Medicine and Health Sciences Commons^™

Dietary Docosahexaenoic Acid And Arachidonic Acid In Early Life: What Is The Best Evidence For Policymakers?, Stewart Forsyth, Philip C. Calder, Francis Zotor, Paul Amuna, Barbara J. Meyer, Bruce Holub

Faculty of Science, Medicine and Health - Papers: part A

Background: A wealth of information on the functional roles of docosahexaenoic acid (DHA) and arachidonic acid (ARA) from cellular, animal, and human studies is available. Yet, there remains a lack of cohesion in policymaking for recommended dietary intakes of DHA and ARA in early life. This is predominantly driven by inconsistent findings from a relatively small number of randomised clinical trials (RCTs), which vary in design, methodology, and outcome measures, all of which were conducted in high-income countries. It is proposed that this selective evidence base may not fully represent the biological importance of DHA and ARA during early and …

Whole Grain Intake Of Australians Estimated From A Cross-Sectional Analysis Of Dietary Intake Data From The 2011-13 Australian Health Survey, Leanne M. Galea, Eleanor J. Beck, Yasmine Probst, Chris Cashman

Faculty of Science, Medicine and Health - Papers: part A

Objective: The Australian Dietary Guidelines recommend Australians choose mostly whole-grain and/or high-fibre varieties within the grains (cereal) foods category, with other groups specifying a whole grain Daily Target Intake of 48 g for Australians aged 9 years or above. The USA and UK report estimates of whole grain intake that are low and declining, and no comprehensive studies on whole grain intake in the Australian population are available. The present study aimed to determine national estimates of whole grain intake, compared with current recommendations. Design: A recently updated whole grain database was applied to the most current population dietary intake …

Dietary Iodine Intake Of The Australian Population After Introduction Of A Mandatory Iodine Fortification Programme, Karen E. Charlton, Yasmine Probst, Gabriella Kiene

Illawarra Health and Medical Research Institute

To address mild iodine deficiency in Australia, a mandatory fortification program of iodised salt in bread was implemented in 2009. This study aimed to determine factors associated with achieving an adequate dietary iodine intake in the Australian population post-fortification, and to assess whether bread consumption patterns affect iodine intake in high-risk groups. Using nationally representative data of repeated 24-h dietary recalls from the 2011-2012 Australian National Nutrition and Physical Activity Survey, dietary iodine intakes and food group contributions were compared by age, socioeconomic status (SES), and geographical remoteness (N = 7735). The association between fortified bread intake and adequacy …

First-Stage Development And Validation Of A Web-Based Automated Dietary Modeling Tool: Using Constraint Optimization Techniques To Streamline Food Group And Macronutrient Focused Dietary Prescriptions For Clinical Trials, Yasmine Probst, Evan Morrison, Emma Sullivan, Hoa K. Dam

Faculty of Science, Medicine and Health - Papers: part A

No abstract provided.

A 6-Month Randomised Controlled Trial Investigating Effects Of Mediterranean-Style Diet And Fish Oil Supplementation On Dietary Behaviour Change, Mental And Cardiometabolic Health And Health-Related Quality Of Life In Adults With Depression (Helfimed): Study Protocol, Dorota M. Zarnowiecki, Jihyun Cho, Amy Wilson, Svetlana Bogomolova, Anthony Villani, Catherine Itsiopoulos, Theo Niyonsenga, Kerin O'Dea, Sarah Blunden, Barbara J. Meyer, Leonie Segal, Natalie Parletta

Faculty of Science, Medicine and Health - Papers: part A

Background: Modern diets, characterised by excess consumption of processed foods, are accompanied by an epidemic of chronic diseases. Cardiovascular disease and depression carry a large burden of disease and often occur together. Poor dietary patterns have been identified as an independent risk factor for depression while healthy diets with minimally processed food are protective. Traditional Mediterranean diets have been shown to reduce risk of cardiovascular disease; however there is a need for clinical trials in people with depression. This paper reports the study protocol of a Mediterranean-style diet intervention conducted in adults with self-reported depression. Methods/design: HELFIMED is a parallel …

Identification Of Dietary Patterns Associated With Blood Pressure In A Sample Of Overweight Australian Adults, Shirin Anil, Karen E. Charlton, Linda C. Tapsell, Yasmine Probst, Rhoda Ndanuko, Marijka Batterham

