Nutrition & Dietetics最新文献

Aim: There is limited understanding about the cost of managing individuals requiring home parenteral nutrition within an outpatient setting. This study aimed to quantify healthcare costs of managing home parenteral nutrition (at-home and within the multidisciplinary outpatient clinic setting) and compare incurred costs against an activity-based funding model.

Methods: A 12-month retrospective study compared parenteral nutrition at-home costs and outpatient clinic costs to funding reimbursement. Costing data were retrieved from electronic medical records and monthly hospital finance reports for 28 individuals that required home parenteral nutrition at a quaternary hospital in Sydney, Australia. Hospital remuneration was calculated. Data are presented as median and range.

Results: Individuals on home parenteral nutrition attended a median (range) of 4 (3-7) multidisciplinary outpatient appointments over the year, where one outpatient appointment cost AU$294.51, less than the reimbursement of AU$366.37 based on the funding model allowing for medical billing; and AU$560.55 for activity-based funding where additional loading was added for multidisciplinary input. The median at-home costs per individual per month were AU$6949.86 (AU$2951.64 to AU$15015.77), compared to the funding model reimbursement of AU$7374.64 per individual per month.

Conclusions: The current healthcare funding model sufficiently covers home parenteral nutrition multidisciplinary outpatient service costs as well as at-home costs within this single-site study. This is likely due to the routine use of ready-to-hang 3-in-1 parenteral nutrition solutions. Further multicentre research is needed to better understand funding, corroborate the findings of this study, and inform future funding revisions.

Aim: The World Health Organization Regional Office for Europe's Nutrient and Promotion Profile Model recommends that commercial infant and toddler foods do not carry compositional, nutrition, health, or marketing claims. Our objective was to identify on-pack claims displayed on commercial foods for infants and toddlers in New Zealand.

Method: The packaging of products intended for infants (aged up to 11 months) and toddlers (ages 12 months to <36 months) was analyzed for the presence of claims using a coding structure based on categories outlined by the World Health Organization Europe Nutrient and Promotion Profile Model. Descriptive statistics were conducted to analyze the frequency of types of claims. Relevant infant and toddler products available in New Zealand supermarkets were identified through a packaged food database of products collected in 2023.

Results: Two hundred and ten products were identified: 167 infant and 43 toddler products. On average, there were 7.5 unique claims per product (range 3-15), with composition and nutrition claims being the most common (mean 4.0 per product), followed by marketing (3.3) and health claims (0.2). Composition and nutrition claims relating to the absence of ingredients generally perceived to be harmful (i.e. 'free from' claims) were prevalent on 97% of products and most commonly referred to flavors (on 72% of products) and colors (71%).

Conclusions: All New Zealand infant and toddler products carried multiple claims. Regulation is needed to align with international best practice and prevent caregivers from being potentially misled by these promotional messages when making purchasing decisions for young children.

Aims: The primary aim of this project was to investigate the provision of Indigenous food items on hospital menus to improve Aboriginal and/or Torres Strait Islander patient meal experiences within Australian public and private hospitals. The secondary aim was to explore other inclusion initiatives at the hospitals.

Methods: A cross-sectional study was completed by surveying food service dietitians from inpatient hospitals around Australia to collect data regarding the provision of Indigenous menu items and cultural practices. A convenience sample of dietitians was used, followed by snowball sampling to increase responses. Closed survey question data was analysed using simple descriptive statistics and free text comments via inductive content analysis.

Results: 67 surveys were completed covering all Australian states and territories. 19% (n = 13) of hospitals provided specific food items for Aboriginal and/or Torres Strait Islander patients while 72% (n = 48) provided Halal and 52% (n = 35) provided Kosher meals. The majority (45%) of responses were from Victoria (n = 30); yet only one Victorian hospital included Indigenous offerings. 72% of hospitals (n = 48) reported they had not considered the needs of Aboriginal and/or Torres Strait Islander patients when it came to food provision.

Conclusions: This study was the first to explore current trends in food provision for Aboriginal and/or Torres Strait Islander patients and highlights the gap in hospital food provision that meets these cultural considerations.

