.2) years. Participants were mostly European (85%) and most had an education level of undergraduate or higher (68.2%). Four patterns emerged from principal component analysis explaining 35.3% of the variation in the diet; Health-Conscious, Convenience, Western and Traditional. The Health-Conscious pattern was positively associated with higher alcohol consumption (p= 0.005) and a higher physical activity score (p=<0.001). The Convenience pattern had a positive association with lower alcohol intake (p= 0.015). The Western pattern was positively associated with being female, having a higher physical activity score (p= 0.009), higher alcohol consumption (p=<0.001) and participants having less than a bachelor's degree of education (p= 0.027). The Traditional pattern was positively associated with older age and lower alcohol consumption (p=<0.001). Conclusion: These results indicate that vegans following a Health-Conscious dietary pattern tend to consume more alcohol but engage in higher levels of physical activity. Those following a Western dietary pattern are also more likely to drink more alcohol and be more physically active but also have lower educational attainment. Those following the Convenience pattern are less likely to consume alcohol and similarly, the Traditional dietary pattern is associated with lower alcohol consumption and older vegans are more likely to follow this pattern.Item The feasibility, validity and reliability of a modified 24-hour multiple pass dietary recall to assess fruit and vegetable intake in New Zealand children : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2025) Patel, Varshika VrindaBackground Adequate intake of fruits and vegetables (F/V) is crucial for children’s growth, development, and health. Despite this, many New Zealand children do not meet recommended F/V intake levels. The validity and reliability of a modified 24-hour multiple pass recall (MPR) and alternative tools such as the Veggie Meter® (VM®) for measuring skin-carotenoid scores (SCS) as a biomarker of F/V intake in children remain unexplored. Aims To establish the feasibility, validity and reliability of the modified 24-hour MPR for the evaluation of carotenoid and fruit and vegetable intake against weighed food diaries in 9 to 13–year–old school children living in Auckland. To estimate the reliability of the VM® as a tool to measure chronic skin carotenoid levels. Methods Thirty-two children (20 boys, 12 girls) participated in this study. Over a one-to-three week period, F/V intake was assessed using a modified 24-hour MPR (child-reported, weighed food diaries (parent-reported), and SCS measured by the VM®. Validity was evaluated by comparing the modified 24-hour MPR to weighed food diaries as the criterion. Reliability of the modified 24-hour MPR F/V servings were determined from raw arithmetic difference, while reliability of the modified 24-hour MPR carotenoid intake (μg/d) was expressed as a ratio. Inter-day reliability of the modified 24-hour MPR and the VM® SCS reliability were estimated using various metrics. Results Children did not meet recommended F/V intake levels based on both the modified 24-hour MPR (1.31 fruit serves; 2.00 vegetable serves) and weighed food diaries (1.26 fruit serves; 1.87 vegetable serves). Boys had higher F/V and carotenoid intakes, while girls had slightly higher SCS. The modified 24-hour MPR demonstrated significant bias and poor reliability for estimating F/V and carotenoid intake. In contrast, the VM® showed good reliability with low variability and excellent intraclass correlation coefficient (ICC). Conclusions The modified 24-hour MPR was valid but unreliable for measuring F/V intake in New Zealand children. The VM® was found to provide a reliable measure of carotenoid intake over a chronic time.Item Evaluating the implementation of an eating disorder prevention programme in the New Zealand tertiary environment : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2024) Davis, CateBackground: Eating disorder (ED) rates increased during the COVID-19 pandemic, indicating the need for increased efforts in ED prevention work. The Body Project is an ED prevention programme that has demonstrated successful reduction in ED onset in young females worldwide. It targets the risk factor of thin-ideal internalisation by encouraging participants to challenge societal beauty standards through written and verbal exercises. The primary objective of this study was to implement the Body Project in the New Zealand (NZ) tertiary environment and gather qualitative experience from student participants and other stakeholders involved in the pilot implementation. Methods: Semi-structured interviews were conducted online with student participants (n=6), peer educators (n=3) and counsellors (n=3) that were involved in the training and implementation of the Body Project at a university in NZ, based on convenience sampling from the wider study. A pragmatic approach to qualitative research was used, to gather real-world perspectives. Codes and themes