Journal of Human Nutrition and Dietetics最新文献

Background

The International Dysphagia Diet Standardisation Initiative (IDDSI) framework establishes a global standard, with standardized terms, descriptors and measurement criteria, to enhance dysphagia care. This paper presents one of the first documented successful implementations of IDDSI in a large acute care hospital. The implementation at the University Hospital Graz, a 1554-bed acute care facility, took place between 2021 and 2024. The project aimed to standardize practices in five patient-focused areas to improve knowledge, and facilitate multiprofessional communication.

Methods

Based on the IDDSI Monitor, Aware, Prepare, Adopt (MAPA) model and IDDSI implementation guide, a project plan was developed. An interdisciplinary working group consisting of dietitians, Speech-Language Pathologists (SLPs) and chefs conducted comprehensive audits of all existing recipes and aligned clinical swallowing assessments and dietetic recommendations with IDDSI standards. Training programs ensured the consistent application of terminology across the therapeutic, nursing, and kitchen teams. Two staff surveys were conducted - one before and one after implementation.

Results

The working group successfully integrated IDDSI into clinical workflows, menu planning, charting and electronic health record systems. Staff surveys showed a significant increase in IDDSI awareness, rising from 42.1% to 76.7%, along with greater use of the IDDSI standardized terminology by the staff during the project's duration.

Key implementation challenges included adapting recipes to meet IDDSI texture levels and integrating the framework into the utilized Cook and Chill food preparation system. Dual project lead with one Speech-Language Pathologist (SLP) and one dietitian, targeted training, and the active engagement of kitchen staff were crucial to the project's success.

Conclusions

This study demonstrates that implementing IDDSI in acute care settings is both feasible and beneficial, leading to multiprofessional knowledge of the framework and fostering collaboration.

Background

Galactosaemia is an inherited metabolic disorder, characterised by the inability to metabolise galactose. Dietary management previously varied worldwide due to the lack of standardised guidelines. The International Clinical Guidelines (CPG) for management of classical galactosaemia were published in 2017. The aim of the current study was to explore dietitians' perspectives and their use of the guidelines worldwide.

Methodology

An international cross-sectional online survey was administered from April to June 2021 to registered dietitians who were working or had worked with galactosaemia patients since the guidelines were published. The study was piloted and received ethical approval. Descriptive statistical analysis and thematic analysis were performed.

Results

A total of 39 dietitians from 17 countries participated. 51% of participants had > 10 years of experience working with patients with galactosaemia. 56.4% reported a change in their dietetic practice since the guidelines were published, namely relaxing the diet, and not restricting fruits and vegetable intake (46%). Most dietitians (76.9%) reported improved confidence because the guidelines support their clinical reasoning and existing dietary management approaches. Most dietitians (82%) suggested improvements for the CPG for classical galactosaemia.

Conclusions

The findings are considered the first to describe how dietitians view and use the guidelines. The CPG for galactosaemia appears to have positively influenced practice. Currently, implementation of the CPG could be improved by addressing the gaps in the existing evidence base and minimising other barriers e.g. patient-related barriers, institutional barriers and lack of resources. Patient-friendly resources are also necessary to provide accessible, comprehensive information regarding the management of galactosaemia.

Purpose

Nutrition-related chronic diseases are among the leading causes of morbidity and mortality worldwide. The increasing prevalence of obesity and changes in lifestyle and dietary behaviours have necessitated innovative approaches in nutritional care. In this context, artificial intelligence (AI) tools such as ChatGPT have emerged as potential aids in generating personalized dietary recommendations. However, their reliability and clinical utility remain underexplored.

Methods

This study aimed to assess the reliability and appropriateness of ChatGPT in creating diet plans for individuals with obesity and diet-related non-communicable chronic diseases. Dietary plans were generated by both a registered dietitian and ChatGPT for hypothetical individuals with identical clinical profiles and conditions. These plans were then evaluated comparatively in terms of nutritional adequacy, safety, individualization and practicality.

Results

ChatGPT-generated diets demonstrated notable deficiencies in meeting specific energy and nutrient requirements and lacked personalization based on individual health needs. In several cases, contraindicated foods were included. These findings highlight the potential risks of using AI tools in clinical dietetics without professional oversight. Ethical and safety considerations are critical when integrating AI into healthcare services.

Conclusion

ChatGPT cannot currently substitute for individualized dietary counselling provided by qualified dietitians, particularly due to its inability to offer tailored motivation, emotional support or clinically safe recommendations. Nevertheless, further research is warranted to optimize the role of AI in diet planning and to enhance its integration into personalized nutrition care.

Background

Foods in commercial squeeze pouches, primarily designed for infants, are expanding into school-aged children and adolescent markets. Such products are increasingly scrutinized for misleading health claims and poor nutritional content. This study aimed to explore the use of commercial squeeze pouches among Australian children (0–17 years), identify sociodemographic predictors of frequent consumption, and examine the relationship between perceived barriers to achieving a healthy diet and commercial squeeze pouch consumption.

Methods

A cross-sectional survey of Australian parents explored their children's frequency of commercial squeeze pouch consumption alongside parents’ sociodemographic data and perceived barriers to achieving a healthy diet (e.g., time, cost). Logistic regression was used to identify factors associated with frequent consumption of commercial squeeze pouches (weekly or more).

Results

Among our sample (n = 343), 73.8% of children consumed food from commercial squeeze pouches in the past 12 months, and around half consumed them weekly or more (49%). Frequent usage was highest among children 0–2 years old and 2–5 years old (64% of each group), with fruit and dairy-based pouches the most frequently consumed. Dairy-based pouches were consumed by 74% of school-aged children and 30% of adolescents within the past 12 months. Younger parents (OR = 4.2, p < 0.001) and middle-income families (OR = 2.5, p = 0.019) were more likely to report their children were frequent consumption of commercial squeeze pouches. Perceived time constraints significantly increased the likelihood of using commercial squeeze pouches (OR = 2.6, p < 0.001).

