Nutrition & Dietetics最新文献

Aim: To investigate enablers and barriers to providing home enteral nutrition care and the use of blended tube feeding for adult clients.

Methods: An explanatory sequential mixed-methods study mapped to the Theoretical Domains Framework, comprising a national cross-sectional web-based survey, descriptive qualitative analysis of focus groups, and triangulation of quantitative and qualitative data. The target population was dietitians operating in all work environments with adult clients in patient-facing roles.

Results: 23 enablers and 24 barriers were identified for the provision of home enteral nutrition and blended tube feeding. Home enteral nutrition enablers: clinical guideline familiarity, confidence in troubleshooting, capacity for home visits, and access to peer support. Barriers centered on time constraints, complex funding arrangements, and an unclear scope of practice, particularly in relation to advanced procedures and community-based roles. Blended tube feeding enablers: patient and caregiver enthusiasm, alignment with person-centred care, peer encouragement, and the availability of written resources. Barriers included limited clinician training, inconsistent messaging between hospital and community sectors, and restrictive or absent organizational policy. Awareness of best practice guidelines emerged as a shared enabler between home enteral nutrition care and blended tube feeding use, while the lack of targeted university education and post-graduate clinical support was the only common barrier across both.

Conclusions: This novel study offers insights into dietitians' experiences in home enteral nutrition care and blended tube feeding use. Tailored strategies must address the unique barriers in home enteral nutrition and blended tube feeding to improve the quality and consistency of care for tube-fed adults.

Aim: To explore how behavioural, normative, and control beliefs shape early dietary implementation after bariatric surgery by exploring patient and dietitian perspectives using the theory of planned behaviour framework.

Methods: Semi-structured interviews were conducted with 16 patients who had bariatric surgery within the past 12 months and 24 dietitians involved in postoperative care to explore beliefs about dietary recommendations. Interviews explored five key dietary recommendations with questions guided by the theory of planned behaviour framework. Data were analysed using a deductive and inductive approach.

Results: Behavioural beliefs indicated a complex relationship between perceived benefits and cognitive demands, with protein intake and symptom management emerging as key motivators. Normative beliefs highlighted the dual influence of supportive family environments and challenging workplace contexts, particularly regarding modified eating behaviours. Control beliefs demonstrated an integrated pattern where physical constraints, psychological factors, and environmental demands seemed to intersect to influence dietary implementation. Of the five key dietary recommendations, patients faced unique challenges with vitamin supplementation due to the interaction between physical limitations and delayed reward perception. The cognitive burden of managing new dietary behaviours appeared to be a determinant of adoption across belief domains.

Conclusion: Early dietary changes after bariatric surgery seem to be influenced by psychological, social, and physical factors beyond education. Future interventions should aim to incorporate strategies to reduce cognitive load, address competing social pressures, and account for the temporal aspects of health-protective behaviours. Theory-based interventions that integrate implementation intention techniques, social support optimisation, and temporal self-regulation strategies may enhance dietary adherence during this critical adaptation phase.

Aim: Investigate changes in diet quality scores in adults who repeated a brief online dietary assessment tool, the Healthy Eating Quiz, and whether changes in diet quality varied by sociodemographic variables, dietary characteristics, or motivations for completing the tool.

Methods: This is a secondary analysis of longitudinal data collected July 2019-May 2022. Data from respondents aged 16-100 years who repeated the dietary assessment tool were analysed, including diet quality, measured using the validated Australian Recommended Food Score (range 0-73), sociodemographic and dietary characteristics (gender, age, socioeconomic status, vegetarian status, and meal sharing), and the main motivation for completing the tool. Paired t-tests assessed change in score between first and second tool completion (reported as mean (SD)). One-way ANOVA was used to test whether mean change in score differed by respondent sociodemographic, dietary, or motivation variables.

