Journals update

Posts on Journal of Human Nutrition and Dietetics Notes

October 2018

Two fatty fish meals per week may be a strategy for reducing airway inflammation in childhood asthma.

by Simon Langley-Evans

Efficacy of a Mediterranean diet supplemented with fatty fish in ameliorating inflammation in paediatric asthma: a randomised controlled trial Papamichael et al., JHND Early View

Background

Childhood asthma is the most common respiratory disorder worldwide, being associated with increased morbidity and a decreased quality of life. Omega‐3 fatty acids have anti‐inflammatory and immunomodulating properties; however, their efficacy in asthma is controversial. The present study aimed to examine the efficacy of a Mediterranean diet supplemented with a high omega‐3 ‘fatty’ fish intake in Greek asthmatic children.

Methods

A single‐centred, 6‐month, parallel randomised controlled trial compared the consumption of a Mediterranean diet supplemented with two meals of 150 g of cooked fatty fish weekly (intervention) with the usual diet (control) with respect to pulmonary function in children (aged 5–12 years) with mild asthma. Pulmonary function was assessed using spirometry and bronchial inflammation by fractional exhaled nitric oxide analysis.

Results

Sixty‐four children (52% male, 48% female) successfully completed the trial. Fatty fish intake increased in the intervention group from 17 g day−1 at baseline to 46 g day−1 at 6 months (P < 0.001). In the unadjusted analysis, the effect of the intervention was of borderline significance (P = 0.06, β = −11.93; 95% confidence interval = −24.32 to 0.46). However, after adjusting for age, sex, body mass index and regular physical activity, a significant effect was observed (P = 0.04, β = −14.15 ppb; 95% confidence interval = −27.39 to −0.91). No difference was observed for spirometry, asthma control and quality of life scores.

Conclusions

A Mediterranean diet supplemented with two fatty fish meals per week might be a potential strategy for reducing airway inflammation in childhood asthma. Future robust clinical trials are warranted to replicate and corroborate these findings.

Improving the nutritional intake of hospital patients: how far have we come?

by Simon Langley-Evans

Improving the nutritional intake of hospital patients: how far have we come? A re‐audit Beavan et al., JHND Early View

Background

Malnutrition affects up to 33.6% of hospitalised patients, with consequences that are detrimental for both patients and healthcare providers. In 2015, an audit demonstrated inadequate nutritional provision and consumption by hospitalised patients, comprising a major risk factor for malnutrition. This re‐audit evaluates whether patients are meeting recommended energy and protein standards and estimated individual requirements, subsequent to food service improvements since 2015.

Methods

Patients (n = 111) were included from a South West hospital, and Malnutrition Universal Screening Tool scores (MUST) categorised patients as ‘nutritionally well’ (MUST 0) or ‘nutritionally vulnerable’ (MUST ≥ 1). Individual energy and protein requirements were estimated using weight‐based equations. Nutritional intakes were assessed via 24‐h dietary recall and compared against the British Dietetic Association's Nutrition and Hydration Digest standards, as well as estimated individual requirements.

Results

In total, the Digest standards for energy and protein were met by 35% and 63% of patients respectively, which is an increase of 19% and 36% since 2015. ‘Nutritionally well’ patients were more likely to meet nutrient standards for protein (62%) than estimated individual requirements (30%) (P ≤ 0.001). ‘Nutritionally vulnerable’ patients were more likely to meet estimated individual requirements for energy (60%) than the Digeststandards (30%) (P = 0.047).

Conclusions

The proportion of patients meeting the Digest standards has increased considerably following numerous food service changes. Nutritional training for housekeepers, energy/protein‐dense snacks and drinks, and fortified dietary items may further increase nutritional intakes. Additionally, as a result of discrepancies between the Digest standards and individual estimated requirements, more research is required to identify the most appropriate auditing standards that reflect best practice.

Dietetics students’ experiences of dietetics workforce preparation and preparedness: a systematic review and qualitative synthesis

Morgan et al., JHND Early ViewEarly View

Background

Dietetics students are a widely researched group. As emerging dietitians, they can provide valuable insights to inform how dietetics education programmes may be enhanced to meet contemporary healthcare needs. This review aimed to systematically synthesise dietetics students’ experiences of dietetics workforce preparation.

Methods

MEDLINE, CINAHL, Embase, PsycINFO, ERIC, Informit and ProQuest Dissertations and Theses Global were searched to identify research published until June 2017. Studies investigating dietetics students’ experiences of dietetics workforce preparation, and employing qualitative data collection and analysis methods were included. Data analysis was guided by thematic synthesis, where themes were constructed through an iterative and inductive process. Study quality was appraised using the RATS Qualitative Research Review Guidelines.

Results

From the 3301 records identified, five studies met the inclusion criteria and the views of 120 dietetics students from two countries over a 9‐year period were synthesised. The overarching theme of ‘navigating through the ups and downs’ was underpinned by four main themes: enduring hurdles; reconciling expectations; transforming self; and making and breaking connections. Quality appraisal results rated selection bias as being inadequate/inappropriate across all studies.

Conclusions

Dietetics students undertake a transformational journey through dietetics education. They are inspired by seeing what is possible through meaningful encounters with practitioners in diverse settings. However, they are challenged by competitive environments and perceived ideals that are embedded in the profession. Strategies that focus on exposing dietetics students to inspirational practitioners, increasing and celebrating diversity in academic/placement settings, and incentivising collaboration across dietetics education, could act as catalysts to enhance the experience of future dietetics students and the nutrition‐related health of those they will serve.

Ethnic differences in body image perception in patients with type 2 diabetes

by Simon Langley-Evans

Ethnic differences in body image perception in patients with type 2 diabetes Toselli et al., JHND Early View

Background

The present study compared the prevalence of obesity, fat distribution, body image perception and lifestyle among diabetic African and Albanian immigrants living in Italy, as well as diabetic Italians, aiming to identify health risks and their possible causes.

Methods

The study sample consisted of 200 diabetic subjects living in Italy. A questionnaire regarding socio‐demographic and lifestyle information was administered to participants, and anthropometric measurements and body image perception were assessed. Proper perception of weight status and the degree of dissatisfaction in body image perception were valued.

Results

Italians showed a higher health risk, both with regard to anthropometric characteristics and lifestyle, whereas African immigrants showed a lower one. All of the male groups underestimated their weight and Albanians were the most dissatisfied. Women perceived their current body image as heavier than their desired body image, showing a dissatisfaction toward their weight. Subjects of both sexes belonging to the overweight and obese categories generally underestimated themselves; this was particularly true in obese Africans. People with a higher body mass index were more likely to be dissatisfied than those with a lower one. Body image dissatisfaction increased when people estimated themselves as being overweight. Among lifestyle habits, being an ex‐smoker increased body image dissatisfaction.

Conclusions

The underestimation of weight detected in the present study requires attention. Nevertheless, the high percentage of overweight/obese people, coupled with the higher frequency of people dissatisfied with their high weight, suggests an awareness of the problem that could be more effective for weight loss.

Protein and energy-enriched formula enhances weight gain in critically ill infants

by Simon Langley-Evans

Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay Eveleens et al., JHND Early View

Background

Reaching an optimal nutritional intake is challenging in critically ill infants. One possible way to minimise nutritional deficits is the use of protein and energy‐enriched (PE)‐formulas. We aimed to describe weight achievement and gastrointestinal symptoms in infants admitted to the paediatric intensive care unit (PICU) while receiving PE‐formula for a prolonged period.

Methods

Records from infants admitted to a multidisciplinary PICU and using PE‐formula were analysed retrospectively. Infants were eligible if they received PE‐formula daily for at least 2 weeks. Weight achievement was determined as the difference between weight‐for‐age (WFA) Z‐scores at the start and end of PE‐formula use. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters.

Results

Seventy infants with a median [interquartile range (IQR)] age of 76 (30–182) days were eligible. The PICU duration was 50 (35–83) days during which they received PE‐formula for 30 (21–54) days. Predominant admission diagnoses were post‐cardiac surgery, respiratory and cardiac diagnosis. A significant mean (SD) WFA Z‐score increase of 0.48 (1.10) (P < 0.001) and a median (IQR) weight gain of 5.80 (3.28–9.04) g kg−1 day−1 was observed. Multivariate regression showed that a lower WFA Z‐score at start was associated with a higher WFA Z‐score increase during PE‐formula use (β −0.35 (95% confidence interval = −0.50 to −0.19); P < 0.001). The maximum 24‐h gastric residual volume was 8.1 mL (IQR = 2.2–14.3) for each 1 kg in bodyweight. Three (4%) infants were treated for diarrhoea and three infants were treated for vomiting.

Conclusions

The majority of infants with a prolonged PICU stay showed weight improvement when using PE‐formula. PE‐formula was well tolerated because gastrointestinal symptoms only occurred in few infants.

Efforts are needed for a more widespread and comprehensive assessment of different issues related to street food availability and consumption

by Simon Langley-Evans

Street food research worldwide: a scoping review Abrahale et al., JHND Early View

Background

Street foods vary with respect to their nutritional value and safety characteristics and contribute to a sizable proportion of food intake in many populations worldwide. Therefore, the present study aimed to describe the coverage in the scientific literature of different health‐related and socio‐economic aspects of street food consumption and trading.

Methods

Three electronic databases (searched from inception to 16 October 2017), a hand‐search of relevant journals and backward citation tracking were used to identify eligible scientific articles with a main objective of investigating or reporting specific results on health‐related or socio‐economic aspects of street food. Papers published in English, Portuguese, French, Spanish or Italian, as well as English abstracts of papers published in other languages, were assessed. The selected articles were evaluated by two independent researchers and described according to year of publication, geographical distribution, definition of street food, main topics addressed and target population.

Results

In total, 441 papers were selected. The number of publications has increased in recent years, almost half of them being published after 2012. Almost three‐quarter of the articles were from Africa or Asia. Most studies addressed food safety (85.5%), whereas street food availability and consumption were much less frequently investigated (30.3%). The focus of the studies was usually the food (mostly its microbiological contamination) and the vendors (mostly their food handling), whereas consumers and vending sites were seldom evaluated. More than half of the studies did not specify a definition for street food.

Conclusions

Efforts are needed for a more widespread and comprehensive assessment of different issues related to street food availability and consumption in different settings, especially regarding street food offer, nutritional composition, and patterns of purchase and consumption by the population.

Nutrition interventions have a significant effect on non-cancer pain reduction

by Simon Langley-Evans

A systematic review and meta‐analysis of nutrition interventions for chronic noncancer pain Brain et al., JHND Early View

Background

This systematic review aimed to evaluate the impact of nutrition interventions on participant reported pain severity and intensity in populations with chronic pain.

Methods

Eight databases were systematically searched for studies that included adult populations with a chronic pain condition, a nutrition intervention and a measure of pain. Where possible, data were pooled using meta‐analysis. Seventy‐one studies were included, with 23 being eligible for meta‐analysis.

Results

Studies were categorised into four groups: (i) altered overall diet with 12 of 16 studies finding a significant reduction in participant reported pain; (ii) altered specific nutrients with two of five studies reporting a significant reduction in participant reported pain; (iii) supplement‐based interventions with 11 of 46 studies showing a significant reduction in pain; and (iv) fasting therapy with one of four studies reporting a significant reduction in pain. The meta‐analysis found that, overall, nutrition interventions had a significant effect on pain reduction with studies testing an altered overall diet or just one nutrient having the greatest effect.

Conclusions

This review highlights the importance and effectiveness of nutrition interventions for people who experience chronic pain

Vitamin D supplementation does not have a detrimental effect on mobility in older adults

by Simon Langley-Evans

Dear Editor,

Rosendahl-Riise et al [1] carried out a meta-analysis of the impact of vitamin D supplements on strength and mobility (assessed by the timed-up-and-go; TUG) in free-living older adults. Contrary to the findings from a previous meta-analysis [2], the authors surprisingly reported, in the abstract and conclusion, an overall negative effect of vitamin D on mobility. However, Figure 3 shows that the overall TUG score mean difference is in favor of the intervention; opposite to having deteriorated, the score improved by 0.31 seconds (i.e. less time to complete the test).

The meta-analysis by Rosendahl-Riise et al has generated interest and is an important contribution to the field of vitamin D and musculoskeletal health as it may inform guiding recommendations. Therefore, the erroneous data interpretation as stated in the abstract as well as in the conclusion should be corrected.

