Nutrition & Dietetics最新文献

Aim: Patients receiving home enteral tube feeding have a high risk of complications and readmission to hospital. Enteral nutrition training for health professionals is essential but often not included in basic training curricula. This paper aims to (i) outline the development of a state-wide gastrostomy training program and (ii) undertake a 7-year evaluation of the program.

Methods: A state-wide gastrostomy education and training program was developed and implemented using a spiral learning model, stakeholder engagement, review of the literature, and consumer involvement. Medico-legal consideration was given to credentialing, competencies, and extended scope of practice. Direct outcomes were evaluated using a RE-AIM framework.

Results: In the 7 years since starting the program 819 clinicians have completed all online modules including the evaluation, and 178 and 42 clinicians have participated in workshop 1 (gastrostomy care and management) and workshop 2 (gastrostomy removal and replacement), respectively. Additionally, 85 extended care paramedic trainees have participated in the program. Average pre-post measures of knowledge and confidence improved 11% and 23%, respectively, across all aspects of the program.

Conclusion: The development of a state-wide gastrostomy education and training program allowed health professionals to gain expertise in the specialty area of gastrostomy care to support consistent safe practice. Over the 7 years the program has been functional it has expanded to include regional and ambulance services. There have also been limitations and learnings along the way. The model used for this program may allow others insight into the developing future programs.

Aim: To describe the burden of malnutrition in an at-risk population and validate a screening tool.

Methods: A 10-year cross-sectional study was conducted in a remote hospital. Dietitians screened participants using the Malnutrition Screening Tool or the Adult Nutrition Tool. Participants scoring ≥2 utilising the Malnutrition Screening Tool or ≥4 utilising the Adult Nutrition Tool, or already under the care of a dietitian, were assessed for malnutrition using a Subjective Global Assessment. The validity of the Adult Nutrition Tool was compared to the Malnutrition Screening Tool in participants undergoing a Subjective Global Assessment.

Results: Of 980 study participants, 70.1% identified as Aboriginal Australian and 42.6% were at risk of malnutrition. Three-hundred and seventy-four (58.8%) participants were malnourished. The Adult Nutrition Tool showed superior area under the curve (0.74, 95% confidence interval [0.67, 0.81], p < 0.001) than the Malnutrition Screening Tool (0.64, 95% confidence interval [0.56-0.73], p 0.001). An Adult Nutrition Tool score ≥2 demonstrated superior sensitivity (98.2%) and specificity (16.7%) compared to a Malnutrition Screening Tool score ≥2 (sensitivity 97.2% and specificity 14.3%). An Adult Nutrition Tool score of ≥3 demonstrated reduced sensitivity (92.0%) but superior specificity (20.2%) than screening scores ≥2 for both tools.

Conclusion: Malnutrition risk is high in a remote Australian hospital. This study confirms the Adult Nutrition Tool and the Malnutrition Screening Tool are valid tools to predict malnutrition in a unique remote hospital, recommending an 'at-risk' threshold of ≥2 for the Adult Nutrition Tool to aid in the early detection of malnutrition.

Aim: This study analyses the Hollywood body horror film The Substance to explore how Western beauty culture regulates emotions and bodies. It aims to explore compassion within dominant body image discourses and considers how this impacts dietetic care.

Methods: Using Foucauldian discourse analysis informed by affect theory, the film was analysed through repeated viewings and close readings of the screenplay. This approach enabled attention to both visual and textual elements. The analysis focused on how subjectivity, bodily regulation, and the possibility for compassion are shaped.

Results: Three key discursive and affective formations were identified: (1) surveillance and affective discipline as mechanisms enforcing normative appearance ideals; (2) the denial of compassion to bodies deemed unworthy; and (3) the inescapability of disciplinary beauty systems, even for idealised bodies.

Conclusions: The film shows how Western media circulates power by shaping what is known and felt about bodies, often denying compassion to those who do not fit dominant beauty ideals. This underscores the need for dietitians to reflect on how professional practices may unintentionally reinforce harmful norms. Compassion, understood as an affective and discursive counter-practice, can disrupt these norms and create space for more inclusive, caring approaches to bodies in dietetic care.