were derived from interview data. Results: Interviewees (n=12) were all female, of which majority (50%) were of New Zealand European/Pakeha ethnicity. Three key themes emerged from analysis: Programme structure and delivery including subthemes training and session logistics; Influences on engagement in the Body Project including subthemes relatability, inclusivity, group dynamics, and personal concerns or perceptions as influencing factors; Impact of the Body Project including subthemes changes participants made since completing the programme and perceived value. Results found that the Body Project improved body satisfaction for 66% of participants (n=4). Participants valued peer educator relatability because it made them feel more comfortable participating. All participants and peer educators could relate to the thin ideal personally. To improve the programme, peer educators should have more training on group management and differentiating behavioural challenges from body activism; and ongoing support from counsellors to maintain boundaries, minimise pro-thin discussion and process personal triggers. Conclusion: The findings of this study highlight the positive impact of the Body Project for body satisfaction, and the programme was well received, with all participants recommending to a friend. To enhance programme effectiveness, improvements in peer educator training, alongside ongoing support from counsellors, are recommended. Relevance of the programme should be further explored from different cultural perspectives in NZ, particularly Māori.Item Protein intake and dietary sources in adolescents aged 14–19 years : insights from the Auckland, Waikato, and Bay of Plenty regions of New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2024) Barrar, JessicaBackground: Adolescence is a critical period of growth and development, increasing the need for adequate protein intake and quality protein sources to support growth and developmental changes. However, current data on protein intake and protein sources among New Zealand (NZ) adolescents are outdated, particularly given recent shifts in dietary patterns and food environments. Aims and objectives: This research aimed to investigate the current protein intake and sources of NZ adolescents and compare protein intake with the Nutrient Reference Values to assess adherence to dietary recommendations. Methods: The data for this research was obtained through the Te Rourou Kai o Ngā Rangatahi: Eating Patterns of Young People in NZ study. This cross-sectional study gathered dietary data from 266 students aged between 14 to 19 years in the Auckland, Waikato, and Bay of Plenty regions of NZ using an electronic multiple pass 24-hour dietary recall, and demographic questionnaire. Dietary data were linked to a preexisting nutrient database and categorised into food groupings to determine protein intake and sources. Protein adequacy was assessed by comparing protein intakes of adolescents with the Nutrient Reference Values for Australia and NZ. Protein intake results were expressed as mean ± standard deviation (SD) for continuous values and as number (percentage) for categorical values. Contributions of each food group to protein intake were reported as both percentage ± SD and grams ± SD. Results: Participants (n=266, 68.0% female) had mean protein intakes of 98.5 ± 66.8 g/day for males and 70.1 ± 45 g/day for females which both exceeded the Estimated Average Requirement (EAR). Males consumed significantly more protein than females (P < 0.001). In total, 19.5% (n=52) of adolescents did not meet the EAR for protein. The percentage of total energy (%TE) from protein was 18.3 ± 8.1% for males and 16.2 ± 5.4% for females, both within but at the lower end of the acceptable macronutrient distribution range (AMDR) of 15-25%, with males showing a significantly higher protein contribution to energy intake (P = 0.035). A high proportion of females (44.2%) and males (36.9%) were below the AMDR. For all participants, the main sources of protein included meat and meat products (17.7 ± 25.7%, 17.6 ± 35.7g/d), burgers, pizza, and Mexican dishes (13.8 ± 26.4%, 9.6 ± 20.1g/d), pasta and rice dishes (9.8 ± 22.4%, 9.7 ± 27.9g/d), and bread and bread products (7.5 ± 13.7%, 5.5 ± 11.8g/d). Conclusions: Protein sources for NZ adolescents include both plant and animal sources, with meat being the largest contributor. Animal proteins, such as meat, will provide high-quality, complete proteins within the adolescent diet. Our findings suggest some adolescents are consuming inadequate amounts of protein to meet their dietary needs. Further research is required with two non-consecutive 24-hour recalls verifying levels of inadequacy seen within this adolescent population.Item An exploration into the use of galactagogues among breastfeeding women in Aotearoa and the factors associated with use : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science majoring in Nutrition and Dietetics, Massey University, Auckland(Massey University, 2024) Gash, Madeline