Journals update

Recently posted articles by the Journal of Human Nutrition and Dietetics Notes

October 2017

A pilot intervention to reduce postpartum weight retention and central adiposity in first-time mothers: results from the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) study

van der Pligt et al., JHND Early View

Background

Postpartum weight retention (PPWR) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour.

Methods

A subsample of first-time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n = 28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n = 48; n = 43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self-reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum.

Results

Mean PPWR decreased in the (I) group (−1.2 kg) and the C2 group (−1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (−6.4 cm) compared to C1 (−1.1 cm; P = 0.002) and C2 (−3.3 cm; P = 0.001). Changes in diet, physical activity or sedentary behaviour were not significant.

Conclusions

The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.

Determinants of a dietary pattern linked with greater metabolic risk and its tracking during adolescence

Appanah et al., JHND Early View

Background

Although growing evidence suggests that dietary patterns associated with noncommunicable diseases in adulthood may develop early in life, when these are established, as well as their determinants, remains unclear.

Methods

We examined determinants and tracking of a dietary pattern (DP) associated with metabolic risk and its key food groups among 860 adolescents in the Western Australian Pregnancy (Raine) Cohort study. Food intake was reported using a food frequency questionnaire (FFQ) at 14 and 17 years. Z-scores for an ‘energy-dense, high-fat, low-fibre’ DP were estimated by applying reduced rank regression at both ages. Tracking was based on the predictive value (PV) of remaining in the DPZ-score or food intake quartile at 14 and 17 years. Early-life exposures included: maternal age; maternal pre-pregnancy body mass index; parent smoking status during pregnancy; and parent socio-economic position (SEP) at 14 and 17 years. Associations between the DPZ-scores, early-life factors and SEP were analysed using regression analysis.

Results

Dietary tracking was strongest among boys with high DPZ-scores, high intakes of processed meat, low-fibre bread, crisps and savoury snacks (PV > 1) and the lowest intakes of vegetables, fruit and legumes. Lower maternal education (β = 0.09, P = 0.002 at 14 years; β = 0.14, P < 0.001 at 17 years) and lower maternal age at birth (β = 0.09, P = 0.003 at 14 years; β = 0.11, P = 0.004 at 17 years) were positively associated with higher DPZ-scores.

Conclusions

An energy-dense, high-fat, low-fibre dietary pattern tracks more strongly among adolescent boys who have high scores for this pattern at 14 years of age. These findings highlight target foods and population subgroups for early interventions aiming to improve dietary behaviours.

Reduced 30-day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study

Hvas et al., JHND Early View

Background

Percutaneous endoscopic gastrostomy feeding allows patients with dysphagia to receive adequate nutritional support, although gastrostomy insertion is associated with mortality. A nutrition support team (NST) may improve a gastrostomy service. The present study aimed to evaluate the introduction of a NST for assessment and follow-up of patients referred for gastrostomy.

Methods

We included adult inpatients referred for gastrostomy insertion consecutively between 1 October 2010 and 31 March 2013. During the first 6 months, a multidisciplinary NST assessment service was implemented. Patient characteristics, clinical condition, referral appropriateness and follow-up were documented prospectively. We compared the frequencies of appropriate referrals, 30-day mortality and mental capacity/consent assessment time spent between the 6 months implementation phase and 2 years following establishment of the assessment service (‘established phase’).

Results

In total, 309 patients were referred for gastrostomy insertion and 199 (64%) gastrostomies placed. The percentage of appropriate referrals rose from 72% (61/85) during the implementation phase to 87% (194/224) during the established phase (P = 0.002). Thirty-day mortality reduced from 10% (5/52) to 2% (3/147) (P = 0.01), whereas time allocated to assessment of mental capacity and attainment of informed consent rose from mean 3 days (limits of normal variation 0–7) to mean 6 (0–13) days.

Conclusions

The introduction of a NST to assess and select patients referred for gastrostomy placement was associated with a rise in the frequency of appropriate referrals and a decrease in 30-day mortality following gastrostomy insertion. Concomitantly, time spent on patient assessment and attainment of informed consent increased.

September 2017

Birthweight, HIV exposure and infant feeding as predictors of malnutrition in Botswanan infants

Chalashika et al., JHND Early View

Background

A better understanding of the nutritional status of infants who are HIV-Exposed-Uninfected (HEU) and HIV-Unexposed-Uninfected (HUU) during their first 1000 days is key to improving population health, particularly in sub-Saharan Africa.

Methods

A cross-sectional study compared the nutritional status, feeding practices and determinants of nutritional status of HEU and HUU infants residing in representative selected districts in Botswana during their first 1000 days of life. Four hundred and thirteen infants (37.3% HIV-exposed), aged 6–24 months, attending routine child health clinics, were recruited. Anthropometric, 24-h dietary intake and socio-demographic data was collected. Anthropometric Z-scores were calculated using 2006 World Health Organization growth standards. Modelling of the determinants of malnutrition was undertaken using logistic regression.

Results

Overall, the prevalences of stunting, wasting and being underweight were 10.4%, 11.9% and 10.2%, respectively. HEU infants were more likely to be underweight (15.6% versus 6.9%), (P < 0.01) and stunted (15.6% versus 7.3%), (P < 0.05) but not wasted (P = 0.14) than HUU infants. HEU infants tended to be formula fed (82.5%), whereas HUU infants tended to breastfeed (94%) for the first 6 months (P < 0.001). Significant predictors of nutritional status were HIV exposure, birthweight, birth length, APGAR (appearance, pulse, grimace, activity and respiration) score and mother/caregiver's education with little influence of socio-economic status.

Conclusions

HEU infants aged 6–24 months had worse nutritional status compared to HUU infants. Low birthweight was the main predictor of undernutrition in this population. Optimisation of infant nutritional status should focus on improving birthweight. In addition, specific interventions should target HEU infants aiming to eliminate growth disparity between HEU and HUU infants.

Clinical significance of nutritional risk screening tool for hospitalised children with acute burn injuries: a cross-sectional study

Bang et al., JHND Early View

Background

We assessed the nutritional risks among children hospitalised with acute burn injuries and their associated clinical outcomes using three nutritional risk screening (NRS) tools: Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGKIDS), Pediatric Yorkhill Malnutrition Score (PYMS) and Screening Tool for the Assessment for Malnutrition in Pediatrics (STAMP).

Methods

This prospective cross-sectional study was conducted from October 2015 to November 2016, in a regional burn centre. Patients were screened by two independent observers, using the three NRS tools.

Results

A total of 100 children aged 3 months to 16.5 years were included. STRONGKIDS identified 16% of patients as having high risk, with being identified 45% by PYMS and 44% by STAMP. After adjustment for confounding factors in multivariate regression analysis, patients in the high-risk group had significantly longer median (SD) lengths of stay and greater median (SD) weight loss than patients in the medium-risk group (P < 0.05). The strengths of agreement in the nutritional risk classification between the two observers were good (κ for STRONGKIDS = 0.61; PYMS = 0.79; STAMP = 0.75) (P < 0.01).

Conclusions

The STRONGKIDS, PYMS and STAMP tools could be useful and practical for determining which hospitalised children with acute burn injuries will need additional nutritional intervention.    

Future Dietitian 2025: informing the development of a workforce strategy for dietetics

Hickson et al., JHND Early View

Background

Healthcare is changing and the professions that deliver it need to adapt and change too. The aim of this research was to inform the development of a workforce strategy for Dietetics for 2020–2030. This included an understanding of the drivers for change, the views of stakeholders and recommendations to prepare the profession for the future.

Methods

The research included three phases: (i) establishing the context which included a literature and document review (environmental scan); (ii) discovering the profession and professional issues using crowd-sourcing technology; and (iii) articulating the vision for the future using appreciative inquiry.

Results

The environmental scan described the current status of the dietetic profession, the changing healthcare environment, the context in which dietitians work and what future opportunities exist for the profession. The online conversation facilitated by crowd-sourcing technology asked the question: ‘How can dietitians strengthen their future role, influence and impact?’ Dietitians and interested stakeholders (726 and 109, respectively) made 6130 contributions. Seven priorities were identified and fed into the appreciative inquiry event. The event bought together 54 dietitians and analysis of the discussions generated five themes: (i) professional identity; (ii) strong foundations-creating structure and direction for the profession; (iii) amplifying visibility and influence; (iv) embracing advances in science and technology; and (v) career advancement and emerging opportunities.

Conclusions

A series of recommendations were made for the next steps in moving the workforce to a new future. The future for dietetics looks bright, embracing technology, as well as exploring different ways of working and new opportunities, as this dynamic profession continues to evolve.   

Fifteen years of using a second stage protein substitute for weaning in phenylketonuria: a retrospective study

Evans et al., JHND Early View

Background

In phenylketonuria (PKU), during weaning, it is necessary to introduce a second stage phenylalanine (Phe)-free protein substitute (PS) to help meet non-Phe protein requirements. Semi-solid weaning Phe-free PS have been available for >15 years, although no long-term studies have reported their efficacy.

Methods

Retrospective data from 31 children with PKU who commenced a weaning PS were collected from clinical records from age of weaning to 2 years, on: gender; birth order; weaning age; anthropometry; blood Phe levels; age commenced and dosage of weaning PS and Phe-free infant L-amino acid formula; natural protein intake; and issues with administration of PS or food.

Results

Median commencement age for weaning was 17 weeks (range 12–25 weeks) and, for weaning PS, 20 weeks (range 13–37 weeks). Median natural protein was 4 g day−1 (range 3–11 g day−1) and total protein intake was >2 g kg−1 day−1 from weaning to 2 years of age. Children started on 2–4 g day−1 protein equivalent (5–10 g day−1 of powder) from weaning PS, increasing by 0.2 g kg−1 day−1 (2 g day−1) monthly to 12 months of age. Teething and illness adversely affected the administration of weaning PS and the acceptance of solid foods. Altogether, 32% of children had delayed introduction of more textured foods, associated with birth order (firstborn 80% versus 38%; P = 0.05) and food refusal when teething (80% versus 29%; P = 0.02).

Conclusions

Timing of introduction of solid foods and weaning PS, progression onto more textured foods and consistent feeding routines were important in aiding their acceptance. Any negative behaviour with weaning PS was mainly associated with food refusal, teething and illness. Parental approach influenced the acceptance of weaning PS.

Food and functional dyspepsia: a systematic review

Duncanson et al., JHND Early View

Background

Functional dyspepsia (FD) is a debilitating functional gastrointestinal disorder characterised by early satiety, post-prandial fullness or epigastric pain related to meals, which affects up to 20% of western populations. A high dietary fat intake has been linked to FD and duodenal eosinophilia has been noted in FD. We hypothesised that an allergen such as wheat is a risk factor for FD and that withdrawal will improve symptoms of FD. We aimed to investigate the relationship between food and functional dyspepsia.

Methods

Sixteen out of 6451 studies identified in a database search of six databases met the inclusion criteria of studies examining the effect of nutrients, foods and food components in adults with FD or FD symptoms.

Results

Wheat-containing foods were implicated in FD symptom induction in six studies, four of which were not specifically investigating gluten and two that were gluten-specific, with the implementation of a gluten-free diet demonstrating a reduction in symptoms. Dietary fat was associated with FD in all three studies that specifically measured this association. Specific foods reported as inducing symptoms were high in either natural food chemicals, high in fermentable carbohydrates or high in wheat/gluten. Caffeine was associated with FD in four studies, although any association with alcohol was uncertain.

Conclusions

Wheat and dietary fats may play key roles in the generation of FD symptoms and reduction or withdrawal eased symptoms. Randomised trials investigating the roles of gluten, FODMAPs (fermentable oligosaccharide, disaccharide, monosaccharide and polyols) and high fat ingestion and naturally occurring food chemicals in the generation of functional dyspepsia symptoms are warranted and further investigation of the mechanisms is now required.

Structured advice provided by a dietitian increases adherence of consumers to diet and lifestyle changes and lowers blood low-density lipoprotein (LDL)-cholesterol: the Increasing Adherence of Consumers to Diet & Lifestyle Changes to Lower (LDL) Cholesterol (ACT) randomised controlled trial

Silver et al., JHND Early View

Background

Evidence from healthcare professionals suggest that consumer compliance to healthy diet and lifestyle changes is often poor. The present study investigated the effect of advice provided by a physician or dietitian on consumer adherence to these measures combined with consuming foods with added plant sterols (PS) with the aim of lowering low-density lipoprotein cholesterol (LDL-C).

Methods

One hundred mildly-to-moderately hypercholesterolaemic individuals were enrolled into a parallel, randomised, placebo-controlled study. Dietitians (dietitian group; DG) advised 50 individuals in six weekly face-to-face behavioural therapy sessions, whereas the other 50 received standard advice from physicians (physician group, PG). Both groups consumed foods with added PS (three servings a day) for 6 weeks. Subsequently, all individuals were followed-up for another 6 weeks under real-life conditions. Blood lipids were measured at baseline and weeks 6 and 12 and 3-day diet diaries were taken at weeks 1, 6 and 12.

