Journal of Human Nutrition and Dietetics最新文献

Background: Dietetics, as an autonomous profession guided by evidence-based practice, requires a dynamic and adaptable workforce to meet evolving challenges in healthcare, public health nutrition and epidemiological research. This study aimed to explore the opportunities presented by the transition to online education of preparing dietetic students for professional demands, particularly, through the lens of problem-based learning (PBL) within the Community of Inquiry (CoI) framework.

Methods: This paper examines the shift from traditional classroom and practice placement education to online and blended learning accelerated by the COVID-19 pandemic. It focuses on the application of PBL, rooted in constructivist theories and the CoI framework, which includes social, cognitive and teaching presences.

Results: PBL encourages active and collaborative learning, aligning with the multifaceted roles of dietetic professionals. The CoI framework guides the development of effective online learning environments, emphasising the importance of social, cognitive and teaching presence.

Conclusion: The transition to online education presents significant opportunities for dietetic education. Careful instructional design and effective teaching strategies are crucial for creating successful online learning environments, as demonstrated through an illustrative case study.

Introduction: Vitamin and mineral deficiencies are commonly seen in children, and they affect the physical, mental and cognitive development of a child.

Objective: This study aimed to map interventions to improve vitamin and mineral inadequacies among children in India.

Methods: A review was conducted using the PRISMA extension for scoping reviews (PRISMA-ScR) 2018 checklist. Based on the PICO framework, further steps were followed in conducting the review. Studies conducted on children and adolescents (ranging in age from 6 months to 19 years) in India were considered. A search was carried out in PubMed, CINAHL, ProQuest, Cochrane Library, Scopus and Web of Science. Interventions that focused on improving vitamin and mineral inadequacies were collated. Studies published in the English language between 1 January 2012, and 30 September 2023, were included. The data from the included studies were reported narratively.

Results: The search yielded 1566 records through the databases. Finally, 18 studies were found to be eligible to be considered in this review. For improving vitamin and mineral deficiencies, different types of supplements like iron, vitamins A, C and D in different amounts; nutritional supplements like zinc-rich foods, whole-wheat recipes, milk, lipid-based vitamin B12 supplements, ragi, porridge and iron-fortified whole-wheat drinks; or nutritional counselling worked better in children.

Conclusion: Vitamin and mineral supplementation for children reduces anaemia among children. Policymakers need to develop a strategy to increase awareness among parents, AWWs, caregivers and schoolteachers to reduce further complications.

Background: Malignant bowel obstruction (MBO) presents with multiple symptoms. The 4-step BOUNCED diet educates patients to self-manage oral intake according to symptoms. It includes clear fluids, thin liquids, purée and soft, sloppy foods, which are low in fibre.

Methods: This mixed methods single-arm feasibility study aimed to establish if the diet could reduce MBO symptoms in patients with inoperable colorectal and gynaecological malignancies. The secondary objectives were to investigate if it was easily followed, improved quality of life (QOL) and reduced hospital admissions. Patients able to tolerate an oral diet with one or more symptoms (pain, bloating, early satiety, nausea and vomiting) were eligible. Following informed consent, an oncology dietitian took a diet history and determined which step of the diet they needed to follow using a detailed patient information leaflet. Patients remained on the trial for 28 days. Symptom and QOL data were collected on Days 1 and 28 using the Memorial Symptom Assessment Scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) questionnaires.

Results: Thirty patients (24 female, 6 male) aged 18-85 years consented from March 2021 to November 2022. Twenty-six participants completed the trial and 25 found the diet very easy or easy to understand. There was a significant reduction in pain from 96% on Day 1 to 63% on Day 28 (p = 0.004). The mean increase of EORTC global health status/QOL was 23.5 points, 95% CI (12.4-32.5) (p ≤ 0.001). There was a significant difference between number of admissions (p = 0.018) and bed days (p = 0.004) in the 28 days prior to consent compared to the trial period.

Conclusions: A modified consistency low-fibre diet is easily followed, may reduce symptoms of MBO, admissions to hospital and improve QOL.

Background: Coeliac disease (CeD) is a type of enteropathy characterised by an immune-mediated reaction to ingested gluten, resulting in impaired absorption of nutrients and symptoms such as bloating, abdominal cramping and diarrhoea. Currently, the only treatment for CeD is adherence to a gluten-free diet (GFD). The latest draft guidance from the US Food and Drug Administration recommends that dietitians experienced in CeD management evaluate patients during the screening and treatment period of CeD clinical trials to assess adherence to a GFD. However, there are currently no standardised guidelines on dietary assessment of patients with CeD on a GFD and there is a lack of widespread availability of expertise in this field.

Methods: Based on the findings of a literature review conducted between April and September 2023, this article provides an overview of key points to consider in the nutritional and dietary assessment of patients with CeD who are following a GFD, with particular focus on the clinical trial setting.