CaitBackground: Galactagogues are herbal, food, or pharmaceutical substances increasingly used to enhance breast milk production in breastfeeding women. Despite limited evidence on galactagogue efficacy and use generally, literature has reported use of G associated use with perceived insufficient milk; a mother’s belief that their quality or quantity is insufficient to meet infant needs. This thesis aims to describe the type, duration, and purpose of galactagogue use by breastfeeding women in Aotearoa. Additionally, this study will identify factors associated with galactagogue use and explore associations with perceived insufficient milk supply. Methods: A quantitative cross-sectional online survey was distributed via study advertisements on Facebook, the Le Leche League, Lactation Consultants, or by word of mouth. Women currently breastfeeding, or who breastfed in the past year, aged 16+ in Aotearoa, were eligible. The 58 question survey included demographics, birth characteristics, breastfeeding practices and galactagogue behaviours. The data were analysed using descriptive statistics and bivariate and logistic analyses. Results: In total, 763 women were included in this study. More than half the participants (63.8%) reported using a galactagogue. The most commonly reported galactagogues were oats (71.1%), followed by lactation cookies (59.3%) and nuts and seeds (42.1%). Bivariate analyses found galactagogue use was higher among primiparous women (68.8% vs 57.6%, p=0.001), those with caesarean births (70.4% vs 60.4%, p=0.010), having previously used galactagogues (yes=69% vs no=30.3%, p=<0.001), those concerned with perceived insufficient milk quantity (44% vs 78%, p=<0.001). Multivariate analysis found perceived insufficient milk quantity was the only predictor of galactagogue use. Many women who never reported perceived insufficient milk quantity (54%) or quality (44%) still reported galactagogue use. The most common reason for using galactagogues was to increase milk supply (47.9%). Nearly two-thirds of women (60.5%) commenced galactagogue use within the first four weeks postpartum. Using a galactagogue for less than one week was uncommon (<13%). Conclusion: This study revealed that galactagogue use was high among breastfeeding women in Aotearoa. Mothers concerned about perceived insufficient milk quantity or quality were more likely to use galactagogues, yet a significant proportion of mothers who never questioned these aspects were also users. Qualitative research is needed to clarify decision making processes and influences.Item A pilot cross-sectional study of colorectal cancer survivors examining their nutritional beliefs, behaviours, and access to dietary care : a thesis presented in partial fulfilment of the requirement for the degree of Master of Science in Nutrition and Dietetics at Massey University, Auckland, New Zealand(Massey University, 2024) Cao, DanluBackground: In New Zealand, colorectal cancer (CRC) ranks as the second most common cancer. Over the past three decades, the survival rate of CRC patients in New Zealand has steadily increased. Diet and lifestyle advice affects cancer recovery and the prevention of cancer recurrence. Understanding CRC survivors’ current dietary and lifestyle beliefs, behaviours, and advice and support from health services and other sources will identify gaps in service provision. Aim: To gather preliminary evidence on the sources and quality of dietary and lifestyle advice delivered in community settings according to CRC survivors. Methods: This study is a pilot cross-sectional study. Participants were sought through convenience sampling. Survivors aged 18 years and older who had been diagnosed with colorectal cancer, received clinical treatment in New Zealand, completed treatment 6 months to 30 months before registration, and resided in the New Zealand community were invited to complete an online questionnaire. Data was collected using the online Qualtrics software. Descriptive statistics were used to examine quantitative data. Results: In total, six valid responses were received (83.3% female, mean age 50 years). CRC survivors believed in the important role diet and lifestyle changes played in aiding cancer recovery and preventing cancer recurrence. Five major findings were identified: 1) CRC survivors received insufficient dietary and lifestyle advice and ongoing support from healthcare professionals (HCPs), 2) CRC survivors prefer to receive individualised dietary information specific to their health status and symptoms, 3) current practice did not meet the National Institute for Health and Care Excellence (NICE) guidelines recommended for CRC by HCPs, 4) despite awareness of World Cancer Research Fund International/American Institute for Cancer Research (WCRF/AICR) dietary guidelines among CRC survivors, for some, this did not lead to change in dietary habits, 5) CRC survivors achieved the physical activity levels recommended in guidelines proposed by the U.S Physical Activity Guidelines Advisory Committee. Conclusion: