Nutrition & Dietetics最新文献

Aims: Utilising the life course perspective as the theoretical framework, we investigate how women from different generations perceive their cooking experiences and articulate their feelings regarding this activity.

Method: Following a review of the literature and four exploratory focus groups, an interview guide was developed and piloted. Interviews were conducted with 22 Brazilian women spanning three distinct generations. Participants were prompted to recall their life stories, spanning from childhood to the present day and focused on cooking-related situations. Interviews were transcripted and analysed using reflexive thematic analysis.

Results: There were three major themes developed. The first theme outlines variations in the food context across generations. The second theme encompasses perceptions of the responsibility for cooking as being linked to the female gender, indicating a generational shift from the role of the 'cooking wife' to that of the 'cooking mother'. The third theme explores thoughts and reflections on feelings of obligation, oppression, and liberation in cooking, tied to changes in the social and temporal context in which these women operate.

Conclusion: Strategies promoting cooking should consider the meanings attributed to it, contribute to the deconstruction of gender-specific family dynamics, and encourage the pursuit for pleasure, satisfaction and autonomy in this practice. This study contributes novel insights into cooking, including reflections on obligation or oppression versus liberation and the evolving social roles of women as primary cooks.

Aims: Researchers were invited by Aboriginal leaders to collaborate on this study which aimed to assess food intake in the Walgett Aboriginal community to inform long-term community-led efforts to improve food and water security and nutrition.

Methods: Aboriginal adults living in or near Walgett, a remote community in north-west NSW, Australia, completed an adapted Menzies Remote Short-item Dietary Assessment Tool, which was administered verbally and face-to-face in early 2022. Aboriginal people were involved in the survey design, training and collection, and analysis of data. Descriptive statistics were tabulated, overall and by gender, age, and location. Differences by sex, age group (18-44 years versus ≥45 years), and location (Walgett town or other) were determined using a chi-square test.

Results: A total of 242 participants completed the survey; 55% were female. Three-quarters of participants reported meeting the recommendations for discretionary foods (73%); however, more than half (56%) exceeded the recommended maximum serves of sugar-sweetened beverages. The proportion of participants meeting core food group guidelines was 72% for meat, 36% for fruit, 20% for bread and cereals, 6% for dairy, and 3% for vegetables. Overall, none of the participants met the recommended serves of all food groups outlined in the Australian Dietary Guidelines.

Conclusion: Findings show that Walgett Aboriginal community members surveyed were consuming a healthier diet than national data reported for Aboriginal and Torres Strait Islander people in Australia. However, none of the participants were meeting all of the national dietary guidelines, placing them at increased risk of diet-related chronic disease. Local Aboriginal community-led efforts to improve food and water security should include specific strategies to improve nutrition.

Aim: This cross-sectional study aims to explore the nutritional composition, cost, country of origin and fortification status of plant-based milk products available for purchase in Illawarra supermarkets and make various comparisons between types of plant-based milks and cow's milk.

Methods: Plant-based milk information was collected from nutrition information panels on packaging and manufacturer websites. Product ingredient lists, including fortifiers, were analysed to estimate the nutrient composition of the identified plant-based milks, including nutrients beyond those listed by manufacturers. Descriptive statistics were used to summarise the characteristics of the plant-based milks identified in the audit. For non-normally distributed data, a Kruskal-Wallis H test with pairwise multiple comparisons and a Bonferroni adjustment were undertaken to explore the differences between various types of plant-based milk and cow's milk.

Results: One hundred twenty-nine plant-based milk products were identified in the audit, primarily almond, oat and soy-based beverages. Of these, 80.6% were fortified with calcium; however, fortification with other micronutrients was less common, ranging from 27.1% being fortified with vitamin B12 and 3.1% being fortified with iodine. The median plant-based milk cost was AU$3.5/L (Q1-Q3: AU$2.8-4.5/L) and 87.6% of products were Australian made. Overall, particularly due to low fortification rates, plant-based milks identified in the audit had significantly lower levels of protein, sugar, iodine, phosphorus, zinc and vitamins A, B2 and B12 compared to cow's milk. However, there was no significant difference in protein content between soy milk and cow's milk.

Conclusions: The nutritional content of plant-based milks identified in this audit varied, and in most instances, Australian plant-based milks were found to be nutritionally different to cow's milk.

Aims: The Australian Dietary Guidelines are currently being revised and ultra-processed foods have been identified as a high priority action area. To better understand how well the current Dietary Guidelines align with level of processing classifications, the aim of this study was to assess the alignment between the Australian Dietary Guidelines and the NOVA classification system for classifying the healthiness of packaged foods.

Methods: Data were sourced from the Australian FoodSwitch dataset, which included 28 071 packaged food and beverage products available in major Australian supermarkets in 2022. Products were classified as (i) core or discretionary (Australian Dietary Guidelines) and (ii) non-ultra-processed or ultra-processed (NOVA). Agreement between the two systems (core vs. non-ultra-processed and discretionary vs. ultra-processed) was evaluated using the kappa statistic.