Results

Individuals in the DG significantly improved their dietary habits, physical activity and increased PS intake compared to the PG. After 6 weeks, LDL-C decreased in both groups compared to baseline without any significant differences between groups. At week 12, LDL-C was further significantly improved only in the DG (P = 0.006) compared to week 6. Total cholesterol, LDL-C and triglycerides were significantly lower in the DG compared to the PG at week 12 after adjusting for levels at week 6 (P < 0.001, P < 0.001 and P = 0.009, respectively).

Conclusions

Although structured counselling by dietitians and common standard advice by physicians were equally effective with respect to improving blood cholesterol after 6 weeks, dietitians were more effective in the longer-term (i.e. 6 weeks after the end of the intervention period).

Patients' perceptions and experiences of patient-centred care in dietetic consultations

Sladdin et al., JHND Early View

Background

Patient-centred care (PCC) is essential to quality healthcare. However, there is a paucity of research on PCC in dietetics, particularly regarding patients' experiences and perspectives of PCC. We aimed to enhance our understanding of PCC in dietetics by exploring patients' perceptions and experiences of PCC in individual dietetic consultations.

Methods

The present study used qualitative methods, situated in a constructivist–interpretivist paradigm. Maximum variation purposive sampling was used to recruit English speaking adult participants who had participated in ≥1 dietetic consultations for nutrition care. Individual semi-structured interviews explored participants' perceptions and experiences of PCC in dietetic consultations. Data were analysed thematically.

Results

Eleven patients were interviewed between September and November 2016. Four overarching themes emerged: (i) fostering and maintaining caring relationships; (ii) delivering individualised care; (iii) enabling patient involvement; and (iv) taking control of one's own health.

Conclusions

PCC is important to patients. Thus, there is opportunity for dietitians to enhance the care they provide by adopting patient-centred practices. As the first study of its kind, these findings can inform future dietetic practice, education and research by contributing patients' perspectives of PCC. By understanding patients' unique needs and preferences, dietitians can better align their practice with a patient-centred approach. Furthermore, these findings are useful for informing future dietetic research and education.

August 2017

An investigation into the nutritional composition and cost of gluten-free versus regular food products in the UK

Fry et al., JHND Early view

Background

The gluten-free (GF) food market has expanded considerably, although there is limited comparative evidence for the nutritional quality and cost of GF food products. The present study aims to compare the nutrient composition and cost of GF and gluten-containing (regular) foods across 10 food categories in the UK.

Methods

Nutritional information and the cost of GF foods available in the UK (n = 679) and comparable regular foods (n = 1045) were systematically collected from manufacturer and supermarket websites. Foods were classified using UK front-of-pack labelling for content of fat, saturated fat, sugar and salt and nutrient content, and cost per 100 g were identified and compared between GF and regular foods.

Results

Overall, more GF foods were classified as containing high and medium fat, saturated fat, sugar and salt than regular foods, although this was not universally consistent. More GF bread and flour products contained high fat and sugar, whereas fewer GF crackers contained high fat and sugar compared to regular foods. High salt content was found more frequently in GF than regular products. On average, GF products were 159% more expensive than regular (£0.44/100 g versus £1.14/100 g). GF items were also more likely to be lower in fibre and protein content than regular foods.

Conclusions

Differences exist in the nutritional composition of GF and regular food. GF food is unlikely to offer healthier alternatives to regular foods, except for those who require a GF diet for medically diagnosed conditions, and it is associated with higher costs.

A qualitative examination of patients experiences of dietitians ' consultation engagement styles within nephrology

Morris et al., JHND Early View

Background

Dietitians provide individuals with tailored, practical nutritional advice. For this reason, skills in effective interpersonal communication are essential. In the case of chronic kidney disease, the specifics of dietary advice may change according to renal function. The conveyance of accurate dietary advice and compliance is critical and requires full engagement with the service. The effect of communication styles on patients ' engagement experiences with renal dietetics is unknown. Accordingly, the present study aimed to explore patients ' engagement experiences with renal dietitians.

Methods

A qualitative phenomenology study using semi-structured in-depth interviews was undertaken with 20 adult renal service users who had engaged with renal dietitians to receive dietary advice. Interpretive phenomenological analysis was used to analyse data.

Results

Two main themes emerged from consultation experiences: helpful and unhelpful engagement styles. Individuals reporting helpful engagement styles experienced dietitians ' communication as empathetic, demonstrating positive regard for their lifestyles. However, individuals who reported experiences of unhelpful engagement styles found dietetic care indifferent and communication styles paternalistic. These individuals continued to engage reluctantly despite unhelpful engagement experiences, but felt disempowered. These diverse experiences of engagement can be interpreted by means of ‘ego states’ within the theoretical model of transactional analysis (TA). Adult ego states may underpin a helpful engagement style whilst a dietitians ' parental ego state was more likely to precipitate an unhelpful engagement style.

Conclusions

Ego states, in the context of TA theory, can help to explain the way in which patients engage with renal dietitians. Attention should be given to the employment of a humanistic approach within dietetic consultations. Dietitans need to ensure that they can demonstrate expertise and confidence in the specific communication skills required for patient-centred care.

Efficacy of vitamin D supplementation in combination with conventional antiviral therapy in patients with chronic hepatitis C infection: a meta-analysis of randomised controlled trials

Kim et al., JHND Early View

Background

Although a contributory role of vitamin D levels for the development of chronic hepatitis C has been suggested, the efficacy of vitamin D supplementation in combination with conventional antiviral therapy consisting of pegylated interferon-α (Peg-IFN-α) injection and oral ribavirin (RBV) remains unclear. We investigated its efficacy in the treatment of chronic hepatitis C via a meta-analysis of randomised controlled trials.

Methods

We searched PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov and the bibliographies of relevant articles to locate additional publications in September 2016. Three evaluators independently reviewed and selected eligible studies based on predetermined selection criteria.

Results

Of 522 articles meeting our initial criteria, a total of seven open-label, randomised controlled trials involving 548 participants, were included in the final analysis. Vitamin D supplementation in combination with Peg-IFN-α injection and oral RBV significantly increased the rate of viral response for hepatitis C at 24 weeks after treatment in a random-effects meta-analysis (relative risk = 1.30; 95% confidence interval = 1.04–1.62; I2 = 75.9%). Also, its significant efficacy was observed in patients with hepatitis C virus genotype 1, which is known to be refractory to antiviral therapy.

Conclusions

In summary, we observed that additional use of vitamin D has a positive effect on sustained viral response rates of patients with chronic hepatitis C infection. However, we cannot establish the efficacy because of substantial heterogeneity, a small sample size and a low methodological quality.

Low validity of predictive equations for calculating resting energy expenditure in overweight and obese women with polycystic ovary syndrome

Rodrigues et al., JHND Early View

Background

Predictive equations are the main clinical tools for determining resting energy expenditure (REE). However, their adequate use in overweight and obese individuals is unclear. Thus, we investigated the best predictive equations for estimating REE in overweight and obese women with polycystic ovary syndrome (PCOS).

Methods

Eleven analyses were performed with prediction equations (pREE) based on anthropometric parameters in 30 overweight or obese women with PCOS without other chronic diseases. The measured REE (mREE) was calculated by indirect calorimetry. The validity of the equations was investigated by comparison, accuracy and agreement tests between pREE and mREE at both the individual and group level.

Results

Four analyses were similar to those of mREE, and smallest mean differences were observed for the World Health Organization/Food and Agriculture Organization of the United Nations/United Nations University (WHO/FAO/UNU) considering weight [0.07 (1.13) MJ (16 [270] kcal)]. Individual accuracy was greater than 50% for Harris and Benedict, Müller and Lazzer equations. The percentage of REE underestimation ranged between 16.7% and 73.3%, whereas higher rates of overestimation were observed in the De Luis (66.7%) and Ireton-Jones (43.3%) equations. Mean bias at the group level was lowest in the WHO/FAO/UNU W and WHO/FAO/UNU considering weight and height (WH), Müller and Lazzer equations (–2.8 to 0.5). The WHO/FAO/UNU W and WHO/FAO/UNU WH formulas were optimal in individual agreement (33.3%).

Conclusions

FAO/WHO/UNU W equations may estimate the REE in overweight and obese women with PCOS. However, the low individual accuracy and agreement in relation to mREE suggest caution regarding when to use the formula to perform an individual nutritional plan.

Accuracy of octa-polar bioelectrical impedance analysis for the assessment of total and appendicular body composition in children and adolescents with HIV: comparison with dual energy X-ray absorptiometry and air displacement plethysmography

De Castro et al., JHND Early View

Background

Body composition analysis has been used to investigate fat mass (FM) and bone mineral content (BMC) in children and adolescents diagnosed with HIV. Investigating the validity of bioelectrical impedance analysis (BIA) is interesting with respect to testing useful techniques for monitoring body composition in children and adolescents in clinical practice. The present study aimed to determine the validity of body composition analysis by BIA compared to dual-energy X-ray absorptiometry (DXA) and air displacement plethysmography (ADP) in children and adolescents an HIV diagnosis.

Methods

Sixty-four children and adolescents (35 females and 29 males) with a mean (SD) age of 12.22 (2.13) years and with an HIV diagnosis participated in the study. Fat-free mass (FFM), FM and body fat percentage (%BF) were obtained by BIA for comparison with DXA and ADP. Segmented FM (trunk, legs and arms), lean soft tissue mass (LSTM) (total and segmented) and BMC were obtained by BIA for comparison with DXA.

Results

BIA presented a clinically acceptable correlation with DXA and ADP for FFM. Values found by BIA were underestimated compared to ADP, and overestimated compared to DXA. BIA presented a clinically acceptable correlation with DXA for LSTM estimates (total and segmented parameters) in both sexes (underestimating FM and overestimating LSTM). For other components (%BF, FM and BMC), BIA had a clinically unacceptable correlation with the reference methods in both sexes.

Conclusions

BIA was suitable for evaluating FFM and LSTM in children and adolescents with an HIV diagnosis. For FM, %BF and BMC, BIA was not suitable for performing an evaluation in both sexes.

What are the dietary treatment research priorities for inflammatory bowel disease? A short report based on a priority setting partnership with the James Lind Alliance

Lomer et al., JHND Early View

Background

Treatment of inflammatory bowel disease (IBD) involves a multidisciplinary approach comprising medical management and sometimes surgery. Although diet is central to IBD management, the optimal diet for patients with IBD is uncertain. A UK collaborative partnership within the James Lind Alliance was set up between patients, clinicians and other stakeholders to develop research priorities in IBD. The aim of this short report is to provide a comprehensive summary of the research priority findings relating to diet in the treatment of IBD.

Methods

The James Lind Alliance Priority Setting Partnership process was used to develop research priorities in IBD. In brief, patients, clinicians and other stakeholders were invited to provide up to five treatment uncertainties in IBD. These uncertainties were collated, revised and ranked, leading to a final top 10 research questions in IBD.

Results

A total of 1671 uncertainties from 531 participants were collected and refined to exclude duplicates leaving 1253 uncertainties. Of these, 348 were categorised as diet-related and grouped according to topic. There were 206 uncertainties related to how diet can be used to treat IBD or alleviate symptoms. Seventy-two percent of diet-related questions came from patients. One broadly diet-related and two diet-specific treatment uncertainties were included in the top 10 research priorities for IBD.

Conclusions

Dietary treatment options in the management of IBD are important research priorities. Almost three-quarters of diet related questions came from patients, who were particularly interested in how diet can impact disease activity and symptom control.

July 2017

Lunch-time food source is associated with school hour and school day diet quality among Canadian children

Tugault-Lafleur et al., JHND Early View

Background

There is limited research on the dietary behaviours of Canadian children at school, including where students obtain food from during school hours or whether lunch-time food source influences diet quality.

Methods

Nationally representative cross-sectional data from 24-h dietary recalls were analysed from the 2004 Canadian Community Health Survey (n = 4589). Dietary outcomes included school hour and school day dietary intakes and School Healthy Eating Index (S-HEI) scores. Survey-weighted covariate-adjusted linear regression models examined differences in dietary outcomes across lunch-time food source groups.

Results

The majority of children (72.8%) reported bringing lunch from home, whereas fewer students obtained lunch from off-campus locations (11.6%), schools (9.6%) or skipped lunch (5.9%). Compared to off-campus lunches, home-packed lunches were significantly higher in fibre, vitamins A, D and C, thiamin, magnesium, iron, grains, vegetables and fruit, but lower in total calories, fat and calories from minimally nutritious foods. Average school hour diet quality required improvement for all age groups, although S-HEI scores did not differ significantly by lunch-time food source among 6–8-year-old children. However, for children age 9–17 years, bringing a home-packed lunch was associated with significantly higher S-HEI scores compared to students obtaining lunch from off-campus locations. After adjusting for age and sex, lunch-time food source was also significantly associated with whole day dietary quality.

Conclusions

Although the nutritional quality of off-campus lunches was lower than home-packed lunches, the quality of foods was suboptimal, regardless of food source. Strategies are needed to enhance access to nutritious foods on campus and improve the nutritional quality of packed lunches, which supply the majority of lunch-time foods consumed by Canadian children.

Breastfeeding as a public health responsibility: a review of the evidence

Amy Brown. JHND Early View

Background

Although intention to breastfeed in Western culture is high, many women stop breastfeeding before they are ready. From a physiological perspective, rates of primary milk insufficiency or contraindications to breastfeed should be low. However, numerous women encounter numerous barriers to breastfeeding, many of which occur at the social, cultural and political level and are therefore outside of maternal control. This review identifies and examines the impact of these barriers and considers how public health services should play a central role in creating a supportive breastfeeding environment.

