1133 results
Development and Validity of the ‘Modified Mediterranean Prime Screen’ to assess Dietary Intake Among Women of Reproductive Age in Lebanon
- Mariam Assaad, Sara Ajjour, Maya Rahme, Laila Al-Shaar, May Sakr, Hala Ghattas, Ghada El-Hajj Fuleihan, Jana Jabbour
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- Journal:
- British Journal of Nutrition / Accepted manuscript
- Published online by Cambridge University Press:
- 31 May 2024, pp. 1-23
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The Mediterranean region registers an increasing prevalence of obesity. The region lacks a diet screener to assess obesogenic nutrients. This study aimed to evaluate the reproducibility and validity of the Modified Mediterranean Prime Screen (MMPS) in estimating obesogenic nutrients’ intake among women of reproductive age, as compared to a culturally validated Food Frequency Questionnaire (FFQ), in Lebanon. We developed the MMPS consisting of 32 food/beverage items specific to the Lebanese Mediterranean culture. The MMPS and FFQ were administered in two visits (2 weeks-6 months apart), face to face, and via telephone during the COVID pandemic. Reproducibility and validity of the MMPS were assessed using intraclass correlation coefficients (ICC) and Pearson’s correlations, respectively. The study included 143 women, age: 31.5 ± 4.6 years, body mass index 24.2 ± 4.0 Kg/ m2, 87% with university education, 91% food secure. The reproducibility of the MMPS was moderate for energy and all assessed nutrients except for saturated fatty acid (ICC=0.428). The agreement of the MMPS with the reference FFQ was adequate for energy and obesogenic nutrients. Yet, the Pearson correlations for energy-adjusted nutrient intake were low for trans-fatty acids (0.294) and polyunsaturated fatty acids (0.377). The MMPS can be a time efficient tool for dietary assessment of energy and many obesogenic nutrients. Future studies should validate the MMPS across the lifespan and revaluate it after updating the fatty acids profiles in the culturally specific food composition tables.
A randomized controlled intervention trial to study the effect of a personalized lifestyle program on cancer-related fatigue among colorectal cancer survivors: protocol for the SoFiT study
- Judith de Vries - ten Have, Koen Manusama, Auke J.C.F. Verkaar, Sandra Beijer, Dirkje W. Sommeijer, Ellen Kampman, Laura H.H. Winkens, Renate M. Winkels
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- Journal:
- British Journal of Nutrition / Accepted manuscript
- Published online by Cambridge University Press:
- 28 May 2024, pp. 1-31
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Observational studies suggest that a healthy diet in combination with ample physical activity is associated with a lower prevalence of cancer-related fatigue. The SoFiT trial (SoFiT: Study on Fatigue: a lifestyle intervention among colorectal cancer survivors) will assess the effect of a personalized lifestyle program on cancer-related fatigue in a randomised study.
We designed a program that aims to increase adherence to lifestyle recommendations on diet and physical activity. The program was person-centred with regards to the lifestyle and personal characteristics of participants, to the determinants of behaviour of that participant, and to the preference, opportunities, and barriers of the participant.
The effect of the program was tested in the SoFiT trial: a two-armed, parallel, randomized controlled trial among adult stage I-III colorectal cancer survivors, who experience cancer-related fatigue after treatment completion; intended sample size n=184. Participants randomized to the intervention group received the personalized lifestyle program. During six months, participants in the intervention group had individual sessions with a lifestyle coach of which four sessions were face-to-face and eight sessions were remote. After six months, participants randomized to the control group had access to two lifestyle coaching sessions and to the same materials that the intervention group also received.
The primary endpoint of the trial is cancer-related fatigue. Secondary endpoints are: sleep quality and duration, health-related quality of life, physical performance, depression and anxiety, skeletal muscle echo intensity and cross-sectional area, and gut microbiota composition.
This trial will show the effects of a personalized lifestyle program on cancer-related fatigue, and on an extensive set of secondary outcomes.
Oral health and multimorbidity: is diet the chicken or the egg?
- Teresa A. Marshall, Riva Touger-Decker
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- Proceedings of the Nutrition Society , First View
- Published online by Cambridge University Press:
- 14 May 2024, pp. 1-8
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Oral health is a critical component of overall health and well-being, not just the absence of disease. The objective of this review paper is to describe relationships among diet, nutrition and oral and systemic diseases that contribute to multimorbidity. Diet- and nutrient-related risk factors for oral diseases include high intakes of free sugars, low intakes of fruits and vegetables and nutrient-poor diets which are similar to diet- and nutrient-related risk factors for systemic diseases. Oral diseases are chronic diseases. Once the disease process is initiated, it persists throughout the lifespan. Pain and tissue loss from oral disease leads to oral dysfunction which contributes to impaired biting, chewing, oral motility and swallowing. Oral dysfunction makes it difficult to eat nutrient-dense whole grains, fruits and vegetables associated with a healthy diet. Early childhood caries (ECC) associated with frequent intake of free sugars is one of the first manifestations of oral disease. The presence of ECC is our ‘canary in the coal mine’ for diet-related chronic diseases. The dietary sugars causing ECC are not complementary to an Eatwell Guide compliant diet, but rather consistent with a diet high in energy-dense, nutrient-poor foods – typically ultra-processed in nature. This diet generally deteriorates throughout childhood, adolescence and adulthood increasing the risk of diet-related chronic diseases. Recognition of ECC is an opportunity to intervene and disrupt the pathway to multimorbidities. Disruption of this pathway will reduce the risk of multimorbidities and enable individuals to fully engage in society throughout the lifespan.
