What do we know about the diets of Aboriginal and Torres Strait Islander peoples in Australia? A systematic literature review

Objective: To provide an overview of published research on the dietary intake of Aboriginal and Torres Strait Islander peoples. Methods: Peer‐reviewed literature from 1990 to October 2016 was searched to identify studies that measured the dietary intake of Australian Aboriginal and Torres Strait Islander populations. Study quality was assessed using a purposely devised quality appraisal tool. Meta‐analysis was not possible due to the heterogeneity in dietary intake assessment methods. A narrative synthesis of study findings, where key themes were compared and contrasted was completed. Results: Twenty‐five articles from twenty studies with outcome measures related to dietary intake were included. Dietary intake was assessed by electronic store sales, store turnover method, 24‐hour dietary recall, food frequency questionnaire and short questions. Consistent findings were low reported intakes of fruit and vegetables and high intakes of total sugar and energy‐dense, nutrient‐poor food and beverages. Conclusions: While differences between studies and study quality limit the generalisability of the findings, most studies suggest that the diets of Aboriginal and Torres Strait Islander peoples are inadequate. Implications for public health: A more concerted approach to understanding dietary patterns of Aboriginal and Torres Strait Islander peoples is required to inform policy and practice to improve diet and nutrition.     

Beverage consumption and adult weight management: A review

Total energy consumption among United States adults has increased in recent decades, and energy-containing beverages are a significant contributor to this increase. Because beverages are less satiating than solid foods, consumption of energy-containing beverages may increase energy intake and lead to weight gain; trends in food and beverage consumption coinciding with increases in overweight and obesity support this possibility. The purpose of this review is to present what is known about the effect of beverage consumption on short-term (i.e., meal) energy intake, as well as longer-term effects on body weight. Specific beverages addressed include water, other energy-free beverages (diet soft drinks, coffee and tea), and energy-containing beverages (soft drinks, juices and juice drinks, milk and soy beverages, alcohol). Existing evidence, albeit limited, suggests that encouraging water consumption, and substituting water and other energy-free beverages (diet soft drinks, coffee and tea) for energy-containing beverages may facilitate weight management. Energy-containing beverages acutely increase energy intake, however long-term effects on body weight are uncertain. While there may be health benefits for some beverage categories, additional energy provided by beverages should be compensated for by reduced consumption of other foods in the diet.     

Advance Australia fair: social democratic and conservative politicians' discourses concerning Aboriginal and Torres Strait Islander Peoples and their health 1972-2001

This paper reports research undertaken as part of a larger project in which we examined whether and how values and beliefs communicated by Australian politicians have shaped decades of health policy and influenced health outcomes for Aboriginal and Torres Strait Islander Peoples of Australia. To first characterise those values and beliefs we analysed the public statements of the politicians responsible nationally for the health of Aboriginal and Torres Strait Islander Peoples 1972-2001, using critical discourse analysis. We found that four discourses, communicated through words, phrases, sentences and grammatical structures, dominated public statements over the study period. These four discourses focused on the competence and capacity of Aboriginal and Torres Strait Islander Peoples to "manage"; matters of control of and responsibility for the health of Aboriginal and Torres Strait Islander Peoples; Aboriginal and Torres Strait Islander Peoples as "Other"; and the nature of the "problem" concerning the health of Aboriginal and Torres Strait Islander Peoples. Analysis of the discursive elements contributing to shaping these four discourses is reported in this paper.     

Coverage of Aboriginal and Torres Strait Islander nutrition in the Koori Mail

Objective : To examine the extent and nature of coverage of nutrition in the Koori Mail. Methods : Content and framing analysis were used to examine articles in the Koori Mail published between 2013 and 2017 that included the terms ‘nutrition?’, ‘diet?’, ‘food’, ‘eating’, ‘weight’, ‘tucker’ or ‘sugary drinks’. The analysis focused on the portrayal of Aboriginal and Torres Strait Islander people/communities, inclusion of First Peoples’ voices and the framing of nutrition issues. Results : A total of 102 articles were included. Most articles (88%, n=90) portrayed Aboriginal and Torres Strait Islander communities in a neutral or positive way and more than half (53%, n=54) included an Aboriginal or Torres Strait Islander voice. While nutrition was often framed as an individual or community responsibility, articles predominantly promoted programs or initiatives undertaken in local communities. Conclusion : Despite the limited prominence of Aboriginal and Torres Strait Islander nutrition in the mainstream media, the coverage of nutrition issues in the Koori Mail demonstrates the salience of this topic for local communities. This study highlights how journalism can better reflect the diversity and strengths of First Peoples. Implications for public health : Including more Aboriginal and Torres Strait Islander voices and using a strengths‐based approach in press releases may improve media advocacy.     