Illawarra Health and Medical Research Institute

The dietary approaches to stop hypertension (DASH) diet provides strong evidence for an optimal dietary pattern for blood pressure (BP) control; however, investigation at the level of key foods in a dietary pattern is sparse. This study aimed to assess the relationship between dietary patterns driven by key foods with BP in a sample of obese Australian adults. Secondary analysis was conducted on baseline data of 118 participants (45.1±8.4 years, mean BP=124.1±15.8/72.6±9.2 mm Hg) recruited in a weight reduction randomized controlled trial (ACTRN12608000425392). Dietary assessment was by a validated diet history interview. The average of three office BP measurements was …

Adherence To Dietary Guideline And 15-Year Risk Of All-Cause Mortality, Joanna Russell, Victoria Flood, Elena Rochtchina, Bamini Gopinath, Margaret Allman-Farinelli, Adrian Bauman, Paul Mitchell

Faculty of Science, Medicine and Health - Papers: part A

Past investigation of diet in relation to disease or mortality has tended to focus on individual nutrients. However, there has been a recent shift to now focus on overall patterns of food intake. The present study aims to investigate the relationship between diet quality reflecting adherence to dietary guidelines and mortality in a sample of older Australians, and to report on the relationship between core food groups and diet quality. This was a population-based cohort study of persons aged 49 years or older at baseline, living in two postcode areas west of Sydney, Australia. Baseline dietary data were collected during …

Changing Health Paradigms - Can The Concepts Of Wellness And Wellbeing Build Bridges In Dietary Counselling?, A T. Mcmahon, L Tapsell, P Williams

Faculty of Science, Medicine and Health - Papers: part A

Abstract of poster that presented at the 20th International Congress of Nutrition, Granada, September 2013.

"Use Salt And Foods High In Salt Sparingly": A Food-Based Dietary Guideline For South Africa, E Wentzel-Viljoen, K Steyn, E Ketterer, K E. Charlton

Faculty of Science, Medicine and Health - Papers: part A

Increased salt intake leads to an increase in blood pressure and decreased sodium intake relative to the usual or increased intake results in lowered blood pressure in adults, with or without hypertension. Blood pressure is a strong proxy indicator for the risk of cardiovascular disease, coronary heart disease and strokes. Hypertension is estimated to have caused 9% of all deaths in South Africa in 2000. In 2008, 42% of men and 34% of women aged 35-44 years, and 60% of men and 50% of women aged 45-54 years, were hypertensive. More than 70% of both men and women older than …

Baseline Dietary Patterns Are A Significant Consideration In Correcting Dietary Exposure For Weight Loss, S J. Grafenauer, L C. Tapsell, E J. Beck, M J. Batterham

Faculty of Science, Medicine and Health - Papers: part A

Background/objectives: Dietary pattern studies are traditionally the domain of epidemiological research. From a clinical perspective, there is a need to explore the effects of changing food and dietary patterns of individuals. The aim was to identify patterns of food choice in the context of a clinical weight loss trial. Cluster analysis based on reported serves of food groups revealed dietary patterns informative for the clinical setting.

Subjects/Methods: Cluster analysis was conducted using diet history data from two clinical trials at baseline, and outcomes at 3 months were reviewed based on these clusters (n=231). The cluster solution was analysed using defined …

Dietary Intake And Food Sources Of Epa, Dpa And Dha In Australian Children, Setyaningrum Rahmawaty, Karen Charlton, Philippa Lyons-Wall, Barbara J. Meyer

Faculty of Science, Medicine and Health - Papers: part A

Secondary analysis of the 2007 Australian National Children's Nutrition and Physical Activity survey was undertaken to assess the intake and food sources of EPA, DPA and DHA (excluding supplements) in 4,487 children aged 2-16 years. An average of two 24-h dietary recalls was analysed for each child and food sources of EPA, DPA and DHA were assessed using the Australian nutrient composition database called AUSNUT 2007. Median (inter quartile range, IQR) for EPA, DPA and DHA intakes (mg/day) for 2-3, 4-8, 9-13, 14-16 year were: EPA 5.3 (1.5-14), 6.7 (1.8-18), 8.7 (2.6-23), 9.8 (2.7-28) respectively; DPA 6.2 (2.2-14), 8.2 (3.3-18), …