A structured and systematic approach should be developed to provide dietary and lifestyle information for CRC survivors throughout their cancer trajectory so that they will have a better quality of life and a reduced CRC recurrence. Please note: Chapter 5 provides a separate stand-alone chapter on a sub-study. Aim: To gain preliminary insights into the role and resources of HCPs in dietary and lifestyle advice provision and support to CRC survivors in New Zealand. Method: This study design is a pilot descriptive cross-sectional survey. HCPs aged 18 and older with experience providing care to CRC survivors in the community or government funded health services were sampled through convenience sampling. Participants were invited to complete an online questionnaire, and data was collected using the online Qualtrics software. Descriptive statistics were used to examine quantitative data. Results: Six responses (100% female, nurse practitioners, and a cancer support worker) were included in this study. Five major findings were identified: 1) HCPs reported many CRC survivors suffered from complex nutritional problems, 2) all HCPs viewed diet as important for CRC recovery, though their attitudes towards the role of diet in CRC recurrence varied, 3) there is a lack of dietitian access for CRC survivors, 4) there is a variation in providing dietary advice to CRC survivors between HCPs, 5) barriers to information provision include limited access to dietitians, lack of funds, insufficient educational resources, time constraints, the cost to patients, limited knowledge or training, and absence of dietitian services within the organisations. Conclusion: The sub-study recognised a potential gap in CRC survivor care and accessibility to dietetic support. These findings highlight a gap in service provision for CRC survivors in advice, support and information on diet and lifestyle.Item Attitudes and beliefs people with head and neck cancer hold towards food and nutrition : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2024) Young, RubyBackground: Head and neck cancers (HNC) are devastating diseases that have significant impacts on a person’s ability to achieve adequate nutrition. HNC treatments and subsequent side effects often cause nausea, taste changes, appetite loss, and most harmfully malnutrition. The severity of these side effects can leave people searching for ways to improve their condition and can lead to the development of strong attitudes and beliefs towards nutrition, some of which are evidence-based and others which are not. Dietary changes that are not evidence-based can lead to reduced recovery, and survival. Objectives: Explore the attitudes and beliefs people with HNC hold towards food and nutrition in HNC prevention, causation, treatment, and recovery. Methods: This study collected qualitative data using an online survey. Data was analysed manually using an inductive thematic analysis. All 39 participants were over 18 years of age, had been diagnosed with, and treated for, HNC in New Zealand (NZ), were currently living in NZ, and could independently complete the survey. Results: The themes were participants’ sources and perceptions of nutrition information, perceptions of food and nutrition, and participants’ desire for additional support. The information sources people with HNC accessed the most and held in the highest regard were dietitians and survivors of HNC due to their relatable support and focus on evidence-based information. Alcohol, energy and protein were correctly identified to have significant roles in HNC. Additionally, very few participants believed the alternative dietary therapies mentioned were effective (ketogenic diet, high-dose vitamin C, prioritisation of fruits and vegetables), further indicating that participants valued evidence-based information and support. Finally, participants desired support for unintentional weight loss, involvement in treatment decision-making, receptivity to their opinions, and advice regarding long term recovery recommendations. These findings highlighted the need for open communication between healthcare professionals and people with HNC. Conclusion: The nutrition beliefs identified in this study highlighted the quality and range of dietary support available to people with HNC in NZ. The findings of this study provided insight into the areas of nutrition education and support that require improvement to ensure that people with HNC achieve the best possible health outcomes.Item Neurobiological impacts of kiwifruit consumption in a pig model and its effects on sleep and mood in young adults : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Sciences at Massey University, Palmerston North, New Zealand(Massey University, 2024) Kanon, Alexander PutraKiwifruit (KF) positively impacts gut health, specifically in alleviating gastrointestinal symptoms and improving laxation. Emerging evidence also suggests that consuming KF influences sleep and mood, with most studies indicating improvements in subjective measures