Results: Based on a consensus from dietitians and gastroenterologists experienced in treating patients with CeD, we present specific recommendations for registered dietitians who manage patients with CeD. We also describe the development of a simplified tool for assessment of adherence to a GFD, the Gluten-Free Adherence Survey, based on these recommendations.

Conclusions: These guidelines cover nutritional and dietary assessment of patients with CeD, physical assessments, intake of oats, environmental considerations and the disease burden.

Background: The dietary restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), called the low-FODMAP diet (LFD), is frequently used to manage irritable bowel syndrome (IBS). This service evaluation aimed to assess the long-term effectiveness of the LFD in managing IBS symptoms and whether symptom response and dietary adherence to the LFD were associated.

Methods: This observational service evaluation collected data via questionnaires during clinical dietetic appointments for IBS management. Symptom severity was reported at baseline, short term (following FODMAP restriction) and long term (following FODMAP reintroduction). Additional data that captured experiences following the LFD were collected at long-term follow-up.

Results: Of 184 patients, 14% reported satisfactory relief from global symptoms at baseline, which increased to 69% at short-term follow-up and 57% at long-term follow-up (p < 0.001). The most notable improvements in individual symptoms between baseline and long-term follow-up were abdominal bloating (72% baseline, 48% long term, p < 0.001), abdominal pain (61% baseline, 30% long term, p < 0.001) and flatulence (71% baseline, 40% long term, p < 0.001). High adherence with the LFD at short-term follow-up was not associated with long-term symptom improvement, but there was an association between long-term adherence and global symptom severity (p = 0.032). Completion of FODMAP reintroduction as per protocol was associated with long-term symptom improvement (p = 0.049).

Conclusions: The LFD is an effective treatment for managing IBS symptoms in the long term, particularly, when the diet is adhered to and reintroduction is completed as per dietetic education. Further randomised-controlled trials are required to explore the cause-and-effect relationship between LFD and IBS symptom management.

Background: Plant-based diets (PBDs) have gained popularity in recent years due to their co-benefits for human and planetary health. Although clinical guidelines now recommend well-balanced PBDs, it remains unclear how dietitians in the United Kingdom (UK) and Republic of Ireland (ROI) view such diets and their implementation in practice. This study aimed to evaluate the perspectives of registered dietitians (RDs) on the role of a whole food plant-based diet (WFPBD) in clinical practice.

Methods: A cross-sectional online survey was conducted amongst RDs in the UK and ROI between September and November 2023.

Results: A total of 335 RDs participated in the survey. Most RDs (76%) agree that a well-planned WFPBD is suitable for all stages of life, with some (48%) expressing concerns over the risk of malnutrition and micronutrient deficiencies. Three-quarters of RDs (75%) incorrectly thought that plant protein is incomplete, necessitating protein combining. A WFPBD was on average ranked fourth out of 14 dietary strategies for managing some of the leading non-communicable diseases. Excluding dairy and eggs was the primary reason preventing RDs from personally adopting a WFPBD, whereas meal preparation and cost were the main barriers for their clients. The majority of RDs (79%) feel they did not receive sufficient education on WFPBDs, with 58% agreeing there are insufficient evidence-based resources available in their field. Only 33% feel supported when advocating for a WFPBD in their workplace.

Conclusions: Although many RDs view WFPBDs as viable and clinically relevant, significant barriers to their implementation exist, underscoring the need for enhanced education and support.

Background: Nut consumption in Australia is low, perhaps due to concerns with weight gain. However, nut consumption is not associated with increased weight, in part because of their lower metabolisable energy. Current energy labelling for nuts use Atwater factors, which over-represent the available energy from nuts. Therefore, this research aimed to examine stakeholders' knowledge, practices and perceptions of displaying true metabolisable energy on nutrition labels and its perceived impact on nut consumption.

Methods: An anonymous and voluntary survey was conducted online. Eligible respondents lived in Australia, were aged 18 years or older and had either no formal nutrition education (consumer group) or had formal training and were working as a stakeholder (stakeholder group; working in nutrition/dietetics, public health, food industry, food regulation or nut growing). Convenience sampling and snowballing were used to recruit respondents primarily via online advertisement.

Results: Three hundred and forty-eight respondents (63.2% female; 71.0% aged 18-39 years; 69.0% Bachelor's degree or higher) were included in the analyses. A larger proportion of stakeholders agreed that nut consumption assists with weight management (67.9%) compared with consumers (47.6%). Theoretical food packaging showing both Atwater and metabolisable energy in the nutrition information panel was favoured among consumers and stakeholders, though 62.3% of consumers reported that a lower metabolisable energy of nuts would not impact their consumption.

Conclusions: This study indicates a need to further investigate the impact of metabolisable energy labelling on nut intake. Further education about the relationship between nuts and body weight is required for consumers and stakeholders.

