Nutrition & Dietetics最新文献

Aim: Private practice is one of the most rapidly growing, but under-researched employment sectors for graduate dietitians in Australia, limiting evidence-based workforce development. This scoping review examines existing international literature to gain an understanding of the current private practice workforce size, distribution, demography and workforce development considerations, including competencies, supply and demand, remuneration and professional development activities.

Methods: The databases MEDLINE, EMBASE, CINAHL, EMCARE, PsycInfo (Ovid) and grey literature were systematically searched in August 2023 using key search terms to identify studies for inclusion. Articles were included if they related to private practice dietetics and described an aspect of workforce. Original research, government and organisational reports, statements of practice and websites providing governmental or organisational statistics were included. A directed content analysis and qualitative constant comparison technique were used to deductively map intelligence sources against a workforce development framework. A gap analysis was also conducted to provide a focus for future workforce development research.

Results: A total of 72 peer-reviewed and grey literature sources were included, with 65% of the studies being Australian-based publications. Private practice dietetics research interest has increased in the last decade. Despite a breadth of published sources, this review found little published data on workforce size, distribution, demography, supply, demand, continued professional development and remuneration, indicating a significant gap in the evidence base. Existing literature focuses on workforce challenges and barriers, the work of private practice dietitians, with limited exploration of competency requirements for graduate private practitioners.

Conclusions: The literature on the private practice dietetics workforce is lacking worldwide, which constrains evidenced-based workforce development initiatives. Workforce development research across all workforce aspects is warranted to address current evidence gaps.

Aim: Objective structured clinical examinations have long been used in dietetics education. This observational study aims to describe the development, deployment, feasibility and validity of assessment using an oral interview in place of traditional objective structured clinical examinations, and to determine the ability of this assessment to identify students who are either not ready for placement or may require early support and/or remediation.

Methods: Student assessment data were collected over a two-and-a-half-year period and used to test the predictive ability of an oral interview to determine dietetic placement outcomes and highlight a need for early remediation. Descriptive statistics as well as a between-group one-way ANOVA was used to describe results.

Results: A total of 169 students participated in the oral interview and subsequent medical nutrition therapy placement over the study period. Significant differences in oral interview score were seen between students who passed placement and students who passed with remediation or those who failed. Oral interview performance was able to predict placement outcome, yet required less resources than traditional objective structured clinical examinations.

Conclusion: An oral interview may provide the same utility as the objective structured clinical examination in dietetics education.

Aim: In 2021, infection control guidelines, including those specific to feeding environments, were introduced by the International Olympic and Paralympic Committees to reduce virus transmission at the Tokyo 2020 Summer and Beijing 2022 Winter games. This observational cross-sectional study aimed to investigate caterers' compliance to these guidelines which included measures for personal hygiene, sanitisation, and physical distancing at these events.

Methods: Expert sport dietitians attending Tokyo (n = 15) and Beijing (n = 7) games were surveyed to rate 11 COVID-19 countermeasures as fully (100%), partially or non-compliant at nine dining locations across both events. Descriptive analysis of each countermeasure based on observed compliance and location was conducted and reported as a proportion of the total responses. To better understand participant perspectives of the factors influencing compliance, open responses were systematically coded into themes and sub-themes by researchers through content analysis. Themes generated from participant comments were categorised based on their relevance to specific countermeasures and locations to identify commonalities and disparities in participant experiences, perceptions, and observations.

Results: All main dining halls at both events were observed as 100% compliant to countermeasures on more occasions compared with Tokyo's venues and satellite villages. However, Beijing's three main dining halls, showed a greater compliance compared with Tokyo's main dining hall, likely due to overcrowding in Tokyo. Comments suggested that smaller dining spaces, with overcrowding, may have contributed to reduced compliance to physical distancing measures. Food safety concerns were raised about gastrointestinal distress in Beijing due to food cross-contamination.

Conclusion: Findings suggest that the food service environment may influence caterers' abilities to comply with foodservice safety and infection control guidelines. In the post-pandemic era, enhanced quality control and standardised risk mitigation strategies are needed to improve athletes' health at international sporting events.

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.

Aim: To explore the effect of blended tube feeding compared to conventional formulas on nutritional status, quality of life, anthropometry, diarrhoea and tube blockages in adults receiving tube feeding.

