Nutrition & Dietetics最新文献

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.

Aims: To describe (1) dietary intake, food avoidance and adequacy, and (2) physical activity levels and barriers among New Zealand adults with inflammatory bowel disease.

Methods: A cross-sectional online survey comprising four questionnaires collecting data on demographics, disease activity index, dietary intake and physical activity levels was distributed. Exclusion criteria applied to those who were pregnant/lactating, with a stoma or pouch, or on enteral/parenteral nutrition. Descriptive analyses were performed, and dietary intakes were compared to established references. T-tests, equality-of-medians tests and two-sample proportion tests investigated differences between disease types.

Results: Two hundred and thirteen adults with mostly quiescent or mildly active inflammatory bowel disease (53% Crohn's disease) completed at least one questionnaire. Participants were predominantly female (70%), New Zealand European (89%) with a median age of 37 years. Discretionary food intake was high, while fruit and vegetable consumption was generally suboptimal. Food avoidances were reported by 69% of participants, primarily dairy and vegetables. A higher proportion of participants with ulcerative colitis or inflammatory bowel disease-unspecified avoided gluten and unprocessed red meat. Inadequate intakes of calcium (69%), selenium (40%) and magnesium (26%) were common. Most participants limited vigorous physical activity, but 67% met the physical activity guidelines. Barriers to physical activity were reported by 63% of participants, where fatigue (54%) and abdominal cramps (26%) were common barriers.

Conclusion: Our findings demonstrate that New Zealand adults with inflammatory bowel disease had inadequate dietary intake and faced several barriers to physical activity, even when in remission.

Aim: To quantify, describe, and compare production waste and food packaging waste in two healthcare centres with different foodservice models.

Methods: In this observational study, all food wasted during production and all food packaging was measured by weight and cost over a 7-day period for two hospitals: Hospital A (800 beds, cook-on demand fresh, a la carte menu room service model) and Hospital B (60 beds, traditional cook chill retherm model with weekly cyclical menu and set meal times). Comparisons between sites were made per patient overnight bed day, as an indicator of hospital activity. The average daily waste was calculated, and costed by multiplying cost (AU$) food item/ kilogram by measured weight; to derive the cost of food waste per kilogram. Food waste by weight and cost per overnight bed day was used as a measure to compare the hospitals.

Results: Over 7 days, Hospital A wasted 916.4 kg (AU$6937.22) and Hospital B wasted 69.7 kg (AU$417.10) of food. Most food wasted at both hospitals was edible (78.6% Hospital A and 93.5% Hospital B) and trayline contributed more food waste than bulk production. At both hospitals, plant-based foods comprised the greatest proportion of edible food waste by weight, but not by cost. When accounting for hospital activity, food waste was lower at Hospital A than at Hospital B (0.15 kg of food per overnight bed day and 0.30 kg, respectively). Hospital A generated 199.5 kg (0.03 kg per overnight bed day) of packaging waste compared to 32.2 kg (0.14 kg per overnight bed day) at Hospital B.

Conclusion: Findings suggest that food waste is costly, that food waste differs between hospitals with different foodservice models, and that overnight bed days is a useful metric for making comparisons. A cook-fresh, on-demand room service foodservice model resulted in less food and packaging waste.

Aim: Nutritional requirements are increased in young people to support growth, and this is particularly critical when pregnancy occurs within young age groups. The aim was to describe nutritional intakes (with particular emphasis on iron and calcium) and selected pregnancy outcomes, in a young antenatal population aged 14-24 years.

Method: A retrospective audit was conducted using 404 records from a young parents' antenatal clinic which included prepregnancy body mass index (BMI), pregnancy weight gain, baby birth weight, nutritional biochemistry, and dietitian assessment of iron and calcium intakes and supplement use. Age groups were compared (adolescents aged 14-18 years versus older 19-24 years clients), and regression analysis was used to explore potential predictors of birth outcomes.

Results: There was no difference in prepregnancy body mass index for age, pregnancy weight gain, baby birth weight or outcomes, between the age groups. Based on food group serves, intakes were inadequate for iron in 82% of clients and for calcium in 72%. Iron status declined in both groups during the pregnancy, while adolescents had less adequate calcium intake (p = 0.0001). Supplement use was more common in clients with poor iron (p = 0.015) or vitamin D status (p < 0.0001).

Conclusion: Iron and calcium intakes were inadequate in this nutritionally vulnerable population. Further research would be beneficial to identify effective interventions to improve nutrition in this cohort.

