Nutrition & Dietetics最新文献

Aims: The aim of this study is to explore the occurrence of food insecurity among pregnant women in Australia.

Methods: This cross-sectional, self-reported study included two measures of food insecurity (the US Department of Agriculture Household Food Security Survey Module and single item measure), use of emergency and community food assistance, health conditions, eating habits during pregnancy, and professional nutritional advice and health seeking behaviours. Participants were recruited using (1) an advertisement posted on social media and (2) flyers with a QR code linked to the online survey, made available for women to take from clinic rooms at a hospital in Melbourne, Victoria. Data were analysed using basic statistics, spearman's rho correlation coefficients, and linear regression to identify factors that may be associated with food insecurity among pregnant women in Australia; the study was open between May 2021 and March 2022.

Results: Three hundred and three valid responses were received from pregnant women in Australia. Food insecurity was determined to be 14.5% (US Department of Agriculture Household Food Security Survey Module) and 6.3% (single item used). Food insecurity was significantly associated with income, education level and age.

Conclusions: Results indicate a high prevalence of food insecurity among pregnant women. Routine screening and referral of food insecure pregnant women should be considered in antenatal care settings.

Aims: This study aimed to develop a scoring index for the healthfulness of food outlet menu offerings available through Australian delivery platforms.

Methods: The Delphi method was employed to achieve consensus among a panel of Australian nutrition and public health experts regarding the food environment scores assigned to online food outlets, classified by type. From previous studies and scoping of delivery platforms, 36 food outlet types were identified. Australian nutrition and public health experts were recruited to complete an online Delphi survey to score the healthfulness of these outlets using a scale from -10 (least healthful) to +10 (most healthful), based on typical menu offerings. The first round of the survey was opened for approximately 5 weeks in July to August 2023, and the second round was opened for 2 weeks in September 2023. The mean food environment score, minimum and maximum awarded food environment score, and SD for each outlet type, and coefficient of variation was calculated after each survey round to provide a measure of the spread of the data around the mean and the degree of consistency in the distribution of responses. Following the second survey round, results were assessed for consensus among the participants.

Results: Fifty-four participants completed the round one survey, and n=14 completed round two. The majority of online food delivery outlet types received a food environment score of less than +5, and were considered 'less healthful.' Participants scored greengrocers as the most healthful outlet type (mean food environment score of 8.83 ± 0.37) and liquor selling stores as the least healthful (score of -8.10 ± 1.14). The group reached consensus after two survey rounds due to decreases in the standard deviations of mean food environment scores.

Conclusions: This study provides an expert-informed tool, the DIGIASSESS tool, that can be easily applied by researchers, policy makers, health workers and public health professionals to understand the rapidly evolving online food delivery environment, including changes over time and areas for potential intervention.

Aim: This multi-method study explored dietetics graduates' preparedness for the landscape of private practice employment.

Methods: Qualitative, in-depth interview and audio-diary data were collected longitudinally in 2019 regarding dietetics graduates' experiences of private practice employability. Framework analysis of qualitative data prompted a quantitative survey of university representatives in 2021-2022 on the use of private practice placements. Survey data were analysed descriptively. Qualitative themes were reviewed alongside quantitative findings and were interpreted in the context of the sociocultural theory, landscapes of practice.

Results: Qualitative data from nine dietetics graduates (total 12 hours of audio data) indicated unpreparedness for this setting, with the following themes identified: 1) private practice skills were lacking; 2) making a living from private practice was challenging; and 3) support was needed. Quantitative data from 18 program directors of accredited universities (100% response) illustrated that private practice placement experiences varied from <10 to 40 days. Placements were most commonly elective (44%) and were not offered by four programs (22%). University program directors expressed concerns that private practice placements were challenging to organise and offered limited client contact hours.

Conclusions: It is an educational priority to prepare graduates for available employment opportunities by providing learning experiences that traverse the dietetics landscape of practice. Co-designing placements with private practice business owners may support authentic experiences of appropriate durations, with ample opportunities for students to build skills to enhance preparedness for this growing employment setting.