The validation of a self‐report measure and physical activity of Australian Aboriginal and Torres Strait Islander and non‐Indigenous rural children

Purpose: To validate a self‐report measure of physical activity for both Australian Aboriginal and Torres Strait Islander and non‐Indigenous rural children, and to describe their physical activity participation. Methods: In this cross‐sectional study, 84 Aboriginal and Torres Strait Islander and 146 non‐Indigenous children aged 10–12 years old completed the Many Rivers Physical Activity Recall Questionnaire (MRPARQ), a modified version of the Adolescent Physical Activity Recall Questionnaire (APARQ). A sub‐group (n=86) wore an accelerometer for seven consecutive days in order to validate the instrument. Results: Pearson and Intra Class Correlation coefficients between the survey and acceleromtery for weekdays only are 0.31 and 0.16, respectively, for Aboriginal and Torres Strait Islander children, and 0.38 and 0.31, respectively, for non‐Indigenous children, and demonstrate a modest (p<0.05) correlation. Self‐reported MVPA for Aboriginal and Torres Strait Islander children is between 162 and 172 minutes/day, and is 125 minutes by accelerometer; for non‐Indigenous children MVPA is between 123 and 149 minutes (survey) and 107 minutes (accelerometer). Conclusion: Australian Aboriginal and Torres Strait Islander children's self‐report of physical activity is at least as valid as non‐Indigenous children, given culturally appropriate support; they tend to be more active than non‐Indigenous children. Implications: The MRPARQ can be administered with Aboriginal and Torres Strait Islander and non‐Indigenous children.     

Public hospital activity,expenditure and staffing levels for indigenous and nonindigenous settlements in remote Queensland

Abstract: Aborigines and Torres Strait Islanders who live in discrete communities have poor health. Their life expectancy is relatively low and the underlying rates of morbidity, mortality and hospitalisation are much higher than the Australian average. For Aborigines and Torres Strait Islanders in the remote communities, the mortality rate is some three times higher than that of the total population. By comparing remote Aboriginal and Torres Strait Islander communities with similarly remote nonindigenous settlements, the paper shows that there was greater hospital activity per person in remote Aboriginal and Torres Strait Islander communities. Paradoxically, whereas there was greater hospital activity in discrete indigenous communities, there was lower expenditure per person on hospital services. The paper finds also that there were fewer medical and nursing staff per person in remote Aboriginal and Torres Strait communities.     

Dietary glycemic index and glycemic load among Indigenous and non-Indigenous children aged 10-12 years

ObjectiveThis study aimed to estimate the dietary glycemic index (GI) and glycemic load (GL) of Australian Aboriginal and Torres Strait Islander and non-Indigenous rural children and identify the main foods contributing to their GI and GL.MethodsA cross-sectional analysis of food intake of 215 children (38.1% were Aboriginal and Torres Strait Islanders) 10 to 12 y old obtained by three 24-h recalls was conducted. The foods were ranked according to their total contribution to total carbohydrates, GI, and GL.ResultsAboriginal and Torres Strait Islander participants had a significantly higher dietary GL (155.8 ± 46.8 versus 135.4 ± 31.2, P < 0.001) and GI (58.3 ± 3.9 versus 56.9 ± 3.8, P = 0.008) than the non-Indigenous participants. White breads were the main contributors of GI and GL in both groups and were a main driver for the increasing GI. Fiber was not associated with GI, whereas sugar and starch were positively associated. Subjects with a higher GI tended to be less physically active.ConclusionThe quality of carbohydrates in the diets of the participants was low, with poorer dietary items contributing most of the GI and GL. Substituting white breads with low/lower GI alternatives may be a useful strategy.     