Results: There was 'moderate' agreement (κ = 0.41, 95% CI: 0.40-0.42) between the Australian Dietary Guidelines and the NOVA system, with 69.8% of products aligned across the two systems. Alignment was more common for discretionary foods (80.6% were ultra-processed) than core foods (59.9% aligned were not-ultra-processed). Food categories exhibiting the strongest levels of alignment included confectionary, foods for specific dietary use, and egg and egg products. Discordance was most common for convenience foods, sugars, honey and related products, and cereal and grain products.

Conclusions: Despite moderate alignment between the Australian Dietary Guidelines and NOVA, the discordance observed for almost one-third of products highlights the opportunity to develop recommendations for ultra-processed foods within the guidelines to advise Australians how these foods should be considered as part of a healthy diet.

Aims: Healthcare foodservices substantially impact global environmental changes. This study investigated environmentally sustainable practices in Australian health foodservices; and perceptions of the influence of COVID-19 on foodservice environmental sustainability.

Methods: An observational study was undertaken collecting data at two time points (2019 and 2022) via a pre-workshop survey with healthcare foodservice stakeholders. The survey used rating scales and free text options to explore sustainable practices, perceived barriers and enablers to sustainable practices, and a free-text response on the impact of COVID-19. Analysis included independent samples t-tests (continuous, normally distributed), Mann-Whitney U tests (continuous non-normally distributed data), and Pearson chi-squared tests (categorical data). A qualitative analysis of free text responses to a single question about the impact of COVID-19 was used to identify, analyse, and report positive and negative aspects of COVID-19 for sustainable foodservice practices.

Results: Demographic and employment characteristics were similar between timepoints n = 37 (2019) and n = 30 (2022), except for number who had attended sustainability training (n = 14, 38.8% vs n = 19, 63.3%; p = 0.038). There were fewer private hospital (n = 6, 16.2% vs n = 0), (0%) and more rural site representation in 2022 (n = 2, 5.4% vs n = 13, 43.3%; p <0.001). Sustainable foodservice practices were consistent across timepoints (overall mean (SD) sum score for sustainable practices 63.3 (20.7) vs 61.3 (20.4); p = 0.715), with recycling cardboard (n = 27, 90.0% vs n = 22, 84.6%), and the use of reusable cutlery (n = 26, 86.7% vs n = 22, 84.6%) the most prevalent practices at both timepoints. A 'lack of equipment' was the primary reported barrier while passionate staff ("champions") was the primary reported enabler. Participants reported that the COVID-19 pandemic led to an increase in single-use disposable items.

Conclusions: This study describes negligible changes in reported environmental sustainability practices by Australian healthcare foodservice stakeholders from 2019 to 2022. The study provides useful information on sustainability beliefs and practices in healthcare foodservices.

Aim: To modify the Australian and New Zealand Health Star Rating to account for ultra-processing and compare the alignment of the modified ratings with NOVA classifications and the current Australian Dietary Guidelines classifications of core (recommended foods) and discretionary (foods to limit).

Methods: Data was cross-sectionally analysed for 25 486 products. Four approaches were compared to the original Health Star Rating: (1) five 'negative' points added to ultra-processed products (modification 1; inclusion approach); (2) ultra-processed products restricted to a maximum of 3.0 Health Stars (modification 2; capping approach); (3 and 4) same approach used for modifications 1 and 2 but only applied to products that already exceeded 10 'negative' points from existing Health Star Rating attributes (modifications 3 and 4, respectively; hybrid approaches). Alignment occurred when products (i) received <3.5 Health Stars and were NOVA group 4 (for NOVA comparison) or discretionary (for Dietary Guidelines comparison), or (ii) received ≥3.5 Health Stars and were NOVA groups 1-3 or core.

Results: All Health Star Rating modifications resulted in greater alignment with NOVA (ranging from 69% to 88%) compared to the original Health Star Rating (66%). None of the modifications resulted in greater alignment to the Dietary Guidelines classifications overall (69% to 76%, compared with 77% for the original Health Star Rating), but alignment varied considerably by food category.

Conclusions: If ultra-processing were incorporated into the Australian and New Zealand Health Star Rating, consideration of ultra-processing within the broader dietary guidance framework would be essential to ensure coherent dietary messaging to Australians.

Aim: This study aimed to identify key health condition correlates of food insecurity in Australia using nationally representative data.

Methods: This cross-sectional study used data from a large, nationally representative Australian survey that included questions on the dynamics of families and households, income, wealth, welfare, labour market activity (including unemployment and joblessness), life satisfaction and wellbeing. Binary logistic regression models of eight items of food insecurity measured the association between 17 health conditions and food insecurity while controlling for various demographic and socioeconomic variables. A zero-inflated negative binomial model identified correlates of the number of food insecurity problems.