Aim: Nutritional requirements are increased in young people to support growth, and this is particularly critical when pregnancy occurs within young age groups. The aim was to describe nutritional intakes (with particular emphasis on iron and calcium) and selected pregnancy outcomes, in a young antenatal population aged 14-24 years.

Method: A retrospective audit was conducted using 404 records from a young parents' antenatal clinic which included prepregnancy body mass index (BMI), pregnancy weight gain, baby birth weight, nutritional biochemistry, and dietitian assessment of iron and calcium intakes and supplement use. Age groups were compared (adolescents aged 14-18 years versus older 19-24 years clients), and regression analysis was used to explore potential predictors of birth outcomes.

Results: There was no difference in prepregnancy body mass index for age, pregnancy weight gain, baby birth weight or outcomes, between the age groups. Based on food group serves, intakes were inadequate for iron in 82% of clients and for calcium in 72%. Iron status declined in both groups during the pregnancy, while adolescents had less adequate calcium intake (p = 0.0001). Supplement use was more common in clients with poor iron (p = 0.015) or vitamin D status (p < 0.0001).

Conclusion: Iron and calcium intakes were inadequate in this nutritionally vulnerable population. Further research would be beneficial to identify effective interventions to improve nutrition in this cohort.

Aim: To identify and achieve expert consensus on the most important and feasible strategies to implement digital health services for nutrition care management of chronic conditions in outpatient settings.

Methods: Determinants and strategies for implementing digital health services for nutrition care management were identified in line with the literature and the Consolidated Framework for Implementation Research. These were presented to team leaders and senior clinicians, as well as dietetic and allied health directors in a two-round e-Delphi process. Consensus was reached when strategies were rated very important/feasible by at least 75% of respondents, calculated by the median, interquartile range and frequency. Following the two survey rounds, a final prioritisation survey was distributed to participants, where participants were asked to prioritise their top strategy for each determinant, which was analysed by frequency calculations.

Results: Twenty participants participated in round one of the survey and 18 completed the final prioritisation round. Following the two rounds, 3 strategies did not meet consensus for importance and 7 strategies did not meet consensus for feasibility out of 25 strategies presented. Nine strategies were prioritised following the survey rounds. Key concepts of the strategies that met consensus and were prioritised related to (i) adhering to quality of care with effective evaluation processes; (ii) providing options for digital health upskilling and support; and (iii) individualising patient care.

Conclusion: Team leaders and senior clinicians as well as dietetic and allied health directors have indicated that there are many important digital health strategies yet not all are feasible to implement within current resourcing and systems.

Aim: The aim of this study was to assess the criterion validity of the Global Leadership Initiative on Malnutrition criteria compared to the subjective global assessment in a diverse inpatient population.

Methods: This cross-sectional study was a retrospective analysis of point prevalence audit data. The prevalence of malnutrition determined by the Global Leadership Initiative on Malnutrition criteria was compared to the Subjective Global Assessment. Validity statistics were determined using all of the Global Leadership Initiative on Malnutrition criteria concurrently as well as each pair that could be used to diagnose malnutrition. Subgroup analysis was undertaken based on severe malnutrition, treatment group, age and body mass index.

Results: Nine hundred and eighty-one patients were included (65.1 ± 18.6 years, 54.8% male). The prevalence of malnutrition was 36.7% using the Subjective Global Assessment and 36.1% using the Global Leadership Initiative on Malnutrition criteria. More patients were classified as severely malnourished using the Global Leadership Initiative on Malnutrition criteria (9.8% vs. 6.0%), whilst more rehabilitation patients were classified as malnourished using the Subjective Global Assessment (42.2% vs. 33.6%). The criterion validity of the Global Leadership Initiative on Malnutrition criteria was good, with a sensitivity of 92.5% (95% CI 90.9-94.2) and specificity of 96.6% (95% CI 95.5-97.8). There was a downward trend in sensitivity with increasing body mass index and a lower sensitivity in the rehabilitation population. The criterion validity was fair at best when each pair of the Global Leadership Initiative on Malnutrition criteria was considered independently of other criteria.

Conclusions: When all criteria are considered concurrently, the Global Leadership Initiative on Malnutrition criteria present good criterion validity and can be applied in clinical practice to diagnose malnutrition.