Human milk, breastfeeding, and early neurodevelopmental outcomes for infants with critical CHD
- Kristin M. Elgersma, Melissa L. Engel, Sara E. Ramel, Jessica A. Davis, Anne C. McKechnie, Katie M. Pfister
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- Journal:
- Cardiology in the Young , First View
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- 13 May 2024, pp. 1-9
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Human milk improves neurodevelopment for preterm infants, but relationships between human milk and neurodevelopment for infants with critical CHD are unknown. We aimed to (1) explore associations between human milk/direct breastfeeding and neurodevelopment at 1-year and 2-year follow-up and (2) describe patterns of human milk (maternal, donor) and commercial formula during hospitalisation in the first year of life.
This retrospective cohort study included infants who underwent surgery for CHD < 6 months old. The primary outcome was neurodevelopment via Bayley Scales of Infant Development-IV. Analysis included adjusted linear regression for associations between exclusive human milk while inpatient during the first 6 months or any direct breastfeeding while inpatient during the first year of life and 1-year Bayley-IV scores. Models were adjusted for race, insurance type, genetic diagnosis, and length of stay.
Of 98 eligible infants, 40% followed up at 1 year; 27% at 2 years. There were differences in follow-up related to demographics (race, ethnicity) and social determinants of health (insurance type, distance from clinic). In adjusted models, infants who directly breastfed had 13.18 points higher cognition (95% CI: 0.84–25.53, p = 0.037); 14.04 points higher language (2.55–25.53, p = 0.018); and 15.80 points higher motor scores (3.27–28.34, p = 0.015) at 1-year follow-up. Infants fed exclusive human milk had 12.64 points higher cognition scores (−0.53–25.82, p = 0.059).
Future investigation into nutrition and neurodevelopment in the context of critical CHD is warranted. As neurodevelopmental follow-up becomes standard of care in this population, efforts are needed to mitigate disparities in access to this care.
12 - Developing an Action Plan for the Neuro-intelligent Lawyer
- Debra S. Austin, University of Denver
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- The Legal Brain
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- 08 May 2024
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- 09 May 2024, pp 189-201
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Summary
When a lawyer discovers the habits that protect brain health and empower mental strength, she will embark on a series of changes. She will be moved to invest in her well-being. It takes only a few months of work to reap the brain health benefits. A recent clinical trial demonstrated that an eight-week diet and lifestyle program can reverse biological aging in otherwise healthy adult males, aged 50-72. The intervention included prescriptions for exercise, sleep, stress management, and diet. Commitment to lifestyle changes can be difficult for some people. Research reveals two helpful strategies: action planning, developing concrete steps for achieving a goal, and coping planning, to identify and overcome the barriers to your goals. This chapter presents tools for creating an action plan for the areas of concern for each individual lawyer, including stress management, self-medication, nutrition, brain health, and mental strength. There are tips for moving from the action plan to durable change, including fresh start strategy, habit stacking, and tracking new practices.
Investigating nutritional status and body composition in children with cerebral palsy; the Eat, Sleep Play-CP study
- M. Copeland, R. Diaz-Rodriguez, N.S. Hill, F.E. Lithander, S.A. Williams
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E186
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Cerebral palsy (CP), or to use the Te Reo term “Hōkai Nukurangi”, is an umbrella name for a group of permanent neurodevelopmental disorders, affecting movement and posture(1), and is the most common childhood onset physical disability globally. The available literature on the nutritional status of children with CP describes high rates of malnutrition, however data appears to be skewed towards children of higher levels of impairment impacting functional independence. Less is known about the nutritional status of children with lower levels of impairment. The aim of the “Eat, Sleep, Play-CP” study was to evaluate total energy intake, total protein intake and the timing of protein intake in relation to physical activity for children with CP across all functional levels living in Aotearoa New Zealand. Children with CP aged 5-12 years were invited to participate in an observational assessment of dietary intake using parent reported 24-hour dietary recall (Intake 24) on three non-consecutive days, accompanied by a questionnaire capturing self-reported sleep and physical activity patterns. Body composition was assessed via whole body dual energy X-ray absorptiometry scan. Nine participants (6 males, median age: 10 years, n = 2 Māori), across Gross Motor Function Classification System levels I-IV, and Eating and Drinking Classification System levels I-III took part in the study. The median total energy intake was 7267kJ/d (range 5355-10731.96kJ/d), and median protein intake was 67g/d (range 49-111g/d). According to the Nutrient Reference Values for Australia and New Zealand (NRV)(2), 3 of the 9 participants (33%) were within the recommended range for energy intake according to their age and reported physical activity levels. Of the other 6, 4 were below and 2 were above the recommended ranges. All 9 met the recommended protein intake (NRV). Participants had a median percentage body fat of 40% (range 20-46%), and non-fat mass of 58% (range 52-76%). Five participants fell within the overweight or obese range for their age and sex, three of whom were within the recommended range of total energy daily intake according to NRVs. This outcome may indicate that for some children with CP, recommendations could be over-estimating the actual requirements. These early results may bring in to question current practice around guidance for energy intake requirements for children with CP and their whānau to support healthy body composition. Further investigations are needed to establish whether specific energy intake guidelines are required for children with CP.
