Nutrition & Dietetics最新文献

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.

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.

Aims: This study aimed to test the feasibility and acceptability of mental health clinicians using a multifaceted nutrition-risk screening tool in Australian mental health settings.

Methods: A mixed-methods cross-sectional design was used. Mental health clinicians implemented the multifaceted NutriMental screener at seven sites across Australia and provided feedback via a standardised form. Primary outcomes were the feasibility, acceptability and appropriateness domains of the feedback questionnaire. Additional outcomes included association/agreement between the consumer's desire for dietetic support, clinicians' impression of need for dietetic support, and total nutrition risks reported. Directed content analysis was employed to analyse open-ended sections of the clinician feedback questionnaire.

Results: Fifty-four clinicians participated, completing the NutriMental screener with a total of 256 mental health consumers. Mean total nutrition risks reported were 6.4 ± 1.8 (out of nine). Mean implementation outcomes (out of five) were 3.1 ± 0.8 for acceptability, 3.7 ± 0.5 for appropriateness, and 4.3 ± 1.7 for feasibility. There was moderate agreement between consumer's desire for dietetic support and clinicians' impression of need for dietetic support κ = 0.32 (95% CI: 0.21-0.43), p < 0.001, and positive correlations between the number of nutrition risks reported and consumer's desire for dietetic support (r = 0.29, p < 0.001) and clinicians' impression of need for dietetic support (r = 0.29, p < 0.001). Six themes and 17 subthemes related to barriers and facilitators to the screener's implementation were identified.

Conclusion: The multifaceted risk screening tool appears to be feasible, acceptable and appropriate for use within Australian mental health services. Refinements of the NutriMental screener based on clinician feedback may further improve its implementation.

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.