Methods

A narrative review to synthesise themes in the literature was conducted, using Web of Science, PubMed and Science Direct. Barriers to breastfeeding at the societal rather than individual level were identified (e.g. in relation to health services, policies and economic factors). Only English language papers were included.

Results

Many barriers to breastfeeding exist at the societal rather than individual level. These influences are typically outside mothers’ control. Five core themes were identified; the need for investment in (i) health services; (ii) population level health promotion; (iii) supporting maternal legal rights; (iv) protection of maternal wellbeing; and (v) reducing the reach of the breast milk substitute industry.

Conclusions

Although individual support is important, breastfeeding must be considered a public health issue that requires investment at a societal level. Focusing solely on solving individual issues will not lead to the cultural changes needed to normalise breastfeeding. Countries that have adopted a multicomponent public heath strategy to increase breastfeeding levels have had significant success. These strategies must be emulated more widely.

Using the method of triads in the validation of a food frequency questionnaire to assess the consumption of fatty acids in adults

Da Silva et al., JHND Early View

Background

It is of great value to develop valid instruments to estimate food consumption; for this purpose, the triads method has been applied in validation studies of dietary intake to evaluate the correlation between three measurements [food frequency questionnaire (FFQ), reference method and biomarker]. The main aim of the present study was to validate a FFQ for Brazilian adults by means of the method of triads by estimating the ingestion of total fatty acids based on the level of saturation.

Methods

The present study enrolled 152 Brazilian adults of both sexes, who were residents in the city of Viçosa, Brazil. The ingestion of total saturated, monounsaturated, polyunsaturated, trans, linoleic and linolenic fatty acids was assessed by means of a FFQ, two food records, and biomarkers, which were detected by gas chromatography. The validation coefficients were calculated using the method of triads and concordance was determined by Kappa statistics.

Results

The FFQ was considered an adequate dietary method, because, based on the validation coefficients, it estimates the intake of total fat (0.84), as well as linolenic (0.90) and linoleic acids (0.31). A high concordance rate was confirmed for all nutrients assessed by the FFQ and food records. Regarding the biomarkers, linolenic acid and linoleic acid presented greater concordance.

Conclusions

According to the validation coefficients, the FFQ precisely estimated total fat, linolenic acid and linoleic acid contents.

Exploring approaches to dietetic assessment of a common task across different universities through assessment moderation

Palermo et al. JHND Early View

Background

Assessment presents one of the greatest challenges to evaluating health professional trainee performance, as a result of the subjectivity of judgements and variability in assessor standards. The present study aimed to test a moderation procedure for assessment across four independent universities and explore approaches to assessment and the factors that influence assessment decisions.

Methods

Assessment tasks designed independently by each of the four universities to assess student readiness for placement were chosen for the present study. Each university provided four student performance recordings for moderation. Eight different academic assessors viewed the student performances and assessed them using the corresponding university assessment instrument. Assessment results were collated and presented back to the assessors, together with the original university assessment results. Results were discussed with assessors to explore variations. The discussion was recorded, transcribed, thematically analysed and presented back to all assessors to achieve consensus on the emerging major learnings.

Results

Although there were differences in absolute scores, there was consistency (12 out of 16 performances) in overall judgement decisions regarding placement readiness. Proficient communication skills were considered a key factor when determining placement readiness. The discussion revealed: (i) assessment instruments; (ii) assessor factors; and (iii) the subjectivity of judgement as the major factors influencing assessment.

Conclusions

Assessment moderation is a useful method for improving the quality of assessment decisions by sharing understanding and aligning standards of performance.

Comparison of nutrient intake in adolescents and adults with and without food allergies

Maslin et al., JHND Early View

Background

Exclusion diets for the management of food allergy pose a risk of nutritional deficiencies and inadequate growth in children, yet less is known about their effect in adolescents and adults. The present study aimed to compare the dietary intake of adolescents and adults with food allergies with that of a control group.

Methods

A food allergic and a control group were recruited from Portsmouth and the Isle of Wight in the UK. Participants were recruited from a food allergy charity, allergy clinics, a local school and university, and previous research studies. Macro and micronutrient intake data were obtained using a 4-day estimated food diary. Sociodemographic and anthropometric data was collected via a constructed questionnaire.

Results

This cross-sectional study included 81 adolescents (48 food allergic and 33 controls) aged 11–18 years and 70 adults aged 19–65 years (23 food allergic and 47 controls). Overall, 19 (22.8%) adolescents and 19 (27.1%) adults took dietary supplements, with no difference according to food allergic status. Adolescents with food allergy had higher intakes of niacin and selenium than adolescents without (P < 0.05). This difference persisted when dietary supplements were removed from the analysis. Adults with food allergies had higher intakes of folate and zinc than those without (P < 0.05); however, this difference did not persist when dietary supplements were removed from the analysis. Across all participants, the intake of several micronutrients was suboptimal. There was no difference in protein or energy intake, or body mass index, according to food allergic status.

Conclusions

The dietary intake of food allergic participants was broadly similar and, in some cases, better than that of control participants. However, suboptimal intakes of several micronutrients were observed across all participants, suggesting poor food choices.

Nutritional monitoring of patients post-bariatric surgery: implications for smartphone applications

Elvin-Walsh et al., JHND Early View

Background

Optimal results from bariatric surgery are contingent on patient commitment to dietary and lifestyle changes and follow-up care. The present study aimed to investigate the attitudes and use of mobile health (mHealth) smartphone applications (apps) as a potential tool for maintaining connectivity between dietitians and patients post-bariatric surgery.

Methods

A cross-sectional online survey was developed and distributed to a purposeful sample of bariatric dietitians and bariatric patients in Australia. The survey questions explored technology penetration (smartphone and app use), communication preferences, nutrition monitoring methods, professional relationship expectations and reasons for loss to follow-up.

Results

Survey completion rate was 85% (n = 50/59) for dietitians and 80% (n = 39/49) for patients. Smartphone ownership was 98% and 95% for dietitians and patients, respectively. Common reasons given for losing patients to follow-up suggest that a traditional in-clinic practice setting could be a barrier for some. Most dietitians (n = 48; 91%) prefer to see patients face-to-face in their clinic, whereas patient preferences extended to e-mail and mobile messaging. Sixty-eight percent of bariatric patients were receptive to two-way communication with dietitians via an app between clinic visits. Both cohorts recognised the potential for emerging technologies to be used in practice, although there was no single routinely recommended mHealth app.

Conclusions

The present study provides the first insight into the use of mobile devices and apps by post-bariatric patients and the dietitians who support them. A mixture of traditional methods and smartphone technology is desirable to both dietitians and patients. The utility and effectiveness of such technologies should be confirmed in future intervention studies.

Eicosapentaenoic acid and docosahexaenoic acid containing supplements modulate risk factors for cardiovascular disease: a meta-analysis of randomised placebo-control human clinical trials

AbuMweis et al., JHND Early View

Background

Over 200 clinical trials have examined the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplements on risk factors associated with cardiovascular disease. However, an updated analysis of the evidence is lacking. The aim of the present meta-analysis was to quantify the effect of supplements containing EPA and DHA on risk factors for cardiovascular disease.

Methods

An analysis was carried on 171 clinical trials with acceptable quality (Jadad score ≥3) that were identified from a comprehensive electronic search strategy of two databases (Pubmed and Cochrane Library). A random effect model was used to obtain an overall estimate on outcomes of interest. Heterogeneity between trial results was tested for using a standard chi-squared test.

Results

Compared with control, EPA and DHA supplements produced significant reductions of triglycerides of 0.368 mmol L−1 [95% confidence interval (CI) = −0.427 to −0.309], systolic blood pressure of 2.195 mmHg (95% CI = −3.172 to −1.217), diastolic blood pressure of 1.08 mmHg (95% CI = −1.716 to −0.444), heart rate of 1.37 bpm (95% CI = −2.41 to −0.325) and C-reactive protein of 0.343 mg L−1 (95% CI = −0.454 to −0.232). This analysis indicates an increase in both low-density lipoprotein cholesterol (mean difference = 0.150 mmol L−1; 95% CI = 0.058–0.243) and high-density lipoprotein cholesterol (mean difference = 0.039 mmol L−1; 95% CI = 0.024–0.054). The triglyceride-lowering effect was dose-dependent.

Conclusions

The lipid-lowering, hypotensive, anti-arrhythmic and anti-inflammatory actions of EPA and DHA supplements were confirmed in this analysis of randomised placebo-control blinded clinical trials.

June 2017

Accuracy of food photographs for quantifying food servings in a lunch meal setting among Danish children and adults 

Biltoft-Jensen et al., JHND Early View

Background

Visual aids, such as food photographs, are widely used in estimating food quantities in dietary surveys. The present study aimed to assess how accurately Danish adults and children can estimate food portion sizes using 37 series of photographs illustrating four to six different portion sizes under real-life conditions; determine whether adults were more accurate than children; and estimate the error caused by using portion size photographs to estimate weights of foods consumed in macronutrient calculation.

Methods

Six hundred and twenty-two adults and 109 children were recruited in three workplace canteens and in two schools, respectively, to estimate their lunchtime portions based on photographs. Participants were instructed to keep the foods separated on their plate when taking lunch. Participants thereafter estimated their own portions by looking at the relevant series of photographs. The actual food portions were then weighed.

Results

The proportion of correct estimations was 42% overall (range 19–77%). The mean difference (%) between estimated and actual weight was 17% (range 1–111%). Small portion size photographs were more often used correctly compared to larger portion photographs. Children had as many correct estimations as adults, although they overestimated portions more. Participants using fractions of (or more than) one photograph to estimate the portion of a food had significantly larger errors. When calculating the macronutrient content of a weekly menu using the estimated portion sizes, protein had the largest error (29%).

Conclusions

When used in a real-life situation, the portion size photographs validated in the present study showed a certain inaccuracy compared to the actual weights.

Dietary glycaemic index and glycaemic load and upper gastrointestinal disorders: results from the SEPAHAN study

Keshtell et al., JHND Early View

Background

Little is known about the effects of carbohydrate, particularly any association between dietary glycaemic index or glycaemic load and uninvestigated heartburn or uninvestigated chronic dyspepsia in the community. The present study aimed to determine associations between dietary glycaemic index or glycaemic load and uninvestigated heartburn or uninvestigated chronic dyspepsia.

Methods

This cross-sectional study was conducted in 2987 adults. Dietary glycaemic index and glycaemic load were estimated using a validated food-frequency questionnaire. Uninvestigated heartburn and uninvestigated chronic dyspepsia were determined using a modified and validated version of the Rome III questionnaire.

Results

After controlling for various confounders, high glycaemic load was associated with an increased risk of uninvestigated heartburn [odds ration (OR) = 1.75; 95% confidence interval CI = 1.03, 2.97; P = 0.04] and uninvestigated chronic dyspepsia (OR = 2.14; 95% CI: 1.04, 4.37; P = 0.04) in men but not in women. In normal-weight individuals, high glycaemic index was related to an increased risk of uninvestigated heartburn (OR = 1.52; 95% CI: 1.07, 2.15; P = 0.02) and high glycaemic load to an increased risk of uninvestigated chronic dyspepsia (OR=1.78; 95% CI: 1.05, 3.01; P = 0.03). No significant associations were observed in subjects with excess body weight.

Conclusions

Our data suggest that there are body mass index- and sex-specific associations between dietary carbohydrate quality with uninvestigated heartburn and uninvestigated chronic dyspepsia.

Reducing the maternal dietary intake of indigestible and slowly absorbed short-chain carbohydrates is associated with improved infantile colic: a proof-of-concept study

Iacovou et al., JHND Early View

Background

To investigate if a low fermentable oligo-, di- and mono-saccharides and polyols (FODMAP) diet consumed by breastfeeding mothers may be associated with reduced symptoms of infantile colic.

Methods

Exclusively breastfeeding mothers and their typically-developing healthy infants who met the Wessel Criteria for infantile colic were recruited from the community, to this single-blind, open-label, interventional study. After a 3-day qualifying period, mothers were provided a low FODMAP 7-day diet. On days 5, 6 and 7 mothers completed a Baby Day Diary. At baseline and at the end of the 7-day dietary intervention, breast milk was analysed for FODMAP content and infant faecal samples for pH.

Results

Eighteen breastfeeding mothers (aged 27–40 years) adhered (100%) to the low FODMAP diet. Infants were of gestational age 37–40.3 weeks and aged 2–17 weeks. At entry, crying durations were a mean [95% CI] of 142 [106–61] min and fell by 52 [178–120] min (P = 0.005; ancova). Combined crying-fussing durations fell by 73 [301–223] min (n = 13; P = 0.007), as did crying episodes (P = 0.01) and fussing durations (P = 0.011). Infant sleeping, feeding, or awake-and-content durations did not change. Infant faecal pH did not change. Breast milk lactose content was stable and other known FODMAPs were not detected. At end of study, mothers reported their baby ‘is much more content’ and ‘can be put down without crying’.