Aims: Delegation of nutrition care activities to Dietetic Assistants in hospitals has been identified as one innovative malnutrition model of care, but there has been limited evaluation of their roles. This study aimed to develop, implement and evaluate a new Malnutrition Model of Care embracing automated delegation and digital systems.

Methods: The Malnutrition Model of Care was created to detect patients at risk of malnutrition (using the Malnutrition Screening Tool) and nutritional decline (via routine intake tracking at all meals and snacks). Digital systems generated automated referrals to dietetics, with protocols to support Dietetic Assistants to action these to direct care escalation to the ward dietitian. Dietetic Assistant training included simulations and clinical task instructions. Implementation evaluation was guided by the Donabedian model of quality and included a review of inpatient dietetics occasions of service, survey of Dietetic Assistant role satisfaction and task confidence, and hospital-wide cross-sectional malnutrition audit. Data was descriptively analysed.

Results: During the first year of implementation, 60% of Dietetics inpatient occasions of service were completed by Dietetic Assistants, with 26% of Dietetic Assistant inpatient tasks initiated from nursing malnutrition risk screening. Most Dietetic Assistants reported adequate training and confidence in completing delegated tasks. Malnutrition prevalence was 14% with no hospital-acquired malnutrition identified. No clinical incidents were reported.

Conclusions: The Dietetic Assistant workforce and technology were harnessed to implement an innovative delegated Malnutrition Model of Care that appears to be safe and effective at managing malnutrition from preliminary evaluation. Work continues to formally assess service efficiencies, cost and patient experience.

Aims: This consensus statement document describes the recommendations of the Australasian Society of Parenteral and Enteral Nutrition regarding the identification and management of refeeding syndrome and refeeding syndrome risk.

Methods: An expert working group completed a review of the literature to develop recommendations for the consensus statements. Review of the drafted consensus statements was undertaken by highly experienced clinicians.

Results: The identification and management of refeeding syndrome requires a multidisciplinary approach. Actual refeeding syndrome is rare; however, all patients should be assessed for the risk of its development. Refeeding syndrome should only be diagnosed if the patient has had adequate nutrition intake (≥50% of estimated requirements), with electrolyte imbalances and clinical symptoms emerging after its commencement. Thiamin and multivitamin supplementation and regular electrolyte monitoring should be provided to all patients at risk of developing refeeding syndrome. There is no evidence that patients at risk of developing refeeding syndrome should be started at an initial lower enteral feeding rate than already recommended for checking tolerance to enteral feeds. Goal nutrition rates should be reached within 24-72 h for all routes of nutrition. Low electrolyte levels should be replaced as per local guidelines, with consideration given to the route of replacement.

Conclusion: These consensus statements are expected to provide guidance at a national level to improve the identification and management of refeeding syndrome and refeeding syndrome risk.

Aim: This study aimed to investigate public perceptions of the Nutrition Care Process standardised diagnosis terms.

Methods: This cross-sectional study used a 5-point Likert scale survey asking participants to rate nutrition diagnosis terms based on the degree of acceptability (offensiveness). Inclusion criteria were adults ≥18 years, living in the United States and fluent in English. Descriptive statistics, Kruskal-Wallis and chi-squared tests were conducted, with statistical significance set at p < 0.05. Qualitative analysis of optional written participant comments was conducted, using an inductive-deductive thematic analysis approach.

Results: The majority of participants (n = 185, average age 46.5 ± 17.8 years) were female (77.8%), White (80.5%), degree-educated (79.5%) and did not work in healthcare (73.0%). The top offensive term was 'undesirable food choices' (20.5% rated the term as offensive). Younger participants found the terms 'undesirable food choices' and 'obesity' more offensive compared to older adults (p < 0.05). Qualitative analysis revealed concerns with and/or understandability of specific nutrition diagnosis terms.

Conclusions: In general, nutrition diagnosis terms were considered acceptable by study participants. The main offensive terms are in the Behavioral-Environmental domain. Findings from our study serve as a foundation for further research and provide rationale to advocate for changes to Nutrition Care Process terminology in the spirit of fostering more inclusive, person-centred care.