Parenting Style And Dietary Behaviour Of Young Children. Findings From The Healthy Beginnings Trial, Huilan Xu, Li Ming Wen, Chris Rissel, Victoria M. Flood, Louise A. Baur

Faculty of Science, Medicine and Health - Papers: part A

Parenting style may have a role in the development of young children's dietary behaviour, and a better understanding of parenting style may lead to better-targeted childhood obesity prevention interventions. This study aimed to investigate the association of parental self-efficacy, parenting style and dietary behaviour of young children. A cross-sectional study with 242 first-time mothers and their children was conducted using the data from the Healthy Beginnings Trial undertaken in one of the most socially and economically disadvantaged areas of south-western Sydney, in 2007-2010. Parental self-efficacy, parenting style (warmth and hostility) and children's dietary behaviours (consumption of vegetables, fruit, soft-drink and …

Meeting Recommended Dietary Intakes In Meal Plans With ≥4 Servings Of Grain-Based Foods Daily, Yasmine Probst, Linda Tapsell

Faculty of Science, Medicine and Health - Papers: part A

Objective To develop meal plans using grain-based foods demonstrating how to incorporate wholegrain foods into a balanced diet for weight maintenance for different cuisines. The present study examines the ability of meal plans with ≥4 grain-based servings daily to meet nutrient recommendations using lacto-ovo vegetarian and rice-based cuisines. Design Eighteen plans from each cuisine for three age brackets for both genders were developed. Plans aimed for ≥4 servings of grain-based foods daily, with separate plans for all wholegrain, all refined-grain and half wholegrain–half refined-grain foods. Meal plans followed an isoenergetic approach and were designed to meet specific Australian nutrient reference …

Reduction Of Histamine H1 Receptor Binding Induced By High-Fat Diet Can Be Prevented By Dha And Dietary Fiber In Specific Brain Areas Of Male Rats, Zhixiang Wu, Yinghua Yu, Yizhen Wu, Craig S. Patch, Alexander Szabo, Xu-Feng Huang

Illawarra Health and Medical Research Institute

High-fat (HF) diet and obesity are risk factors for a number of mental health problems including depression, cognitive dysfunction, dementia, and neurodegenerative diseases. Histamine H1 receptors (H1Rs) are involved in many of these conditions. This study examined H1R receptor binding density in the brain of male rats fed a high-saturated fat (HF) diet, as well as the effect of docosahexaenoic acid (DHA), galacto-oligosaccharide (GOS) and resistant starch (RS) supplementation of HF diet. Alterations of H1R expression in the post-mortem rat brain were detected by [ 3H]-pyrilamine binding autoradiography. We found that HF diet significantly decreased H1R binding densities in the …

Dietary Intake Of Fish And Pufa, And Clinical Depressive And Anxiety Disorders In Women, Felice N. Jacka, Julie A. Pascoe, Lana J. Williams, Barbara J. Meyer, Rebecca Digger, Michael Berk

Faculty of Science, Medicine and Health - Papers: part A

Fish and PUFA consumption are thought to play a role in mental health; however, many studies do not take into account multiple sources of PUFA. The present study analysed data from a sample of 935 randomly selected, population-based women aged 20-93 years. A validated and comprehensive dietary questionnaire ascertained the consumption of n-3 and n-6 PUFA. Another assessed fish and energy intake and provided data for a dietary quality score. The General Health Questionnaire-12 (GHQ-12) measured psychological symptoms and a clinical interview (Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition) assessed depressive and anxiety disorders. Median dietary intakes of …

The Link Between Dietary Glycemic Index And Nutrient Adequacy, Jimmy Chun Yu Louie, Annette E. Buyken, Jennie C. Brand-Miller, Victoria M. Flood

Faculty of Health and Behavioural Sciences - Papers (Archive)

BACKGROUND: Low-glycemic index (low-GI) diets may be less nutritious because of limited food choices. Alternately, high-GI diets could be less healthful because of a higher intake of refined carbohydrate. OBJECTIVE: The objective was to investigate the association between dietary GI, intakes of carbohydrates from high-GI (CHO(high GI)) and low-GI (CHO(low GI)) sources, and the risk of nutrient inadequacy in children and adolescents. DESIGN: Children, aged 2-16 y, who provided 2 plausible 24-h recalls in a national survey were included (n = 4140). The ORs of not meeting the Australian Nutrient Reference Values (NRVs) were calculated by logistic regression. RESULTS: Subjects …