The author did not declare any conflicts of interest.

Anne-Julie Tessier, RD

PhD student

School of Human Nutrition, McGill University

Research Institute, McGill University Health Center

Montreal, QC H4A 3J1

References

1. Rosendahl-Riise, H.; Spielau, U.; Ranhoff, A.H.; Gudbrandsen, O.A.; Dierkes, J. Vitamin d supplementation and its influence on muscle strength and mobility in community dwelling older persons: A systematic review and meta-analysis. J Hum Nutr Diet 2017, 30, 3-15. DOI: 10.1111/jhn.12394.

2. Muir, S.W.; Montero-Odasso, M. Effect of vitamin d supplementation on muscle strength, gait and balance in older adults: A systematic review and meta-analysis. J Am Geriatr Soc 2011, 59, 2291-2300. DOI: 10.1111/j.1532-5415.2011.03733.x.

A medical recommendation of a gluten‐free diet fails to acknowledge the difficulties those with coeliac disease experience in the current gluten‐free landscape.

by Simon Langley-Evans

Experiences of coeliac disease in a changing gluten‐free landscape King et al., JHND Early View

Background

Coeliac disease is an autoimmune disorder triggered by the ingestion of gluten. In recent years, there has been considerable increase in the availability of gluten‐free products in North America. The present study investigated how the recent proliferation of the gluten‐free industry has affected individuals living with coeliac disease, with a primary focus on their social lives and relationships.

Methods

Interpretive phenomenology was utilised for study design and analysis. Semi‐structured interviews were conducted with 17 adults diagnosed with coeliac disease in Calgary, Alberta. Interviews were audio recorded and then transcribed for analysis.

Results

People living with coeliac disease experience the growth of the gluten‐free industry as a ‘double‐edged sword’. Although they are grateful for more palatable gluten‐free options, they are increasingly faced with misunderstandings about the severity of coeliac disease as a result of many noncoeliac disease individuals subscribing to the gluten‐free diet. This ‘double‐edged sword’ made certain types of social situations more easily manageable (e.g. more gluten‐free options available at restaurants), whereas others produced distress (e.g. increased risk of inadvertently consuming gluten). Participants also felt they may be perceived or even perceived themselves differently (e.g. felt high maintenance). To help mitigate these social ramifications of following the gluten‐free diet, participants utilised various strategies.

Conclusions

The sole medical recommendation of a gluten‐free diet fails to acknowledge the ongoing difficulties those with coeliac disease can endure in the current gluten‐free landscape. Recommendations beyond the gluten‐free diet are advisable to alleviate many of the indirect burdens revealed in the present study.

September 2018

Oral nutrition support interventions for patients who are malnourished or at risk of malnutrition

by Simon Langley-Evans

Oral nutrition support interventions for patients who are malnourished or at risk of malnutrition: a survey of clinical practice amongst UK dietitians Gibbs et al., JHND Early View

Background

Guidance on choosing oral nutritional support strategies varies and the evidence for different approaches is discordant. The present study aimed to examine opinion and practice in the use of oral nutritional support amongst UK dietitians and to assess the factors that influence these clinical decisions.

Methods

The study comprised a cross‐sectional, anonymous, national survey of UK dietitians.

Results

There were 207 completed responses (3% response rate). More dietitians reported using combined approaches (COMB) [n = 129 (62%)] over food‐based (FB) strategies [n = 70 (34%)] or oral nutritional supplements (ONS) alone [n = 8 (4%)] (N = 207, P < 0.001). Intervention choice was associated with clinical setting and clinical speciality; community dietitians reported more frequent use of FB or ONS alone [n = 48 (59%)] versus COMB [n = 34 (41%)] compared to acute dietitians [COMB: n = 83 (78%) COMB versus FB or ONS alone: n = 24 (22%)] (N = 207, P < 0.0001). Specialist nutrition support dietitians reported more frequent use of FB or ONS alone [n = 22 (54%)] versus COMB [n = 19 (46%)] compared to nonspecialists [FB or ONS alone: n = 17 (45%) versus COMB: n = 21 (55%)] and other specialist dietitians [FB or ONS: n = 39 (30%) alone versus COMB: n = 89 (70%)] (P = 0.017). The greatest influences on choice were ease of implementation [n = 192 (93%)], departmental protocols [n = 184 (89%)], professional management pathways [n = 179 (87%)] and published research [n = 165 (80%)]. Patient circumstances [n = 117 (57%) and n = 99 (48%)] and ease of implementation [n = 35 (17%) and n = 48 (24%)] were reported as most influential in the first and second case scenarios, respectively.

Conclusions

There is a need for further research on approaches to the dietetic management of adult malnutrition.

The impact of minimum nutritional guidelines on school food practices

by Simon Langley-Evans

‘There is such a thing as too healthy!’ The impact of minimum nutritional guidelines on school food practices in secondary schools Addis and Murphy, JHND Early View

Background

Pressure to improve school meals has resulted in stringent nutritional guidelines across the UK. In Wales, the ‘Appetite for Life’ guidelines of 2008 resulted in significant changes to the provision of food in Welsh schools. Although evaluation of these changes has focussed on nutritional quality, there is little evidence of how pupils perceive these changes and their impact on school food practices. Using a Collective Lifestyles approach, the present study reports how secondary school pupils perceive and negotiate menu changes and the implications for lunchtime practices.

Methods

Seven focus groups (52 pupils) were undertaken in four secondary schools within one local authority in Wales. Participatory techniques were used to facilitate discussion, and the focus groups were recorded, transcribed and analysed using a framework approach. Analysis was underpinned by a Collective Lifestyles approach, which provides a framework to understand behaviour in context using three domains: (i) patterns of consumption; (ii) the construction and maintenance of identity; and (iii) power relationships.

Results

Pupils reported that the new menus were unpopular in terms of content and meal type; the preference was for portable and snack style foods. In terms of power relationships, pupils’ ability to negotiate within the school setting was constrained by the institutional nature of school dining. As a result, pupils tended to opt out of school food provision, accessing alternatives where possible.

An intervention to enhance training of health care workers improved infant feeding practices in Brazil

by Simon Langley-Evans

The impact of a primary health care intervention on infant feeding practices: a cluster randomised controlled trial in Brazil Ferreira et al., JHND Early View

Background

Proper feeding practices in early life can enhance the full human potential development of children. We aimed to evaluate the impact of a primary health care intervention on infant feeding practices among children from low‐income families.

Methods

A cluster randomised controlled trial was conducted in Porto Alegre, Brazil. Healthcare centres were randomised into intervention (n = 9) and control (n = 11) groups. In intervention sites, health workers were trained in accordance with the national guidelines. Infant feeding practices were assessed in children at 6 months (n = 617) and 12 months (n = 516) of age. Feeding practice quality was assessed using the Infant and Child Feeding Index (ICFI). Additionally, we evaluated the introduction of nonrecommended foods.

Results

At 6 months, the mean ICFI score was higher in the intervention group [MD = 0.22; 95% confidence interval (CI) = 0.24–1.11]. The prevalence of infants who met the recommendation for meat into the food‐frequency score was higher in the intervention than the control group [relative risk (RR) = 1.63; 95% CI = 1.26–2.11]. At 12 months of age, the ICFI mean (MD = 0.23; 95% CI = 0.35–0.56) and the prevalence of children who met the recommendation for dietary diversity (RR = 1.11; 95% CI = 1.01–1.22) and meal frequency (RR = 4.68; 95% CI = 1.34–16.36) were higher in the intervention group, although only among children who had more than seven follow‐up appointments during the first year of life. The children from intervention group had a significant delay for added sugar (MD = 0.51; 95% CI = 0.13–0.89), tea (mean = 0.47; 95% CI = 0.13–0.82), jelly (MD = 0.35; 95% CI = 0.11–0.58) and filled cookies (MD = 0.29; 95% CI = 0.06–0.52) compared to the control group.

Conclusions

The health workers’ training was effective with respect to improving infant feeding practices.

August 2018

Effectiveness of therapeutic interventions for anorexia of ageing

by Simon Langley-Evans

Are the therapeutic strategies in anorexia of ageing effective on nutritional status? A systematic review with meta‐analysis Perna et al., JHND Early View

Background

Anorexia of ageing (AA) may be considered as a risk factor for frailty and has an important impact on quality of life, morbidity and mortality.

Methods

A systematic review and a meta‐analysis were performed to summarise the results from several trials on the effectiveness of treatments in AA, as associated with depression, sensory impairment of taste and smell, decreased appetite or early satiety, and disability. Eligible studies were required to report baseline and follow‐up values, the mean change (∆‐change) from baseline, and/or the mean difference among intervention groups versus control group, concerning food intake (kcal/daily) and/or nutritional outcomes, such as body weight, body mass index, albumin and Mini Nutritional Assessment.

Results

The systematic review included 20 papers based on different therapeutic approaches concerning food intake and/or nutritional outcomes. The results of the meta‐analysis indicate that the interventions for AA have an important impact on body weight [+1.59 kg; 95% confidence interval (CI) = 1.48–+1.71 kg; P < 0.001) and on energy intake (+56.09 kcal; 95% CI = −54.05 to +166.25 kcal; P = 0.32). Regarding secondary outcomes, it was not possible to meta‐analyse the limited amount of data availab le.

Conclusions

The different variants of AA need to be defined because diverse therapeutic approaches are available. A more precise definition of the functional impairments associated with AA may allow a more correct decision about the most appropriate therapy to be prescribed. Moreover, this may allow for a more effective performance of the different therapeutic approaches once they are better targeted to the different scenarios of AA.

Enabling wider food choices increases oral intakes among patients who have undergone colorectal surgery

by Simon Langley-Evans

A qualitative exploration of patients’ experiences with and perceptions of recommencing feeding after colorectal surgery Rattray et al., JHND Early View

Background

Many patients who undergo lower gastrointestinal surgery neither recommence feeding within timeframes outlined by evidence‐based guidelines, nor meet their nutrition requirements in hospital. Given that the success of timely and adequate post‐operative feeding is largely reliant on patient adherence, the present study explored patients’ perceptions of recommencing feeding after colorectal surgery to determine areas of improvement to meet their needs and expectations.

Methods

This qualitative study involved one‐on‐one, semi‐structured interviews with patients receiving care after colorectal surgery in an Australian tertiary teaching hospital. Purposive sampling was used to ensure maximal variation in age, sex, procedural type and post‐operative nutrition care experience. Interviews were audio recorded, with data transcribed verbatim before being thematically analysed. Emergent themes and subthemes were discussed by all investigators to ensure consensus of interpretation.

Results

Sixteen patients were interviewed (female 56%; age 61.5 ± 12.3 years). Three overarching themes emerged from the data: (i) patients make food‐related decisions based on ideologies, experience and trust; (ii) patients appreciate the opportunity to participate in their nutrition care; and (iii) how dietary information is communicated influences patients’ perceptions of and behaviours towards nutrition.

Conclusions

Enabling patients to select from a wide range of foods from post‐operative day 1 (by prescribing an unrestricted diet in line with evidence‐based practice guidelines) in conjunction with delivering clear, simple and encouraging dietary‐related information may facilitate patient participation in care and increase oral intakes among patients who have undergone colorectal surgery.

Interactions of FTO genotype with dietary factors in relation to C-reactive protein

by Simon Langley-Evans

Effect of FTO rs9930506 on obesity and interaction of the gene variants with dietary protein and vitamin E on C‐reactive protein levels in multi‐ethnic Malaysian adults

Mitra et al., JHND Early View

Background

Individual variations of obesity‐related traits can be a consequence of dietary influence on gene variants.

Methods

This cross‐sectional study aimed to evaluate (i) the effect of FTO rs9930506 on obesity and related parameters and (ii) the influence of diet on the above association in Malaysian adults. In total, 79 obese and 99 nonobese Malaysian adults were recruited.

Results

In comparison with Chinese and Malays, Indians had significantly higher waist circumference (P ≤ 0.001 and P = 0.016), waist–hip ratio (P = 0.001 and P < 0.001), body fat percentage (P = 0.001 and P = 0.042), fasting insulin (P = 0.001 and P = 0.001), homeostatic model assessment‐insulin resistance (P = 0.001 and P = 0.001) and lower high‐density lipoprotein‐cholesterol levels (P < 0.001 and P < 0.001), respectively. Indians consumed significantly lower dietary cholesterol (P = 0.002), percentage energy from protein (P < 0.001) and higher fibre (P = 0.006) compared to the other two groups. Malaysian Indians expressed the highest risk allele frequency (G) of FTO rs9930506 compared to the Malays and the Chinese (P < 0.001).

