Nutrition & Dietetics最新文献

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.

Aims: To describe an Aboriginal cultural immersion delivered to dietetics students at a large university in Australia and assess its effectiveness as a method to teach Aboriginal history, culture, diet, and health in dietetics.

Methods: Taking a strength-based approach, Aboriginal processes of learning were privileged, with the cultural immersion being co-designed with immersion educators, a First Nations researcher, and dietetics academic. The cultural immersion consisted of an opening ceremony and four stations of yarning, weaving, bush tucker, and artefacts/medicines. A mixed-methods approach was used, with triangulation of data from pre- and postsurveys, station mapping, and focus group interviews. Quantitative and qualitative data were simultaneously analysed from participating first-year Master of Nutrition and Dietetics students and then drawn together for an integrated understanding of the impact of the cultural immersion on student learnings.

Results: Fifty-three students completed pre- and postsurveys and 36 participated in focus groups. Through sharing lived experiences, learning through culture, and keeping sessions practical and Aboriginal leadership, each cultural immersion station utilised Aboriginal processes of learning that meaningfully engaged students with Aboriginal education content, appreciate holistic health and increased their general knowledge on Aboriginal history, culture, diet, and health (all p < 0.001).

Conclusion: Cultural immersion is one teaching method to enhance student knowledges and can be a part of a programmatic and integrated approach that embeds Aboriginal content throughout the whole curriculum. It is necessary that institutions recognise the value of cultural immersions to student learnings and commit to providing ongoing support.

Aim: The aim of this study was to examine expectations, perceptions and attitudes about dietetics services among the Australian and New Zealand public, to provide insights for building a future dietetics workforce that will meet consumer needs.

Methods: A cross-sectional, anonymous, online survey was employed to gain perspectives of a representative sample of Australian and New Zealand adults. Questions were purposely designed to collect views regarding sources of dietary information, expectations of dietetics service providers and factors influencing choice of dietetics service provider. Data were analysed descriptively and using Pearson's chi-square test to assess relationships between categorical variables. Free-text responses were analysed using content analysis.

Results: Of 2601 respondents, approximately one third (32%) had seen a dietitian. Doctors were the most trusted sources of dietary information (87%), particularly with participants over 60 years (χ(1) = 44.168, V = 0.130, p < 0.001). Cost was the most frequently reported factor influencing choice of dietetics services (56%), with 88% of respondents interested in accessing a dietitian, preferably in-person (64%), if they could do so for no cost. Participants anticipated that dietitians would offer services like meal plans (59%) and nutritional analysis (48%) as well as weight and other body measurements (56%). Some expectations such as blood tests (54%) were outside the usual scope of dietetic practice.

Conclusion: The results of this study have implications for practising dietitians, dietetics educators, and funders of dietetics services. Cost as a barrier suggests that advocacy to government for funding type, duration and number of visits to dietitians is still required.