Does experience of music enhance olfaction: music as a potential nutrition intervention?
- G. Ellender, P. Moynihan, G. Koehne
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E78
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Olfaction, the sense of smell, is under recognised and underappreciated despite being vital in wellbeing. It confers a major influence on the feeding process being the major contributor of flavour and has a direct involvement in the cephalic phase responses. Along with its influence on food and nutrition, olfaction is directly associated with cognitive function and impacts social communication and safety(1). Loss of olfactory acuity, commonly occurring in aging and frailty, significantly influences dietary behaviour and food selection(2). Unlike the senses of vision and audition, interventions are lacking. We propose in a proof-of-concept that crossmodal integration of olfaction and audition could inhibit olfactory decline in lifelong musicians through encouraging neuroplasticity of the olfactory brain centres. Ethical approval was obtained from The University of Adelaide Human Research Ethics Committee. Male musicians with a lifetime experience of music (ME) and naïve non-musicians (NM) aged 55 years and over were recruited through music organisations and controls through the Australian Men’s Shed network. The initial target sample size was twenty per cohort. Olfactory acuity was assessed with Sniffin’ sticks® (Odofin, Groningen, The Netherlands), a well validated system of a battery of three tests regimes. Sniffin’ sticks represent ‘felt tipped pens’ impregnated with odourants presented 20mm below the nose of participants who were then prompted to ‘sniff’. Assays determined participant ‘Threshold’, ‘Discrimination’ and ‘Identification’ of test odours (3). Measurement of Threshold and Discrimination were undertaken in triplet fifteen seconds apart with eyes closed; measurement of Threshold being conducted in an ascending ‘staircase’ to detect lowest odour concentration detectable, whereas measurement of Discrimination selected the ‘odd-man-out’ of a triplet comprising two identical and one different odour. Measurement of Identification, with eyes open, selected the odour of a single ‘pen’ from a prompt list of four. All tests demanded selection. Each of the test batteries were scored out of sixteen along with total aggregate of Threshold, Discrimination, and Identification (TDI). Twenty-six participants completed the study (18 ME and 8 NM); numbers were limited owing to active COVID-19. Mean and standard deviations (SD) of Threshold, Discrimination, Identification and TDI were derived and compared between groups using ‘t’-test. For ME, Threshold, Discrimination, and Identification values were 6.2 (SD ± 3.7), 10.6 (SD ± 1.9), and 12.9 (SD ± 1.6). The respective values for NM were 5.0 (SD ± 2.3), 8.8(SD ± 2.9), and 10.8 (SD ± 2.5). The ME group showed a significantly higher Discrimination (p = 0.164). Significant differences were not seen for Threshold, Identification, and overall TDI scores, however the small sample size may have accounted for this. Based on this proof-of-concept, further exploration of music is warranted as an intervention to enhance olfactory acuity to potentially improve the intake of food and nutrition, and enrich pleasure of eating and drinking, and quality of life.
An e-Delphi study to evaluate content validity of the Teacher Food and Nutrition-Questionnaire
- T. Jakstas, T. Bucher, A. Miller, V.A. Shrewsbury, C.E. Collins
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E165
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Teacher food and nutrition (FN) related factors include diet quality, health perceptions and FN attitudes. These factors are associated with both personal health and wellbeing, and teacher classroom FN practices. With Australian schoolteachers currently experiencing high levels of stress, anxiety and burnout, measuring and understanding the status of teacher FN-related health and wellbeing is needed. However, first there needs to be a comprehensive and validated tool to collect these data. This study aims to evaluate content validity of a new tool, the Teacher Food and Nutrition Questionnaire (TFNQ), to measure FN-related health and wellbeing of Australian schoolteachers. The TFNQ was developed following an extensive literature review of FN data collection methods previously used in schoolteacher populations internationally. It initially included 16 FN-related constructs alongside six constructs of wellbeing and mental health, and seven lifestyle covariates identified from the literature review. A two-round e-Delphi methodology was implemented using a mix of structured, rank-order and qualitative questions administered to an international, multidisciplinary group of experts via an online survey1. Descriptive statistics were used to derive a consensus vote (set at 75%) of constructs and covariates to be prioritised for inclusion. Qualitative feedback was analysed to identify areas of potential change. Twenty-three experts participated in round-one from Australia (n = 15), Switzerland (n = 3), The United Kingdom (n = 2), Canada (n = 1), The United States of America (n = 1) and New Zealand (n = 1). Of the 29 constructs and covariates evaluated in round-one of the e-Delphi, all achieved above 75% consensus, yet qualitative feedback indicated potential to reduce and streamline the number of constructs. Rank order questions and qualitative feedback resulted in the removal of four FN and two wellbeing constructs along with four lifestyle covariates. Round-two included 19 (83%) experts from round-one, with 83% (n = 15) in agreement regarding question order. Final feedback indicated only minor adjustments to question item phrasing. The e-Delphi process modified the TNFQ and established content validity. Further construct validity and reliability testing is required to produce a robust tool for measuring FN-related health and wellbeing of contemporary Australian schoolteachers.