Background: Facebook groups providing breastfeeding support are widespread. Some are created and/or facilitated by midwives, but little is known about their motivations or experiences. The present study aimed to examine how midwives involved in providing breastfeeding support via local Breastfeeding support Facebook (BSF) groups perceive the value of this provision and their experiences of creating these services and engaging with mothers online.

Methods: Participants were recruited through Facebook advertising and snowballing techniques. UK registered midwives with experience of providing breastfeeding support via Facebook groups were eligible. Semi-structured interviews were conducted using Microsoft Teams/Zoom with nine midwives between July and September 2021. Reflexive thematic analysis was conducted.

Results: Three themes, each with three subthemes, were identified: (1) Imperatives and Value; (2) Goodwill & Lack of Resources; and (3) Community of Practice. Theme 1 described groups as necessary for meeting current mothers' needs and improving low breastfeeding rates. Theme 2 highlighted that BSF groups rely on voluntary work by midwives and peer supporters, with sustainability and recognition of their efforts being major concerns. Theme 3 showed that BSF groups function as communities of practice, offering social learning opportunities and benefits for midwives.

Conclusions: Midwives became involved in delivering online support motivated by a belief in the value of this provision, but acted as volunteers and felt unsupported by wider services. This has impacts for the sustainability of this provision regardless of its value. However, midwives reported significant benefits from involvement. Thus, there is a need for services to provide additional guidance and investment.

Background: Child undernutrition is a major public health problem in developing countries that contributes to increased incidence of morbidity and mortality. Stunting is a valid and widely acknowledged measure of chronic child malnutrition.

Methods: This study extracted data of 7778 under-5 children from the 2017-2018 Bangladesh Demographic and Health Survey and aims to explore the relationship between socio-demographic factors and the nutritional status of children under the age of 5. The anthropometric indicator height-for-age z-score (HAZ) was used as the target variable. The quantile regression method was employed to examine the heterogeneous relationship between the covariates and the conditional HAZ distribution across five different quantiles.

Results: This study found that 31.4% of children were severely to moderately stunted and a negative association between children's age and their HAZ. Additionally, children whose mothers had attained at least a secondary education exhibited a positive correlation with their HAZ. Another important factor was the mother's body mass index, which had a two-fold effect on the HAZ. Among the administrative divisions, children from the Sylhet division exhibited a negative association with the HAZ. Additionally, children with a high wealth index exhibited a positive association with the HAZ.

Conclusions: Collaborative efforts from different organisations, as well as small and large communities in rural and urban areas, are necessary to improve nutritional status of children in Bangladesh.

Background: Blended tube feeds are reported to be better tolerated in some children compared to standard commercial enteral formulas, allowing children to normalise feeding by having similar foods as the rest of the family. However, a blended tube feed is contraindicated in patients who are immunocompromised or require post-pyloric feeding as a result of a food safety risk. Other contraindications for blended diet include children who require continuous pump feeding via gastrostomy or nasogastric feeding tube (< 12 Fr) and fluid restrictions. To meet the demands of consumers, manufacturers have developed enteral formulas with food-derived ingredients (EFI). Commercially available EFIs are relatively novel in the UK. The present study aimed to monitor the implementation of an EFI by dietitians in a specialist children's hospital.

Methods: A single-centre retrospective study was conducted to monitor the dietetic practice of commencing a commercially available EFI (Compleat® paediatric; Nestlé Health Science; 1.2 kcal/ml with 14% food-derived ingredients). Using electronic medical notes, data were collected on all children who commenced an EFI via an enteral feeding tube in a specialist paediatric hospital between August 2022 and December 2023. Data were gathered on demographics (age, sex and primary diagnosis), anthropometric measurements (weight-for-age Z-score and height-for-age Z-score), feed regimens (feed volume, feeding route, mode of feeding [continuous, bolus]), gastrointestinal symptoms (gastro-oesophageal reflux, vomiting, abdominal discomfort, constipation and loose stools) and geographical discharge area for children on home enteral nutrition.

Results: Seventy children were included in the analysis. The mean ± SD age was 4.7 ± 6 years. The median admission weight-for-age Z-score was -1.50. The most common primary diagnosis was a neurological impairment in 37/70 (47%) children. Most children were fed via a percutaneous endoscopic gastrostomy 31/70 (44%) and 8/70 (11%) of the children fed directly into the jejunum. The most common reason being gastrointestinal symptoms, 58/70 (83%). The most common gastrointestinal symptom reported before commencing an EFI was loose stools in 22/58 (38%) children. Within 7 days of commencing an EFI, there was reported improvement in gastrointestinal symptoms in all categories. In total, 42/70 children were discharged on an EFI.

Conclusions: In our specialist children's hospital, EFI is primarily implemented by dietitians in children who are already established on an enteral formula displaying gastrointestinal symptoms. However, dietitians are increasingly implementing an EFI as their first-line whole protein enteral formula. Furthermore, an EFI was also implemented as a compromise to a blended diet.