No significant association was found between FTO rs9930506 and obesity (dominant model). Risk allele carriers (G) consumed significantly lower vitamin E (P = 0.020) and had a higher fibre intake (P = 0.034) compared to the noncarriers (A). Gene–diet interaction analysis revealed that risk allele carriers (G) had lower high sensitivity C‐reactive protein (hsCRP) levels with higher energy from protein (≥14% day−1; P = 0.049) and higher vitamin E (≥5.4 mg day−1; P = 0.038).

Conclusions

The presence of the risk allele (G) of FTO rs9930506 was not associated with an increased risk of obesity. Malaysian Indians had a significantly higher frequency of the risk allele (G). Indian participants expressed higher atherogenic phenotypes compared to Chinese and Malays. FTO rs9930506 may interact with dietary protein and vitamin E and modulate hsCRP levels.

A Healthy Nordic diet may reduce mortality in patients with established CVD.

by Simon Langley-Evans

Adherence to the Healthy Nordic Food Index and the incidence of acute myocardial infarction and mortality among patients with stable angina pectoris

Puaschitz et al., JHND Early View

Background

The Healthy Nordic Food Index (HNFI) has been associated with beneficial effects on markers of cardiovascular disease (CVD). Whether such effects are present among patients with established coronary heart disease is unknown. In the present study, we investigated the association between adherence to the HNFI and the risk of acute myocardial infarction (AMI) (fatal or nonfatal) and death among patients with stable angina pectoris.

Methods

In the Western Norway B?vitamin Intervention Trial, participants completed a 169?item semi?quantitative food frequency questionnaire. The HNFI was calculated from six food groups (fish, cabbage, apples/pears, root vegetables, whole grain bread and oatmeal), scoring 0–6. Three adherence groups were defined: 0–1 points (low), 2–3 points (medium) or 4–6 points (high). Cox regression analyses investigated associations between adherence to the HNFI and outcomes.

Results

Among 2019 men (79.7%) and women with mean age of 61.7 years, 307 patients experienced an AMI event during a median (25th and 75th percentiles) follow?up of 7.5 (6.3 and 8.7) years. Median follow?up for total mortality was 10.5 (9.3 and 11.7) years; 171 patients died from CVD and 380 from any cause. No association between HNFI and the risk of AMI was detected. However, the HNFI was associated with a reduced risk of all?cause death, both by linear estimates [hazard ratio (95% confidence interval = 0.91 (0.84–0.98)] and by comparison of the highest with the lowest adherence group [hazard ratio (95% confidence interval = 0.70 (0.52–0.95)].

Conclusions

The results of the present study suggest that a Healthy Nordic diet may reduce mortality in patients with established CVD.

Evidence is insufficient for recommending oropharyngeal colostrum as a routine clinical practice in the prevention of necrotising enterocolitis in very low birthweight infants.

by Simon Langley-Evans

Effect of oropharyngeal colostrum therapy in the prevention of necrotising enterocolitis among very low birthweight neonates: A meta?analysis of randomised controlled trials

Garg et al., JHND Early View

Background

Necrotising enterocolitis (NEC) is one of the most common life?threatening emergencies of the gastrointestinal tract in preterm neonates. The present study aimed to determine the efficacy of oropharyngeal colostrum with respect to reducing NEC in preterm neonates.

Methods

A literature search was conducted for various randomised control trials by searching the Cochrane Central Register of Controlled Trials, PubMed, EMBASE and ongoing clinical trials. Randomised or quasi?randomised trials comparing oropharyngeal colostrum versus placebo in neonates (birthweight ≤ 1500 g or gestational age ≤ 32 weeks) were included in the review. The methodological quality of each trial was independently reviewed by the authors. For categorical and continuous variables, typical estimates for relative risk and typical estimates for weighted mean difference were calculated, respectively. A random effect model was assumed for meta?analysis.

Results

In total, four eligible trials were included in the review. Oropharyngeal colostrum therapy was not associated with a statistically significant reduction in the incidence of NEC stage ≥2 [typical relative risk (RR) = 0.64; 95% confidence interval (CI) = 0.27–1.49], mortality from any cause (typical RR = 0.86; 95% CI = 0.15–4.80) and time to reach full feed [typical weighted mean difference (WMD) = −3.26; 95% CI = −8.87 to 2.35]. Duration of hospital stay was significantly less in the control group (typical WMD = 9.77; 95% CI = 3.96–15.59).

Conclusions

The current evidence is insufficient for recommending oropharyngeal colostrum as a routine clinical practice in the prevention of NEC. We emphasise the need for large randomised controlled trials with an adequate sample size and validated clinical outcomes in preterm neonates.

July 2018

Malnutrition is significantly related to prolonged hospitalisation in older people.

by Simon Langley-Evans

Nutritional status in patients aged over 65 years and its influence on the quantity and type of complications occurring 3, 6 and 12 months after hospitalisation: a clinical prospective study

Ostrowska et al JHND Early View

Background

Malnutrition in hospitalised patients is associated with frequent complications and increased mortality. The present study aimed to determine the prevalence of abnormal nutritional status in patients aged over 65 years with a diagnosis of cardiovascular diseases and also to determine its relationship with the duration of hospitalisation and the incidence of complications over 3, 6 and 12 months of observation. A comparison was also made of diagnostic performance between the various classifications used to diagnose abnormal nutritional status.

Methods

In total, 76 patients aged over 65 years with cardiovascular conditions were involved in the study. Abnormal nutritional status was identified on the basis of Mini?Nutritional Assessment?Short Form (MNA?SF) test results, laboratory tests and European Society for Clinical Nutrition and Metabolism (ESPEN) nutritional status assessment criteria. During 3, 6 and 12 months of observation, data were collected concerning the number of re?hospitalisations and the presence of complications.

Results

Abnormal nutritional status was reported in 78% of participants. Malnutrition, as diagnosed on the basis of laboratory findings and also on the basis of ESPEN criteria comprising the value of fat free mass index (FFMI), was significantly related to prolonged hospitalisation and an increased complication rate. The results of the MNA?SF test performed at baseline revealed no relationship with the incidence of complications during the first stage of the study.

Conclusions

Abnormal nutritional status was a common phenomenon in the group of patients under investigation. The set of criteria for assessing the nutritional status that had the highest association with the duration of hospitalisation and the incidence of complications includes laboratory tests and ESPEN criteria comprising the value of FFMI.

Optimising nutritional status and symptom management throughout the treatment pathway should be a clinical priority for oesophageal-gastric cancers

by Simon Langley-Evans

Nutritional status, the development and persistence of malnutrition and dietary intake in oesophago?gastric cancer: a longitudinal cohort study

Grace et al. JHND Early View

Background

Patients with oesophago?gastric (OG) cancer may be at risk of malnutrition, troublesome gastrointestinal symptoms (GI) and reduced dietary intake in view of the tumour location and multimodality curative treatment approach. Longitudinal research is lacking. The present study aimed to assess (i) nutritional status and how it evolved over the first year; (ii) the association between nutritional status scores and GI symptom scores; and (iii) the nutrient and food group intake pattern.

Methods

This was a prospective, observational study of patients with an OG lesion planned for radical treatment, with assessment at diagnosis, 3 months and 12 months after the start of treatment. Nutritional assessment was performed using the Patient?Generated Subjective Global Assessment, GI symptoms measured using the modified Gastrointestinal Symptom Rating Scale and dietary intake assessed using a semi?quantitative food frequency approach.

Results

Eighty patients (61 males, 19 females; aged 46–89 years) were recruited. At baseline, 3 (n = 68) and 12 months (n = 57), 61%, 62% and 60%, respectively, were moderately/severely malnourished. Higher symptom burden was associated with poorer nutritional status at baseline (r = 0.55, P < 0.001), 3 months (r = 0.51, P < 0.001) and 12 months (r = 0.42, P = 0.001). At each respective time point, 37%, 38% and 42% were meeting their estimated average requirement for energy. No change in mean (SD) intake of energy, fibre, nutrient and food groups was observed over time.

Conclusions

Patients with OG cancer have progressive weight loss, with malnutrition present over the majority of the 12?month study period. Optimising nutritional status and symptom management throughout the treatment pathway should be a clinical priority.

The relationship between alcohol and body composition depend upon frequency as well as quantity of intake

July 16, 2018 ~ Simon Langley-Evans

Different associations between body composition and alcohol when assessed by exposure frequency or by quantitative estimates of consumption

Lean et al., JHND Early Viewunknown-2

Background

Alcohol intake is widely assumed to contribute to excess body fatness, especially among young men; however, the evidence is inconsistent. We have addressed this research question by investigating associations between reported alcohol consumption and body composition from large representative national surveys in a high alcohol?consuming country with a high obesity prevalence.

Methods

The present study comprised a secondary analysis of combined cross?sectional nationally representative Scottish Health Surveys (1995–2010). Reported alcohol?drinking frequency was divided into five groups: from ‘nonfrequent drinking’ (reference) to daily/‘almost every day’ among 35 837 representative adults [mean (SD) age: 42.7 (12.7) years (range 18–64 years)]. Quantitative alcohol consumption was categorised into seven groups: from ‘1–7 to ≥50 10 g units per week’. Regression models against measured body mass index (BMI) and waist circumference (WC) were adjusted for age, physical activity, income, smoking, deprivation category and economic status.

Results

Among alcohol?consuming men, heavier drinking (21–28 units per week) was associated with a higher BMI by +1.4 kg m–2 [95% confidence interval (CI) = 1.38–1.43] and higher WC by +3.4 cm (95% CI = 3.2–3.6) than drinking 1–7 units per week. However, those who reported daily drinking frequency were associated with a lower BMI by −2.45 kg m–2 (95% CI = −2.4 to −2.5) and lower WC by −3.7 cm (95% CI = −3.3 to −4.0) than those who reported less?frequent drinking. Similar associations were found for women. Most of these associations were restricted to subjects aged >30 years. Unexplained variances in BMI and WC are large.

Conclusions

Quantitative alcohol consumption and frequency of consumption were positively and inversely associated, respectively, with both BMI and WC among alcohol?consuming adults. Surveys are needed that evaluate both the quantity and frequency of consumption. The lowest BMI and WC were associated with a ‘Mediterranean’ drinking style (i.e. relatively little, but more frequently).

A patient?centred food service model can cost?effectively improve clinical outcomes.

July 11, 2018 ~ Simon Langley-Evans

Room service in a public hospital improves nutritional intake and increases patient satisfaction while decreasing food waste and cost

McCray et al., JHND Early View unknown

Background

Room service (RS) is a hospital foodservice model that is traditionally unique to the private sector. It allows patients to order meals compliant to their nutritional requirements from a single integrated menu at a time that suits them. Meals are prepared and delivered within 45 min of order. Following implementation in a private adult facility in 2013, Mater Group implemented the first RS in a public adult facility in Australia in 2016. In a pre–post study comparing RS with a traditional foodservice model (TM), key outcomes were measured and analysed.

Methods

A retrospective analysis of quality assurance data audits in a pre–post study design was undertaken to assess patient nutritional intake, plate waste, satisfaction and meal costs before and after RS implementation.

Results

Comparison of nutritional intake between TM (n = 84) and RS (n = 103) showed statistically significant increases with RS in both energy (5513 kJ day−1 versus 6379 kJ day−1, P = 0.020) and protein (53 g day−1 versus 74 g day−1, P < 0.001) intake, as well as energy and protein intake as a percentage of requirements (64% versus 78%, P = 0.002 and 70% versus 99%, P < 0.001, respectively). Total average plate waste decreased from 30% to 17% (P < 0.001). Patient satisfaction indicated an improvement with RS, with 98% of patients scoring the service good to very good, compared to 75% for TM (P < 0.04). Patient food costs decreased by 28% per annum with RS.

Conclusions

This research provides insight into the benefits achievable with RS in the public hospital setting, confirming that a patient?centred food service model can cost?effectively improve clinical outcomes.