Conclusions

Maternal low FODMAP diet may be associated with a reduction in infant colic symptoms. A randomized controlled study is warranted to determine if a maternal low FODMAP diet is effective in reducing symptoms.

Deprivation and healthy food access, cost and availability: a cross-sectional study

Williamson et al., JHND Early View

Background

Food access, cost and availability have been identified as determinants of dietary choice. It has been suggested that these are socio-economically patterned; however, the evidence is inconclusive. The present study investigated whether differences exist with respect to healthy food access, cost and availability between areas of contrasting deprivation.

Methods

An ecological, cross-sectional study was conducted in two of the most and two of the least deprived wards in Plymouth. Food retail outlets (FROs) (n = 38) were identified and mapped using Geographic Information Systems to assess ‘physical access’, by foot, to food retail provision. Healthy food basket (HFB) surveys were conducted (n = 32) to compare the cost and availability of 28 healthy food items between the more and less deprived areas.

Results

Areas of poor access to food retail provision were identified in both study areas, with a higher number of households in the more-deprived areas being affected than in the less-deprived areas, after accounting for car ownership levels. Median [IQR] HFB availability was lower in more-deprived than the less-deprived areas (48%, [39-71%] vs. 75%, [68-82%]; P=0.003), and in convenience stores than supermarkets (54%, [43-72%] vs. 78%, [72-96%]; P=0.001). Descriptive summaries revealed negligible differences in total median HFB cost between the more-deprived and less-deprived areas (£55.97 versus £55.94) and a larger cost difference between convenience stores and supermarkets (£62.39 versus £44.25).

Conclusions

Differences were found with respect to healthy food access, cost and availability in areas of contrasting deprivation. These appeared to be related to FRO type rather than deprivation alone.

A systematic review of feeding practices among postoperative patients: is practice in-line with evidenced-based guidelines?

Rattray et al., JHND Early View

Background

Early oral feeding after surgery is best practice among adult, noncritically ill patients. Evidenced-based guidelines (EBG) recommend commencing liquid and solid feeding within 24 h of surgery to improve patient (e.g. reduced morbidity) and hospital (e.g. reduced length of stay) outcomes. Whether these EBG are adhered to in usual clinical practice remains unknown. The present study aimed to identify the time to commencement of first oral feed (liquid or solid) and first solid feed among postoperative, noncritically ill, adult patients.

Methods

MEDLINE, CINAHL, SCOPUS and Web of Science databases were searched from inception to June 2016 for observational studies reporting liquid and/or solid feeding practices among postoperative patients. Studies reporting a mean/median time to first feed or first solid feed within 24 h of surgery or where ≥75% of patients were feeding by postoperative day one were considered in-line with EBG.

Results

Of 5826 articles retrieved, 29 studies were included. Only 40% and 22% of studies reported time to first feed and time to first solid feed in-line with EBG, respectively. Clear and free liquids were the first diet types commenced in 86% of studies. When solids were commenced, 44% of studies reported using various therapeutic diet types (e.g. light) prior to the commencement of a regular diet. Patients who underwent gastrointestinal procedures appeared more likely to experience delayed postoperative feeding.

Conclusions

Our findings demonstrate a gap between postoperative feeding evidence and its practical application. This information provides a strong rationale for interventions targeting improved nutritional care following surgery.

Are energy and protein requirements met in hospital?

Pullen et al., JHND Early View

Background

Malnutrition is a problem within hospitals, which impacts upon clinical outcomes. The present audit assesses whether a hospital menu meets the energy and protein standards recommended by the British Dietetic Association's (BDA) Nutrition and Hydration Digest and determines the contribution of oral nutrition supplements (ONS) and additional snacks.

Methods

Patients in a UK South West hospital were categorised as ‘nutritionally well’ or ‘nutritionally vulnerable’ in accordance with their Malnutrition Universal Screening Tool score. Energy and protein content of food selected from the menu (‘menu choice’), menu food consumed (‘hospital intake’) and total food consumed including snacks (‘overall intake’) were calculated and compared with the standards.

Results

In total, 93 patients were included. For ‘nutritionally well’ patients (n = 81), energy and protein standards were met by 11.1% and 33.3% (‘menu choice’); 7.4% and 22.2% (‘hospital intake’); and 14.8% and 28.4% (‘overall intake’). For ‘nutritionally vulnerable’ patients (n = 12), energy and protein standards were met by 0% and 8.3% (‘menu choice’); 0% and 8.3% (‘hospital intake’); and 8.3% and 16.7% (‘overall intake’). Ten percent of patients consumed ONS. Patients who consumed hospital snacks (34%) were more likely to meet the nutrient standards (P ≤ 0.001).

Conclusions

The present audit demonstrated that most patients are not meeting the nutrient standards recommended by the BDA Nutrition and Hydration Digest. Recommendations include the provision of energy/protein-dense snacks, as well as menu, offering ONS where clinically indicated, in addition to training for staff. A food services dietitian is ideally placed to lead this, forming a vital link between patients, caterers and clinical teams.

An evaluation of the feasibility and validity of a patient-administered malnutrition universal screening tool (‘MUST’) compared to healthcare professional screening in an inflammatory bowel disease (IBD) outpatient clinic

Keetarut et al., JHND Early View

Background

Malnutrition is common in inflammatory bowel disease (IBD) and is associated with poor health outcomes. Despite this, screening for malnutrition in the outpatient-setting is not routine and research in the area is limited. The present study aimed to evaluate whether agreement between malnutrition screening completed by patients and healthcare professionals (HCPs) could be achieved by comparing patient self-administered ‘MUST’ (‘MUST’-P) with HCP administered ‘MUST’ (‘MUST’-HCP) in a single tertiary IBD outpatient clinic.

Methods

We conducted a feasibility and validity study on adult outpatients with IBD. We collected anthropometric, nutritional and clinical data from patients. All patients completed ‘MUST’-P using a self-administered questionnaire, followed by ‘MUST’-HCP. ‘MUST’-P was timed and feedback on ease-of-use was obtained. The risk of malnutrition was classified as low (score = 0), medium (score = 1) and high (score ≥ 2) and agreement was tested using kappa statistics (κ).

Results

Eighty patients were recruited (Crohn's disease: n = 49, ulcerative colitis: n = 29, unclassified: n = 2), with a mean (SD) age of 39.9 (15.1) years (51.2% were males). Seventy-one (92%) of patients found ‘MUST’-P either easy or very easy. The mean (SD) time to complete ‘MUST’-P was 3.1 (1.8) min (range 1–10 min). Sixty-eight (85%) of patients were at low risk of malnutrition when screened by the HCP. There was moderate agreement (κ = 0.486, P < 0.001) between ‘MUST’-P and ‘MUST’-HCP, with 100% agreement in scoring for medium- and high-risk categories.

Conclusions

The results of the present study suggests that self-screening using ‘MUST’ could be effectively used in an IBD outpatient clinic to identify those at medium and high risk of malnutrition. The patient friendly version of ‘MUST’ (‘MUST’-P) was considered quick and easy to use by patients. Implementation of self-screening with ‘MUST’ could improve the nutritional management of IBD patients.

Integrating renal nutrition guidelines into daily family life: a qualitative exploration

Morris et al., JHND Early View

Background

Renal dietary compliance is challenging for individuals with chronic renal disease. Advice may change depending on renal function and medical treatment. Although patients seek support from family members with these changes, no literature exists with respect to how family members experience the offering of this support. The present study aimed to describe and interpret this lived experience of family members.

Methodology

Phenomenological qualitative semi-structured interviews were conducted with 12 adult family members via telephone (transcribed verbatim). Framework analysis and the qualitative software nvivo, version 10 (QSR International Pty Ltd, Melbourne, VIC, Australia) were used. Participants commented on the themes for accuracy of experience representation.

Results

Four major themes emerged: (i) intrusion of the renal diet; (ii) dealing with the recommendations of a renal diet; (iii) seeking a new identity; and (iv) transition of family dynamics. Perceived conflicting advice intruded into family life. Children in the family resulted in more complex nutritional decisions. Continuing a diet to avoid perceived family and wider social judgement was not an option. Balance between nurturing the family as a whole and the necessity of attending to the specific needs of one individual with renal disease was challenging. Transition to a new identity included family members being drawn to scientifically guided understandings of nutrition and a medicalisation of daily food requirements, which included low prioritisation of children's nutritional needs.

Conclusion

Family members who cooked found the integration of renal nutrition guidelines challenging, with children presenting further challenges. The present study highlights the need to offer practical and psychological support to families who are coping with end-stage renal failure and renal nutritional guidelines.

May 2017

Effect of RRR-α-tocopherol supplementation on serum of breastfeeding women up to 60 days after delivery: a randomised controlled trial

Lira et al., JHND Early View.

Background

Maternal supplementation is a viable strategy to combat vitamin E deficiency in newborns, although a protocol for maternal vitamin E supplementation has not been defined. The present study assessed the effect of maternal supplementation in a single dose on the serum of postpartum women up to 60 days after delivery.

Methodology

Fifty healthy breastfeeding women were recruited at two maternity hospitals both located in Natal, RN, Brazil. The participants were randomly allocated to a control group and a treatment group in a 1 : 1 ratio. Serum was collected 1, 20, 30 and 60 days after delivery. Immediately after the first collection, the treatment group received a single dose of 400 IU of RRR-α-tocopherol. α-Tocopherol was quantified by high-performance liquid chromatography. The usual dietary vitamin E intake was determined using four 24-h recalls, and intake adequacy was assessed based on the estimated average requirements for lactating women (16 mg day−1).

Results

The mean dietary vitamin E intakes of the both groups were similar (P > 0.05) and inadequate. The serum levels of α-tocopherol assessed at 1, 20, 30 and 60 days indicated adequate vitamin E status in both the control group (1194.6, 907.7, 910 and 748.6 μg dL−1, respectively) and treatment group (1183.7, 956.0, 935.9 and 766.4 μg dL−1, respectively). The comparison at each day showed no difference between treatments (P > 0.05).

Conclusions

A single vitamin E supplement did not change the mean serum level of α-tocopherol in breastfeeding women; thus, it does not improve their vitamin E status in the first 60 days after delivery.

Patient-centred dietetic care from the perspectives of older malnourished patients

Hazzard et al., JHND Early View.

Background  

Governing organisations for health services currently recommend a patient-centred (PC) approach to practice for all health professions, including dietetics. For the vulnerable older malnourished patient, this approach needs to be prioritised to improve outcomes. The paucity of patient experience data likely limits evidence-based, patient-centred care (PCC) from being implemented effectively. The present study aimed to identify quality indicators of dietetic services from the perspectives of older malnourished patients to inform evidence-based PC dietetic care.

Methods

Surveys were completed by a sample of 28 females and 28 males (mean age 81 years) who had been seen by a dietitian for malnutrition assessment. In-depth, face-to-face, semi-structured interviews were undertaken with a sub-sample of four females and six males (mean age 81 years). Interviews were transcribed verbatim. Thematic analysis of transcripts and open-ended survey responses was conducted to determine patient-identified quality indicators.

Results

Three structure indicators (continuity of care through regular contact and post-discharge dietetic follow-up; interdisciplinary coordination and collaboration; and high-quality hospital food services), five process indicators (addressing a patient's primary medical concern; involving the patient's family; providing clear and simple dietetic information; providing expert dietary knowledge; utilising interpersonal communication skills) and three outcome indicators (improvement in health status; improvement or maintenance of independence; weight gain) were identified. The experiences of older malnourished patients with dietetic services, as described in the present study, reinforce the importance of ensuring high-quality and tailored dietetic care as a key element of PC dietetic services.

Conclusions

The quality indicators of dietetic services identified in the present study may facilitate dietitians to provide evidence-based PCC for older malnourished patients.

Patient-reported dietetic care post hospital for free-living patients: a Canadian Malnutrition Task Force Study

Keller et al., JHND Early View

Background

Transitions out of hospital can influence recovery. Ideally, malnourished patients should be followed by someone with nutrition expertise, specifically a dietitian, post discharge from hospital. Predictors of dietetic care post discharge are currently unknown. The present study aimed to determine the patient factors independently associated with 30-days post hospital discharge dietetic care for free-living patients who transitioned to the community.

Methodology

Nine hundred and twenty-two medical or surgical adult patients were recruited in 16 acute care hospitals in eight Canadian provinces on admission. Eligible patients could speak English or French, provide their written consent, were anticipated to have a hospital stay of ≥2 days and were not considered palliative. Telephone interviews were completed with 747 (81%) participants using a standardised questionnaire to determine whether dietetic care occurred post discharge; 544 patients discharged to the community were included in the multivariate analyses, excluding those who were admitted to nursing homes or rehabilitation facilities. Covariates during and post hospitalisation were collected prospectively and used in logistic regression analyses to determine independent patient-level predictors.

Results

Dietetic care post discharge was reported by 61/544 (11%) of participants and was associated with severe malnutrition [Subjective Global Assessment category C: odd's ratio (OR) 2.43 (1.23–4.83)], weight loss post discharge [(OR 2.86 (1.45–5.62)], comorbidity [(OR 1.09 (1.02–1.17)] and a dietitian consultation on admission [(OR 3.41 (1.95–5.97)].

Conclusions

Dietetic care post discharge occurs in few patients, despite the known high prevalence of malnutrition on admission and discharge. Dietetic care in hospital was the most influential predictor of post-hospital care.