Aim: To assess the prevalence of undernutrition, overnutrition, and simultaneous malnutrition in a hospital setting, as well as undernutrition risk and dietetic intervention rates.

Methods: A point prevalence survey was conducted annually from 2016 to 2024 (excluding 2020-2021 due to Coronavirus Disease 2019) across three metropolitan health service hospital sites. Eligible multiday inpatients underwent bedside assessments and medical record reviews to determine Body Mass Index, Malnutrition Universal Screening Tool scores, and undernutrition status based on either the International Classification of Diseases, 10th Revision, or the Global Leadership Initiative on Malnutrition. Data were analysed descriptively.

Results: Of 5186 patients surveyed, 21.2% were undernourished, 39.5% were overnourished, and 4.8% were simultaneously under- and overnourished. Just over one-third (37.4%) of all participants were at risk of undernutrition. Dietitian intervention rates were highest among the simultaneously malnourished (70.6%) and undernourished (69.6%), and low among the overnourished (3.6%).

Conclusion: The findings underscore the need for improved detection of simultaneous malnutrition and increased rates (towards 100%) of dietary intervention among patients with either under- or simultaneous malnutrition during a patient's hospital stay.

Aims: This study aimed to describe private dietetics practices in Australia in terms of ownership, size, and operation, team composition, and products and services.

Methods: Australian dietitians operating private practices were invited to participate in a cross-sectional survey between May and June 2024. The survey captured data regarding the business, including ownership, revenue, business and clinical operation, team composition and remuneration, products and services, and consultation and program characteristics. Data were analyzed descriptively.

Results: One hundred and fifty-four participants completed the survey (22% response rate). Businesses were primarily sole traders (n = 105; 68%) that neither employed nor contracted health professionals (n = 94; 61%) and generated less than AU$149999 in revenue (n = 114; 77%). Most businesses specialised (n = 107; 69%), with common areas of specialisation being eating disorders (n = 49; 32%), disability support (n = 35; 23%), and weight inclusive care (n = 35; 23%). Client consultations (n = 146; 95%) were the most frequently offered service. Initial consultations were most frequently 60 min (n = 83; 59%), attracting a mean fee of AU$173 (±$9 95% CI), while review consultations were most frequently 30 min (n = 80, 57%) and AU$113 (±$7 95% CI). Business and dietitian performance evaluation were typically not performed periodically, yet both were positively correlated with revenue (τ_b = 0.231, p < 0.001 and τ_b = 0.338, p < 0.001, respectively).

Conclusions: Sole practitioners represent a significant proportion of private dietetics practice. With a significant proportion of the workforce working in this area, support is needed to ensure private practices are sustainable and the workforce can continue to provide much-needed services for Australians.

Aims: This study aimed to establish the processes for a national dataset describing Australian private practice dietetics and to report baseline workforce data.

Methods: A cross-sectional survey captured workforce and business data for dietitians working in private practice dietetics in Australia. Business owners from a national register were invited to complete the survey and to share the survey with employed or contracted dietitians between May and June 2024. Data were analysed descriptively.

Results: Seven hundred and three business owners were invited to participate, and 176 participants completed the workforce items (25% response rate). Participants were primarily female (n = 158; 90%) business owners (n = 161; 91%), mean ± SD age of 42 ± 9 years and mean time since graduation of 15 ± 9 years. Mean time spent per week working in private practice was 26 ± 15 hours. Most participants were satisfied with their work in private practice (n = 160, 91%) and anticipated working in private practice in 5 years' time (n = 155, 88%), though some (n = 62, 35%) felt some degree of unwellness due to stress. Business owners were generally dissatisfied with the applications received for advertised dietetics roles. One hundred twenty-one participants consented to follow-up in 2 years as part of the ongoing survey.

Conclusions: A national dataset describing the dietetics workforce, supported by ongoing data capture, is essential to support workforce planning and ensure that private practice is a legitimate and sustainable career path, thereby future-proofing this segment of the workforce and ensuring access to high-quality preventative and primary dietetics care.