Using linkage between hospital and ABS mortality data to enhance reporting of deaths among Aboriginal and Torres Strait Islander peoples

Objective: To investigate the potential of record linkage between the Australian Bureau of Statistics (ABS) mortality data and the NSW Admitted Patient Data Collection (APDC) to improve reporting of deaths among Aboriginal and Torres Strait Islander peoples. Methods: ABS mortality data for 2002 to 2006 were linked with APDC records for 2001 to 2006. Six algorithms were developed to enumerate deaths. Possible biases by age, sex and geographic remoteness were investigated. Results: Levels of reporting ranged from baseline reporting on the ABS mortality data to the largest enhancement with the ‘ever reported as Aboriginal or Torres Strait Islander’ algorithm. Enhancement was more likely in females, older people and residents of major cities. Conclusions: Data linkage substantially improved reporting of Aboriginal and Torres Strait Islander deaths. An algorithm that includes both the number of APDC records and the number of facilities reporting a person as Aboriginal or Torres Strait Islander was considered most promising. Implications: Inclusion of other datasets in the enhancement process is warranted to further improve reporting and address possible bias produced by using APDC records only. Further work should take into account the possibility that a person may be falsely reported as Aboriginal or Torres Strait Islander or not reported in either hospital or death records.     

Coverage of Aboriginal and Torres Strait Islander nutrition in major Australian newspapers, 1996–2015

Objective: To examine the extent and nature of coverage of Aboriginal and Torres Strait Islander nutrition issues in major Australian newspapers over two decades. Methods : Content and framing analysis of Australian newspaper articles published between 1996 and 2015 that included the terms ‘Aboriginal or Indigenous’ and ‘nutrition or diet’ in the headline and/or lead paragraph. Analysis focused on the nature of coverage, trends over time, stakeholder representation and how coverage related to policy. Results : A total of 79 articles were included. Coverage of nutrition fluctuated over time, with peaks in 1998 and 2008. The majority of articles focused on remote Aboriginal communities. Both individual and structural representations of nutrition were used and dietary quality and food insecurity were the most commonly reported nutrition issues. Few articles employed positive representations of Aboriginal peoples. Six policy functions of articles were identified: highlighting problems; reporting government announcements; promoting programs; advocating solutions; critiquing government; and defending policy. Conclusion : The coverage of Aboriginal and Torres Strait Islander nutrition in newspapers does not reflect the diversity and strengths of Australia’s First Peoples. Implications for public health : This study highlights the role of the media in policy advocacy; however, advocates should ensure that they do not perpetuate negative representations of Aboriginal and Torres Strait Islander peoples.     

Needs of Aboriginal and Torres Strait Islander clients residing in Australian residential aged-care facilities

This review was undertaken to identify evidence-based practice guidelines to support the care needs of Aboriginal and Torres Strait Islander clients residing in residential aged-care facilities. A systematic literature review was undertaken. An electronic search of online databases and subsequent manual retrieval process was undertaken to identify relevant reports and studies that explored interventions for care of an Aboriginal and Torres Strait Islander person. Very limited published material identified strategies necessary within residential aged care. Sixty-seven articles were considered for inclusion, and a subsequent review resulted in 34 being included due to direct alignment with the study aim. Strategies recommended within the review cover areas such as care, communication, palliative care, activities and the environment. Care for an Aboriginal and Torres Strait Islander person in an Australian residential aged-care facility requires a collaborative and individual approach. Cultural safety principles should be maintained across a culturally competent workforce. Aboriginal and Torres Strait Islander persons in care is a significant experience that should not be considered 'routine' as there is much to consider in the care of this person and their community.     

Low Calorie Beverage Consumption Is Associated with Energy and Nutrient Intakes and Diet Quality in British Adults

It is unclear whether consumption of low-calorie beverages (LCB) leads to compensatory consumption of sweet foods, thus reducing benefits for weight control or diet quality. This analysis investigated associations between beverage consumption and energy intake and diet quality of adults in the UK National Diet and Nutrition Survey (NDNS) (2008–2011; n = 1590), classified into: (a) non-consumers of soft drinks (NC); (b) LCB consumers; (c) sugar-sweetened beverage (SSB) consumers; or (d) consumers of both beverages (BB), based on 4-day dietary records. Within-person data on beverage consumption on different days assessed the impact on energy intake. LCB consumers and NC consumed less energy and non-milk extrinsic sugars than other groups. Micronutrient intakes and food choices suggested higher dietary quality in NC/LCB consumers compared with SSB/BB consumers. Within individuals on different days, consumption of SSB, milk, juice, and alcohol were all associated with increased energy intake, while LCB and tea, coffee or water were associated with no change; or reduced energy intake when substituted for caloric beverages. Results indicate that NC and LCB consumers tend to have higher quality diets compared with SSB or BB consumers and do not compensate for sugar or energy deficits by consuming more sugary foods.     