Results: Across 5189 respondents (73.6% female, 42.0 (17.4) years), mean score improved by 2.28 points during a mean 231 (11) days (p <0.001). Non-vegetarians reported a significantly greater improvement in score than vegetarians (2.39 (6.78) versus 1.56 (6.97) points, p = 0.003). Similarly, those who ate main meals alone improved more (2.70 (7.05) points) compared to those who ate with one (2.15 (6.67) points) or ≥two others (2.14 (6.72) points, p = 0.035).

Conclusion: Using the Healthy Eating Quiz, a diet quality assessment tool, on repeated occasions may contribute to improvements in diet quality in adults.

Aim: To capture published research describing aged care residents' experiences with food, eating and mealtime environments.

Methods: A scoping review involved a comprehensive search of six electronic databases: Medline, EMBASE, Scopus, CINAHL, Ageline and PsychInfo. No date and language limits were applied. Original research papers using qualitative methods and residents as participants to explore food, eating and/or the mealtime environment were included. Study selection involved screening and then full-text review completed in duplicate. Data from the included studies was extracted and charted and then thematic analysis and interpretive synthesis were applied.

Results: From 3421 studies identified in the database search, 11 studies were included. They explored aged care residents' experiences with food, eating and/or the mealtime environment through interviews, focus groups or observations. Five themes were identified: (1) respecting autonomy; (2) connection and community with others; (3) provision of quality, diverse and culturally appropriate foods; (4) mealtimes and the dining/eating environment; and (5) relationships, availability and skills of staff.

Conclusions: Mealtimes, food and dining experiences have a direct impact on residents' intake. Positive mealtime experiences, quality and varied food choices will maintain and improve outcomes for aged care residents. This review captures how residents experience mealtimes, what food means to them, and the barriers and enablers to resident-centred care. Understanding these may support aged care homes to align with Quality Standards.

Aims: Pressuring children to eat can override hunger and satiety cues, which may lead to over- or under-eating and food refusal. This study aims to describe the manifestations of pressure-to-eat in child care from early childhood educators.

Methods: A secondary data analysis was conducted using qualitative content analysis. Observations of educators from child care centres in Nova Scotia and Prince Edward Island (n = 9) occurred over 2 days. Observation data were coded and counted to determine the most and least prevalent forms of pressure. The count results were then assessed quantitatively by educator demographic characteristics to explore potential associations using nonparametric tests (Mann-Whitney U test, Spearman's correlations).

Results: Offering food and encouraging eating without referencing hunger or satiety was found to be the most common type of pressure; serving children without asking if they were hungry made up the majority of this type of pressure. This was less common with both increasing educator age (r = -0.692, p = 0.039), as well as years of experience (r = 0.878, p = 0.002). Pressuring children to eat by referring to health benefits and consequences was the least common type of pressure.

Conclusion: This study provides insight into the types and frequency of pressure-to-eat strategies implemented in child care centres, which can inform interventions to create more responsive feeding environments.

Aims: Delayed gastric emptying is a common complication of a pancreaticoduodenectomy and can adversely impact nutritional status, and potentially clinical outcomes due to delays in nutrition initiation post-operatively. The aim of this study was to explore associations between delayed gastric emptying and patient baseline characteristics, early post-operative nutritional status, post-operative nutritional practices and clinical outcomes in a tertiary Australian hospital.

Methods: This was a retrospective, observational study of 80 consecutive patients who underwent a pancreaticoduodenectomy between January 2019 and June 2022. Delayed gastric emptying was classified according to the International Study Group of Pancreatic Surgery definition. Continuous variables were compared using the independent t test, and categorical variables were compared using chi-squared or Fisher's exact test. Significant variables were included in a multivariable model.