Aim: This study aimed to describe the utilisation of item numbers for dietetic services available through the Australian Medicare Benefits Schedule, with particular focus on changes between 2015 and 2024.

Methods: This descriptive observational study used publicly available, population-level data from Medicare Australia describing item utilisation in terms of number and services per 100 000 population, benefit paid, and patient demographics for dietetic-related item numbers. Utilisation of related items for other allied health professions was also described. Data were analysed using descriptive statistics (frequency, percentage) and change in utilisation was calculated for periods defined a priori.

Results: The total number of Medicare-subsidised dietetic services increased by 7%, to 1691 services per 100 000 population, between 2015 and 2024. However, the number of chronic disease dietetic services per 100 000 population decreased by 12% over the decade, while other allied health professions increased over the same period. In addition, the proportion of group services for diabetes delivered by dietitians declined from 7% in 2015 to 4% in 2024, with just 13 services claimed per 100 000 population. Conversely, utilisation of dietetic services for eating disorders has consistently increased, with an annual growth rate between 8% and 47%, seeing 273 dietetic eating disorder services claimed per 100 000 in 2024.

Conclusions: Change in utilisation of Medicare-subsidised dietetic services varied over the last decade, with claims for eating disorders increasing while claims for chronic disease and diabetes group services decreased. The lack of dietitian-specific item numbers for case conferencing and some telehealth services impedes accurate evaluation of utilisation and, therefore, planning.

Aims: To quantify the volume of tray-line packaging waste at an Australian metropolitan tertiary hospital and explore current disposal methods and their environmental impact.

Methods: The patient menu ordering system was used to retrospectively quantify packaged menu items served on the tray-line from March 2023 to March 2024, with some of the data extrapolated from a 3-month period to provide an estimate of 12-month quantities. The packaged weight of all menu items was multiplied by the number of times they were plated and served to patients. Carbon emissions (expressed as carbon equivalents) were calculated using the methods outlined in the Australian Government National Greenhouse Accounts Factors 2023.

Results: Packaging waste was analysed for 1068 main meals and 712 mid-meals over 365 days. Sixteen tonnes of food packaging was sent to patients, all of which was sent to landfill. This equates to 7.73 tonnes of carbon equivalents. Of this food packaging, 9.4 tonnes of waste (60%) had the potential to be recycled and diverted from landfill.

Conclusion: This study quantified the annual packing waste generated from this tertiary hospital food service tray-line. Implementation of a recycling system could divert significant packaging waste from landfill and reduce carbon emissions.

Aims: Iodine and selenium are important nutrients for thyroid function; however, the New Zealand food supply is generally low in both minerals. Bread can be a good source of these minerals; although the popularity of lower carbohydrate diets means some people avoid bread. This study aimed to investigate the effect of low bread intakes on iodine and selenium intakes and status, and thyroid function in mid-life women in New Zealand.

Methods: Self-selecting women (n = 46), aged 40-63 years, with a mean daily intake of 1.6 ± 1.5 slices of fortified commercial bread, were recruited into a cross-sectional study in Auckland, New Zealand. Assessment of iodine and selenium intake was via a 3-day diet diary. Iodine and selenium concentrations were measured in 24-h urine samples and selenium concentrations in plasma using inductively coupled plasma mass spectrometry. Thyroid hormones including triiodothyronine and thyroxine were also determined.

Results: Median urinary iodine concentration was 49 (35, 78; 25, 75 centile) μg/L indicating iodine deficiency. Of plasma samples measured, 32% had selenium concentrations below 110 μg/L, suggesting inadequacy. Data suggested at least 40% of participants had low intakes of both nutrients. Only two participants had impaired thyroid function; however, plasma selenium concentrations predicted the ratio of triiodothyronine to thyroxine (p = 0.038).

Conclusions: A high prevalence of inadequate selenium and iodine intake was observed in women with low bread intakes. Those with low bread intakes need to ensure they consume alternative sources such as dairy, fish and seafood, eggs, meat, other grains, and nuts.