Israeli standardised terminology and definitions for soft diets

July 11, 2018 ~ Simon Langley-Evans

Texture?modified foods and thickened fluids used in dysphagia: Israeli standardised terminology and definitions

Icht et al., JHND Early View Unknown.png

Background

Texture?modified foods and thickened fluids are used as a strategy that aims to compensate for dysphagia and improve the safety and efficiency of swallowing. Currently, in Israel, there are no standardised terminologies and definitions for texture?modified diets. The inconsistent terminology adversely affects patient safety and the efficiency of communication between staff members both within and between health institutions. This present study describes a project of the Israeli Ministry of Health in which the labels and definitions of prevalent foods and fluids used in health institutions are mapped to develop a consensus on national standards.

Methods

A multidisciplinary committee of speech?language pathologists (SLPs) and registered dietitians (RDs) was appointed. A questionnaire was developed to identify the labels of texture?modified foods and fluids used in the Israeli healthcare system. The questionnaire included questions on knowledge, attitudes and barriers related to the need for a consistent national terminology for texture?modified diets. Questionnaires were sent to 120 institutions. The project was conducted between September 2016 and December 2017.

Results

Twenty?six SLPs and 42 RDs responded. The answers revealed that there were 50 labels in use for texture?modified foods. When asked to describe the texture of a particular food item, up to 17 different labels were used. There was broad support for a standardised terminology.

Conclusions

The results of the present study confirm the lack of national standards in clinical practice and the need for a consistent terminology. A consensus was achieved between the committee members and the committee adopted the International Dysphagia Diet Standardization Initiative (IDDSI) recommendations and adapted the terminology to Hebrew.

Patient-directed meal ordering systems improve dietary intake and mealtime experience

July 4, 2018 ~ Simon Langley-Evans

Engaging the patient: improving dietary intake and meal experience through bedside terminal meal ordering for oncology patients

Barrington et al., JHND Early View unknown

Background

The present study aimed to determine changes in patient dietary intake, plate waste and meal experience associated with the implementation of a patient?directed bedside electronic meal ordering system (BMOS) compared to traditional paper menus (PMs).

Methods

The study evaluated the effect of a BMOS compared to PM at an oncology hospital between 2015 and 2016. Patient dietary intake, plate waste and patient meal experience were the key outcomes measured. Plate waste was determined using a validated seven?point visual wastage scale. The weight eaten estimates were converted into nutrients consumed in each food item to estimate dietary intake. Patient meal experience was measured via written surveys.

Results

There was an increase in patient dietary intake and patient meal experience, with BMOS compared to PM. Comparison between BMOS (n = 105) and PM (n = 96) showed statistically significant increases in ordering sufficient energy (8683 kJ day−1 versus 6773 kJ day−1, P = 0.004) and protein (97 g day−1 versus 82 g day−1, P = 0.023), as well as average energy intake (6457 kJ day−1 versus 4805 kJ day−1, P < 0.001) and protein intake (73 g day−1 versus 58 g day−1, P < 0.001). Average plate waste remained the same for both cohorts. Patient meal experience showed that 60% of patients accessed the BMOS independently. The BMOS cohort had significant increases in receiving the food that they ordered (P < 0.001) and in choosing food that they liked (P = 0.006).

Conclusions

The results of the present study demonstrate that a patient?directed electronic meal ordering system improved patient dietary intake and meal experience. These results are most likely a result of empowering patients to make decisions about their meal selections and nutritional care through accessible meal ordering and improved menu communication.

June 2018

Fluid diets should not be used indiscriminately in older post-operative patients.

June 29, 2018 ~ Simon Langley-Evans

Early post?operative diet upgrade in older patients may improve energy and protein intake but patients still eat poorly: an observational pilot study

Byrnes et al., JHND Early View unknown

Background

Malnutrition is prevalent across acute care facilities, particularly in older patients, and contributes to poor surgical outcomes. Clinical practice guidelines recommend the early reintroduction of a full oral diet post?operatively. The present study aimed to compare estimated energy (EEI) and protein (EPI) intake of patients who received early diet upgrade with those who did not.

Methods

Patients ≥65 years admitted post?operatively to general surgical wards were included. EEI and EPI were calculated and dichotomised as meeting ≥50% or <50% estimated energy (EER) and protein (EPR) requirements. Mean intake and proportion of patients meeting <50% estimated requirements were compared between those who received early upgrade and those who did not at post?operative day (POD)2.

Results

Thirty?four patients [mean (SD) age 72.9 (5.7) years, 59% male] were analysed at POD2 [EEI: mean 4.2 (2.6) MJ day–1, 56% (n = 19) met ≥50% EER; EPI: mean 38.7 (29.5) g day–1, 26% (n = 9) met ≥50% EPR]. The majority (n = 25, 74%) were upgraded to a nonfluid diet by POD2. More patients on fluid diets consumed <50% EER (P = 0.025) and <50% EPR (P = 0.073). No patient on a fluid diet met ≥50% of EPR.

Conclusions

Although the majority of older patients received early diet upgrade and these patients consumed more energy and protein than those on fluid diets, as a whole, older patients ate poorly post?operatively. Fluid diets should therefore not be used indiscriminately and other approaches to improve post?operative intake of older patients, such as fortified diets, oral nutritional supplements and meal environment interventions, should be adopted.

Dietary intakes of Australian children are poorly aligned to national recommendations

June 22, 2018 ~ Simon Langley-Evans

Do the contemporary dietary patterns of children align with national food and nutrient recommendations?

Holmes et al., JHND Early View unknown

Background

Childhood nutrition is important in optimising growth, development and future health. The present study compared dietary intakes of Australian children aged 4–8 years with (i) Australian Guide to Healthy Eating (AGHE) food group recommendations and (ii) age?specific Nutrient Reference Values (NRVs), in addition to (iii) describing food group intakes of children meeting key NRVs.

Methods

Data were obtained from a representative sample of children (n = 789) from the National Nutrition and Physical Activity Survey between May 2011 and June 2012. Parent?reported 24?h recall dietary data were disaggregated into five core food groups, along with energy?dense, nutrient?poor (EDNP) foods, with intakes being compared with AGHE recommendations. Food group intakes were compared for children meeting the NRVs for 10 nutrients used for the development of AGHE food groups. Chi?squared and t?tests were performed to determine differences in food group intakes with P < 0.05 considered statistically significant.

Results

Only one child met the recommended daily servings for all AGHE core food groups and none met both core and energy?dense, nutrient?poor (EDNP) food group recommendations. The lowest level of alignment (percentage meeting recommendations) was for vegetables (4.6%) and the highest was for fruit (47.7%). Mean (SD) daily intake of EDNP foods [4.7 (3.2) serves day−1] accounted for 38.4% of total energy intakes. Children meeting key NRVs (n = 395) consumed greater daily servings of fruit [2.2 (1.7)], dairy [2.2 (1.2)] and EDNP foods [5.0 (3.4)] compared to the total sample (n = 789).

Conclusions

Significant discrepancies exist between contemporary dietary patterns of Australian children and national recommendations. Future AGHE revisions should incorporate greater diversity of consumption patterns, including sub?categories of EDNP foods.

Experiences of intermittent dieting compared to continuous energy restriction.

June 21, 2018 ~ Simon Langley-Evans

‘For me it’s about not feeling like I’m on a diet’: a thematic analysis of women’s experiences of an intermittent energy restricted diet to reduce breast cancer risk.

Donnelly et al., JHND Early View unknown-2

Background

Weight?loss programmes requiring intermittent energy restriction offer an alternative to continuous energy restriction programmes that typically have low adherence. We reported greater weight loss, better adherence and spontaneous reduced energy intake on healthy eating days with intermittent as opposed to continuous energy restriction. The present study aims to explore why intermittent energy restriction diets exert these positive effects.

Methods

Semi?structured interviews were carried out with 13 women aged 39–62 years, who followed a 4?month intermittent energy restriction (2 days of low energy/low carbohydrate, 5 days of healthy eating). Nine of the 13 women successfully lost >5% of their total body weight. Data were analysed using thematic analysis.

Results

The intermittent regimen redefined the meaning of dieting and normal eating. Women reconceptualised dieting as only two low energy days per week, even though this often differed from their pre?diet eating patterns. Women reported that they could adhere more closely to the rules of the intermittent diet compared to previously attempted continuous diets. They found that the intermittent diet was less cognitively demanding because the restrictive and clear rules of the intermittent diet were easier to understand and easier to follow than with continuous dieting.

Conclusions

Many participants found intermittent dieting preferable to previous experiences of continuous dieting. The findings provide some insight into the ways in which intermittent dieting is successful, and why it could be considered a viable alternative to continuous energy restriction for weight loss.

10-13 year olds comprise a responsive target group for nutrition education at schools

June 12, 2018 ~ Simon Langley-Evans

Theory?informed nutrition education curriculum Tools For Feeling Good promotes healthy eating patterns among fifth grade pupils: cross?sectional study

Tilles-Tirkkonen et al., JHND Early View Unknown

Background

The eating patterns of school?aged children rarely meet recommendations: meal frequency is irregular and the consumption of vegetables is lower and sugar?sweetened products higher than recommended. Although school is an excellent arena for nutrition education to support pupils eating patterns, teachers usually lack efficient tools. The present study aimed to develop a curriculum for nutrition education to be used by teachers and to examine its efficacy in the school environment with respect to the eating patterns of pupils.

Methods

The curriculum was developed in collaboration with school teachers using self?determination theory as a theoretical standpoint. The Health at Every Size concept and sensory?based food education were utilised in the curriculum. Self?reported questionnaires were used to assess the feasibility and impact of the curriculum. Fourteen teachers implemented the curriculum during 2012–2013 with 194 pupils aged 10–13 years (fifth and sixth grades). The control schools included 140 pupils of the same age not following the curriculum.

Results

The teachers reported that the curriculum was easy to integrate in the school environment. The fifth graders improved their breakfast frequency, increased their consumption of vegetables and reduced their consumption of ice cream, sweets and sugar?sweetened drinks. No improvement was found in the fifth graders at the control schools. In the sixth graders, no dietary changes were detected in the intervention or control schools.

Conclusions

The pupils in the fifth grade appeared to comprise a responsive target group for nutrition education at schools. The curriculum offers a promising approach for developing healthy eating patterns among fifth graders. Collaboration with teachers in developing the curriculum likely enhanced its feasibility and teacher commitment for implementation.

Workplace learning and career progression for dietitian

June 11, 2018 ~ Simon Langley-Evans

Workplace learning and career progression: qualitative perspectives of UK dietitians

Boocock and O’Rourke JHND Early View unknown-2

Background

Post?graduate education and continuous professional development (CPD) within dietetics lack clearly defined pathways. The current literature primarily focuses on new graduate perceptions of workplace learning (WPL). The present study raises issues of how CPD is sustained throughout a National Health Service (NHS) career, how informal learning might be made more visible and whether the workplace withholds learning opportunities.

Methods

Qualified dietitians participated in focus groups (n = 32) and a nominal group technique (n = 24). Data from audio recordings were transcribed and triangulated. Thematic analysis took an interpretative approach.

Results

One size for WPL for dietetics and, likely, other allied health professionals (AHPs) did not meet the learning needs of everyone. The informal implicit learning affordances often went unrecognised. A greater emphasis on teaching, picking up on the strong preference for discussion with others voiced in the present study, may improve recognition of all WPL opportunities. Better scaffolding or guided support of entry level dietitians may ease the transition from study to workplace and challenge any perception of ‘clipped wings’. Where development and career progression proves difficult for experienced dietitians, mentoring or stepping outside the NHS may revitalise by providing new communities of practice.

Conclusions

WPL cannot be understood as a unitary concept. Dietitians engage with WPL differently across their careers. Future visions of WPL, especially explicit post?graduate career and education frameworks, must accommodate these differences to retain the highest calibre dietitians. The implications of a period of learning ‘maintenance’ rather than CPD among experienced dietitians offers a topic for further research, particularly as the workforce ages.

Patients admitted to hospice care are not adequately assessed for nutritional status

June 11, 2018 ~ Simon Langley-Evans

Nutritional status and interventions in hospice: physician assessment of cancer patients

Flynn et al., JHND Early View images

Background

Cancer cachexia is a multifactorial syndrome characterised by a progressive loss of skeletal muscle mass. It adversely influences quality of life, treatment response and survival. Early identification and multimodal interventions can potentially treat cancer cachexia. However, healthcare professionals demonstrate a lack of understanding and the ability to identify cancer cachexia early. The present study aimed to evaluate the assessment by physicians of nutritional status in cancer patients admitted to hospice.