The economic burden of gluten-free products and gluten-free diet: a cost estimation analysis in Greece

Panagiotou and Kontogianni JHND Early View

Background

Adherence to a gluten-free diet (GFD) demonsrates various difficulties, including the high cost of the diet. The present study aimed to (i) compare the cost of gluten-free products (GFP) from supermarkets and pharmacies with the cost of their conventional counterparts and (ii) estimate the weekly economic burden of a GFD.

Methods

The prices of all food products labelled as ‘gluten-free’ available at four supermarket chains in Athens, as well as the prices of all similar conventional food products, were recorded. The prices of the pharmacy GFP were recorded from the official list of the National Health Service Organisation. For every product, the price per 100 g was calculated. All products were classified into 24 categories, which consisted of three subcategories: conventional, supermarket GFP and pharmacy GFP. Three weekly menus were designed for children, adolescents and adults, selecting the upper levels of energy intake, to cover the majority of the patients. For all three weekly menus, the price difference between conventional and GFP, both from supermarkets and pharmacies, was calculated.

Results

Compared with conventional food products, all supermarket GFP, except for one, were more expensive by 22–334% (P < 0.05) and all pharmacy GFP were more expensive by 88–476% (P < 0.05). The weekly economic burden of a GFD ranged from €12 to €28 per week, depending on age and GFP place of purchase.

Conclusions

The present study confirms the higher cost of GFP compared to their conventional equivalents in Greece, leading to a weekly economic burden for people on a gluten-free diet.

April 2017

Enhancing the confidence of student dietitians prior to placement

by Simon Langley-Evans

Is it possible to enhance the confidence of student dietitians prior to professional placements? A design-based research model

Ross et al., JHND Early View

Background

Student confidence is an important contributor to a successful professional placement experience. The present study aimed to evaluate a placement preparation program for student dietitians and to assess the impact on self-rated confidence with respect to commencing placements.

Methods

The present study is part of a design-based research approach that involves students in a cyclic enquiry to evaluate and improve curricula. Nutrition and Dietetics students at an Australian university participated in a 1-week mandatory workshop – Pre-Placement week (PrePW), N = 98 students: in 2015 (n = 54) and 2016 (n = 44). An online survey was conducted before and after PrePW using a five-point Likert scale (1 = not confident; 5 = very confident) to assess self-rated confidence to commence placements. Mean (SD) scores were calculated. Paired and independent t-tests evaluated within- and between-group differences, respectively.

Results

Before PrePW, the mean (SD) for student confidence to commence placements overall (in all areas of practise) was ‘somewhat confident’ [2.9 (0.6) in 2015 and 3.0 (0.7) in 2016]. Students were least confident to commence Clinical Practice [2015: 2.5 (0.6); 2016: 2.8 (0.6)] compared to Food Service Management (FSM) [2015: 3.2 (0.9); 2016: 3.1 (0.9)] and Community and Public Health Nutrition (CPHN) [2015: 3.3 (0.9); 2016: 3.2 (0.8)]. Student feedback from PrePW 2015 was used to change the curriculum and PrePW program. The 2016 students reported significantly greater confidence within all areas of practice: Clinical Practice [3.4 (0.6)], FSM [3.7 (0.6)] and CPHN [3.8 (0.6)], including confidence to commence placements overall [3.6 (0.6)] (P < 0.05).

Conclusions

Design-based research provides a useful framework for improvement to curricula and, in this case, was successful in enhancing student confidence in preparation for professional placement.

Disordered eating in coeliac disease

by Simon Langley-Evans

Disordered eating patterns in coeliac disease: a framework analysis

Satherley et al., JHND Early View

Objective

The need for dietary-management in coeliac disease may lead to the development of disordered eating patterns. A theoretical model of disordered eating has been proposed to explain disordered eating in coeliac disease. The aim of this study was to explore the experiences of typical and disordered eating in coeliac disease to gain a greater understanding of these processes and explore specific pathways within this model.

Methods

We interviewed 21 individuals with coeliac disease, recruited from a previous database, about their experiences with food and food environments. Information about disordered eating status was assessed via questionnaire. The interviews were analysed qualitatively using Framework analysis, which was underpinned by the theoretical model of disordered eating in coeliac disease.

Results

Experiences differed between participants scoring high on measures of disordered eating and those who scored low (typical eaters). Participants scoring high on measures of disordered eating were concerned about the consequences of their gluten-free diet on body image and they described eating patterns similar to binge/restrict cycles. Typical eaters reported being able to integrate their dietary self-management into their daily lives; however, general concerns around food and cross-contamination were associated with a restriction in food intake.

Conclusions

Coeliac disease has a varied impact on eating patterns. The need to follow a gluten-free diet and to be vigilant around food has to be balanced with concerns around food availability and cross-contamination which have the potential to contribute towards disordered eating attitudes and behaviours. The findings suggest that the theoretical model of disordered eating provides an adequate explanation of disordered eating patterns in coeliac disease.

Post-prandial triglyceride metabolism

by Simon Langley-Evans

Post-lunch triglyceridaemia associates with HDLc and insulin resistance in fasting normotriglyceridaemic menopausal women

Sanz-Paris et al., JHND Early View

Objectives

Post-prandial hypertriglyceridaemia (P-HTG) is associated with cardiovascular disease. This association is of paramount importance during menopause, which is also related to reduced high-density lipoprotein-cholesterol (HDLc) and elevated triglyceride (TG) levels. We aimed to provide a self-assesing tool to screen for P-HTG in menopausal women who were normotriglyceridaemic at fasting and adhered to a Mediterranean-style eating pattern.

Methods

We performed oral fat loading tests (OFLT) in combination with self-measurements of diurnal capillary TG at fixed time-points (DC-TG) in 29 healthy menopausal women. TG levels >220 mg dL−1 at any given time during the OFLT served as diagnostic criteria for P-HTG. Subsequently, DC-TG profiles were examined to determine the best mealtime (breakfast, lunch or dinner), as well as optimal cut-off points to classify these women as having P-HTG according to the OFLT. Insulin resistance was defined as the upper tertile of the homeostatic model assessment of insulin resistance.

Results

We found that, despite having normal fasting TG levels, P-HTG was highly prevalent (approximately 40%). Moreover, self-assessed 3-h post-lunch TG levels >165 mg dL−1 increased the odds of having hypo-HDL cholesterolaemia by 14.1-fold (P = 0.026) and the odds of having insulin resistance by 31.6-fold (P = 0.007), adjusted for total fat intake in women adhering to a Mediterranean eating pattern having their highest energy intake at lunch.

Conclusions

Self-assessed 3-h post-lunch TG can be used to study post-prandial TG metabolism in Southern European menopausal women who are normotriglyceridaemic at fasting. Characterising an individual's post-prandial response may help menopausal women to evaluate their risk of cardiovascular disease.

What is the role of dietitians in management of mental illness?

by Simon Langley-Evans

A review of the nutritional challenges experienced by people living with severe mental illness: a role for dietitians in addressing physical health gaps

Teasdale et al., JHND Early View

People experiencing a severe mental illness (SMI), such as schizophrenia, schizoaffective disorder, bipolar affective disorder or depression with psychotic features, have a 20-year mortality gap compared to the general population. This ‘scandal of premature mortality’ is primarily driven by preventable cardiometabolic disease, and recent research suggests that the mortality gap is widening. Multidisciplinary mental health teams often include psychiatrists, clinical psychologists, specialist mental health nurses, social workers and occupational therapists, offering a range of pharmacological and nonpharmacological treatments to enhance the recovery of clients who have experienced, or are experiencing a SMI. Until recently, lifestyle and life skills interventions targeting the poor physical health experienced by people living with SMI have not been offered in most routine clinical settings. Furthermore, there are calls to include dietary intervention as mainstream in psychiatry to enhance mental health recovery. With the integration of dietitians being a relatively new approach, it is important to review and assess the literature to inform practice. This review assesses the dietary challenges experienced by people with a SMI and discusses potential strategies for improving mental and physical health.

March 2017

Nutritional screening to determine malnutrition and cardiometabolic risk in haemodialysis.

by Simon Langley-Evans

Comparison between direct and indirect methods to diagnosis of malnutrition and cardiometabolic risk in haemodialysis patients

Balbino et al., JHND Early View.

Background

The present study aimed to evaluate the nutritional status of patients undergoing haemodialysis (HD) by comparing nutritional risk scores with biochemical, anthropometric and body composition variables.

Methods

Eighty-five individuals [65.9% male, mean (SD) age 62 (14) years] participated in a cross-sectional study. Global Objective Assessment (GOA) and Modified Global Subjective Assessment (mGSA) scores, as well as biochemical, anthropometric and body composition data, were collected using standardised procedures.

Results

The prevalence of malnutrition ranged from 20.0% (% body fat by electrical bioimpedance) to 95.3% (by GOA), depending on the indicator or score used. According to the waist circumference, 61.2% of the individuals presented abdominal obesity and visceral adipose tissue was excessive in 20% of them. Malnutrition diagnosis by GOA showed the relationship between the anthropometric and body composition indicators, as assessed by the extent that the ratings of risk nutritional/mild malnutrition and mainly moderate malnutrition were accompanied by a significant decrease in nutritional status and body composition variables. However, with respect to categories of mGSA, no statistically significant differences were observed for nutritional status and body composition variables. In the receiver operator characteristic curve analyses, mGSA and GOA were good indicators for diagnosing malnutrition because both achieved an AUC > 0.5.

Conclusions

mGSA and GOA were more sensitive with respect to identifying individuals at nutritional risk compared to the isolated anthropometric indicators, thus indicating their utility in diagnostic malnutrition. However, individuals at high nutritional risk also presented cardiometabolic risk, as diagnosed mainly by central fat indicators, suggesting the application of both malnutrition and cardiometabolic risk markers in HD patients.

Fish oils improve inflammatory profile and survival in patients with haematological malignancies

by Simon Langley-Evans

Oral fish oil positively influences nutritional-inflammatory risk in patients with haematological malignancies during chemotherapy with an impact on long-term survival: a randomised clinical trial

Chagas et al., JHND Early View

Background

Studies suggest that the ingestion of fish oil (FO), a source of the omega-3 polyunsaturated fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), can reduce the deleterious side-effects of chemotherapy. The aim of this randomised clinical trial was to evaluate the effect of supplementation with oral FO for 9 weeks on nutritional parameters and inflammatory nutritional risk in patients with haematological malignancies during the beginning of chemotherapy.

Methods

Twenty-two patients with leukaemia or lymphoma were randomised to the unsupplemented group (UG) (n = 13) or supplemented group (SG) (n = 9). SG received 2 g/day of fish oil for 9 weeks. Nutritional status, serum acute-phase proteins and plasma fatty acids were evaluated before (T0) and after (T1) the intervention period. Data were analysed using two models; model 1, comprising data from all patients included in the study, and model 2, comprising data from UG patients with no increase in the proportions of EPA and DHA in plasma and data from SG patients showing an at least 100% increase in plasma EPA and DHA.

Results

SG showed an increased plasma proportion of EPA and DHA in both models. In model 2, C-reactive protein (CRP) and CRP/albumin ratio showed larger reductions in the SG. Overall long-term survival in both models (465 days after the start of the chemotherapy) was higher in the group ingesting fish oil (P < 0.05).

Conclusions

These findings indicate an improved nutritional-inflammatory risk and potential effects on long-term survival in patients with haematological malignancies supplemented with FO during the beginning of chemotherapy.

Dietetic protocols for management of haemodialysis patients on low phosphorus diets.

by Simon Langley-Evans

Effect of stage-based education provided by dedicated dietitians on hyperphosphataemic haemodialysis patients: results from the Nutrition Education for Management of Osteodystrophy randomised controlled trial

Rizk et al., JHND Early View

Background

The Nutrition Education for Management of Osteodystrophy trial showed that stage-based nutrition education by dedicated dietitians surpasses existing practices in Lebanon with respect to lowering serum phosphorus among general haemodialysis patients. The present study explores the effect of nutrition education specifically on hyperphosphataemic patients from this trial.

Methods

Hyperphosphataemic haemodialysis patients were allocated to a dedicated dietitian (DD), a trained hospital dietitian (THD) and existing practice (EP) protocols. From time-point (t)-0 until t-1 (6 months), the DD group (n = 47) received 15 min of biweekly nutrition education by dedicated dietitians trained on renal nutrition; the THD group (n = 89) received the usual care from trained hospital dietitians; and the EP group (n = 42) received the usual care from untrained hospital dietitians. Patients were followed-up from t-1 until t-2 (6 months). Analyses used two-way repeated measures analysis of variance and Cohen's effect sizes (d).

Results

At t-1, phosphataemia significantly decreased in all groups (DD:−0.27 mmol L−1; EP:−0.15 mmol L−1; THD:−0.12 mmol L−1; P < 0.05); the DD protocol had the greatest effect relative to EP (d = −0.35) and THD (d = −0.50). Only the DD group showed more readiness to adhere to a low phosphorus diet at t-1; although, at t-2, this regressed to baseline levels. The malnutrition inflammation score remained stable only in the DD group, whereas the EP and THD groups exhibited a significant increase (DD: 6.74, 6.97 and 7.91; EP: 5.82, 8.69 and 8.13; THD: 5.33, 7.92 and 9.42, at t-0, t-1 and t-2, respectively).