Aim: To identify and achieve expert consensus on the most important and feasible strategies to implement digital health services for nutrition care management of chronic conditions in outpatient settings.

Methods: Determinants and strategies for implementing digital health services for nutrition care management were identified in line with the literature and the Consolidated Framework for Implementation Research. These were presented to team leaders and senior clinicians, as well as dietetic and allied health directors in a two-round e-Delphi process. Consensus was reached when strategies were rated very important/feasible by at least 75% of respondents, calculated by the median, interquartile range and frequency. Following the two survey rounds, a final prioritisation survey was distributed to participants, where participants were asked to prioritise their top strategy for each determinant, which was analysed by frequency calculations.

Results: Twenty participants participated in round one of the survey and 18 completed the final prioritisation round. Following the two rounds, 3 strategies did not meet consensus for importance and 7 strategies did not meet consensus for feasibility out of 25 strategies presented. Nine strategies were prioritised following the survey rounds. Key concepts of the strategies that met consensus and were prioritised related to (i) adhering to quality of care with effective evaluation processes; (ii) providing options for digital health upskilling and support; and (iii) individualising patient care.

Conclusion: Team leaders and senior clinicians as well as dietetic and allied health directors have indicated that there are many important digital health strategies yet not all are feasible to implement within current resourcing and systems.

Aim: The aim of this study was to assess the criterion validity of the Global Leadership Initiative on Malnutrition criteria compared to the subjective global assessment in a diverse inpatient population.

Methods: This cross-sectional study was a retrospective analysis of point prevalence audit data. The prevalence of malnutrition determined by the Global Leadership Initiative on Malnutrition criteria was compared to the Subjective Global Assessment. Validity statistics were determined using all of the Global Leadership Initiative on Malnutrition criteria concurrently as well as each pair that could be used to diagnose malnutrition. Subgroup analysis was undertaken based on severe malnutrition, treatment group, age and body mass index.

Results: Nine hundred and eighty-one patients were included (65.1 ± 18.6 years, 54.8% male). The prevalence of malnutrition was 36.7% using the Subjective Global Assessment and 36.1% using the Global Leadership Initiative on Malnutrition criteria. More patients were classified as severely malnourished using the Global Leadership Initiative on Malnutrition criteria (9.8% vs. 6.0%), whilst more rehabilitation patients were classified as malnourished using the Subjective Global Assessment (42.2% vs. 33.6%). The criterion validity of the Global Leadership Initiative on Malnutrition criteria was good, with a sensitivity of 92.5% (95% CI 90.9-94.2) and specificity of 96.6% (95% CI 95.5-97.8). There was a downward trend in sensitivity with increasing body mass index and a lower sensitivity in the rehabilitation population. The criterion validity was fair at best when each pair of the Global Leadership Initiative on Malnutrition criteria was considered independently of other criteria.

Conclusions: When all criteria are considered concurrently, the Global Leadership Initiative on Malnutrition criteria present good criterion validity and can be applied in clinical practice to diagnose malnutrition.

Aims: This consensus statement document describes the recommendations of the Australasian Society of Parenteral and Enteral Nutrition regarding the identification and management of refeeding syndrome and refeeding syndrome risk.

Methods: An expert working group completed a review of the literature to develop recommendations for the consensus statements. Review of the drafted consensus statements was undertaken by highly experienced clinicians.

Results: The identification and management of refeeding syndrome requires a multidisciplinary approach. Actual refeeding syndrome is rare; however, all patients should be assessed for the risk of its development. Refeeding syndrome should only be diagnosed if the patient has had adequate nutrition intake (≥50% of estimated requirements), with electrolyte imbalances and clinical symptoms emerging after its commencement. Thiamin and multivitamin supplementation and regular electrolyte monitoring should be provided to all patients at risk of developing refeeding syndrome. There is no evidence that patients at risk of developing refeeding syndrome should be started at an initial lower enteral feeding rate than already recommended for checking tolerance to enteral feeds. Goal nutrition rates should be reached within 24-72 h for all routes of nutrition. Low electrolyte levels should be replaced as per local guidelines, with consideration given to the route of replacement.

Conclusion: These consensus statements are expected to provide guidance at a national level to improve the identification and management of refeeding syndrome and refeeding syndrome risk.

Aims: Delegation of nutrition care activities to Dietetic Assistants in hospitals has been identified as one innovative malnutrition model of care, but there has been limited evaluation of their roles. This study aimed to develop, implement and evaluate a new Malnutrition Model of Care embracing automated delegation and digital systems.