Methods: The protocol was registered (PROSPERO CRD42022372443). Five databases (MEDLINE, EMBASE, CINAHL, Scopus, CENTRAL) were searched from commencement of database to 14th June 2023 to identify studies comparing blended tube feeding to conventional formulas in adults receiving tube feeding. Certainty assessment was conducted using the Cochrane Risk of Bias Tools and the Grading of Recommendations, Assessment, Development and Evaluations framework, and a narrative synthesis of results is provided.

Results: From 4227 studies screened, eight were included (total n = 763 patients, 9-215 patients). Three studies were hospital-based and five were home-based with duration from 8 days-8 months. Blended tube feeding and conventional formulas were nutritionally equivalent in only three studies; energy and protein concentration of formulas ranged from 1.7-7.1 kJ/mL and 21-68.5 g/L for the blended tube feeding groups, and 4.2-6.7 kJ/mL and 39-100 g/L for the conventional groups. No studies assessed nutrition status or quality of life using validated measures. Blended tube feeding was associated with a clinically relevant reduction in diarrhoea with a low level of certainty. For remaining outcomes, there were inconclusive findings and an overall very low certainty of evidence for each.

Conclusion: The effect of blended tube feeding compared to conventional formulas on all outcomes remains uncertain. Blended tube feeding may reduce the incidence of diarrhoea. Future research using nutritionally equivalent comparisons and validated outcome measures is required.

Aim: Food literacy programs aim to improve food related skills and knowledge and are selected Governments as a strategy to address dietary intakes at a community level. The purpose of this research is to identify behaviour change techniques in a food literacy program, which were assessed by the achievement of participant goals related to food literacy and dietary behaviour changes.

Methods: Consensus methods were applied to map behaviour change techniques to an adult food literacy program. A second phase investigation applied content analysis of participant process evaluation data (collected between 2016 and June 2021) to align target behaviours and behaviour change techniques. Chi-square and ANCOVA were used to assess the statistically significant demographic characteristics, food literacy, and dietary behaviour scores for participants who set goals and recorded changes.

Results: A total of 4697 program participants provided evaluation data from the 4-week food literacy program. Participants who set goals and made changes were statistically more likely to have higher food literacy factor scores (p < 0.001) and fruit serves (p = 0.004). Statistical analysis showed that participants were more likely to have set goals and recorded changes if they were female (p < 0.001), older (p < 0.001), higher education level (p < 0.001), had a higher socioeconomic status (p = 0.049), lived with children (p = 0.014), were born in Australia (p = 0.019), or did not identify as Indigenous (p < 0.001). The behaviour change technique mapping process identified nine techniques used weekly and a total of 22 techniques used over the entire 4 week program curriculum.

Conclusions: This is the first Australian study to link the contribution of behaviour change techniques to food literacy and dietary behaviour change in an established effective food literacy program. Knowing the behaviour change techniques associated with effective programs will facilitate replication of effective interventions.

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.

Aims: This study investigates the utilisation of blended tube feeding by health professionals in Australia and New Zealand, assessing factors influencing its implementation following the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding consensus statement.

Methods: A cross-sectional survey was conducted targeting health professionals across Australia and New Zealand. The survey comprised 35-questions including multiple choice, Likert scales and open-ended responses, to gain insights into blended tube feeding practices and perspectives. The effect of the health professional factors on outcomes was explored in pairs with a series of Chi-squared tests. Odds ratios (ORs) were calculated using standard univariate logistic regression. An exploratory content analysis was used to code the open-ended text responses to the survey questions which were then categorised and further synthesised into overarching themes.

Results: Out of 89 health professionals who completed the survey, the majority were dietitians, 63% reported managing fewer than five patients using blended tube feeding within their services. Parental request was the leading reason for adoption. Notable barriers included clinician time constraints, resource limitations and a lack of formal guidelines. Some health professionals considered the primary risk associated with blended tube feeding to be poor growth and/or weight loss. Professional development was pivotal in increasing confidence and advocating for blended tube feeding, with significant correlations observed between blended tube feeding training and clinical practice.

Conclusions: This study emphasises the essential role of education, resource availability and institutional policy in promoting blended tube feeding practices for health professionals. Findings suggest that focusing on professional development and standardised resources could significantly enhance knowledge, confidence and competence of health professionals in blended tube feeding application. The outcomes point towards the need for a coordinated approach to support evidence-based blended tube feeding practices, aligning with the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding resources and recommendations.

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.

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.