Conclusions

The results of the present study suggest that the DD protocol decreases serum phosphorus compared to EP and THD, at the same time as maintaining the nutritional status of hyperphosphataemic haemodialysis patients. Assessing the cost-effectiveness of the DD protocol is recommended.

A pilot RCT of a pregnancy intervention to prevent allergy in infants.

by Simon Langley-Evans

A pilot randomised controlled trial investigating a Mediterranean diet intervention in pregnant women for the primary prevention of allergic diseases in infants

Sewell et al., JHND Early View

Background

Observational studies suggest a potentially protective role of the Mediterranean diet (MD) in allergic diseases, including asthma. Large scale randomised controlled trials (RCTs) are needed to test the hypothesised allergy-prevention benefits of a MD during pregnancy. The present two-arm pilot RCT in pregnant women at high-risk of having a child who would develop allergic disease investigated maternal recruitment, retention and acceptability of an MD dietary intervention in the UK. The trial also assessed the effect of the intervention on MD adherence scores at 12 and at 24 weeks post-randomisation.

Methods

Thirty women were recruited at around 12 weeks of gestation. Retention was high (28 out of 30; 93%). The intervention was acceptable to participants. Mean (SD) adherence to the MD at baseline was 12.4 (2.9) in the intervention arm (n = 14) and 13.0 (1.9) in the control arm (n = 16), where 24 represents maximal adherence. There was a favourable short-term change in MD score: the adjusted mean difference (intervention – control) in the change in MD score from baseline to 12 weeks post-randomisation was 2.4 (95% confidence interval = 0.6–4.2, P = 0.012).

Conclusions

The trial provides important insights into recruitment, retention and sustaining the dietary intervention, which will be used in the design of a large RCT.

Dietary epigallocatechin 3-gallate supplements improve outcomes of gestational diabetes

by Simon Langley-Evans

Dietary epigallocatechin 3-gallate supplement improves maternal and neonatal treatment outcome of gestational diabetes mellitus: a double-blind randomised controlled trial

Zhang et al., JHND Early View

Background

Gestational diabetes mellitus (GDM) is an increasing prevalent health risk in pregnant women. Epigallocatechin 3-gallate (EGCG) is known to benefit the insulin secretory machinery. We aimed to investigate the effect of daily dietary EGCG supplementation on both the maternal and neonatal treatment outcomes in GDM-affected pregnancies.

Methods

In total, 472 pregnant women during their third trimester of pregnancy were diagnosed with GDM and subsequently enrolled into this trial. After exclusion, 404 patients were randomly assigned into EGCG and placebo study groups and subsequently administered either 500 mg of EGCG or placebo, respectively, on a daily basis until full term. The daily nutritional intake of all patients was monitored throughout the study. Maternal diabetic parameters at baseline and full term, including metabolism of glucose and insulin, as well as neonatal symptoms at birth, including birth weight, macrosomia, hypoglycaemia, respiratory distress and Apgar scores, were analysed.

Results

In total, 176 and 150 patients from the EGCG and placebo study groups, respectively, completed the trial. Patients from the EGCG group displayed significantly improved maternal diabetic parameters, and fewer cases of neonatal complications, compared to the placebo group.

Conclusions

Daily dietary EGCG supplement improves both maternal and neonatal treatment outcomes of GDM.

February 2017

Changing short-term purchasing through price promotion and healthy eating advice

by Simon Langley-Evans

Impact of a targeted direct marketing price promotion intervention (Buywell) on food-purchasing behaviour by low income consumers: a randomised controlled trial

Stead et al., JHND Early View

Background

Price promotions are a promising intervention for encouraging healthier food purchasing. We aimed to assess the impact of a targeted direct marketing price promotion combined with healthy eating advice and recipe suggestions on the purchase of selected healthier foods by low income consumers.

Methods

We conducted a randomised controlled trial (n = 53 367) of a direct marketing price promotion (Buywell) combined with healthy eating advice and recipe suggestions for low income consumers identified as ‘less healthy’ shoppers. Impact was assessed using electronic point of sale data for UK low income shoppers before, during and after the promotion.

Results

The proportion of customers buying promoted products in the intervention month increased by between 1.4% and 2.8% for four of the five products. There was significantly higher uptake in the promotion month (P < 0.001) for the intervention group than would have been expected on the basis of average uptake in the other months. When product switching was examined for semi-skimmed/skimmed milk, a modest increase (1%) was found in the intervention month of customers switching from full-fat to low-fat milk. This represented 8% of customers who previously bought only full-fat milk. The effects were generally not sustained after the promotion period.

Conclusions

Short-term direct marketing price promotions combined with healthy eating advice and recipe suggestions targeted at low income consumers are feasible and can have a modest impact on short-term food-purchasing behaviour, although further approaches are needed to help sustain these changes.

Disparity in accuracy and actionability of renal advice

by Simon Langley-Evans

Evaluation of the quality and health literacy demand of online renal diet information

Lambert et al Early View

Background

Dietary modification is critical in the self-management of chronic kidney disease. The present study describes the accuracy, quality and health literacy demand of renal diet information for adults with kidney disease obtained from the Internet and YouTube (www.youtube.com).

Methods

A comprehensive content analysis was undertaken in April and July 2015 of 254 eligible websites and 161 YouTube videos. The accuracy of the renal diet information was evaluated by comparing the key messages with relevant evidence-based guidelines for the dietary management of people with kidney disease. The DISCERN tool (www.discern.org.uk) was used to evaluate the quality of the material. Health literacy demand was evaluated using the Patient Education Material Assessment Tool (www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/pemat/index.html) and seven validated readability calculators.

Results

The most frequent renal diet topic found online was generic dietary information for people with chronic kidney disease. The proportion of renal diet information obtained from websites that was accurate was 73%. However, this information was mostly of poor quality with extensive shortcomings, difficult to action and written with a high health literacy demand. By contrast, renal diet information available from YouTube was highly understandable and actionable, although only 18% of the videos were accurate, and a large proportion were of poor quality with extensive shortcomings. The most frequent authors of accurate, good quality, understandable, material were government bodies, dietitians, academic institutions and medical organisations.

Conclusions

Renal diet information found online that is written by government bodies, dietitians, academic institutions and medical organisations is recommended. Further work is required to improve the quality and, most importantly, the actionability of renal diet information found online.

Usability of electronic food systems in hospital

by Simon Langley-Evans

Technology to engage hospitalised patients in their nutrition care: a qualitative study of usability and patient perceptions of an electronic foodservice system

Roberts et al., Early View

Background

Active patient involvement in nutrition care may improve dietary intakes in hospital. Our team is developing an innovative programme allowing patients to self-assess and self-monitor their nutrition at the bedside. The present study aimed to assess usability and patient perceptions of an electronic foodservice system (EFS) for participating in nutrition care.

Methods

This qualitative study was conducted in an Australian tertiary hospital. Participants were sampled purposively and included patients who were able to provide informed consent and communicate in English. Patient interviews were conducted at the bedside and consisted of: (i) usability testing of the EFS using ‘Think Aloud’ technique and (ii) questioning using a semi-structured interview guide to understand perceptions of the EFS. Interview data were analysed using inductive content analysis.

Results

Thirty-two patients were interviewed. Their perceptions of using the EFS to participate in nutrition care were expressed in five categories: (i) Familiarity with technology can affect confidence and ability but is not essential to use EFS; (ii) User interface design significantly impacts EFS usability; (iii) Identifying benefits to technology increases its acceptance; (iv) Technology enables participation, which occurs to varying extents; and (v) Degree of participation depends on perceived importance of nutrition.

Conclusions

Patients found the EFS acceptable and acknowledged benefits to its use. Several factors appeared to influence usability, acceptability and willingness to engage with the system, such as user interface design and perceived ease of use, benefits and importance. The present study provides important insights into designing technology-based interventions for engaging inpatients in their nutrition care.

Impact of lifestyle change on the cardio- metabolic risk factors of relatives of diabetic subjects

by Simon Langley-Evans

Lifestyle change reduces cardiometabolic risk factors and glucagon-like peptide-1 levels in obese first-degree relatives of people with diabetes

Bowes et al., JHND Early View

Background

Preventing type 2 diabetes in a real-world setting remains challenging. The present study aimed to assess the effectiveness of a lifestyle-based programme for individuals at high risk of developing type 2 diabetes as assessed by achieved weight loss, cardiovascular risk factors and glucagon-like peptide-1 (GLP-1).

Methods

Sixty-six obese individuals with history of diabetes in first-degree relatives participated in an 8-month lifestyle programme consisting of 12 × 1.25 h group education sessions led by dietitian and a weekly exercise programme. Before and after comparisons were made of fasting blood glucose, insulin, HbA1c, lipids, GLP-1 and quality of life (QoL).

Results

Fifty-four participants of whom the majority were women [47 females; mean (SD) body mass index 35.3 (2.8) kg m−2; age = 52 (10) years] completed the 8-month programme. Mean (SD) weight loss was 10.1 (6.0) kg (P < 0.001). Out of 54 participants, 36 lost more than 7% of their body weight and 47 lost more than 5%, with significant improvements in cardiovascular risk factors, glycaemia and QoL scores. The fall was observed in basal (P < 0.05 versus baseline) but not stimulated GLP-1 levels. In the subgroup of participants losing >10 kg, a correlation was found between weight change and change in both basal (r = 0.61, P < 0.05) and stimulated (r = 0.49, P < 0.05) GLP-1.

Conclusions

An evidence-based lifestyle programme achieved sustained weight loss in obese first-degree relatives of individuals with type 2 diabetes associated with improvements in cardiometabolic risk factors and QoL without the ‘voltage drop’ of less benefit commonly seen when moving from the clinical trial experience into the real world.

Mediterranean diet screening tool for the USA

by Simon Langley-Evans

Evaluation of a dietary screener: the Mediterranean Eating Pattern for Americans tool

Cerwinske et al., JHND Early View

Background

Evidence exists for an association between accordance with a Mediterranean diet pattern and slower rates of cognitive decline. However, an ‘Americanised’ version of the Mediterranean diet screener is needed to assess accordance in the USA. Thus, the Mediterranean Eating Pattern for Americans (MEPA) tool was developed to assess accordance with a Mediterranean-like food pattern when time is limited. The present study aimed to determine whether the MEPA screener captured the key elements of the Mediterranean diet compared to the more comprehensive food frequency questionnaire (FFQ).

Methods

The study comprised a cross-sectional study in which 70 women completed both the VioScreen™ FFQ (Viocare, Princeton, NJ, USA) electronically and the 16-item MEPA screener, either electronically or by telephone, aiming to evaluate the inter-method reliability of the proposed screener. The convenience sample included patients (n = 49) and healthcare providers (n = 21) recruited from a tertiary care medical centre.

Results

The overall score from the MEPA screener correlated with corresponding overall MEPA FFQ score (ρ = 0.365, P = 0.002). Agreement between screener items and FFQ items was moderate-to-good for berries (κ = 0.47, P < 0.001), nuts (κ = 0.42, P < 0.001), fish (κ = 0.62, P < 0.001) and alcohol (κ = 0.64, P < 0.001), whereas those for olive oil (κ = 0.33, P = 0.001) and green leafy vegetables (κ = 0.36, P = 0.0021) were fair. Usual intakes of potassium, magnesium, vitamin C, saturated fat, selected carotenoids, folate and fibre derived from the FFQ varied with MEPA screener scores in the anticipated directions.

Conclusions

The MEPA screener captures several components of the Mediterranean style pattern, although further testing of the MEPA screener is indicated.

Predicting success in a weight loss trial

by Simon Langley-Evans

Using data mining to predict success in a weight loss trial

Batterham et al., JHND Early View

Background

Traditional methods for predicting weight loss success use regression approaches, which make the assumption that the relationships between the independent and dependent (or logit of the dependent) variable are linear. The aim of the present study was to investigate the relationship between common demographic and early weight loss variables to predict weight loss success at 12 months without making this assumption.

Methods

Data mining methods (decision trees, generalised additive models and multivariate adaptive regression splines), in addition to logistic regression, were employed to predict: (i) weight loss success (defined as ≥5%) at the end of a 12-month dietary intervention using demographic variables [body mass index (BMI), sex and age]; percentage weight loss at 1 month; and (iii) the difference between actual and predicted weight loss using an energy balance model. The methods were compared by assessing model parsimony and the area under the curve (AUC).

Results

The decision tree provided the most clinically useful model and had a good accuracy (AUC 0.720 95% confidence interval = 0.600–0.840). Percentage weight loss at 1 month (≥0.75%) was the strongest predictor for successful weight loss. Within those individuals losing ≥0.75%, individuals with a BMI (≥27 kg m–2) were more likely to be successful than those with a BMI between 25 and 27 kg m–2.

Conclusions

Data mining methods can provide a more accurate way of assessing relationships when conventional assumptions are not met. In the present study, a decision tree provided the most parsimonious model. Given that early weight loss cannot be predicted before randomisation, incorporating this information into a post randomisation trial design may give better weight loss results.