Dietary Fish Oil Preserves Cardiac Function In The Hypertrophied Rat Heart, Peter L. Mclennan, Mahainda Y. Abeywardena, Julie A. Dallimore, Daniel Raederstorff

Graduate School of Medicine - Papers (Archive)

Regular fish or fish oil intake is associated with a low incidence of heart failure clinically, and fish oil-induced reduction in cardiac remodelling seen in hypertrophy models may contribute. We investigated whether improved cardiac energy efficiency in non-hypertrophied hearts translates into attenuation of cardiac dysfunction in hypertrophied hearts. Male Wistar rats (n 33) at 8 weeks of age were sham- operated or subjected to abdominal aortic stenosis to produce pressure-overload cardiac hypertrophy. Starting 3 weeks post-operatively to follow initiation of hypertrophy, rats were fed a diet containing 10% olive oil (control) or 5% fish oil (ROPUFA30 (17% EPA, 10% DHA)) …

Effectiveness Of Dietary Advice To Increase Fish Consumption Over A 12 Month Period, Elizabeth P. Neale, Amanda Cossey, Yasmine Probst, Marijka Batterham, Linda C. Tapsell

Faculty of Science, Medicine and Health - Papers: part A

Habitual fish consumption is associated with numerous health benefits; however, in Australia fish intake remains low. The aim of this study was to compare the effect of specific or general fish consumption recommendations on fish intake behavior over the duration of a 12-month clinical trial. Participants were randomized into a control group (general die-tary advice), and two intervention groups (received dietetic advice to consume 180 g fish/wk), with one intervention group receiving LC omega-3 PUFA supplements. Dietary data was available for n = 117 at baseline, n = 85 at 3 months and n = 63 at 12 months. Total, …

Dietary Docosahexaenoic Acid (22:6) Incorporates Into Cardiolipin At The Expense Of Linoleic Acid (18:2): Analysis And Potential Implications, Colin Cortie, Paul L. Else

Faculty of Science, Medicine and Health - Papers: part A

Cardiolipin is a signature phospholipid of major functional significance in mitochondria. In heart mitochondria the fatty acid composition of cardiolipin is commonly viewed as highly regulated due to its high levels of linoleic acid (18:2n − 6) and the dominant presence of a 4×18:2 molecular species. However, analysis of data from a comprehensive compilation of studies reporting changes in fatty acid composition of cardiolipin in heart and liver mitochondria in response to dietary fat shows that, in heart the accrual of 18:2 into cardiolipin conforms strongly to its dietary availability at up to 20% of total dietary fatty acid and …

Reporting Of Dietary Assessment Methods And Use Of Information Technology In Food-Based Randomised Controlled Trials, Yasmine Probst

Faculty of Health and Behavioural Sciences - Papers (Archive)

The range of randomised controlled trials reported in the scientific literature is extensive. A systematic literature review was conducted with the aim of determining how dietary assessment methods were reported and the use of assisted technologies. OVID (Medline, PreMedline, PsychINFO, Cochrane, ERIC and Cynahl) and ScienceDirect databases 2000- 2010 were searched for food-based parallel randomised controlled trials in humans. Studies relating to drug testing, vitamin or mineral supplements, enteral or parenteral nutrition and behavioural/educational interventions were excluded. Meal replacement studies were included. A total of 1364 abstracts were reviews and 347 studies identified. Additional articles referred to in the methods …

Seven Out Of Ten Most Popular Vegetables Remain Top Choice During First 3 Months Of A 12 Month Weight Loss Dietary Intervention Trial, Jane O'Shea, Yasmine Probst, Rebecca Thorne, Sara Grafenauer, Linda Tapsell

Faculty of Health and Behavioural Sciences - Papers (Archive)

Increasing vegetable consumption is part of dietary advice for weight loss, but how this converts to vegetable choices is not known. In this context, our aim was to identify the main vegetable groups reported by the study sample in the Healthy Eating and Lifestyle Trial [ACTRN1260000784011] at baseline (Oct 2010-Feb 2011) and after 3mo (Feb - May 2011). Data from diet histories (DH) were analyzed using the AUSNUT 2007 database in Foodworks (Xyris, version 6.0.2562) to determine the average daily amount (g) of vegetables consumed by the study sample. Baseline DH (n=113 subjects; 85 female) exposed 32 vegetable categories. The …