Aims: The opening of a new digital metropolitan hospital with surgical and subacute cohorts required a flexible food service model to meet diverse patient needs. This project aimed to design, implement and evaluate such a system, optimising service efficiencies and patient experience.

Methods: A flexible, mixed-model food service was designed by reviewing research, consulting experts, and gathering consumer feedback. The Knowledge-To-Action framework guided the model's development and implementation. Key features included an on-demand meal ordering system on the surgical ward; efficient and safe communal dining and snack services for long-stay patients; routine patient food intake hospital-wide to proactively identify at-risk patients; innovative waste and cost recovery strategies. Evaluation was based on the quadruple aims of healthcare measuring patient satisfaction, malnutrition prevalence, mealtime assistance, food waste and cost, and staff satisfaction. The success of targeted implementation strategies was also monitored.

Results: Patients were highly satisfied with the food service model (4.6/5, n = 1284). High rates of mealtime assistance (>90% over 3 years) were achieved, and malnutrition prevalence was 21% (82/369) over the 3 years. Low plate waste (3-year average 16.5%) and an average food cost per meal of $4.73 were reported. Staff satisfaction was high, with a culture of success noted.

Conclusions: This flexible, mixed model food service met the needs of different patient cohorts across surgical, subacute and outpatient services, optimising service efficiencies, patient outcomes and staff satisfaction. This project serves as a guide for creating food service models that address diverse patient needs in hospital settings, translating contemporary evidence into practice.

Aims: Demand for infant and child foods in squeeze pouches is increasing, yet limited evidence exists to inform public health strategies on who uses them and why. The aim of this scoping review was to explore the frequency and types of squeeze pouches consumed by children, the sociodemographic characteristics of users and insights from parental experiences regarding their use.

Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. Between January and April 2024, three databases were searched (MEDLINE, Scopus and CINAHL) in addition to grey literature. Two independent reviewers screened 125 articles, of which 16 underwent full-text review. Results were summarised narratively.

Results: Eleven studies across five countries were included. Eight studies reported on the prevalence of squeeze pouch consumption, ranging from 23.5% to 82.8% for infants and children. Frequency of intake ranged from daily (n = 4; 8.7%-29.2%), weekly (n = 7; 20.9%-75.2%), to monthly consumption (n = 7 16.7%-70.4%), depending on the study. Predominantly fruit- and dairy-based pouches were consumed. Frequent use was linked to higher deprivation, childcare use, larger families, early breastfeeding cessation and early solid food introduction. Studies on parental perceptions (n = 6) reported their perceived convenience, healthiness and low cost and concerns related to waste.

Conclusions: This review identified widespread use of squeeze pouches among infants and children, particularly fruit and dairy-based pouches. More research is needed on their nutritional impact to guide public health strategies promoting healthy early feeding practices.

Aims: This study aims to evaluate the existing definitions of double burden of malnutrition and to synthesise and propose operational definitions at different levels, with the goal of improving consistency in measurement and policy development.

Methods: We conducted a narrative review that used structured search and narrative synthesis to review and summarise how double burden of malnutrition has been defined at different levels. We performed a structured search across PubMed, Web of Science and Scopus, focusing on peer-reviewed articles published between January 2010 and December 2024. We screened articles for relevance to double burden of malnutrition and categorised them based on the level of the definition, such as households, individuals and populations.

Results: Of the 60 selected studies, the majority originated from Latin America (n = 19, 32%), followed by South Asia (n = 10, 17%) and Southeast Asia (n = 8, 13%). At the household level, the most common definition of double burden of malnutrition was the coexistence of an overweight/obese mother and a stunted child. Individual-level definitions commonly included the coexistence of overweight/obesity with anaemia or stunting. However, definitions at the population level varied considerably and lacked consistency across studies.

Conclusions: Our findings highlight the need for consistent operational definitions of double burden of malnutrition across different levels of analysis. Drawing on existing literature, we synthesise practical definitions at different levels to more accurately reflect the coexistence of different forms of malnutrition. Clarifying these definitions can improve the comparability of prevalence estimates across contexts and support the development of more effective, evidence-based strategies to address the growing burden of double burden of malnutrition.