Are there systematic barriers to participation in cancer treatment trials by Aboriginal and Torres Strait Islander cancer patients in Australia?

Objective : To identify factors that may systematically reduce opportunities for Aboriginal and Torres Strait Islander Australians to participate in cancer clinical trials. Methods : Analysis of online documents from the Australia and New Zealand Clinical Trials Registry for cancer treatment trials (Phase 3, 4 or Not Applicable) with at least one Australian site, registered in 2014–2018. Results : Among 365 eligible trials, most (89%) had sites only in major cities/inner regional areas, but 39% of Aboriginal and Torres Strait Islander Australians live outside these areas. Seven cancer types accounted for 58% of cancers among Aboriginal and Torres Strait Islander people, but only 46% of trials addressed these cancers. Most trials specified exclusions relating to comorbidities/health status. A substantial minority of trials (38%) explicitly referred to investigator opinion/judgment as a relevant determinant of patient eligibility. Conclusion : Aboriginal and Torres Strait Islander patients appear to have a reduced opportunity to participate in trials because of where they live, their type of cancer and their general health status, as well as for less transparent reasons relating to investigator judgment. I mplications for public health : Greater transparency and greater scrutiny of barriers to trial participation for Aboriginal and Torres Strait Islander Australians are needed to ensure equitable access.     

Estimated nutrient intake of urban Indigenous participants enrolled in a lifestyle intervention program

Aim:  The present study evaluates the reported nutrient intake of adult urban Aboriginal and Torres Strait Islander people who participated in a medically based lifestyle intervention program.
Methods:  The analysis was based on dietary records from all Indigenous participants (n = 100) enrolled in a 2003–2005 prospective lifestyle intervention study that followed a cohort of overweight (body mass index > 25) participants served by the Townsville Aboriginal and Islanders Health Service, Queensland, Australia. Standardised multiple-pass 24-hour dietary recalls were collected at baseline and 12-month program completion. Changes in pre- and post-program reported intake were evaluated using a paired-sample t -test. The Mann–Whitney test was used to compare baseline intake with an age and gender-matched sample created from 1995 National Nutrition Survey data.
Results:  The cohort was 88% female with a mean age of 44.4 ± 1.3 standard error of the mean. Dietary intake improved between baseline and program completion. At baseline, there was a high prevalence of reported intakes below the Estimated Average Requirement for vitamin A, thiamine, riboflavin, niacin, folate, vitamin C, magnesium, calcium, phosphorus, iron and zinc. Compared with the median Australian intake, the Indigenous intake was significantly higher in protein and cholesterol; however, vitamin A, vitamin C, niacin, potassium, magnesium, iron and fibre were lower.
Conclusions:  The present study found the intake in a cohort of Indigenous people was significantly different than the previously measured Australian nutrient intake. The nutrient patterns observed in the present study may be associated with the excess chronic disease burden experienced by Australian Indigenous populations.     

Aboriginal and Torres Strait Islander peoples at higher risk of invasive meningococcal disease in NSW

OBJECTIVE: To assess the completeness of data describing Aboriginal and Torres Strait Islander status in NSW invasive meningococcal disease notifications and determine the relative risk for invasive meningococcal disease among Aboriginal and Torres Strait Islander peoples in NSW. METHODS: Surveillance data from the NSW Notifiable Diseases Database was reviewed for 5-year periods between 1991 and 2005. RESULTS: Invalid and missing data on Aboriginal and Torres Strait Islander status decreased from 42% to 8% during the study period. Higher rates of disease were found in young children and significantly higher rates in Aboriginal and Torres Strait Islander children aged 0-4 years compared with their non-Aboriginal counterparts. CONCLUSION: Aboriginal and Torres Strait Islander children in NSW experience higher rates of notified invasive meningococcal disease than non-Aboriginal children.     