Methods

A retrospective medical record review was conducted on all cancer admissions to a specialist in?patient palliative care unit over a 4?month period between October 2016 and January 2017. Charts were reviewed for evidence of documented nutritional assessment by physicians. Data were collected from the referral letter, admission notes, drug kardex and discharge letter. The information extracted included: (i) patient demographics and characteristics; (ii) terms used by physicians to describe nutritional status; (iii) any record of nutritional impact symptoms (NIS) experienced by the patient; and (iv) nutritional interventions prescribed.

Results

One hundred and forty admissions were evaluated. Nutritional terminology and NIS were most commonly documented on the admission notes. Only 41% of documents recorded any nutritional term used by physicians to assess nutritional status. Furthermore, 71% of documents recorded at least one NIS experienced by the patient. Fatigue was the most frequent NIS.

Conclusions

We identified an inadequate nutritional assessment of cancer patients admitted to hospice. Implementation of a nutritional symptom checklist and nutrition screening tools, along with enhanced physician education and multidisciplinary nutrition care, could improve the identification and management of cancer cachexia in the palliative care setting.

Improving dietitian communications skills- a workplace education approach

June 8, 2018 ~ Simon Langley-Evans

Advancing practice in dietitians’ communication and nutrition counselling skills: a workplace education program

Notaras et al., JHND Early Viewunknown

Background

Communication is the primary method in which dietitians conduct their practice. However, continuing education and competency standards are often focused on clinical knowledge and skills, with few programs being available to improve the communication and nutrition counselling skills of dietitians. Dietitians have reported reduced confidence in the knowledge and use of these skills, particularly when dealing with people who are struggling to find motivation to change their eating behaviours. The present study aimed to evaluate the effect of a workplace education program on the self?reported communication and nutrition counselling skills of dietitians.

Methods

An education program was developed using techniques from motivational interviewing, patient?centred therapy, solution?focused therapy and narrative therapy. These techniques were chosen based on evidence of potential application to dietetic practice for behaviour change. Dietitians working in acute care hospitals and community health services completed the program. Pre? and post?written surveys incorporating five?point Likert scales (1?5) were used to evaluate the program. The results were analysed using parametric and nonparametric statistics.

Results

Fifty dietitians completed the program and evaluation. The dietitians’ self?rating of their communication and nutrition counselling skills improved significantly (median = 3 versus 4, Z = 4.562, P < 0.001, r = 0.65). Dietitians also reported knowledge of a greater variety of behaviour change techniques to use with their patients post?program.

Conclusions

To our knowledge, this is the first dietitian?specific workplace education program of its type to address essential skills for better communication with patients. Ongoing workplace support, such as peer observation, is recommended to assist with skill development and sustainability.

Lifespan vs healthspan- how can lifestyle extend healthy years?

June 4, 2018 ~ Simon Langley-Evans

A holistic approach to healthy ageing: how can people live longer, healthier lives?

Calder et al., JHND Early View unknown-2

Background

Although lifespan is increasing, there is no evidence to suggest that older people are experiencing better health in their later years than previous generations. Nutrition, at all stages of life, plays an important role in determining health and wellbeing.

Methods

A roundtable meeting of UK experts on nutrition and ageing considered key aspects of the diet–ageing relationship and developed a consensus position on the main priorities for research and public health actions that are required to help people live healthier lives as they age.

Results

The group consensus highlighted the requirement for a life course approach, recognising the multifactorial nature of the impact of ageing. Environmental and lifestyle influences at any life stage are modified by genetic factors and early development. The response to the environment at each stage of life can determine the impact of lifestyle later on. There are no key factors that act in isolation to determine patterns of ageing and it is a combination of environmental and social factors that drives healthy or unhealthy ageing. Too little is known about how contemporary dietary patterns and sedentary lifestyles will impact upon healthy ageing in future generations and this is a priority for future research.

Conclusions

There is good evidence to support change to lifestyle (i.e. diet, nutrition and physical) activity in relation to maintaining or improving body composition, cognitive health and emotional intelligence, immune function and vascular health. Lifestyle change at any stage of life may extend healthy lifespan, although the impact of early changes appears to be greatest.

May 2018

Intake of low quality carbohydrate is associated with obesity and hypertension

May 14, 2018 ~ Simon Langley-Evans

Association between dietary carbohydrate quality and the prevalence of obesity and hypertension

Kim et al. JHND Early View Unknown

Background

Dietary carbohydrate quality may play an important role in disease development. We evaluated the association between carbohydrate quality index (CQI) and the prevalence of obesity and metabolic disorders among adults in South Korea.

Methods

We analysed 12 027 adults aged 19–64 years from the fifth Korea National Health and Nutrition Examination Survey (KNHANES). CQI was based on four criteria: crude fibre intake, dietary glycaemic index (DGI), whole grains/total grains ratio and solid carbohydrates/total carbohydrates ratio.

Results

Participants with a lower CQI were younger, had a lower income and were more likely to be smokers and to drink alcohol. The highest quintile CQI group showed the lowest DGI and the lowest consumption of liquid carbohydrates and refined grains, as well as the highest consumption of solid carbohydrates, crude fibre and whole grains (P < 0.05). A higher CQI was negatively associated with the prevalence of obesity (odds ratio = 0.83; 95% confidence interval = 0.69–0.99) and hypertension (odds ratio = 0.78; 95% confidence interval = 0.61–0.99) but was not associated with other metabolic disorders.

Conclusions

These results suggest that the quality of carbohydrates consumed is associated with the risk of obesity and hypertension. However, the cross?sectional design does not preclude reverse causality.

Determining energy requirements in patients receiving parenteral nutrition

May 14, 2018 ~ Simon Langley-Evans

Accurate determination of energy requirements in hospitalised patients with parenteral nutrition

Quiroz-Olguin et al., JHND Early View. Unknown

Background

The prescription of parenteral nutrition (PN) in hospitalised patients requires an estimation of the energy requirements. Most studies employing prediction equations (PEs) to estimate energy requirements have focused on critically ill patients. The present study aimed to evaluate several PEs of the resting energy expenditure (REE) to identify the most accurate equation for estimating the REE required for PN.

Methods

This cross?sectional and descriptive study included patients hospitalised with medical or surgical diagnoses, making them candidates for PN. Epidemiological data, the reason for hospital admission, nutritional screening results, characteristics of the PN administered and REE by indirect calorimetry (IC) were recorded and, subsequently, PEs were calculated.

Results

In total, 116 patients were recruited with a mean (SD) age of 56.7 (13.8) years and body mass index of 21.3 (4.25) kg m−2. The diagnosis was medical in 52% of patients and surgical in 48%. The mean (SD) REEs of patients, according to IC, were: 6.11 (1.18) MJ [1461 (281) kcal]; and according to PEs: Mifflin, 5.07 (1.05) MJ [1212 (252) kcal]; Owen, 5.43 (0.72) MJ [1298 (172) kcal]; Harris–Benedict, 5.38 (0.85) MJ [1285 (204) kcal]; Ireton?Jones, 6.20 (1.69) MJ [1481 (403) kcal]; and short equation, 6.12 (0.92) MJ [1464 (220) kcal]. A comparison of the results obtained for the REE by IC and with PEs indicated that the short equation had less bias than the other equations, with an accuracy of 54%

Conclusions

In hospitalised patients who receive PN, determination of the REE should ideally be made by IC. PEs are acceptable but not exact and so their estimation could overfeed or underfeed the patient.

April 2018

Better diet quality is associated with lower healthcare costs in Australian women

April 18, 2018 ~ Simon Langley-Evans

Diet quality and 10?year healthcare costs by BMI categories in the mid?age cohort of the Australian Longitudinal Study on Women’s Health

Patterson et al. JHND Early View unknown

Background

Better diets, as evaluated by diet quality indices, are associated with lower rates of morbidity and mortality. Although governments and researchers alike recognise the burden that obesity incurs for increased healthcare spending, there is insufficient evidence for the role of diet quality on healthcare costs.

Methods

Diet quality was assessed by the Australian Recommended Food Score (ARFS) for 6328 women aged 50–55 years from the Australian Longitudinal Study on Women’s Health. The ARFS was ranked by quintile, and 10?year cumulative data on healthcare costs from Medicare (Australia’s Universal healthcare cover) were reported by body mass index category, using generalised linear modelling.

Results

Healthy weight women with the highest diet quality were found to make significantly fewer Medicare claims (P = 0.012) compared to those with the lowest diet quality. In healthy weight and overweight women, the number of healthcare claims and charges was inversely associated with consuming a greater variety of vegetables. For every 1 point increase in the ARFS vegetable component score, healthy weight women made 1.9 fewer healthcare claims and were charged $139 less, whereas overweight women made 2.3 fewer claims and were charged $176 less for healthcare over 10 years.

Conclusions

The results of the present study support the need to prioritise an improved diet quality with the aim of reducing healthcare claims and overall costs in a population?based sample of Australian females. As the burden of overweight and obesity on the healthcare system increases, strategies to improve diet quality may be of particular importance; however, more research is required to further establish this relationship.

The sensory perception of food is partly dependent on the nature of preparation and cooking processing and the complexity of the foodstuff

April 17, 2018 ~ Simon Langley-Evans

Affective evaluation of food images according to stimulus and subject characteristics

Padulo et al., JHND Early ViewUnknown.png

Background

The food?rich environment in which we live makes the regulation of food choices a very complex phenomenon determined by many factors, as well as their interactions. Much evidence suggests that the sensory perception of food can be considered as a central factor affecting individual food choices. Despite this, the approaches used to study the various food aspects usually do not distinguish between different types of food.

Methods

In the present study, a large and heterogeneous sample of 1149 participants aged 7–90 years was asked to judge food images that were labelled differently (i.e. Raw versus Cooked, Natural versus Transformed and Simple versus Complex) with respect to arousal, valence, typicality and familiarity.

Results

We observed that, across food dimensions (i.e., Raw versus Cooked, Natural versus Transformed and Simple versus Complex), arousal, valence and typicality judgments were principally affected by a subjective hunger level and gender (and their interaction) and, to a lesser extent, by age.

Conclusions

As a whole, our findings suggest that the level of transformation (which includes cooking) and the complexity of a foodstuff could at least partially affect food processing, entailing that future research should also address these features.

The rise of social media as a source of information for nutrition in pregnancy.

April 17, 2018 ~ Simon Langley-Evans

Beliefs and advice?seeking behaviours for fertility and pregnancy: a cross?sectional study of a global sample

Walker et al., JHND Early View unknown

Background

Pregnancy can motivate individuals to adopt lifestyle behaviours that protect the health of their offspring. The aims of the present study were to explore men’s and women’s beliefs about lifestyle, fertility and pregnancy, as well as where they seek advice.

Methods

Participants (2185 women and 221 men, six unspecified) from 104 countries completed a questionnaire that explored their beliefs about what was important for a healthy pregnancy and their advice?seeking behaviours. Recruitment was via a Massive Open Online Course entitled ‘Food as Medicine’, with food, nutrient and health content. Comparisons of categorical data were performed using a chi?squared test (P = 0.05).

Results

Eating a variety of fruits and vegetables and not smoking (both 93.7%) were the most frequently and equally ranked in the top?five factors for a healthy pregnancy. Taking prenatal supplements (26.8%) was considered to be less important. Participants in Westernised countries ranked not smoking or drinking alcohol as being significantly more important than those in other countries. Overall, doctors (47.7%) were the most common source of fertility and pregnancy advice. Larger proportions of those aged <40 years used the Internet (<40 years 44.1%, >40 years 18.2% χ2 = 152.7, P < 0.01) and social media (<40 years 16.1%, >40 years 3.6%; χ2 = 110.18, P < 0.01) for health information.

Conclusions

There is disconnection between beliefs and actions regarding the lifestyle behaviours considered to be important for a healthy pregnancy, particularly nutrition. Pregnancy advice?seeking has evolved, with younger men and women utilising the Internet and social media. Health professionals must consider new communication strategies to deliver evidence?based lifestyle advice, particularly for younger men and women and where access to healthcare is limited.

Ethnic differences in maternal child-feeding style

April 11, 2018 ~ Simon Langley-Evans

Significant differences in maternal child?feeding style between ethnic groups in the UK: the role of deprivation and parenting styles

Korani et al., JHND Early View unknown-2

Background

Nonresponsive maternal child?feeding interactions, such as restricting, pressurising and emotional feeding, can affect the ability of a child to self?regulate intake and increase the risk of becoming overweight. However, despite findings that South Asian and Black children living in the UK are more likely to be overweight, UK research has not considered how maternal child?feeding style might differ between ethnic groups. The present study aimed to explore variations in maternal child?feeding style between ethnic groups in the UK, taking into account associated factors such as deprivation and parenting style.