Aims: The views of parents/caregivers about food programs in schools internationally is not well understood. This review aimed to synthesise what parents/caregivers identify as the key features of school food programs and their perspectives of these programs globally.

Methods: A mixed papers review was undertaken with a systematic search (January 2024) and screening of three databases (Scopus, Web of Science, PubMed). Eligible studies captured parent/caregiver perspectives across all school food models. Study findings were extracted using Bayesian methods to translate quantitative findings into qualitative data. Data was deductively categorised to identify features of school food models, and separately themed to identify parent perspectives.

Results: Twenty-six eligible studies were identified from 11 countries. Fifteen features were identified, including cost, time, effort and convenience, child preferences, nutrition, policy and messaging, eating environment and food education. Parent perspective themes were: child is the priority, lunchbox procurement, preparation and provision is challenging, school-provided meals have strengths and limitations, and parents acknowledge they are central to feeding. An overarching theme was that compromises must be made to meet the needs of family members, when parents make decisions on school food.

Conclusions: This review found that globally parents perceive benefits and challenges to school food programs, regardless of provision model, with a range of features that influence parent acceptability. Considering parent/caregiver perspectives when developing or changing school food provision models is likely to increase caregiver acceptability, supporting children to engage with health promotion efforts.

Aims: This review aimed to describe the current evidence on fluid requirements for adults with medically compromised eating disorders, with objectives to: (1) review study designs and aims, (2) describe participant characteristics, (3) identify modes of fluid delivery, and (4) examine fluid reporting methods and adverse events relating to fluid intake.

Methods: This scoping review was conducted following the Joanna Briggs Institute's methodology. Three research databases (PubMed, CINAHL, Embase) were searched until 25 November 2024 for relevant studies. Research articles examining adult (aged ≥18 years), acutely unwell, hospitalised patients with eating disorders and that included information on fluid (requirements, provision, intake, output and/or restrictions) and any fluid-related outcomes were included. Screening of search results was conducted independently in duplicate. Results were synthesised narratively.

Results: The search strategy yielded 1691 articles, and 13 studies (total n = 104 participants) were included. All studies were observational, including case report (n = 10 studies) and prospective study designs (n = 3 studies). No study specifically aimed to examine fluid requirements. Participants were predominantly female, and all had anorexia nervosa. Fluid was provided by multiple routes in most studies, and fluid reporting was inconsistent.

Conclusions: Limited evidence is available with no studies specifically addressing fluid requirements for adults with medically compromised eating disorders. The results identify major gaps in the evidence, including no justification for fluid provision or restrictions applied, minimal explanation as to how fluid may have impacted clinical presentations, and no fluid measurements conducted in totality from all fluid provision routes. Future research should prioritise larger, well-designed cohort studies with detailed fluid information to assist with building the evidence base and thereby enhancing nutritional support for this vulnerable group.

Aim: Identify and describe research that explores interest-holder perceptions and definitions of foodservice quality in residential aged care.

Methods: This review follows the Joanna Briggs Institute methodological framework for conducting scoping reviews and was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. PubMed, Embase, CINAHL, and Scopus were used to search for peer-reviewed literature. Grey literature was searched through Google and six Australian government sources. No restrictions were applied to methodology, year, or geographical location published. Findings were synthesised into distinct interest-holder and foodservice component groups using meta-synthesis.

Results: A total of 31 eligible texts, including peer-reviewed (n = 17) and grey literature (n = 14) were included in this review. Texts identifying perceptions (n = 23) were predominantly those of residents (n = 11) while definitions of quality (n = 13) were all described by researchers and experts. Despite some agreement that foodservice quality is associated with how acceptable food or meals are to residents, there is a lack of consensus on what defines quality, with none of the literature addressing quality across the whole foodservice system.

Conclusion: Published research and reports that examine the perspectives of interest-holders in residential aged care provided no consensus on definitions or clear sets of indicators defining foodservice quality. Further research is required to understand the perceptions of foodservice quality in order to guide the development and implementation of specific measures to support assessment and evaluation.