Results: The incidence of delayed gastric emptying within this cohort was 45% (36/80) and was higher in males compared to females (p = 0.025). Early post-operative nutritional status was not significantly associated with delayed gastric emptying (p = 0.124). Patients with delayed gastric emptying had a higher incidence of post-operative pancreatic fistula (p = 0.03) and Clavien-Dindo complications ≥3 (p = 0.011). Delayed gastric emptying was associated with greater usage of enteral (p < 0.001) and parenteral nutrition (p < 0.001), a longer length of stay (p < 0.001) and increased re-admissions (p = 0.014). Male sex remained significantly associated with delayed gastric emptying following regression analysis.

Conclusions: Delayed gastric emptying rates were high, associated with greater use of artificial nutrition and worse outcomes in our patient population post-operatively. Early post-operative malnutrition was not significantly associated with delayed gastric emptying.

Aim: Nutritional status is a factor that impacts the clinical outcomes of various medical conditions, including cardiovascular disease and surgical procedures; however, little is known about its role in percutaneous procedures. This study aimed to assess the association between nutritional status and risk in patients undergoing coronary angiography and in-hospital mortality and length of stay to improve risk stratification and peri-procedural care.

Methods: Patients who underwent coronary angiography between January 2022 and August 2023. Nutritional status was assessed with body mass index, and nutritional risk was assessed with the Nutritional Risk Screening 2002 score. Multivariate regression models assessed independent predictors of in-hospital mortality, adjusting for age, sex, coronary event, Canadian Cardiovascular Society class, and cardiac arrest at admission. Subgroup analyses were performed based on coronary event type to evaluate whether the associations differed across clinical presentations.

Results: Patients who underwent angiography (n = 1343) were aged 69.2 ± 11.1 years, 51% male, and 49% had acute coronary syndrome. The mean length of stay at the hospital was 4.5 ± 4.8 days; 38% of patients stayed ≥5 days. The in-hospital mortality rate was 1.3%. Regression analyses revealed that the Nutritional Risk Screening 2002 score independently predicted the length of stay (β = 0.63, p = 0.002), and this relationship was strongest in the non-ST segment elevation myocardial infarction subgroup (β = 1.26, p = 0.02). Body mass index did not predict the length of stay. There was no significant relationship between in-hospital mortality and body mass index or the Nutritional Risk Screening 2002 score.

Conclusion: Nutritional risk significantly predicts the length of stay after coronary angiography, independent of age, sex, and coronary event type. Clinicians should consider routine nutritional risk assessment preceding coronary angiography to help individualise post-procedure, in-hospital care.

Aims: Hospital food provision/intake dashboards may improve malnutrition screening. The aim of this study was to use Nutrition Dashboard data to determine the optimal threshold for screening for malnutrition risk, and compare the accuracy of this method with estimated dietary requirements.

Methods: Observational data were extracted from medical files and food service records of 267 patients for a 4-month period in a 99-bed hospital. Energy (2500-8000 kJ) and protein (30-90 g) thresholds were applied for Nutrition Dashboard categorisation by supply and intake of food. Deficits in estimated requirements (105 kJ/kg/day and 0.75 g/kg/day) were also applied as a comparative method. The association between Nutrition Dashboard categories and the Malnutrition Screening Tool was explored using generalised estimating equations.

Results: A total of 267 patients and 1908 days of data were analysed. The use of estimated requirements for Nutrition Dashboard categorisation was not a statistically significant predictor of malnutrition risk. Application of energy (≤6000 kJ) and protein (≤65 g) thresholds for categorisation was significant (χ² = 9.50, df = 3, p = 0.023). When 5000 kJ and 55 g of protein were used for categorisation, patients were more likely to be at malnutrition risk when within low supply (odds ratio = 2.11, p = 0.002) and low intake (odds ratio 2.23, p < 0.001) categories.

Conclusions: Nutrition Dashboard categories are associated with an increased risk of malnutrition when categorised using thresholds of up to 6000 kJ and 65 g protein. Technologies like the Nutrition Dashboard present innovative opportunities for dietitians to utilise nutrition informatics to enhance and optimise nutrition care.