Dietary Shiitake Mushroom (Lentinus Edodes) Prevents Fat Deposition And Lowers Triglyceride In Rats Fed A High-Fat Diet, D Handayani, J-Z Chen, Barbara J. Meyer, Xu-Feng Huang

Faculty of Health and Behavioural Sciences - Papers (Archive)

High-fat diet (HFD) induces obesity. This study examined the effects of Shiitake mushroom on the prevention of alterations of plasma lipid profiles, fat deposition, energy efficiency, and body fat index induced by HFD. Rats were given a low, medium, and high (7, 20, 60 g/kg = LD-M, MD-M, HD-M) Shiitake mushroom powder in their high-fat (50% in kcal) diets for 6 weeks. The results showed that the rats on the HD-M diet had the lowest body weight gain compared to MD-M and LD-M groups (P < 0.05). The total fat deposition was significantly lower (-35%, P < 0.05) in rats fed an HD-M diet than that of HFD group. Interestingly, plasma triacylglycerol (TAG) level was significantly lower (-55%, P < 0.05) in rats on HD-M than HFD. This study also revealed the existence of negative correlations between the amount of Shiitake mushroom supplementation and body weight gain, plasma TAG, and total fat masses.

Influence Of Dietary Modifications On The Blood Pressure Response To Antihypertensive Medication, Catherine E. Huggins, Claire Margerison, Anthony Worsley, Caryl A. Nowson

Faculty of Health and Behavioural Sciences - Papers (Archive)

Identifying dietary modifications that potentiate the blood pressure (BP)-lowering effects of antihypertensive medications and that are practical for free-living people may assist in achieving BP reduction goals. We assessed whether two dietary patterns were effective in lowering BP in persons on antihypertensive therapy and in those not on therapy. Ninety-four participants (38/56 females/males), aged 55·6 (SD 9·9) years, consumed two 4-week dietary regimens in random order (Dietary Approaches to Stop Hypertension (DASH)-type diet and low-Na high-K (LNAHK) diet) with a control diet before each phase. Seated home BP was measured daily for the last 2 weeks in each phase. Participants …

Increased Intake Of Dietary Polyunsaturated Fat Does Not Promote Whole Body Or Preferential Abdominal Fat Mass Loss In Overweight Adults, Sze-Yen Tan, Marijka Batterham, Linda Tapsell

Faculty of Health and Behavioural Sciences - Papers (Archive)

Objective: There is evidence that increasing the proportion of polyunsaturated fatty acids (PUFA) in a diet can enhance the rate of fat oxidation acutely. Higher PUFA in a diet has also been associated with greater abdominal fat loss in longer term studies. This study aimed to investigate if higher PUFA intake would result in greater fat mass loss over a 12-week period, mainly from the abdominal region.

Methods: Data at the 12-week time point from two weight loss studies, both comparing high PUFA versus low PUFA diets was, accessed for 141 overweight subjects from the same area. Specifically, data on …

Dietary Glycaemic Index And Glycaemic Load Among Australian Children And Adolescents, Jimmy Chun Yu Louie, Anette E. Buyken, Kristina Heyer, Victoria M. Flood

Faculty of Health and Behavioural Sciences - Papers (Archive)

There are no published data regarding the overall dietary glycaemic index (GI) and glycaemic load (GL) of Australian children and adolescents. We therefore aim to describe the dietary GI and GL of participants of the 2007 Australian National Children’s Nutrition and Physical Activity Survey (2007ANCNPAS), and to identify the main foods contributing to their GL. Children, aged 2–16 years, who provided two 24 h recalls in the 2007ANCNPAS were included. A final dataset of 4184 participants was analysed. GI of each food item was assigned using a previously published method. GL was calculated, and food groups contributing to the GL …

Dietary Behaviours During Pregnancy: Findings From First-Time Mothers In Southwest Sydney, Australia, Li Ming Wen, Judy Simpson, Christopher Rissel, Victoria M. Flood, Louise Baur

Faculty of Health and Behavioural Sciences - Papers (Archive)