Resistant starch content of selected Australian foods
- L. Hareer, C. Tran, H. O’Neill, A. Genoni
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E50
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A growing body of research has identified interactions between microorganisms and nutrients within the gut, collectively referred to as the ‘gut microbiome’(1). Alongside this, distinct structural characteristics/components of dietary fibre have been recognised to exhibit various physiological effects on the body(1). These inherent physiological properties have the potential to result in diverse health benefits through the consumption of resistant starch, a specific form of dietary fibre(2). It is important to note that the laboratory-based techniques employed to assess resistant starch content from current Australian dietary composition data are antiquated and have not been conducted using updated testing methods(3). Results from updated testing methods may contribute to and inform nutritional recommendations to support and improve health outcomes. To assess the resistant starch content of starch-containing Australian foods using the updated Association of Analytical Chemists (AOAC) 2002.02 testing methods approved by Food Standards Australia New Zealand(3). Standardised kits (K-RSTAR) and control flours were used for assaying. Forty commonly consumed and available Australian foods were tested in duplicate for their resistant starch content. Calculated resistant starch values (in grams) were recorded using calculation tools provided by Megazyme. Means, standard deviations, and coefficient of variations between duplicate samples were recorded in a Microsoft Excel spreadsheet. The resistant starch content of foods varied from 0-13.72g/100g for rice crackers, beetroot, and hi-maize pancakes, respectively. Foods with the highest resistant starch were hi-maize flour pancakes, red kidney beans, Lebanese bread, and Cornflakes cereal, which ranged from 2.30-13.72g/100g. The lowest resistant starch foods included beetroot, rice crackers, All Bran cereal, and Nutri-grain cereal, ranging from 0-0.04g/100g. Changes in the foods’ natural chemical, physical, and enzymatic qualities may have led to slight batch variations and deviations from the literature available. This study is the first known Australian study to investigate the resistant starch content of selected Australian foods using the AOAC 2002.02 assay method. This data can be used to assess resistant starch consumption in the Australian population, inform gut microbiome research, and guide clinical practice recommendations for fibre intake.
Psychosocial impacts of Baby Friendly Spaces for Rohingya refugee mothers in Bangladesh: A pragmatic cluster-randomized controlled trial
- Amanda J. Nguyen, Sarah M. Murray, Kh Shafiur Rahaman, Molly E. Lasater, Suzit Barua, Catherine Lee, Matthew Schojan, Brigitte Tonon, Laetitia Clouin, Karine Le Roch
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- Journal:
- Cambridge Prisms: Global Mental Health / Volume 11 / 2024
- Published online by Cambridge University Press:
- 07 May 2024, e64
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Background
This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports.
MethodsIn matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters.
ResultsSignificant within-group improvements in BFSIE were observed for distres (−.48, p = .014), functional impairment (−.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = −.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons.
DiscussionFeasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research.
Reducing hip and non-vertebral fractures in institutionalised older adults by restoring inadequate intakes of protein and calcium is cost-saving
- Y. Baek, S. Iuliano, J. Robbins, S. Poon, E. Seeman, Z. Ademi
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E108
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Older adults in aged care homes account for 30% of the population burden of hip fractures(1). Nutritional interventions to correct protein and calcium inadequacies reduce these and other debilitating fractures, perhaps partly by reducing falls and slowing deterioration in bone morphology. We aimed to determine whether a nutritional approach to fracture risk reduction in aged care homes is cost-effective. Costing was estimated based on results of a prospective two-year cluster-randomised controlled trial involving 3313 residents in 27 aged care homes (intervention using high dairy menus), 3911 residents in 29 aged care homes (controls consuming from normal menus) and cost of ambulance, hospital, rehabilitation, and residential care incurred after fracture. The incremental cost-effectiveness ratios per fracture averted within a 2-year time horizon were estimated from the Australian healthcare perspective applying a 5% discount rate on costs after the first year. Intervention resulted in a total of 3.5 servings of milk, yoghurt and/or cheese daily, achieving 1,142mg calcium and 69g protein versus usual daily intakes of 700mg calcium and 58g protein consumed by controls. This intervention reduced all fractures by 33% at a daily cost of AU$0.66 per resident. The base-case results showed that intervention was cost-saving per fracture averted, with robust results in a variety of sensitivity and scenario analyses. Scaling the benefits of intervention to the Australian community equated to a saving of AU$66,780,000 annually in Australia and remained cost saving up to a daily food expenditure of AU$1.07 per aged care resident. Averting hip and other non-vertebral fractures in older adults in aged care homes by restoring nutritional inadequacies of protein and calcium is cost saving and supports the wide-spread implementation of this type of nutritional intervention in similar settings.