Methods

Six hundred and fifty?nine UK mothers with a child who was aged 5–11 years old completed a questionnaire. Items included ethnicity and demographic data, as well as copies of the Child Feeding Questionnaire, Parental Feeding Styles Questionnaire and Parenting Styles and Dimensions Questionnaire.

Results

Significant differences in perceived responsibility (P = 0.002), restriction (P = 0.026), pressure to eat (P = 0.045), instrumental feeding (P < 0.001) and emotional feeding (P < 0.001) were found between the groups. Mothers from South Asian backgrounds reported higher levels of pressure to eat, emotional feeding and indulgent feeding styles, whereas mothers from Chinese backgrounds reported greater perceived responsibility and restriction. Mothers from Black and White British backgrounds were not significantly higher with respect to any behaviour. Maternal child?feeding style was also associated with deprivation and parenting style, although these did not fully explain the data.

Conclusions

Understanding cultural factors behind maternal child?feeding style, particularly around pressurising and indulgent feeding behaviours, may play an important part in reducing levels of children who are overweight and obese in the UK.

Sarcopenia associated with haemodialysis may be greater in Asian patients.

April 11, 2018 ~ Simon Langley-Evans

Differences in the prevalence of sarcopenia in haemodialysis patients: the effects of gender and ethnicity

Yoowannakul et al., JHND Early View Unknown.pngunknown-2

Background

There is no universal consensus definition of sarcopenia, although there is agreement that sarcopenia is a risk factor for mortality in haemodialysis (HD) patients. We aimed to determine the effect of using different operational definitions in a multiracial group of HD patients.

Methods

We measured hand grip strength (HGS) and appendicular lean mass (ALM) by segmental bioimpedance using the Foundation for the National Institutes of Health Sarcopenia Project (FNIH), European Working Group on Sarcopenia (EWGS) and Asian Working Group on Sarcopenia definitions for HGS weakness and loss of appendicular lean mass.

Results

In total, there were 600 HD patients: 373 men (62.2%), mean (SD) age 66.3 (14.7) years, 45.6% diabetic, ethnicity: 281 (48.5%) White, 167 (27.8%) Asian and 149 (24.8%) Black. On HGS criteria, 90.5% of Asian women and 88.5% of Asian men were weak according to EWGS compared to 62.3% of Black women and 52.5% of Black men and 64.5% of White women and 69.1% of White men by FNIH criteria (P < 0.001). On adding appendicular lean mass, the prevalence of sarcopenia was 68.3% for Asian, 27.1% for Black and 36.6% for White women by FNIH and 59.6% Asian, 21.3% Black and 39.9% White men by EWGS criteria.

Conclusions

Current definitions of sarcopenia report a greater prevalence of muscle weakness compared to appendicular muscle loss in female compared to male HD patients and this is greater for Asian compared to Black and White patients. Because HGS weakness is a greater risk for death, definitions of sarcopenia may underestimate risk in HD patients.

March 2018

The diets of indigenous Australian women are inadequate during pregnancy

March 26, 2018 ~ Simon Langley-Evans

Disparities exist between the dietary intake of Indigenous Australian women during pregnancy and the Australian dietary guidelines: the Gomeroi gaaynggal study

Lee et al., JHND Early View unknown

Background

Little is known about the adequacy of nutrient intakes and the overall diet quality of Indigenous Australian pregnant women. The aim of this cross?sectional study was to assess nutrient sufficiency and diet quality, as measured using the Australian Recommended Food Score (ARFS), in pregnant women from the Gomeroi gaaynggal cohort (n = 58).

Methods

Maternal dietary intake during pregnancy was assessed using the Australian Eating Survey Food Frequency Questionnaire, which was self?administered in the third trimester. Diet quality was determined using the ARFS. Food group servings and nutrient intakes were compared to the Australian Guide to Health Eating (AGHE) and Australian Nutrient Reference Values (NRVs). The current analysis examined the adequacy of usual intakes from food sources only, excluding supplements.

Results

None of the women met all AGHE daily food group serving recommendations. The highest alignment rates were for dairy (33%), meat/alternatives (31%) and vegetables (29.3%). Almost 93% of participants exceeded the recommended intake of energy?dense, nutrient?poor foods and percentage energy from saturated fat was high (15%). Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the NRVs were zinc (77.6%) and folate (68.9%), whereas iron was the lowest. Only one person achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. The median ARFS was 28 points (maximum of 73).

Conclusions

Although the small cohort limits the generalisability of the findings of the present study, the data obtained indicate that the diets of these Indigenous pregnant women are inadequate. Therefore, strategies aiming to optimise nutrient intakes of Indigenous pregnant women are needed urgently.

Video consultations achieve positive outcomes for postpartum women

March 18, 2018 ~ Simon Langley-Evans

VITAL change for mums: a feasibility study investigating tailored nutrition and exercise care delivered by video?consultations for women 3–12 months postpartum

Vincze et al., JHND Early View unknown

Background

A tailored approach to nutrition and physical activity advice can support women following childbirth in managing barriers (i.e. time and childcare) to making healthy lifestyle changes. The aim of the present study was to evaluate the implementation, acceptability and preliminary efficacy of a personally tailored nutrition and exercise programme for postpartum women delivered via video?consultations by an accredited practising dietitian (APD) and accredited exercise physiologist (AEP).

Methods

In this feasibility study (VITAL change for mums), postpartum (3–12 months) women (body mass index ≥25 or >2 kg above pre?pregnancy weight) who were seeking to achieve a healthy weight participated in a single?arm intervention. Participants received up to five real?time personalised video?consultations (2 × APD, 2 × AEP, 1 × either) over the 8?week intervention period. Implementation (recruitment, retention, utilisation), acceptability (participant satisfaction) and preliminary efficacy (anthropometry, dietary intake, cardiovascular fitness, physical activity level, psychological wellbeing) were assessed.

Results

Thirty women [mean (SD) age 31.6 (3.1) years, body mass index 29.0 (4.0) kg m−2, 100% married/de facto, 80% university level education] were recruited within 10 days and 27 completed the study. Women’s mean (SD) ratings (out of a score of 5) indicated satisfaction with the video?consultations [4.4 (0.9)] and the online setting [4.5 (0.8)]. Women agreed that accessing an APD [4.4 (0.8)] and AEP [4.3 (0.9)] was easier using video?consultations than attending an in?person consultation. Statistically significant improvements in waist circumference, body composition, cardiorespiratory fitness, dietary intake and physical activity were observed from baseline to 8 weeks.

Conclusions

The findings of the present study suggest that a nutrition and exercise intervention delivered by qualified health professionals via video?consultations is feasible, acceptable and achieves positive outcomes for women following childbirth.

February 2018

Low FODMAP foods for vegetarian diets.

February 26, 2018 ~ Simon Langley-Evans

Fermentable short chain carbohydrate (FODMAP) content of common plant-based foods and processed foods suitable for vegetarian- and vegan-based eating patterns

Tuck et al., JHND Early View unknown

Background

The low FODMAP (fermentable, oligo-, di-, mono-saccharides and polyols) diet is an effective strategy to improve symptoms of irritable bowel syndrome. However, combining the low FODMAP diet with another dietary restriction such as vegetarianism/veganism is challenging. Greater knowledge about the FODMAP composition of plant-based foods and food processing practices common to vegetarian/vegan eating patterns would assist in the implementation of the diet in this patient population. The present study aimed to quantify the FODMAP content of plant-based foods common in vegetarian/vegan diets and to investigate whether food processing can impact FODMAP levels.

Methods

Total FODMAP content was quantified in 35 foods, including fructose-in-excess-of-glucose, lactose, sorbitol, mannitol, galacto-oligosaccharide and total fructan, using high-performance-liquid-chromatography and enzymatic assays. The effects of cooking, sprouting, pickling, fermentation, activation and canning on FODMAP content were assessed. The Monash University criteria to classify foods as low FODMAP was used.

Results

Of the 35 foods, 20 were classified as low FODMAP, including canned coconut milk (0.24 g serve–1), dulse (0.02 serve–1), nutritional yeast (0.01 serve–1), soy cheese (0.03 serve–1), tempeh (0.26 serve–1), wheat gluten (0.13 serve–1) and wheat grass (0.05 serve–1). No FODMAPs were detected in agar-agar, egg replacer, vegan egg yolk, kelp noodles and spirulina. Food processing techniques that produced the greatest reduction in FODMAP content included pickling and canning.

Conclusions

The present study provides a greater FODMAP composition knowledge of plant-based foods that can now be applied to the dietetic management of vegetarians/vegans requiring a low FODMAP diet. Food processing lowered the FODMAP content of foods, thereby increasing options for patients following a low FODMAP diet.

Dietitians are progressing in relation to access, attitudinal and aptitudinal readiness for eHealth

February 26, 2018 ~ Simon Langley-Evans

eHealth readiness of dietitians

Maunder et al., JHND Early View unknown

Background

The present study aimed to determine the eHealth readiness and changes over time of dietitians in Australia.

Methods

Two cross-sectional analyses of Australian dietitians were conducted in 2013 and 2016, using a survey adapted from one conducted in 2011 by the US Academy of Nutrition and Dietetics. The survey encompassed 30 questions on eHealth readiness across five dimensions: access, standards, attitude, aptitude and advocacy. Descriptive statistics, independent t-tests, chi-squared tests and Z-tests were computed to compare responses from the 2013 and 2016 surveys.

Results

The survey completion rate represented 14.5% (747) of the Dietitians Association of Australia members in 2013 and 8% (417) in 2016. The survey responses in relation to access and standards suggest that dietitians are well positioned for eHealth. For attitude and aptitude, there is a moderate level of preparedness, with minor improvements over time. Although showing significant improvement (P < 0.05), advocacy highlights the area requiring the most development because the majority of dietitians (61%) reported ‘no role’ in eHealth solutions.

Conclusions

Dietitians are progressing in relation to access, attitudinal and aptitudinal readiness for eHealth, although they rate poorly with respect to advocacy readiness. It was concluded that dietitians are not yet ready, and also that valuable opportunities to achieve the benefits that eHealth can deliver will be missed, if dietitians do not take the lead in guiding the development, selection and implementation of nutrition-related technologies. Strengthening the dimension of advocacy and ensuring collaboration across the profession, drawing on the varying expertise demonstrated across the practice areas and by the different generations, will be central to improving dietitian eHealth readiness.

Dietary soy improves glycaemic control and promotes weight loss in women with polycystic ovary syndrome

February 23, 2018 ~ Simon Langley-Evans

The effect of dietary soy intake on weight loss, glycaemic control, lipid profiles and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome: a randomised clinical trial

Karamali et al., JHND Early View Unknown

Background

The present study aimed to evaluate the effects of dietary soy intake on weight loss and metabolic status of patients with polycystic ovary syndrome (PCOS).

Methods

A randomised clinical trial was conducted among 60 women with PCOS. Participants were randomly assigned into two groups to receive either a test diet (n = 30) or a control diet (n = 30) for 8 weeks. Participants in the test group consumed a diet containing 0.8 g protein kg–1body weight (35% animal proteins, 35% soy protein and 30% vegetable proteins) and participants in the control group consumed a similar diet containing 70% animal proteins and 30% vegetable proteins.

Results

Adherence to the test diet, compared with the control diet, resulted in significant decreases [mean (SD)] in body mass index (BMI) [−0.3 (0.6) versus +0.1 (0.5) kg m–2, P = 0.02], fasting plasma glucose [−0.2 (0.5) versus +0.1 (0.3) mmol L−1, P = 0.01], total testosterone [−0.3 (0.7) versus +0.3 (0.3) mmol L−1, P < 0.001], insulin [−15.0 (18.0) versus +4.8 (18.6) pmol L−1, P < 0.001] and insulin resistance [−0.6 (0.6) versus +0.2 (0.7), P < 0.001], as well as a significant increase in quantitative insulin sensitivity check index [+0.01 (0.01) versus −0.002 (0.02), P = 0.01]. In addition, significant decreases in triglycerides [−0.1 (0.4) versus +0.2 (0.3) mmol L−1, P = 0.01] and malondialdehyde (MDA) [−1.2 (1.0) versus +0.2 (1.2) μmol L−1, P < 0.001] and significant increases in nitric oxide (NO) [+13.6 (14.1) versus +0.9 (24.3) μmol L−1, P = 0.01] and glutathione (GSH) [+170.1 (175.5) versus +24.2 (168.7) μmol L−1, P = 0.002] were seen in the test group compared to the control.