Background: Limited prevalence data are available for nutrition related health behaviours during pregnancy. This study aimed to assess dietary behaviours during pregnancy among first-time mothers, and to investigate the relationships between these behaviours and demographic characteristics, so that appropriate dietary intervention strategies for pregnant women can be developed. Method: An analysis of cross-sectional survey was conducted using data from 409 first-time mothers at 26-36 weeks of pregnancy, who participated in the Healthy Beginnings Trial conducted in southwestern Sydney, Australia. Dietary behaviours, including consumption of vegetables, fruit, water, milk, soft drinks, processed meat products, fast foods/take away and chips, were assessed …

Urinary Sodium Excretion, Dietary Sources Of Sodium Intake And Knowledge And Practices Around Salt Use In A Group Of Healthy Australian Women, Karen E. Charlton, Heather Yeatman, Fiona Houweling, Sophie Guenon

Faculty of Health and Behavioural Sciences - Papers (Archive)

Objective: Strategies that aim to facilitate reduction of the salt content of foods in Australia are hampered by sparse and outdated data on habitual salt intakes. This study assessed habitual sodium intake through urinary excretion analyses, and identified food sources of dietary sodium, as well as knowledge and practices related to salt use in healthy women. Methods: Cross-sectional, convenient sample of 76 women aged 20 to 55 years, Wollongong, NSW. Data included a 24 hour urine sample, three-day food diary and a self-administered questionnaire. Results: Mean Na excretion equated to a NaCl (salt) intake of 6.41 (SD=2.61) g/day; 43% had …

Dietary Fish Oil Reduces Skeletal Muscle Oxygen Consumption, Provides Fatigue Resistance And Improves Contractile Recovery In The Rat In Vivo Hindlimb, Gregory E. Peoples, Peter L. Mclennan

Faculty of Health and Behavioural Sciences - Papers (Archive)

Dietary fish oil modulates skeletal muscle membrane fatty acid composition. Similar changes in heart membrane composition modulate myocardial oxygen consumption and enhance mechanical performance. The rat in vivo autologous perfused hindlimb was used to investigate the influence of membrane composition on skeletal muscle function. Male Wistar rats were fed either saturated fat (SF), n-6 PUFA (linoleic acid rich) or n-3 PUFA (fish oil) diets for 8 weeks. Hindlimb skeletal muscle perfused using the animal’s own blood was stimulated via the sciatic nerve (1 Hz, 6-12 V, 0·05 ms) to contract in repeated 10 min bouts. The n-3 PUFA diet markedly …

Short Term Effects Of Energy Restriction And Dietary Fat Sub-Type On Weight Loss And Disease Risk Factors, Linda C. Tapsell, Marijka Batterham, Xu-Feng Huang, Sze Yen Tan, Grigorijs Teuss, Karen E. Charlton, Jane E. O'Shea, Eva M. Warensjo

Faculty of Health and Behavioural Sciences - Papers (Archive)

Background and aims: Decreasing energy intake relative to energy expenditure is the indisputable tenet of weight loss. In addition to caloric restriction modification of the type of dietary fat may provide further benefits. The aim of the present study was to examine the effect of energy restriction alone and with dietary fat modification on weight loss and adiposity, as well as on risk factors for obesity related disease. Methods and results: One-hundred and fifty overweight men and women were randomized into a 3 month controlled trial with four low fat (30% energy) dietary arms: (1) isocaloric (LF); (2) isocaloric with …

Comparison Of Multiple And Novel Measures Of Dietary Glycemic Carbohydrate With Insulin Resistant Status In Older Women, Therese O'Sullivan, Alexandra P. Bremner, Sheila O'Neill, Philippa M. Lyons-Wall

Faculty of Health and Behavioural Sciences - Papers (Archive)

Background: Previous epidemiological investigations of associations between dietary glycemic intake and insulin resistance have used average daily measures of glycemic index (GI) and glycemic load (GL). We explored multiple and novel measures of dietary glycemic intake to determine which was most predictive of an association with insulin resistance. Methods: Usual dietary intakes were assessed by diet history interview in women aged 42-81 years participating in the Longitudinal Assessment of Ageing in Women. Daily measures of dietary glycemic intake (n = 329) were carbohydrate, GI, GL, and GL per megacalorie (GL/Mcal), while meal based measures (n = 200) were breakfast, lunch …