Minerals and trace elements in broad-leaved Geebung (Persoonia stradbrokensis), an underutilised native Australian fruit
- J. Zhang, D. Sivakumar, M.E. Netzel, Y. Sultanbawa
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E56
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Minerals and trace elements are essential for human health and wellness. Fruits can be an important dietary source of these micronutrients. For centuries, native Australian fruits have been a vital source of nutrition and well-being for the Indigenous Communities(1). However, comprehensive information on the mineral and trace element composition of these native fruits, including broad-leaved Geebung (Persoonia stradbrokensis), is lacking. Therefore, the aim of the present study was to determine the mineral and trace element composition of broad-leaved Geebung, an important but still underutilised native Australian fruit, at different maturity stages. Inductively coupled plasma mass spectrometry (ICP-MS) and inductively coupled plasma-optical emission spectroscopy (ICP-OES) were used to analyse the fruit. Statistical analysis was performed using one-way ANOVA and the means (n = 3) were compared by Tukey’s multiple comparison post hoc test with p < 0.05 as significant. Calcium and potassium could be identified as the main minerals, and iron, zinc and manganese as the main trace elements. The calcium content in broad-leaved Geebung was lower than Australian desert lime, kakadu plum, and riberry, respectively (35.7-271.5 vs. 384.2 vs. 282.5 vs. 307.7 mg/100g dry weight (DW))(2). Potassium has a vital role in the prevention of bone loss and is essential for the heart, kidney, and blood pressure. The potassium content of broad-leaved Geebung fruit was lower than Australian desert lime, kakadu plum, lemon aspen, quandong and riberry (average 516.4 vs. 1287.8 vs. 1905.5 vs. 1512.9 vs. 3456.2 vs. 1715.7 mg/100g DW)(2), which contributes to approximately 15% recommended dietary allowance (RDA). Iron is the main element in the production of hemoglobin and is important for maintaining healthy blood. Iron content in the fruit ranged from 0.8-2.6 mg/100g DW, which was higher than that of Davidson’s plum (1.2 mg/100g DW), but lower than the Green Plum, Australian desert lime, and kakadu plum (3.8 vs. 4.7 vs. 4.0 mg/100g DW) (2,3). Besides, the manganese levels were relatively high in broad-leaved Geebung fruit and considerably higher than in other native Australian fruits such as Kakadu plums, Desert limes and Quandongs (11.2-26.4 vs. 3.5 vs. 0.9 vs. 0.3 mg/100 g DW)(2). Interestingly, the mineral and trace element content decreased (p < 0.05) during fruit maturity. In general, broad-leaved Geebung fruit can provide considerable amounts of essential minerals and trace elements and its potential as a healthy “snack” alternative should be investigated further.
Inflammatory Bowel Disease exercise and diet (IBDeat) habits study: exploring lifestyle habits and cardiometabolic disease risk factors
- J.M. Yap, C. Wall, R. Turner, K. Meredith-Jones, H. Osborne, M. Schultz
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E69
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Patients with inflammatory bowel disease (IBD) have higher risk of developing cardiometabolic diseases due to chronic gut and systemic inflammation which promotes atherogenesis. Adopting healthy lifestyle habits can prevent development of cardiometabolic diseases, but can be challenging for people with IBD. The IBD exercise and diet (IBDeat) habits study describes the lifestyle habits and cardiometabolic disease risk factors of adults with IBD in Aotearoa, New Zealand (NZ).
This is a cross-sectional study including adult NZ IBD patients recruited online via Crohn’s and Colitis NZ and Dunedin hospital from 2021 to 2022. An online questionnaire collected demographics, smoking status, comorbidities, medications, disease severity scores, quality of life, physical activity, and dietary intake. The Dunedin cohort had physical measurements taken including anthropometrics, handgrip strength, blood pressure, body composition (bioelectrical impedance), blood nutritional markers, and faecal calprotectin. Data were compared to established reference values and linear regression analysis investigated associations between lifestyle habits and cardiometabolic risk factors. The study received University of Otago ethical approval (reference: H21/135). A total of 213 adults with IBD (54% Crohn’s disease; 46% ulcerative colitis) completed the online questionnaire and a subset of 102 from Dunedin provided physical measurements. Participants characteristics were: median age 37 (IQR 25, 51) years, 71% female, 82% NZ European, 4% smokers, and 1.4% had active IBD. Thirty-five percent of participants had at least one comorbidity and 34% of participants had poor quality of life. Known dietary risk factors associated with cardiometabolic diseases were common: low intakes of vegetables (77%), fruit (51%), fibre (35%) and high intakes of total fat (84%) and saturated fat (98%). Physical activity recommendations were met by 61% of participants and 63% reported barriers to being more active from fatigue (63%) and joint pain (54%). Other cardiometabolic risk factors were common in the Dunedin cohort: high LDL (79%) and total cholesterol (76%), central adiposity (64%), high body fat percentage (44%), high blood pressure (26%), and low handgrip strength (25%). Regression analysis showed that vegetable (per serve) and carbohydrate (per 5% of total daily energy intake (TE)) were associated with 0.22 mmol/L (95%CI 0.43, 0.013) and 0.20 mmol/L (95%CI 0.34, 0.057) lower LDL cholesterol. Discretionary food items were associated with higher LDL cholesterol, 0.11 mmol/L per daily serve (95%CI 0.028, 0.19). A 5% difference in TE intake from carbohydrate was associated with 1.11% (95%CI 2.22%, 0.0038%) lower body fat percentage while protein was associated with 3.1% (95%CI 0.81%, 5.39%) higher body fat percentage. Physical activity had weak associations with cardiometabolic disease risk factors. Adults with IBD have multiple modifiable risk factors for cardiometabolic diseases. Vegetable and carbohydrate intake were associated with lower LDL cholesterol concentration while discretionary food items showed otherwise. Protein intake was associated with higher body fat percentage.
