What Do Australians Eat? A Systematic Review of Dietary Patterns and Adverse Health Outcomes

Abstract

A suboptimal diet is a leading factor in the current burden of chronic diseases. In Australia, dietary factors contribute to one-fifth of the chronic disease burden. Understanding the dietary patterns of Australian adults and summarizing their effects on chronic conditions are imperative for improving interventions targeting dietary behaviors. This systematic review aims to summarize the dietary patterns of Australian adults derived using a posteriori and hybrid analysis methods and their associations with adverse health outcomes. Six databases were first searched in December 2020 and updated in August 2023. Cardiometabolic health, cardiovascular mortality, cancer, pregnancy-related metabolic conditions (gestational diabetes mellitus [GDM] or hypertensive disorders during pregnancy [HDP]), mental health, and cognitive function were the main health outcomes. Dietary patterns from each study were classified as either healthy or unhealthy. A narrative synthesis was used to describe the association of dietary patterns with adverse health outcomes in longitudinal studies. Fifty-nine observational studies (31 cross-sectional, 3 case-control, 22 longitudinal, and 3 combining both cross-sectional and longitudinal designs) were included, involving a total of 362 263 participants aged 18 years and older. Higher adherence to a healthy dietary pattern (characterized by higher consumption of dark-yellow, green leafy, cruciferous vegetables and fruits, nuts, whole grains, tomatoes, fish, and low-fat dairy) is associated with improved cardiometabolic risk factors, reduced risk of GDM and HDP, better mental health, and improved pregnancy outcomes. On the other hand, an unhealthy dietary pattern (characterized by a higher intake of processed and red meat, takeaway foods, white bread, high-fat dairy, potatoes, discretionary fat, sweet snacks, soft drinks, fat spreads, jam, and Vegemite) is linked to increased cardiometabolic risks. Overall, while healthy dietary patterns are associated with a reduced risk of several physical and mental health outcomes, unhealthy dietary patterns are linked to an increased risk in Australian adults. PROSPERO registration no. CRD42023452960.