What do we know about 7vPCV coverage in Aboriginal and Torres Strait Islander children? A 2007 update

In 2001, a publicly funded 7 valent pneumococcal conjugate vaccine (7vPCV) program commenced for Aboriginal and Torres Strait Islander children aged less than 2 years. This study updates early estimates of 7vPCV coverage in Aboriginal and Torres Strait Islander children using Australian Childhood Immunisation Register data between 31 December 2004 and 30 September 2007. We chose four 3-month birth cohorts of children and assessed their immunisation status at 12 months of age for pneumococcal conjugate vaccine and for 'fully immunised'. After the introduction of universal childhood conjugate pneumococcal vaccination in 2005, 7vPCV coverage increased substantially among Aboriginal and Torres Strait Islander children nationally, and in all jurisdictions but remained lower than among non-Indigenous children. The results re-emphasise the greater impact of universal, compared with targeted, programs on vaccine coverage among Indigenous children.     

Inequity in Australian health care: how do we progress from here?

OBJECTIVE: To determine some of the key problems in pursuing equity in Australian health care and to identify some of the ways of overcoming these problems, particularly in Aboriginal and Torres Strait Islander health care. METHODS: To identify and debate the key equity issues particularly related to Aboriginal and Torres Strait Islander health care but also with respect to public versus private and rural/remote versus metropolitan. RESULTS: Political leadership and political will plus a more compassionate, less complacent society are crucial. CONCLUSIONS AND IMPLICATIONS: Political leadership is needed that can inspire a more compassionate society and which reflects better the informed values of the Australian people, adopting a communitarian paradigm. There is a need for a 'health care constitutional convention' to allow the values of the populace with respect to equity to be elicited and to ensure that voices of the disadvantaged are heard. In the specific context of Aboriginal and Torres Strait Islander health care, there is a need first to recognise and thereafter break down the racism that exists in many Australian institutions.     

A comparison of dietary estimates from the National Aboriginal and Torres Strait Islander Health Survey to food and beverage purchase data

Objective : We compared self‐reported dietary intake from the very remote sample of the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (VR‐NATSINPAS; n=1,363) to one year of food and beverage purchases from 20 very remote Indigenous Australian communities (servicing ～8,500 individuals). Methods : Differences in food (% energy from food groups) and nutrients were analysed using t‐test with unequal variance. Results : Per‐capita energy estimates were not significantly different between the surveys (899 MJ/person/day [95% confidence interval ?152,1950] p=0.094). Self‐reported intakes of sugar, cereal products/dishes, beverages, fats/oils, milk products/dishes and confectionery were significantly lower than that purchased, while intakes of meat, vegetables, cereal‐based dishes, fish, fruit and eggs were significantly higher (p<0.05). Conclusion : Differences between methods are consistent with differential reporting bias seen in self‐reported dietary data. Implications for public health : The NATSINPAS provides valuable, much‐needed information about dietary intake; however, self‐reported data is prone to energy under‐reporting and reporting bias. Purchase data can be used to track population‐level food and nutrient availability in this population longitudinally; however, further evidence is needed on approaches to estimate wastage and foods sourced outside the store. There is potential for these data to complement each other to inform nutrition policies and programs in this population.     

Hospital use for potentially preventable conditions in Aboriginal and Torres Strait Islander and other Australian populations

The poor state of Aboriginal and Torres Strait Islander health has been documented in many ways, most obviously by comparing the relatively higher age-specific mortality and morbidity rates. This paper demonstrates the use of acute hospital separation data as a way to identify potential deficiencies in providing appropriate primary health care services for Aboriginal and Torres Strait Islander populations. It does so by using 'ambulatory sensitive conditions': those conditions (and procedures) for which high-quality appropriate primary health services deliverable under ideal circumstances are thought to potentially reduce or eliminate the need for hospitalisation. Potential or realised access to primary care is not analysed directly using primary health service data. In this study, 1993–94 acute hospital separation data from NSW, Queensland, South Australia, Western Australia and the Northern Territory were used to calculate separation rates and odds ratios for Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander populations. Age-specific acute hospital separation rates for ambulatory sensitive conditions were 1.7 to 11 times higher for the Aboriginal and Torres Strait Islander populations studied. This supports clinical contentions that much Aboriginal and Torres Strait Islander morbidity and mortality is preventable and that further consideration is needed to service delivery reform at all levels in the health system and the distribution of funding.