Exploring school food provision programs and links to local foods in Pacific Island countries
- J. Perry, B. Horsey, J. Raneri, D. Hunter, S. O’Connor, M. Hyland-Wood, E. Casey, S. Burkhart
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E20
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Providing access to food in schools can serve as a platform for food system transformation, while simultaneously improving educational outcomes and livelihoods. Locally grown and procured food is a nutritious, healthy, and efficient way to provide schoolchildren with a daily meal while, at the same time, improving opportunities for smallholder farmers(1). While there is significant potential for school food provision activities to support healthy dietary behaviours in the Pacific Islands region, there is limited evidence of these types of activities(2), including scope and links to local food production in the region. Therefore, the aim of this scoping study was to understand the current state of school food activities (school feeding, gardening and other food provision activities) and any current, and potential links to local agriculture in the Pacific Islands. A regional mapping activity was undertaken, initially covering 22 Pacific Island countries. The mapping included two steps: 1) a desk based scoping review including peer-reviewed and grey literature (2007-2022) and 2) One-hour semi-structured online Zoom interviews with key country stakeholders. Twelve sources were identified, predominately grey literature (n = 9). Thirty interviews were completed with at least 1 key stakeholder from 15 countries. A variety of school food provision activities were identified, including school feeding programs (n = 16, of varying scale), programs covering both school feeding and school gardens (n = 2), school garden programs (n = 12), and other school food provision activities (n = 4, including taste/sensory education, food waste reduction, increasing canteen capacity for local foods, supply chain distribution between local agriculture and schools). Existing links to local agriculture varied for the different programs. Of the 16 school feeding programs, 8 had a requirement for the use of local produce (policy requirement n = 6, traditional requirement from leaders n = 2). Of the 12 school garden programs, 6 used local or traditional produce in the garden and 5 involved local farmers in varying capacities. Challenges to linking local agriculture into school food provision programs were reported for 17 activities and were context dependent. Common challenges included limited funding, inflation, Covid-19, inadequate produce supply for the scale of program, limited farmer capacity, limited institutional support for local produce, low produce storage life, climatic conditions and disasters, water security, delayed procurement process, and limited professional development and upskilling opportunities. Modernisation and colonisation of food systems resulting in a preference for hyperpalatable foods and challenges in incorporating local produce in a way that is accepted by students was also identified as a challenge. This evidence can be used to develop a pathway to piloting and implementing models of school food provision programs and promoting opportunities for shared learning and collaboration with key stakeholders across the Pacific Islands region.
More dietary advice may be needed to support healthy body composition for children with cerebral palsy in Aotearoa New Zealand
- R. Diaz-Rodriguez, M. Copeland, N.S. Hill, F.E. Lithander, S.A. Williams
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E168
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The available literature on the nutritional status of children with cerebral palsy (CP) worldwide has identified high rates of malnutrition, specifically undernutrition(1). However, there is a current lack of clear CP-specific dietary guidelines for children with CP across all functional levels. Standard reference tools such as estimated energy requirement (EER) and recommended dietary intake (RDI) may overestimate requirements in children with CP, especially those with reduced mobility and activity levels. Furthermore, for children with severe CP, body composition data indicates higher risks of obesity and obesity-related conditions(2). There can be a wide range of functional abilities, classifiable with tools such as the Gross Motor Function Classification System (GMFCS) and the Eating and Drinking Ability Classification System (EDACS). The majority of nutrition-related CP literature focuses on children requiring assistance for feeding (EDACS IV-V) with little information available for children with higher levels of functional independence. The aim of this study was to determine whether children with CP had received any prior dietary guidance for healthy body composition and to summarise the type of advice received. Children aged 5-12 years and their whānau were invited to participate in a study where a purpose-developed questionnaire captured their history of receiving tailored dietary recommendations for CP. Body composition was assessed via whole-body dual-energy X-ray absorptiometry scan. Nine participants (6 males, median age: 10y, n = 2 Māori), across GMFCS levels I-IV and EDACS levels I-III took part in the study. Out of 9 children, 5 (55%) indicated that their child had never received dietary advice, 3 of whom were classified as obese or overweight based on growth chart percentiles using their measures of body fat percentage, 1 was classified as underweight and 1 was within the healthy ranges. Of the 4 who had previously received advice, its nature was reported as in support of weight gain (n = 3), and weight loss (n = 1). All 4 received dietary advice from a dietitian and 1 reported some additional advice from a pediatrician and/or orthopedic doctor. Two of the children who had received dietary advice fell within a healthy body fat percentage based on the growth chart percentiles at the time of the study, while the other two were classified as overweight or obese. The results indicate the importance of developing clear dietary guidance for children with CP which may differ from that for typically developing children, particularly depending upon CP subtype diagnosis and functional level, in order to support healthy body composition.