January 2017 

Older People

Vitamin D supplementation and its influence on muscle strength and mobility in community-dwelling older persons: a systematic review and meta-analysis (pages 3–15) H. Rosendahl-Riise, U. Spielau, A. H. Ranhoff, O. A. Gudbrandsen and J. Dierkes

The nutrition and food-related roles, experiences and support needs of female family carers of malnourished older rehabilitation patients (pages 16–26) S. Marshall, D. P. Reidlinger, A. Young and E. Isenring

Supplementation with nutrients modulating insulin-like growth factor-1 negatively correlated with changes in the levels of pro-inflammatory cytokines in community-dwelling elderly people at risk of undernutrition (pages 27–35) M. Kim, M. Kim, Y. J. Lee, H. J. Song, J. K. Shim, D. H. Chang, W. K. Yu, S.-H. Lee and J. H. Lee

Dietary guidelines

How much is ‘5-a-day’? A qualitative investigation into consumer understanding of fruit and vegetable intake guidelines (pages 105–113) C. Rooney, M. C. McKinley, K. M. Appleton, I. S. Young, A. J. McGrath, C. R. Draffin, L. L. Hamill and J. V. Woodside

Clinical nutrition

Patients with inflammatory bowel disease and their treating clinicians have different views regarding diet (pages 66–72) D. Q. Holt, B. J. Strauss and G. T. Moore

Adding glucose to food and solutions to enhance fructose absorption is not effective in preventing fructose-induced functional gastrointestinal symptoms: randomised controlled trials in patients with fructose malabsorption (pages 73–82) C. J. Tuck, L. A. Ross, P. R. Gibson, J. S. Barrett and J. G. Muir

Nutritional status of Vietnamese outpatients with chronic obstructive pulmonary disease (pages 83–89) D. Hogan, L. T. T. Lan, D. T. N. Diep, D. Gallegos and P. F. Collins

Dietary carbohydrate composition is associated with polycystic ovary syndrome: a case–control study (pages 90–97) G. Eslamian, A.-R. Baghestani, S. Eghtesad and A. Hekmatdoost

Patient adherence in following a prescribed diet and micronutrient supplements after laparoscopic sleeve gastrectomy: our experience during 1 year of follow-up (pages 98–104) L. Schiavo, G. Scalera, V. Pilone, G. De Sena, F. R. Ciorra and A. Barbarisi

Paediatrics

Validity of short food questionnaire items to measure intake in children and adolescents: a systematic review (pages 36–50) R. K. Golley, L. K. Bell, G.A. Hendrie, A.M. Rangan, A. Spence, S. A. McNaughton, L. Carpenter, M. Allman-Farinelli, A. de Silva, T. Gill, C.E. Collins, H. Truby, V. M. Flood and T. Burrows

Association between gestational weight gain and risk of obesity in preadolescence: a longitudinal study (1997–2007) of 5125 children in Greece (pages 51–58) S. P. Mourtakos, K. D. Tambalis, D. B. Panagiotakos, G. Antonogeorgos, C. D. Alexi, M. Georgoulis, G. Saade and L. S. Sidossis

Growth status of children with autism spectrum disorder: a case–control study (pages 59–65) K. Barnhill, A. Gutierrez, M. Ghossainy, Z. Marediya, C. N. Marti and L. Hewitson

December 2016

Weight and Health

Outcomes of a community-based weight management programme for morbidly obese populations (pages 669–676) L. Nield and S. Kelly

Implementing healthier foodservice guidelines in hospital and federal worksite cafeterias: barriers, facilitators and keys to success (pages 677–686) S. B. Jilcott Pitts, J. Graham, A. Mojica, L. Stewart, M. Walter, C. Schille, J. McGinty, M. Pearsall, O. Whitt, P. Mihas, A. Bradley and C. Simon

Setting targets leads to greater long-term weight losses and ‘unrealistic’ targets increase the effect in a large community-based commercial weight management group (pages 687–696) A. Avery, S. C. Langley-Evans, M. Harrington and J. A. Swift

Nutritional Assessment and Screening

Implementation of nutrition risk screening using the Malnutrition Universal Screening Tool across a large metropolitan health service(pages 697–703) P. L. Cooper, R. Raja, J. Golder, A. J. Stewart, R. F. Shaikh, M. Apostolides, J. Savva, J. L. Sequeira and M. A. Silver

Evaluation of the nutritional status of older hospitalised geriatric patients: a comparative analysis of a Mini Nutritional Assessment (MNA) version and the Nutritional Risk Screening (NRS 2002) (pages 704–713) S. Christner, M. Ritt, D. Volkert, R. Wirth, C. C. Sieber and K.-G. Gaßmann

Body composition and functional assessment of nutritional status in adults: a narrative review of imaging, impedance, strength and functional techniques (pages 714–732) S. Smith and A. M. Madden

Rehabilitation

Oral nutrition supplements reduce inflammatory cytokine concentrations in community-dwelling elderly  Kim et al., JHND

 Nutritional intervention as part of functional rehabilitation in older people with reduced functional ability: a systematic review and meta-analysis of randomised controlled studies (pages 733–745) A. M. Beck, E. Dent and C. Baldwin

Cancer

Meats, milk and fat consumption in colorectal cancer(pages 746–756) R. F. Tayyem, H. A. Bawadi, I. Shehadah, S. S. AbuMweis, L. M. Agraib, T. Al-Jaberi, M. Al-Nusairr, D. D. Heath and K. E. Bani-Hani

Dietary patterns and risk of colorectal adenoma: a systematic review and meta-analysis of observational studies (pages 757–767) J. Godos, F. Bella, A. Torrisi, S. Sciacca, F. Galvano and G. Grosso

A prospective study comparing prophylactic gastrostomy to nutritional counselling with a therapeutic feeding tube if required in head and neck cancer patients undergoing chemoradiotherapy in Thai real-world practice (pages 768–776) P. Pramyothin, S. Manyanont, A. Trakarnsanga, J. Petsuksiri and S. Ithimakin

Infancy

Fortifying cows milk may be an effective approach to improve vitamin D status in preschool infants. Kehoe et al., JHND

The accuracy of dietary recall of infant feeding and food allergen data (pages 777–785) Z. van Zyl, K. Maslin, T. Dean, R. Blaauw and C. Venter

Taste preference, food neophobia and nutritional intake in children consuming a cows’ milk exclusion diet: a prospective study (pages 786–796) K. Maslin, K. Grimshaw, E. Oliver, G. Roberts, S. H. Arshad, T. Dean, J. Grundy, G. Glasbey and C. Venter - The Prof's Pick for December

Nutrition and Metabolism

The effect of soy or isoflavones on homocysteine levels: a meta-analysis of randomised controlled trials(pages 797–804) X. Song, R. Zeng, L. Ni and C. Liu          

Favourable effects of DASH diet on polycystic ovary syndrome

by Simon Langley-Evans

Effects of Dietary Approach to Stop Hypertension diet on androgens, antioxidant status and body composition in overweight and obese women with polycystic ovary syndrome: a randomised controlled trial

Azadi-Yazdi et al., JHND Early View

Background Polycystic ovary syndrome (PCOS) is the most common endocrine disease in reproductive age women. The present study aimed to determine the effects of Dietary Approaches to Stop Hypertension (DASH) diet on reproductive hormones, plasma total antioxidant status and anthropometric indices in overweight and obese PCOS women.

Methods In this randomised controlled clinical trial, 60 women with PCOS were randomly assigned to one of two diets with energy restriction: the DASH diet and a control diet. The DASH and control diets consisted of 50–55% carbohydrate, 15–20% protein and 25–30% total fat. The DASH diet was designed to be rich in vegetables, fruits, whole grains and low-fat dairy products, as well as low in saturated fats, cholesterol, refined grains and sweets. In the present study, the anthropometric indices, body composition, total testosterone, androstenedione, sex hormone binding globulin (SHBG), free androgen index and 2,2′-diphenyl-1-picryylhydrazyl (DPPH) scavenging activity were measured before and after 3 months.

Results The consumption of DASH diet compared to the control diet was associated with a significant reduction in weight [−5.78 (1.91) kg versus −4.34 (2.87) kg, P = 0.032], body mass index (BMI) [−2.29 (0.15) kg m–2 versus −1.69 (0.20) kg m–2, P = 0.02], fat mass [−3.23(1.66) kg versus −2.13 (1.26) kg, P = 0.008] and serum androstenedione [−1.75 (1.39) ng mL–1 versus −1.02 (0.72) ng mL–1, P-value = 0.019]. Increased concentrations of SHBG [28.80 (21.71) versus 11.66(18.82) nmol L–1, P = 0.003) and DPPH scavenging activity [30.23% (19.09) versus 12.97% (25.12) were also found in the DASH group.

Conclusions The DASH diet could improve weight loss, BMI and fat mass. Furthermore, it could result in a significant reduction in serum androstenedione and a significant increase in antioxidant status and SHBG.

Variable advice from dietitians on carbohydrate

by Simon Langley-Evans

Dietitians' practice in giving carbohydrate advice in the management of type 2 diabetes: a mixed methods study

McArdle et al., JHND Early View

Background Carbohydrate is accepted as the principal nutrient affecting blood glucose in diabetes; however, current guidelines are unable to specify the optimal quantity of carbohydrate for glycaemic control. No studies exist that describe current practice amongst healthcare professionals giving carbohydrate advice in type 2 diabetes. The present study aims to improve understanding of the degree of variation in the current practice of UK registered dietitians (RDs) by describing how RDs advise patients.

Methods UK RDs were contacted through national networks and asked to complete an online survey, which was analysed using stata, version 12 (StataCorp, College Station, TX, USA). Three consultations between dietitians and patients with type 2 diabetes were observed, followed by semi-structured interviews with the dietitians.

Results In total, 320 complete survey responses were received. Dietitians' advice varied according to expertise, training and confidence, and the complexity of the patient's blood glucose treatment. Some 48% (n = 154) of respondents advised patients to restrict carbohydrate intake either occasionally or frequently, with 35.6% (n = 114) considering 30–39% of total energy from carbohydrate to be a realistic expectation. The overall theme from the interviews was ‘Conflicting Priorities’, with three sub-themes: (i) how treatment decisions are made; (ii) the difference between empowerment and advice; and (iii) contradictory advice. A disparity existed between what was observed and interview data on how dietitians rationalise the type of carbohydrate advice provided.

Conclusions Dietitians' advice varies for a number of reasons. Consensus exists in some areas (e.g. carbohydrate awareness advice); however, clear definitions of such terms are lacking. Clarification of interventions may improve the consistency of approach and improve patient outcomes.

n-6 and n-3 fatty acids and the metabolic syndrome

by Simon Langley-Evans

Omega-6 polyunsaturated fatty acids, serum zinc, delta-5- and delta-6-desaturase activities and incident metabolic syndrome

Yary et al., JHND Early View

Background The associations of n-6 polyunsaturated fatty acids (PUFA) with metabolic syndrome have been poorly explored. We investigated the associations of the serum n-6 PUFA and the activities of enzymes involved in the PUFA metabolism, delta-5-desaturase (D5D) and delta-6-desaturase (D6D) with risk of incident metabolic syndrome. We also investigated whether zinc, a cofactor for these enzymes, modifies these associations.

Methods A prospective follow-up study was conducted on 661 men who were aged 42–60 years old at baseline in 1984–1989 and who were re-examined in 1998–2001.

Results Men in the highest versus the lowest serum total omega-6 PUFA tertile had a 70% lower multivariate-adjusted risk of incident metabolic syndrome [odds ratio (OR) = 0.30; 95% confidence interval (CI) = 0.18–0.51, Ptrend < 0.001]. Inverse associations were also observed for linoleic acid, arachidonic acid and D5D activity. By contrast, men in the highest tertile of D6D activity had an 84% higher risk (OR = 1.84; 95% CI = 1.15–2.94, Ptrend = 0.008). Similar associations were observed with many of the metabolic syndrome components at the re-examinations. Most associations were attenuated after adjustment for body mass index. Finally, the associations of D6D and LA were stronger among those with a higher serum zinc concentration.

Conclusions Higher serum total n-6 PUFA, linoleic acid and arachidonic acid concentrations and D5D activity were associated with a lower risk of developing metabolic syndrome and higher D6D activity was associated with a higher risk. The role of zinc also needs to be investigated in other populations.

Comparisons of physical activity, adipokines, vitamin D status and dietary vitamin D intake among adolescents

Virecoulon Giudici et al., JHND Early View

Background Considering that lifestyle and diet are key factors responsible for the increases in adiposity in youth, it is important to understand how vitamin D, adipokines and markers of glucose metabolism are related to physical activity level (PAL) during growth. The present study aimed to investigate associations between physical activity level, adiponectin/leptin ratio, vitamin D status and dietary vitamin D intake among adolescents.

Methods A cross-sectional study was conducted with adolescents aged 14–18 years old who were living in São Paulo, Brazil. Serum 25 hydroxyvitamin D [25(OH)D], adiponectin (A), leptin (L), glucose and insulin were obtained after 12 h of fasting. Dietary calcium and vitamin D intake were measured by 24-h food record, as repeated in 62.6% of the sample. PAL was measured by the International Physical Activity Questionnaire (IPAQ). Pearson's chi-square test, Pearson correlation and linear regression analysis were performed.