Conclusions

Adherence to test diet among subjects with PCOS significantly decreased BMI, glycaemic control, total testosterone, triglycerides and MDA, and significantly increased NO and GSH compared to the control diet.

Fathers as agents of change in tackling childhood obesity

February 23, 2018 ~ Simon Langley-Evans

Dietary outcomes of overweight fathers and their children in the Healthy Dads, Healthy Kids community randomised controlled trial

Williams et al., JHND Early View unknown

Background

Few studies have examined dietary intake changes following a weight loss intervention in fathers and the association between father–child dietary intakes. The present study aimed to: (i) evaluate the change in dietary intake in overweight fathers randomised to a family-based lifestyle intervention [Healthy Dads Healthy Kids (HDHK)] versus controls and (ii) investigate whether an association exists between father–child dietary intakes.

Methods

A secondary analysis was conducted of father–child baseline and 3-month post-intervention data (n = 93) collected in the HDHK community randomised controlled trial. Intention-to-treat linear mixed models were used to assess dietary changes by group, time (baseline and 3-month) and the group-by-time interaction. Cohens d was used to determine effect sizes.

Results

Significant group-by-time effects (all P < 0.05) favouring fathers in the intervention group were identified for total daily energy intake (−1956 kJ, d = 0.74), total sugars (−45 g, d = 0.63), sodium (−414 mg, d = 0.58) and % energy from nutrient-dense, core foods (+10.1%, d= 0.86), fruit (+2.4%, d = 0.71), vegetarian protein sources (+1.2%, d = 0.57), pre-packed snacks (+1.7%, d = 0.58) and sugar-sweetened beverages (−4.1%, d = 0.58). At baseline, positive correlations were observed between father–child intakes for a number of dietary variables, and significant correlations were observed between father–child change scores for % energy carbohydrate (r = 0.35, P = 0.023), % energy from fruit (r = 0.47, P = 0.002), vegetarian protein sources (r = 0.46, P = 0.002) and frequency of consuming meals with vegetables (r = 0.38, P = 0.012).

Conclusions

The HDHK intervention successfully improved some aspects of father’s dietary intakes compared to controls. The fathers’ eating patterns also correlated with those of their children for several dietary variables. These novel data suggest that fathers can be targeted as agents of dietary change within obesity prevention and treatment programmes

An increased intake of low-fat cheese between pre-pregnancy and early pregnancy is associated with a lower risk of gestational diabetes

February 23, 2018 ~ Simon Langley-Evans

The effect of pre-pregnancy lifestyle counselling on food intakes and association between food intakes and gestational diabetes in high-risk women: results from a randomised controlled trial

Valkama et al., JHND Early ViewUnknown

Background

Healthy diets before and during pregnancy have been suggested to reduce the risk of gestational diabetes (GDM). Several lifestyle intervention studies for pregnant women have reported dietary improvements after counselling. However, evidence concerning the effect of counselling initiated before pregnancy on diets is limited.

Methods

This randomised controlled study explored whether pre-pregnancy lifestyle counselling influenced food intakes, as well as whether changes in food intakes were associated with GDM. The participants comprised 75 women with prior GDM and/or a body mass index ≥ 30 kg m–2. Women were randomised into a control or an intervention group, and their food intakes were followed from pre-pregnancy to early pregnancy using a food frequency questionnaire. The control and intervention groups were combined to assess the association between changes in food intakes and GDM. The diagnosis of GDM was based on a 75-g oral glucose tolerance test conducted in the first and second trimester of pregnancy.

Results

Pre-pregnancy lifestyle counselling showed no major overall effect on food intakes. The intake of low-fat cheese increased significantly in women who did not develop GDM compared to women who did after adjusting for potential confounders (P = 0.028). This association was not observed for regular-fat cheese.

Conclusions

The findings obtained in the present study suggest that an increased intake of low-fat but not regular-fat cheese between pre-pregnancy and early pregnancy is associated with a lower risk of GDM in high-risk women.

Ulcerative colitis is associated with high consumption of sugar and soft drinks

February 22, 2018 ~ Simon Langley-Evans

Dietary patterns and risk of ulcerative colitis: a case–control study

Rashvand et al JHND Early View Unknown.png

Background

Recent evidence indicates a role for dietary factors in the pathogenesis of ulcerative colitis (UC). The aim of the present study was to investigate the relationship between dietary patterns and UC risk.

Methods

Sixty-two newly diagnosed cases of UC and 124 healthy age and sex-matched controls were studied. Data on diet was measured using a validated country-specific food frequency questionnaire. Factor analysis was used to define major dietary patterns based on 28 food groups and nutrient content.

Results

After adjustment for confounding factors, subjects who were in the highest tertile of the healthy dietary pattern had a 79% lower risk of UC (odds ratio = 0.21, 95% confidence interval = 0.07–0.59, P = 0.003), whereas the consumption of an unhealthy dietary pattern was associated with a significantly increased risk of UC (odds ratio = 3.39, 95% 95% confidence interval = 1.16–9.90, P = 0.027).

Conclusions

The findings of the present study suggest that dietary patterns are associated with UC risk.

Vitamin B12 deficiency is seen in a third of healthy Indian adolescents

February 22, 2018 ~ Simon Langley-Evans

Prevalence of vitamin B12 deficiency in healthy Indian school-going adolescents from rural and urban localities and its relationship with various anthropometric indices: a cross-sectional study

Chakraborty et al., JHND Early ViewUnknown.png

Background

Micronutrient deficiency is a global health burden, especially among developing countries. The present cross-sectional study aimed to determine the prevalence of vitamin B12 deficiency in healthy Indian school-going adolescents, based on area of residence, sex and body mass index (BMI). Furthermore, the relationship of serum B12 concentration with dietary vitamin B12 intake and anthropometric indices was assessed among adolescents from rural and urban India.

Methods

A total of 2403 school-going adolescents (11–17 years) from National Capital Region and rural areas of Haryana, India were selected. Serum B12 concentrations were estimated using an electrochemiluminescence immunoassay. Dietary assessments were conducted on 65% of total participants (n = 1556) by two 24-h diet recalls.

Results

The prevalence of vitamin B12 deficiency in the total study population was 32.4% (rural: 43.9% versus urban: 30.1%, P < 0.001; male: 34.4% versus female: 31.0%, P < 0.05; normal weight: 28.1%, versus overweight: 39.8%, versus obese: 51.2%, P < 0.001). More than half (51.2%) of obese adolescents were vitamin B12 deficient. On multiple linear regression analysis, serum B12 in rural adolescents was associated with age (β = −0.12, P < 0.05). Among urban adolescents, serum B12was associated with BMI (β = −0.08, P < 0.05) and adjusted dietary vitamin B12 intake (β = 0.14, P < 0.001). Serum vitamin B12 levels were found to be lower in rural females (β = −0.12, P = 0.030) and urban males (β: 0.11, P < 0.001) compared to their respective contemporaries.

Conclusions

Vitamin B12 deficiency was higher among rural school-going adolescents. Boys had a higher B12deficiency than girls. Inverse associations of serum B12 with adiposity indices were observed. Serum B12 levels were positively associated with dietary vitamin B12 intake.

January 2018

Food addiction and binge eating are associated with anxiety and depression

January 25, 2018 ~ Simon Langley-Evans

Food addiction and associations with mental health symptoms: a systematic review with meta-analysis

Burrows et al., JHND Early View unknown

Background

The present study systematically reviewed the literature aiming to determine the relationships between food addiction, as measured by the Yale Food Addiction Scale (YFAS), and mental health symptoms.

Methods

Nine databases were searched using keywords. Studies were included if they reported: (i) YFAS diagnosis or symptom score and (ii) a mental health outcome, as well as the association between (i) and (ii). In total, 51 studies were included.

Results

Through meta-analysis, the mean prevalence of food addiction diagnosis was 16.2%, with an average of 3.3 (range 2.85–3.92) food addiction symptoms being reported. Subanalyses revealed that the mean number of food addiction symptoms in populations seeking treatment for weight loss was 3.01 (range 2.65–3.37) and this was higher in groups with disordered eating (mean 5.2 3.6–6.7). Significant positive correlations were found between food addiction and binge eating [mean r = 0.602 (0.557–0.643), P < 0.05], depression, anxiety and food addiction [mean r = 0.459 (0.358–0.550), r = 0.483 (0.228–0.676), P < 0.05, respectively].

Conclusions

A significant, positive relationship exists between food addiction and mental health symptoms, although the results of the present study highlight the complexity of this relationship.

Educating parents about the potential benefits of frequent shared meals may lead to a higher fruit and vegetable consumption among preschoolers.

January 25, 2018 ~ Simon Langley-Evans

Is frequency of family meals associated with fruit and vegetable intake among preschoolers? A logistic regression analysis

Caldwell et al., JHND Early View unknown-1

Background

The present study aimed to examine the associations between frequency of family meals and low fruit and vegetable intake in preschool children. Promoting healthy nutrition early in life is recommended for combating childhood obesity. Frequency of family meals is associated with fruit and vegetable intake in school-age children and adolescents; the relationship in young children is less clear.

Methods

We completed a secondary analysis using data from the Early Childhood Longitudinal Study-Birth Cohort. Participants included children, born in the year 2001, to mothers who were >15 years old (n = 8 950). Data were extracted from structured parent interviews during the year prior to kindergarten. We used hierarchical logistic regression to describe the relationships between frequency of family meals and low fruit and vegetable intake.

Results

Frequency of family meals was associated with low fruit and vegetable intake. The odds of low fruit and vegetable intake were greater for preschoolers who shared less than three evening family meals per week (odds ratio = 1.5, β = 0.376, P < 0.001) than preschoolers who shared the evening meal with family every night.

Conclusions

Fruit and vegetable intake is related to frequency of family meals in preschool-age children. Educating parents about the potential benefits of frequent shared meals may lead to a higher fruit and vegetable consumption among preschoolers. Future studies should address other factors that likely contribute to eating patterns during the preschool years.

A low GI diet improves glucose handling in prediabetic individuals

January 25, 2018 ~ Simon Langley-Evans

Diets with a low glycaemic load have favourable effects on prediabetes progression and regression: a prospective cohort study

He JHND Early View Unknown

Background

To date, no study assessing the associations among glycaemic index (GI), glycaemic load (GL) and progression to diabetes has focused specifically on prediabetes. Moreover, the available data on the association between these variables and regression to normal glucose regulation (NGR) are insufficient. Therefore, the present study aimed to evaluate the longitudinal associations among GI, GL and prediabetes outcomes.

Methods

This prospective study included 640 adults aged 40–79 years with prediabetes at baseline. Dietary data were assessed using a previously validated 3-day food record. The participants were divided into three groups according to GI and GL tertiles. Outcomes were defined based on annual oral glucose tolerance test results.

Results

During a median of 5 years of follow-up, 127 incident cases of diabetes and 249 incident cases of NGR were identified. Dietary GL was positively associated with the risk of developing diabetes and negatively associated with the likelihood of reaching NGR at least once. Comparing the highest and lowest tertiles of GL, the multivariable-adjusted hazard ratios (95% confidence intervals) were 1.85 (1.07–3.21) for progression and 0.65 (0.44-0.96) for regression. No association was observed between GI and prediabetes outcomes in the fully adjusted models.