A comparison of nutritional contents and price differential between dairy and plant-based milk in Fijian supermarkets
- S. Kumar, A. Chand
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E159
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Plant-based milk import has been increasing in the Fijis supermarkets. While this milk may cater for vegans(1) and people with allergies from dairy milk, the question always remains that if the plant-based milk are equally nutritious and available at reasonable price in comparison to the dairy milk. Dairy milk is commonly consumed by the Fijian population while the plant-based milk is positioning itself into the market as alternatives. Therefore, this paper is aimed at comparing the nutrient content and price of milk from dairy cows and plant milk sources available in the supermarkets in Fiji. This study examines different brands of dairy and plant-based milk in 6 major supermarket chains in the central part of Fiji. There was 22 dairy milk, 6 soya milk, 5 almond milk and 4 oat milk sampled from these supermarkets. The median value of milk nutrient composition and price for dairy milks and different plant-based milks were calculated as the data was not normally distributed. The Kruskal- Wallis test was conducted to further analyse the difference between the nutrient composition and price of dairy milks and plant-based milk. The energy composition in the dairy milk was significantly higher (p < 0.01) when compared with plant-based milks soya almond milk and oat. There was a significant difference (p < 0.01) in dairy milk protein, fat and saturated fat when compared to plant-based milks. The result indicated that the protein, fat, and saturated fat are both significantly higher in cow’s milk. Milk carbohydrate analysis indicate higher composition in dairy milk therefore a significant difference (p < 0.01) was noted when compared to almond milk(except soya and oat milk). There is a significant difference (p < 0.01) in sugar indicating cow’s milk having higher sugar when compared to plant-based milk (except soya milk The sodium composition in the dairy milk and all the plant- based milk showed no significance difference (p > 0.05) in the composition. There was also significant difference (p < 0.05) in comparison of calcium composition of dairy milk and plant-based milk indicating almond milk with lower calcium. The phosphorus composition in dairy milk and plant-based milk indicates that there is a strong significant difference (p < 0.01) (except soya and oat milk). The riboflavin composition was significantly higher (p < 0.01) in dairy milk compared to soya and oat milk. Lastly, there was significant difference (p < 0.01) between price of dairy milk when compared to plant-based milk. The study concludes that there is more nutrient in dairy milk and the price is significantly lower than plant-based milk at which these nutrients are available in dairy milk.
Food providers and public health professional’s experiences with the adoption and implementation of the National Healthy Food and Drink Policy in New Zealand healthcare facilities
- M. Rosin, S. Mackay, C. Ni Mhurchu
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E61
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Publicly-funded healthcare facilities in Australia(1) and New Zealand(2) have adopted healthy food and drink policies to enable staff and visitors to choose and consume healthier options. However, adopting such policies does not translate to their full implementation and compliance by food providers, who face barriers to providing healthier food and drinks(3). As part of the wider HealthY Policy Evaluation (HYPE) study, we interviewed hospital food providers and public health dietitians/professionals to understand their experiences implementing the voluntary National Healthy Food and Drink Policy introduced in New Zealand in 2016. Semi-structured interviews focused on the awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. All semi-structured interviews were transcribed verbatim, inductively coded with the assistance of QSR’s NVivo software, and analysed using the reflexive thematic analysis method by Braun and Clarke(4). Twelve participants from across New Zealand were interviewed. Time in their roles ranged from one to 14.5 years, and many were not in the position when the Policy was first adopted. There was a discrepancy in the awareness of the voluntary Policy. However, there was agreement that hospitals should be healthy eating role models for the wider community. Reflexive thematic analysis identified three themes relating to the implementation of the Policy in New Zealand: 1) complexities of operating food outlets under the Policy in hospitals; 2) adoption, implementation and monitoring of the Policy as a series of incoherent ad-hoc actions; and 3) the Policy as (currently) not achieving the desired impact. Participants recognised that the current food supply, presence of food outlets nearby hospitals serving unhealthy foods and culture of unhealthy eating, combined with the difficulty of changing people’s eating habits, leaves doubts if the Policy and healthier options served in the healthcare facilities have any tangible positive impact on staff or visitors. Key suggestions to promote successful Policy implementation included adoption of a mandatory National Policy, funding of central government support for implementation (including supportive implementation tools), regular and systematic monitoring of food availability in each region, and frequent and ongoing communication with staff and visitors using positive messaging around healthy eating and non-health related benefits (e.g. sustainability) to increase their buy-in. Findings from stakeholder interviews and the remaining parts of the HYPE evaluation study are informing the update of the National Policy and associated supportive tools, and highlight the potential positive impact a comprehensive policy evaluation could have on improving policy implementation.