Results: Prevalence of food insecurity ranged from 3% to 9% depending on the measure analysed. Individuals experiencing blackouts, fits or loss of consciousness were 2-6 times more likely to report food insecurity than other individuals. When including control variables and incorporating other health conditions, several conditions significantly increased probability of any food insecurity: sight problems; blackouts, fits or loss of consciousness; difficulty gripping things; nervous conditions; mental illness; and chronic or recurring pain.

Conclusions: Detailed information on how health conditions are associated with different types of food insecurity was generated using population-representative data, 17 sets of health conditions, and eight measures of food insecurity. Understanding connections between food insecurity and health conditions allows public health professionals to create effective, targeted and holistic interventions.

Aims: To co-create strategies and identify opportunities to integrate eating disorder content within dietetics curricula at one Australian university with stakeholders using a design thinking approach.

Methods: A pragmatic mixed-methods, participatory design approach was used. An online survey explored the learning needs of dietetic students and recent graduates regarding eating disorders. Following the survey, a one-day design thinking retreat was held with stakeholders who were identified from the research team's professional networks. Eating disorder dietitians, learning experts, dietetic students, graduates, and those with lived experience were asked to identify strategies to enhance students' confidence and competence to provide care for people living with eating disorders. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using inductive coding and reflexive thematic analysis.

Results: Sixty-four students (n = 55, 86%) and recent graduates (n = 9, 14%) completed the online survey (26% response). Seventeen stakeholders attended the retreat. Four themes were identified: (1) changing perceptions of eating disorder care from specialist to 'core business'; (2) desiring and advocating for a national change to dietetics curricula; (3) importance of lived experience at the centre of curriculum design and delivery; and (4) collaborating to co-design and deliver eating disorder content at university.

Conclusion: Raising awareness, upskilling students and educators, enhanced collaboration between universities and stakeholders, and the inclusion of lived experience were key to preparing students to provide care to people seeking support for eating disorders. Further research is needed to assess the impact these strategies have on dietetic students' confidence and competence.

Aims: Healthcare needs of the Australian population are changing, providing an opportunity for dietitians to embrace innovation and entrepreneurship to meet evolving demands. This study explored the expectations and experiences of participants in a 12-month mentoring circle designed to provide entrepreneurship learning and formal mentoring for the Provisional Accredited Practising Dietitians Program.

Methods: A qualitative study design was employed. New graduate dietitians (<2 years) participating in the Entrepreneurial Dietetics Mentoring Circle in 2019, 2020 or 2021 were invited to participate. Baseline demographic and employment data were collected via survey. Semi-structured interviews were conducted before mentoring circle session 1 (baseline) and after the final session (completion), exploring insights into participant expectations and experiences in entrepreneurship. Thematic analysis, using methods outlined by Braun and Clark, was conducted to identify themes and subthemes.

Results: Twenty-eight dietitians participated (85% of mentees). Participants were mostly female (89%), less than 12 months post-graduation (75%), registered as Provisional Accredited Practising Dietitians (82%) and employed at least part-time (55%). Forty five interviews were conducted (28 baseline, 18 completion). Themes developed were: (1) entrepreneurial career path as a deliberate choice; (2) the value of being prepared for entrepreneurial careers; and (3) the importance of networks to support entrepreneurship.

Conclusion: The mentoring circle at this single university was seen by participants as supporting their transition into entrepreneurial careers, while meeting their requirement to be formally mentored through their Provisional status. Future research could consider the applicability of the mentoring circle model across a wider graduate population to support innovative practice.

Aims: Digital health transformation may enhance or impede person-centred care and interprofessional practice, and thus the provision of high-quality rehabilitation and nutrition services. We aimed to understand how different elements and factors within existing digital nutrition and health systems in subacute rehabilitation units influence person-centred and/or interprofessional nutrition and mealtime care practices through the lens of complexity science.

Methods: Our ethnographic study was completed through an interpretivist paradigm. Data were collected from observation and interviews with patients, support persons and staff. Overall, 58 h of ethnographic field work led to observing 125 participants and interviewing 77 participants, totalling 165 unique participants. We used reflexive thematic analysis to analyse the data with consideration of complexity science.

Results: We developed four themes: (1) the interplay of local context and technology use in nutrition care systems; (2) digitalisation affects staff participation in nutrition and mealtime care; (3) embracing technology to support nutrition and food service flexibility; and (4) the (in)visibility of digitally enabled nutrition care systems.

Conclusions: While digital systems enhance the visibility and flexibility of nutrition care systems in some instances, they may also reduce the ability to customise nutrition and mealtime care and lead to siloing of nutrition-related activities. Our findings highlight that the introduction of digital systems alone may be insufficient to enable interprofessional practice and person-centred care within nutrition and mealtime care and thus should be accompanied by local processes and workflows to maximise digital potential.