Conclusions

Among patients with prediabetes, high dietary GL was positively associated with diabetes risk. Furthermore, a low-GL diet contributed to an increased incidence of reaching NGR

Energy- and protein-based fortification and supplementation are an effective intervention to improve dietary intake amongst older inpatients

January 11, 2018 ~ Simon Langley-Evans

Evidence and practice guidance to assist in delivering high-quality clinical service in relation to the low FODMAP diet

January 16, 2018 ~ Simon Langley-Evans

The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice

Whelan et al.,JHND Early View unknown-2

Dietary restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is effective in the management of functional gastrointestinal symptoms that occur in irritable bowel syndrome (IBS). Numerous reviews have been published regarding the evidence for their restriction in the low FODMAP diet; however, few reviews discuss the implementation of the low FODMAP diet in practice. The aim of this review is to provide practical guidance on patient assessment and the implementation and monitoring of the low FODMAP diet. Broadly speaking, the low FODMAP diet consists of three stages: FODMAP restriction; FODMAP reintroduction; and FODMAP personalisation. These stages can be covered in at least two dietetic appointments. The first appointment focuses on confirmation of diagnosis, comprehensive symptom and dietary assessment, detailed description of FODMAPs and their association with symptom induction, followed by counselling regarding FODMAP restriction. Dietary counselling should be tailored to individual needs and appropriate resources provided. At the second appointment, symptoms and diet are re-assessed and, if restriction has successfully reduced IBS symptoms, education is provided on FODMAP reintroduction to identify foods triggering symptoms. Following this, the patient can follow FODMAP personalisation for which a less restrictive diet is consumed that excludes their personal FODMAP triggers and enables a more diverse dietary intake. This review provides evidence and practice guidance to assist in delivering high-quality clinical service in relation to the low FODMAP diet.

Can fortified foods and snacks increase the energy and protein intake of hospitalised older patients? A systematic review

Mills et al., JHND Early View unknown-2

Background

Undernutrition affects over 44% of hospitalised older people, who often dislike oral nutritional supplements (ONS). This review summarises the evidence for an alternative strategy, using energy and protein dense meals (via fortification) or snacks (supplementation) to increase the dietary energy and protein intake of older inpatients.

Methods

A search was conducted through PubMed, EMBASE, CINAHL and the Cochrane database of systematic reviews (May 1996 to May 2016) that used fortification or supplementation to increase the energy or protein intake of patients (mean age ≥60 years) in hospitals or rehabilitation centres.

Results

Ten articles (546 patients, mean age 60–83 years) were identified. Compared with usual nutritional care, six studies using either energy or protein based fortification and supplementation significantly increased intake of energy (250–450 kcal day−1) or protein (12–16 g day−1). Two studies enriched menus with both energy and protein, and significantly increased both energy (698 kcal day−1 and 21 kJ kg−1) and protein (16 g and 0.2 g kg−1) intake compared to usual care. ONS was similar to supplementation in one study but superior to fortification in another. Four studies reported good acceptability of enriched products and two studies that found they were cost-effective.

Conclusions

Compared with usual nutritional care, energy- and protein-based fortification and supplementation could be employed as an effective, well-tolerated and cost-effective intervention to improve dietary intake amongst older inpatients. This strategy may be particularly useful for patients with cognitive impairment who struggle with ONS, and clinical trials are required to compare these approaches and establish their impact on functional outcomes.

December 2017

Dietary intake in people consuming a low-carbohydrate diet in the UK Biobank

December 13, 2017 ~ Simon Langley-Evans

Dietary intake in people consuming a low-carbohydrate diet in the UK Biobank

Shafique et al., JHND Early View unknown-2

Background

Low-carbohydrate diets are becoming increasingly popular, although their dietary quality outside of clinical studies is unknown. A previous study analysed the dietary intake in people consuming a reduced-carbohydrate diet (<40% calories). However, it is not clear what foods people consume when carbohydrate is reduced to below 26% of total calories.

Methods

In the present cross-sectional study, the dietary and nutrient intake collected via up to five consecutive 24-h dietary recalls and a food frequency questionnaire of 444 individuals (aged 46-79 years) consuming <26% of calories from carbohydrate (LCHO) was compared with that of 131 897 individuals consuming ≥45% calories from carbohydrate (NCHO) using the UK Biobank Dataset. Absolute cut-offs to define the low-carbohydrate group (<130 g day–1; n = 1953 versus ≥225 g day–1, n = 113 036) were also used.

Results

Both NCHO (>45% calories and ≥225 g) groups consumed significantly more high-sugar, high-fat snacks [median 6.0, interquartile range (IQR) = 2.0–11.0 and median 6.0, IQR = 3.0–11.8, respectively) compared to the LCHO (<26% calories and <130 g) groups (median 0, IQR = 0–2.8 and median 1, IQR = 0–3.8, respectively) (P < 0.0001). Both LCHO groups reported consuming significantly more red meat, oily fish, nuts and seeds but fewer fruits, vegetables and pulses compared to the NCHO groups. In general, the consumption of oily fish, nuts, seeds and pulses was low across the whole cohort and differences in intake between the LCHO and NCHO groups were small. After adjusting for socio-economic status, most differences remained.

Conclusions

Carbohydrate restriction is associated with both beneficial and potentially deleterious dietary changes compared to a normal carbohydrate intake  

No difference in self-reported frequency of choking between infants introduced to solid foods using a baby-led weaning or traditional spoon-feeding approach

December 5, 2017 ~ Simon Langley-Evans

No difference in self-reported frequency of choking between infants introduced to solid foods using a baby-led weaning or traditional spoon-feeding approach

Brown JHND Early View unknown-2

Background

Baby-led weaning (BLW) where infants self-feed family foods during the period that they are introduced to solid foods is growing in popularity. The method may promote healthier eating patterns, although concerns have been raised regarding its safety. The present study therefore explored choking frequency amongst babies who were being introduced to solid foods using a baby-led or traditional spoon-fed approach.

Methods

In total, 1151 mothers with an infant aged 4–12 months reported how they introduced solid foods to their infant (following a strict BLW, loose BLW or traditional weaning style) and frequency of spoon-feeding and puree use (percentage of mealtimes). Mothers recalled if their infant had ever choked and, if so, how many times and on what type of food (smooth puree, lumpy puree, finger food and specific food examples).

Results

In total, 13.6% of infants (n = 155) had ever choked. No significant association was found between weaning style and ever choking, or the frequency of spoon or puree use and ever choking. For infants who had ever choked, infants following a traditional weaning approach experience significantly more choking episodes for finger foods (F2,147 = 4.417, P = 0.014) and lumpy purees (F2,131 = 6.46, P = 0.002) than infants following a strict or loose baby-led approach.

Conclusions

Baby-led weaning was not associated with increased risk of choking and the highest frequency of choking on finger foods occurred in those who were given finger foods the least often. However, the limitations of noncausal results, a self-selecting sample and reliability of recall must be emphasised

November 2017

Improving future research will enhance the quality of the evidence-base that investigates the outcomes of dietary interventions involving dietitians.

November 27, 2017 ~ Simon Langley-Evans

Quality of development and reporting of dietetic intervention studies in primary care: a systematic review of randomised controlled trials

Ball et al., JHND Early Viewunknown

Background

High-quality research methodologies and clear reporting of studies are essential to facilitate confidence in research findings. The aim of the present study was to conduct an in-depth examination of the methodological quality and reporting of studies included in a recent systematic review of dietitians’ effectiveness at providing individualised nutrition care to adult patients.

Methods

The methodological quality and reporting of 27 Randomised Controlled Trials (RCTs) were appraised using the UK Medical Research Council (MRC) Guidelines for complex interventions and the CONSORT checklist for reporting RCTs. A quality appraisal checklist was developed for each guideline/assessment tool aiming to evaluate the extent to which each study met the designated criteria. Excerpts from studies that best addressed criteria were collated to provide exemplary accounts of how criteria may be achieved in future studies.

Results

None of the reviewed studies met more than half of the MRC Guidance criteria, indicating that there is clear room for improvement in reporting the methodological underpinnings of these studies. Similarly, no studies met all criteria of the CONSORT checklist, suggesting that there is also room for improvement in the design and reporting of studies in this field.

Conclusions

Dietitians, researchers and journal editors are encouraged to use the results and exemplary accounts from this review to identify key aspects of studies that could be improved in future research. Improving future research will enhance the quality of the evidence-base that investigates the outcomes of dietary interventions involving dietitians

Long-term impact of a weight management intervention is independent of sociodemographic factors.

November 27, 2017 ~ Simon Langley-Evans

The impact of social deprivation on the response to a randomised controlled trial of a weight management intervention (BeWEL) for people at increased risk of colorectal cancer

Fisher et al., JHND Early ViewUnknown.png

Background

Although 45% of colorectal cancer (CRC) cases may be avoidable through appropriate lifestyle and weight management, health promotion interventions run the risk of widening health inequalities. The BeWEL randomised controlled trial assessed the impact of a diet and activity programme in overweight adults who were diagnosed with a colorectal adenoma, demonstrating a significantly greater weight loss at 12 months in intervention participants than in controls. The present study aimed to compare BeWEL intervention outcomes by participant deprivation status.

Methods

The intervention group of the BeWEL trial (n = 163) was classified by the Scottish Index of Multiple Deprivation (SIMD) quintiles into ‘more deprived’ (SIMD 1–2, n = 58) and ‘less deprived’ (SIMD 3–5, n = 105). Socio-economic and lifestyle variables were compared at baseline to identify potential challenges to intervention adherence in the more deprived. Between group differences at 12 months in primary outcome (change in body weight) and secondary outcomes (cardiovascular risk factors, diet, physical activity, knowledge of CRC risk and psychosocial variables) were assessed by deprivation status.

Results

At baseline, education (P = 0.001), income (P < 0.001), spending on physical activity (P = 0.003) and success at previous weight loss attempts (P = 0.007) were significantly lower in the most deprived. At 12 months, no between group differences by deprivation status were detected for changes in primary and main secondary outcomes.

Conclusions

Despite potential barriers faced by the more deprived participants, primary and most secondary outcomes were comparable between groups, indicating that this intervention is unlikely to worsen health inequalities and is equally effective across socio-economic groups.

Eat a Mediterranean diet- but what is it?

Barriers to adopting a Mediterranean diet in Northern European adults at high risk of developing cardiovascular disease

Moore et al., JHND Early View unknown-2

Background

Strong evidence links the consumption of a Mediterranean diet (MD) with a reduced cardiovascular disease (CVD) risk; however, there is uncertainty as to whether non-Mediterranean regions will adopt this diet. The present qualitative research aimed to investigate attitudes towards a MD in individuals at high CVD risk in a Northern European population. This information is needed to inform development of MD interventions in non-Mediterranean high-risk populations.

Methods

Focus groups (n = 12) were held with individuals at high CVD risk from Northern Europe (≥2 CVD risk factors, aged ≥50 years, no established CVD/type 2 diabetes). Attitudes to dietary change towards a MD were explored. Data were analysed using inductive thematic analysis.

Results

Sixty-seven adults participated (60% female, mean age 64 years). There was some awareness of the term MD but limited knowledge of its composition. Barriers to general dietary change were evident, including perception of expense, concern over availability, expectation of time commitment, limited knowledge, lack of cooking skills, amount and conflicting nature of media information on diets, changing established eating habits and resistance to dietary change. Barriers specific to MD adoption were also identified, including perceived difficulty living in a colder climate, perceived impact on body weight, acceptability of a MD and cultural differences.

Conclusions

Knowledge of a MD was limited in this Northern European sample at high CVD risk. In addition to general barriers to dietary change, barriers specific to a MD were identified. These findings have implications for the development of interventions aiming to promote MD adoption in non-Mediterranean populations.

Identification of factors contributing to successful self-directed weight loss

Background

Despite the number of weight management programmes and their wide promotion, most overweight and obese individuals tend to lose weight on their own. The present study aimed to understand the characteristics and strategies of those who successfully engage in self-directed weight loss, which could empower other overweight and obese individuals with information and strategies to manage their weight on their own.

Methods

Men and women who had lost at least 5% of their body weight without direct interaction with professionals or weight management programmes were recruited. Demographic data were collected by questionnaire and participants’ weight-loss experiences were explored using semi- structured interviews to elicit in-depth individual experiences and perspectives. Iterative thematic method data analysis was used to generate themes describing contributing factors to the success of self-directed weight loss identified by participants.

Results

Most characteristics of those who successfully self-managed their weight loss were in line with those reported by successful weight losers participating in professional-led projects. However, strategies such as early embedding of new lifestyle behaviours into daily routine, the ability to learn from previous weight-loss experiences, and not requiring social support were identified as distinctive factors that contributed to the success of self-directed weight loss by participants of the present study.

Conclusions

Overweight or obese individuals with strong internal motivation, problem-solving skills and self-reliance are more likely to be successful at achieving self-directed weight loss. The patients identified with these characteristics could be encouraged to self-manage their weight-loss process, leaving the places available in more resource-intensive professional-led programmes to those individuals unlikely to succeed on their own.

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).