A systematic review of nutritional guidelines for preterm infants
- M. Meiliana, T. Alexander, F.H. Bloomfield, B.E. Cormack, J.E. Harding, O. Walsh, L. Lin
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E86
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The estimated global preterm birth rate in 20201 was more than 10% of livebirths or 13.4 million infants. Nutrition in the neonatal period is a key factor to optimise growth, neurodevelopment, and later metabolic disease risk2. There is no consensus on optimal nutrition for preterm infants, leading to substantial practice variation3. We aimed to assess the quality of nutritional guidelines for preterm infants, the consistency of recommendations, and the gaps in these recommendations. This review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 checklist. The study protocol was registered with PROSPERO (CRD42022327248). We searched six databases and 44 websites for nutritional guidelines for preterm infants before first hospital discharge, which were endorsed, prepared, or authorised by a regional, national, or international body, written in English, and published between 2012-2023. Two reviewers independently screened articles and extracted relevant data including nutritional recommendations (ranges or descriptions), the quality of recommendations (certainty of evidence and strength of recommendation), and gaps in recommendations, defined as those identified by the guidelines or when recommendations were based on very low certainty evidence. Disagreements were resolved by discussion or a third reviewer. Four reviewers appraised the included guidelines using AGREE II. We identified 7051 records, 27 guidelines were included in the review, 26% of which were of high quality. Most guidelines lacked stakeholder involvement and rigour of development. Twelve guidelines had recommendations for macronutrient intake, 18 for micronutrient intake, 12 for feeding, eight for fortification, and 14 for monitoring of nutritional adequacy. Only two guidelines provided recommendations for all five of these aspects. We found considerable variation in recommendations, many of which lacked details of certainty of evidence and strength of recommendation. Recommendations for feeding types and breastmilk fortification were consistent among high quality guidelines, but recommendations varied for intakes of almost all nutrients and monitoring of nutritional adequacy. Different guidelines gave different certainty of evidence for the same recommendations. Most gaps in recommendations were due to a very low certainty of evidence. Future development of nutritional guidelines for preterm infants should follow the standard guideline development method and ensure rigorous process including stakeholders’ involvement to improve the reporting of strength of recommendation, certainty of evidence, and gaps in recommendation. Evidence is needed to support recommendations about macro and micronutrient intakes, breastmilk fortification, and markers on adequacy of intake of different nutrients.
A systematic review of the effect of dietary and nutritional interventions on the behaviours and mental health of prisoners
- Matthew Poulter, Shelly Coe, Catherine Anna-Marie Graham, Bethan Leach, Jonathan Tammam
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- Journal:
- British Journal of Nutrition , First View
- Published online by Cambridge University Press:
- 29 April 2024, pp. 1-14
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Prisoners experience a higher burden of poor health, aggressive behaviours and worsening mental health than the general population. This systematic review aimed to identify research that used nutrition-based interventions in prisons, focusing on outcomes of mental health and behaviours. The systematic review was registered with Prospective Register of Systematic Reviews on 26 January 2022: CRD42022293370. Inclusion criteria comprised of current prisoners with no limit on time, location, age, sex or ethnicity. Only quantitative research in the English language was included. PubMed/Medline, Web of Science, EMBASE, PsycINFO and CINAHL were searched, retrieving 933 results, with 11 included for qualitative synthesis. Studies were checked for quality using the revised tool to assess risk of bias in randomised trials or risk of bias in non-randomised studies of interventions tool. Of the included studies, seven used nutritional supplements, three included diet changes, and one used education. Of the seven supplement-based studies, six included rule violations as an outcome, and only three demonstrated significant improvements. One study included mental health as an outcome; however, results did not reach significance. Of the three diet change studies, two investigated cognitive function as an outcome, with both reaching significance. Anxiety was included in one diet change study, which found a significant improvement through consuming oily fish. One study using diet education did not find a significant improvement in overall mental resilience. Overall, results are mixed, with the included studies presenting several limitations and heterogeneity. Future research should aim to consider increased homogeneity in research design, allowing for a higher quality of evidence to assess the role nutrition can play in improving the health of prisoners.
Chapter 5 - Privacy and Dignity in Acute Hospitals
- Edited by George Tadros, Aston University, Birmingham, George Crowther, Leeds and York Partnership NHS Foundation Trust, Leeds
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- Book:
- Handbook of Old Age Liaison Psychiatry
- Published online:
- 04 April 2024
- Print publication:
- 11 April 2024, pp 59-69
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Summary
Numerous reports addressing the care of older people have highlighted deficiencies in th provision of nutrition, hydration, and personal hygiene. Healthcare organisations may inadvertently compromise dignity by prioritising measurable targets and not placing due emphasis on the core work of looking after frail older people who are at risk of having their dignity violated.
The concept of dignity draws on ideas of dignity of merit, moral stature, and Menschenwürde (human dignity) – the dignity that each individual has as an essential component of being a human being. It is argued here that older people, as a group, are particularly worthy of the dignity of merit of wisdom, by virtue of their experience and associated understanding.
A suitable environment is important to promoting dignity; the emphasis is not only on basics like nutrition, hydration, and hygiene but on the delivery of person-centred care that encourages understanding of an older person’s life story.
Dying will come to us all (with even greater certainty than old age), and all older people have a right to respect and dignity when dying. Understanding how someone lived their life, and what was important to that person allows us to co-write the final chapter with preservation of autonomy and maintenance of dignity of personal identity.