Results A total of 198 subjects, mean (SD) age 16.3 (1.4) years, 51% male, were enrolled in the study. Some 9% of participants were sedentary, 22% were insufficiently active (IA), 51% were active and 18% were very active (VA). The A/L ratio was lower among sedentary/IA subjects [2.2 (4.0) versus 5.6 (12.3); P = 0.01] compared to active/VA subjects. PAL was not associated with vitamin D status or markers of glucose metabolism. Serum 25(OH)D positively associated with vitamin D intake, after adjusting for sex, sun exposure and season of the year in regression analysis (partial r2=0.026, P = 0.02).

Conclusions Low PAL was associated with a lower A/L ratio. Vitamin D status was not associated with sun exposure habits, although it was positively correlated with vitamin D intake.

An evaluation of diabetes targeted apps for Android smartphone in relation to behaviour change techniques

Hoppe et al., JHND Early View

Background Mobile applications (apps) could support diabetes management through dietary, weight and blood glucose self-monitoring, as well as by promoting behaviour change. The present study aimed to evaluate diabetes apps for content, functions and behaviour change techniques (BCTs).

Methods Diabetes self-management apps for Android smartphones were searched for on the Google Play Store. Ten apps each from the following search terms were included; ‘diabetes’, ‘diabetes type 1’, ‘diabetes type 2’, ‘gestational diabetes’. Apps were evaluated by being scored according to their number of functions and BCTs, price, and user rating.

Results The mean (SD) number of functions was 8.9 (5.9) out of a possible maximum of 27. Furthermore, the mean (SD) number of BCTs was 4.4 (2.6) out of a possible maximum of 26. Apps with optimum BCT had significantly more functions [13.8; 95% confidence interval (CI) = 11.9–15.9] than apps that did not (4.7; 95% CI = 3.2–6.2; P < 0.01) and significantly more BCTs (5.8; 95% CI = 4.8–7.0) than apps without (3.1; 95% CI = 2.2–4.1; P < 0.01). Additionally, apps with optimum BCT also cost more than other apps. In the adjusted models, highly rated apps had an average of 4.8 (95% CI = 0.9–8.7; P = 0.02) more functions than lower rated apps.

Conclusions ‘Diabetes apps’ include few functions or BCTs compared to the maximum score possible. Apps with optimum BCTs could indicate higher quality. App developers should consider including both specific functions and BCTs in ‘diabetes apps’ to make them more helpful. More research is needed to understand the components of an effective app for people with diabetes.    

Compliance with dietary guidelines following laparoscopic sleeve gastrectomy

Patient adherence in following a prescribed diet and micronutrient supplements after laparoscopic sleeve gastrectomy: our experience during 1 year of follow-up

Schiavo et al., JHND Early View

Background One of the most effective surgeries for sustainable weight loss in morbidly obese patients is laparoscopic sleeve gastrectomy (LSG). The present study aimed to assess the adherence of LSG patients with respect to following post-operative dietary requirements and micronutrient supplementation, as well as to investigate their perceived barriers in achieving optimal adherence.

Methods Retrospective data analysis was performed (3, 6, 9 and 12 months after LSG) using the medical records of 96 morbidly obese patients who had undergone LSG at our institution during 2011–2013. Data collected from patient records were: adherence to prescribed diet; adherence to prescribed consumption of fruit, vegetables, legumes and cereals; use of prescribed micronutrient supplements; and barriers to diet and micronutrient therapy adherence. Data were analysed using spss, version 14.0 (SPSS Inc., Chicago, IL, USA).

Results At 3, 6, 9 and 12 months post-LSG, the rates of patient non-adherence to a prescribed diet were 39%, 45%, 51% and 74%, respectively. In particular, there was a low consumption of fruit, vegetables, legumes and cereals compared to the post-surgery prescription. In addition, the rates of patient non-adherence to prescribed micronutrient supplements at 3, 6, 9 and 12 months post-LSG were 43%, 51%, 59% and 67%, respectively. The main reasons for patient non-adherence to diet were poor self-discipline (72%) and poor family support (11%) whereas difficulty swallowing pills or capsules (61%) and cost (20%) were reported as the main barriers to post-LSG adherence.

Conclusions Morbidly obese patients who have undergone LSG do not follow exactly the post-operative dietary guidelines, including micronutrient therapy.

Cognitive outcomes of food based anthocyanin interventions

Food-based anthocyanin intake and cognitive outcomes in human intervention trials: a systematic review Kent et al., JHND Early View

Background Preclinical evidence suggests that the anthocyanins, which comprise a subclass of dietary flavonoids providing the purple and red pigmentation in plant-based foods, may have a beneficial impact on cognitive outcomes.

Methods A systematic review was conducted to identify the published literature on food-based anthocyanin consumption and cognitive outcomes in human intervention trials. The literature search followed PRISMA guidelines and included six databases, as well as additional hand searching.

Results Seven studies were included in this review, comprising acute trials (n = 4) and longer-term (n = 3) interventions that assessed multiple cognitive outcomes in children, adults and older adults with cognitive impairment. Six of seven studies reported improvements in either a single, or multiple, cognitive outcomes, including verbal learning and memory, after anthocyanin-rich food consumption. As a result of methodological limitations and the large clinical and methodological diversity of the studies, the pooling of data for quantitative analysis was not feasible.

Conclusions The impact of food-based anthocyanin consumption on both acute and long-term cognition appears promising. However, adequately powered studies that include sensitive cognitive tasks are needed to confirm these findings and allow the translation of research into dietary messages.

Alternative Healthy Eating Index as a predictor of cardiovascular disease

Evaluation of the Alternative Healthy Eating Index as a predictor of 10-year cardiovascular disease risk in a group of Iranian employees Hariri et al., JHND Early View

Background Noncommunicable diseases, of which almost half are some form of cardiovascular disease (CVD), have overtaken communicable diseases as the world’s major disease burden. There is growing evidence that indices of diet quality could have an association with a decreased risk of CVD in several countries. We aimed to examine the association between diet quality, as measured by the Alternative Healthy Eating Index (AHEI), and 10-year predicted CVD risk based on the Framingham Risk Score (FRS) in a group of Iranian employees.

Methods A cross-sectional descriptive study was conducted on 296 (232 male, 64 female) employees aged ≥30 years selected by nonrandom sampling. AHEI was calculated according to a food frequency questionnaire with complementary questions on intake of cooking fats and oils among households. The 10-year risk of CVD was calculated based on FRS. Total and high-density lipoprotein-cholesterol, fasting blood sugar and blood pressure were measured to help in the calculation of FRS.

Results AHEI did not have a significant relationship with FRS (r = −0.02, P = 0.67). However, some of its components, such as the intake of nuts and soy groups (r = −0.11, P = 0.04) and fruits (r = −0.14, P= 0.01), had a significant relationship with a reduced risk of CVD. According to stepwise multiple linear regression results, for every single increase in the intake of fruit servings, there would be a 0.14 reduction in the 10-year CVD risk score (β = −0.14, P = 0.01).

ConclusionsThe present study showed no significant relationship between AHEI and the 10-year predicted risk of CVD among Iranian employees.

Downward trend in consumption of added sugar in Australian adults

Trends in added sugar intake and food sources in a cohort of older Australians: 15 years of follow-up from the Blue Mountains Eye Study

Moshtaghian et al., JHND Early View

Background The trend of added sugar (AS) intake has not been investigated in the Australian population, including in older adults. The present study aimed to assess trends and food sources of AS intake among a cohort of older Australians during 15 years of follow-up.

Methods Dietary data from participants of the Blue Mountains Eye Study (1264 men and 1614 women), aged ≥49 years at baseline, were collected. Dietary intakes were assessed at 5-yearly intervals (1992–94 to 2007–09) using a 145-item food frequency questionnaire (FFQ). AS content of FFQ food items was estimated using a stepwise systematic method. Trends for AS intake between baseline and the three follow-up periods were assessed using linear mixed modelling.

Results In men, the mean (SEM) percentage of energy provided by AS intake (EAS%) declined from 10.4% (0.1%) at baseline to 9.4% (0.2%) at 15-year follow-up (Ptrend = 0.028). Women’s mean (SEM) EAS% intake at baseline and 15-year follow-up was 9.2% (0.1%) and 8.8% (0.2%), respectively (Ptrend = 0.550). EAS% intake of men was significantly higher than that of women for 10 years (P < 0.05). Sugar products (table sugar, syrup, jam and honey) were the major sources of AS at all-time points and contributed to more than 40% and 35% of AS intake in men and women, respectively. Intake of sugar products decreased in men during follow-up (Ptrend < 0.001).

Conclusions An overall downward trend was observed in AS intake in both genders, however, was only significant for men during 15 years of follow-up. Table sugar and sugar-containing spreads represent the major source of AS in this cohort of older Australians.

Clinical evaluation of obese teenagers-relating anthropometry to disease risk indicators

Body composition of obese adolescents: association between adiposity indicators and cardiometabolic risk factors

Araujo et al., JHND Early View

Background - The association between obesity during adolescence and the increased risk of cardiometabolic diseases indicates the need to identify reproducible and cost effective methods for identifying individuals who are at increased risk of developing diseases. The present cross-sectional study investigated the occurrence of metabolic consequences of obesity in adolescents and the use of adiposity indicators as predictors of cardiometabolic risk.

Methods - A fasting blood sample was taken in 93 pubertal obese adolescents aged 13–18 years old (39 males, 54 females) for the assessment of cardiometabolic risk markers (glucose, lipid profiles, insulin resistence, and inflammatory and endothelial dysfunction markers). Together with anthropometry, total fat mass and lean mass were determined by dual-energy X-ray absorptiometry (DXA).

Results - The prevalence of dyslipidaemia and disorders in glucose metabolism are noticeably higher in the present study. There was no correlation between the percentage of body fat according to DXA and most indicators of adiposity. For boys, the arm circumference values predicted the increase in fasting insulin (r² = 0.200), homeostasis model assessment of insulin resistance (r² = 0.267) and cardiometabolic risk score (r² = 0.338). The percentage of body fat according to DXA predicted the inflammation score (r² = 0.172). For girls, body mass index was the parameter that best described the variability of fasting insulin (r² = 0.079) and inflammation score (r² = 0.263). The waist-to-stature ratio was able to predict the triglyceride values (r² = 0.090).

Conclusions - Anthropometric measures of adiposity, such a body mass index, waist-to-stature ratio, arm circumference and waist circumference,should be considered in the clinical evaluation of obese adolescents.

Development and validation of a quantitative snack and beverage food frequency questionnaire for adolescents

De Cock et al., JHND Early View

Background - A short, reliable and valid tool to measure snack and beverage consumption in adolescents, taking into account the correct definitions, would benefit both epidemiological and intervention research. The present study aimed to develop a short quantitative beverage and snack food frequency questionnaire (FFQ) and to assess the reliability and validity of this FFQ against three 24-h recalls.

Methods - Reliability was assessed by comparing estimates of the FFQ administered 14 days apart (FFQ1 and FFQ2) in a convenience sample of 179 adolescents [60.3% male; mean (SD) 14.7 (0.9) years]. Validity was assessed by comparing FFQ1 with three telephone-administered 24-h recalls in a convenience sample of 99 adolescents [52.5% male, mean (SD) 14.8 (0.9) years]. Reliability and validity were assessed using Bland–Altman plots, classification agreements and correlation coefficients for the amount and frequency of consumption of unhealthy snacks, healthy snacks, unhealthy beverages, healthy beverages, and for the healthy snack and beverage ratios.

Results - Small mean differences (FFQ1 versus FFQ2) were observed for reliability, ranking ability ranged from fair to substantial, and Spearman coefficients fell within normal ranges. For the validity, mean differences (FFQ1 versus recalls) were small for beverage intake but large for snack intake, except for the healthy snack ratio. Ranking ability ranged from slightly to moderate, and Spearman coefficients fell within normal ranges.

Conclusions - Reliability and validity of the FFQ for all outcomes were found to be acceptable at a group level for epidemiological purposes, whereas for intervention purposes only the healthy snack and beverage ratios were found to be acceptable at a group level.

Adherence to the Healthy Eating Index and Alternative Healthy Eating Index dietary patterns and mortality from all causes, cardiovascular disease and cancer: a meta-analysis of observational studies

Onvani et al., JHND Early View

Background - This meta-analysis investigated the association of diet quality indices, as assessed by HEI and AHEI, and the risk of all-cause, cardiovascular and cancer mortality.

Methods - We used PubMed, ISI Web of Science and Google Scholar to search for eligible articles published before July 2015. A total of 12 cohort studies (38 reports) and one cross-sectional study (three reports) met the inclusion criteria and were included in our meta-analysis.

Results - The highest level of adherence to the Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) was significantly associated with a reduced risk of all-cause mortality [relative risk (RR) = 0.77, 95% confidence intterval (CI) = 0.76–0.78], cardiovascular mortality (RR = 0.77, 95% CI = 0.74–0.80) and cancer mortality (RR = 0.83, 95% CI = 0.81–0.86). Egger regression tests provided no evidence of publication bias.

Conclusions - The present study indicates that high adherence to HEI and AHEI dietary patterns, indicating high diet quality, are associated with reduced risk of all-cause mortality (as well as cardiovascular mortality and cancer mortality).