Methods: The Malnutrition Model of Care was created to detect patients at risk of malnutrition (using the Malnutrition Screening Tool) and nutritional decline (via routine intake tracking at all meals and snacks). Digital systems generated automated referrals to dietetics, with protocols to support Dietetic Assistants to action these to direct care escalation to the ward dietitian. Dietetic Assistant training included simulations and clinical task instructions. Implementation evaluation was guided by the Donabedian model of quality and included a review of inpatient dietetics occasions of service, survey of Dietetic Assistant role satisfaction and task confidence, and hospital-wide cross-sectional malnutrition audit. Data was descriptively analysed.

Results: During the first year of implementation, 60% of Dietetics inpatient occasions of service were completed by Dietetic Assistants, with 26% of Dietetic Assistant inpatient tasks initiated from nursing malnutrition risk screening. Most Dietetic Assistants reported adequate training and confidence in completing delegated tasks. Malnutrition prevalence was 14% with no hospital-acquired malnutrition identified. No clinical incidents were reported.

Conclusions: The Dietetic Assistant workforce and technology were harnessed to implement an innovative delegated Malnutrition Model of Care that appears to be safe and effective at managing malnutrition from preliminary evaluation. Work continues to formally assess service efficiencies, cost and patient experience.

Aim: This study aimed to investigate public perceptions of the Nutrition Care Process standardised diagnosis terms.

Methods: This cross-sectional study used a 5-point Likert scale survey asking participants to rate nutrition diagnosis terms based on the degree of acceptability (offensiveness). Inclusion criteria were adults ≥18 years, living in the United States and fluent in English. Descriptive statistics, Kruskal-Wallis and chi-squared tests were conducted, with statistical significance set at p < 0.05. Qualitative analysis of optional written participant comments was conducted, using an inductive-deductive thematic analysis approach.

Results: The majority of participants (n = 185, average age 46.5 ± 17.8 years) were female (77.8%), White (80.5%), degree-educated (79.5%) and did not work in healthcare (73.0%). The top offensive term was 'undesirable food choices' (20.5% rated the term as offensive). Younger participants found the terms 'undesirable food choices' and 'obesity' more offensive compared to older adults (p < 0.05). Qualitative analysis revealed concerns with and/or understandability of specific nutrition diagnosis terms.

Conclusions: In general, nutrition diagnosis terms were considered acceptable by study participants. The main offensive terms are in the Behavioral-Environmental domain. Findings from our study serve as a foundation for further research and provide rationale to advocate for changes to Nutrition Care Process terminology in the spirit of fostering more inclusive, person-centred care.

Aims: To report the changes in nutritional status, nutrition-related complaints and risk of sarcopenia in individuals attending a primary care dietitian in the Netherlands after a COVID-19 infection.

Methods: The study was registered on the clinicaltrials.gov registry (NCT04735744). Nutritional status and nutrition-related complaints were assessed with the Patient-Generated Subjective Global Assessment Short Form and body composition measurements when possible. Risk of sarcopenia was assessed with the Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls questionnaire. Dietitians reported on treatment goals, content and volume of dietetic treatment. Descriptive statistics were used to describe the study population and outcomes at baseline and end of treatment. For continuous variables, paired samples t-tests were used to compare scores at the start and the end of dietetic treatment. For dichotomous variables. McNemar tests and Wilcoxon signed-rank tests were used to determine differences between the start and end of treatment.

Results: A total of 222 participants were included [mean age 50 (SD 13), 58% female, 34% overweight, 40% obese]. Malnutrition risk decreased from 44% (medium risk) and 20% (high risk) to 29% and 12% by the end of treatment (p < 0.001). The risk of sarcopenia decreased from 31% to 22% (p < 0.001). There was an imbalance between fat-free mass and fat mass in about half of the participants. The most commonly reported nutrition-related complaints were fatigue, no appetite, the feeling of being full and changed or loss of taste. Median treatment duration was 21 weeks [interquartile range (IQR) 13-26] and 5 consultations (IQR 4-7). Most participants (46%) aimed to maintain weight, with others aiming to lose (14%) or gain (14%) weight. At the end of treatment, 57% had achieved the goals.

Conclusions: Significant improvements in nutritional status and risk of sarcopenia were observed after dietetic treatment in primary care, and most participants achieved the treatment goals. Nevertheless, nutrition-related complaints and the risk of malnutrition or sarcopenia remained prevalent.