of these attributes. Previous research has explored the mechanisms behind these effects using in vitro and rodent models, which have considerable differences to human physiology. This study explores the impact of New Zealand KF on various brain physiological aspects in animal models and humans. It explores the antioxidant neuroprotective potential of KF, examines alterations in the gut microbiome composition and bioamine concentrations, analyses temporal bioamine concentration effects in plasma and brain regions, and assesses the acute effects on human sleep quality and mood. Findings reveal that in one week, consumption of both green and gold KF reduced oxidative potential in plasma, increased concentrations of 5-Hydroxyindoleacetic Acid (5HIAA, a serotonin metabolite), and induced changes in the abundance of specific microbial genera along the colon of adult pigs, a more representative model of human physiology. Furthermore, green KF enhances antioxidant protective potential in plasma and various brain regions, while gold KF elevates plasma vitamin C levels and tends to reduce acetylcholinesterase activity across the entire brain. Temporal effects highlight distinct patterns in metabolite concentrations between green and gold KF, with γ-Aminobutyric Acid (GABA) and serotonin exhibiting notable interactions in different brain regions. Good and poor sleepers consuming KF before sleep had improved sleep quality and mood. Fresh KF facilitates easier sleep onset for good sleepers, while freeze-dried KF leads to increased ease of awakening in the morning for poor sleepers. Notably, both forms of KF increase the urinary excretion of 5HIAA and reduce feelings of sleepiness while increasing alertness. The inclusion of the fruit skin appears to increase improvements in sleep quality, suggesting a more noticeable effect. These studies provide valuable insights into the neurobiological effects of KF and support its potential as a functional food to improve sleep in humans.Item The association between calcium intake, osteoporosis knowledge and osteoporosis health beliefs among post-menopausal women : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand(Massey University, 2024) Nicholson, ColetteBackground: Osteoporosis is the most prevalent metabolic bone disease globally. It is caused by excessive loss of bone mineral density (BMD), with a subsequent increase in fracture risk. The condition is costly in terms of healthcare and older adult quality of life. Older women are most likely to experience the onset of osteoporosis due to the cessation of oestrogen production during menopause. Though prevalence is thought to be underestimated, as much as 35.5% of females over 50 years of age are living with osteoporosis in most western countries. Compelling evidence exists that onset can be arrested among older females through ongoing diet and lifestyle choices to mitigate menopausal related loss of BMD. However, randomised control trials of various interventions designed to support positive bone health behaviours have delivered mixed long-term results. This indicates that engagement in positive bone health behaviours is complex. It is thought that actions may also be influenced by health beliefs rather than knowledge of osteoporosis. Health beliefs are also thought to change according to age, gender, and ethnicity. Previous New Zealand-based studies on osteoporosis bone health behaviours and beliefs have focussed on pre-menopausal women. Subsequently, the associations between osteoporosis knowledge, health beliefs, and bone health behaviours, among the vulnerable population of post-menopausal women are largely unknown. Objectives: To investigate the relationship between the bone health behaviour of calcium intake, osteoporosis knowledge, and health beliefs amongst post-menopausal New Zealand women. Methods: This study is a secondary data analysis of a cohort of 66 post-menopausal females from the “Footprint” study. Surveys completed by the participants included the osteoporosis knowledge test, the osteoporosis health belief survey, demographic questions, and a calcium food frequency questionnaire. Pearson’s and Spearman’s rho correlations were used to determine the relationship between calcium intake and the independent variables. Linear regression is used to identify predictors of calcium intake. Results: A weak negative correlation was found between the perception of severity (rs = -0.301, p = 0.017) and calcium intake, as well as a weak positive correlation with university level of education (rs = 0.355, p = 0.008). Following linear regression analysis, the benefits of exercise (β = 0.430, p = 0.007) was identified as the only health belief construct to predict calcium intake, accounting for 17.2% of the variation. Conclusions: The findings of this study suggest that there may be an association between calcium intake and health beliefs around osteoporosis in older women in New Zealand; however, further research with a larger sample size would be required to support these results.