Conclusion

Commercial squeeze pouches are frequently consumed by Australian children, driven in part by demographic factors and parenting challenges like time constraints. In addition to supporting parents to make informed choices, public health strategies could extend beyond individual-level education to include regulatory reforms that limit inappropriate marketing and improve the nutritional quality of foods in commercial squeeze pouches.

Introduction

Food hypersensitivity describes a range of nonimmune food related reactions of varying aetiology causing gastrointestinal and extraintestinal symptoms. This study aimed to evaluate if the low-chemical diet improves gastrointestinal and/or extraintestinal symptoms, and whether specific food challenges induce symptoms.

Methods

A retrospective clinical audit was conducted on files from 2011 to 2022 from a gastrointestinal specialist dietetic practice. Fifty eligible patient files were identified, all of whom had been recommended to follow a low-chemical diet. One research dietitian extracted data on diet implementation, symptom change during the Restrictive Phase, and symptom provocation during the Rechallenge Phase. Descriptive statistics were used.

Results

The cohort was predominantly female (80%), mean age 47 years (range 7–85). At baseline the most common gastrointestinal symptom was diarrhoea (22/50, 44%), and extraintestinal symptom was nasal congestion (14/50, 28%). Improvement in at least one symptom following the Restrictive Phase occurred in 88% (44/50). The Restrictive Phase was followed for 2–78 weeks, and unintentional weight loss was documented in 24% (2–10 kg). The Rechallenge Phase duration ranged from 5 to 191 weeks, with 96% (48/50) reporting symptom provocation following at least one challenge. Salicylate challenge most commonly induced diarrhoea (16%), bloating (16%), and itch (14%), while amine challenge induced abdominal pain (10%) and nausea (8%).

Conclusion

Patients reported an improvement in gastrointestinal and extraintestinal symptoms, but commonly experienced prolonged dietary restriction. Rechallenge with salicylates and amines provoked symptoms; but this may be confounded by other diet and non-diet factors. High-quality trials with isolated food chemical components are needed.

Introduction

Very low calorie diets have achieved remission of type 2 diabetes in obese individuals and lowered cardiovascular risk. However, there is less evidence for prevention of diabetes with these diets. Oxidative stress is a feature of obesity, diabetes and cardiovascular disease, but it is not clear what impact these diets have on oxidative stress in diabetes or prediabetes. Commercial meal replacement products may be expensive, so in this pilot study, we sought to explore the use of a homemade very low calorie diet to achieve weight loss in obese individuals with prediabetes or early onset type 2 diabetes and the effect on oxidative stress.

Methods

Individuals with a BMI > 35 kg/m² and prediabetes or type 2 diabetes for less than 4 years followed a three-phase diet plan over 48 weeks, including a homemade meal replacement of 800 calorie for the first 12 weeks. Data was collected for weight, waist circumference, glycosylated HbA1_c, oxidised LDL and protein carbonyls at 12 weekly intervals. Quality of Life and Self-regulation of Eating Behaviour questionnaires were completed at 12 weekly intervals. Data was analysed using Friedman's test or mixed effects analysis for non-normally and normally distributed data respectively.

Results

Of 22 individuals enroled at baseline, 16 completed the 12 week diet intervention phase and 12 completed 48 weeks. There were significant falls in weight (p < 0.001), and in waist circumference (p < 0.001) up to 36 weeks with mean weight loss of 15 kg at 48 weeks. HbA1_c fell significantly (p < 0.001) up to 24 weeks. By 48 weeks, 67% of participants were in the prediabetes or no diabetes categories. Oxidised LDL (p = 0.039) and protein carbonyls (p = 0.005) both increased significantly through the 12 week diet intervention and the ongoing study phases. There were significant improvements in Quality of Life (p = 0.005) and Self-regulation of Eating Behaviour (p < 0.0001) scores throughout the study.

Conclusion

We have demonstrated that an inexpensive homemade very low calorie meal replacement as a weight loss tool has high levels of acceptability in addition to health and quality of life benefits in type 2 or prediabetes. The effect of very low calorie diets on inflammation and oxidative stress require further exploration.

Aim

Weight management is a core area of dietetic primary practice. Understanding the behavioural drivers that influence dietitians' weight management practice is essential for gaining insight into how to better support dietitians in this area. This study used the Capability, Opportunity, Motivation-Behaviour (COM-B) model, a behavioural framework, to explore how dietitians' practice is influenced by their skills and knowledge (capability), environmental factors (opportunity) and professional desires and habits (motivation).

Methods

This qualitative descriptive study used an interpretivist approach guided by social constructionism. Primary care dietitians practising in Australia were recruited through purposive and snowball sampling for semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analysed using content analysis. Constructed content categories were then mapped to the COM-B model to understand the behavioural factors shaping dietitians' weight management practice.

Results

Fourteen primary care dietitians participated in the study; 13 were women, 11 were aged between 20 and 50 years, and 8 had over 9 years dietetic practice experience. Eight content categories were constructed and mapped against the COM-B components. Aligned with Capability, dietitians demonstrated comprehensive ‘Understanding [of] Weight Management Complexity’ and employed ‘Holistic Practice Approaches’ in their care delivery, though they found ‘Navigating Clients’ Psychosocial Needs’ challenging. Opportunity was shaped by ‘System Constraints’ that influenced care provision, ‘Multidisciplinary Care Environment[s]’ that had varied impacts on collaborative care delivery, and ‘Digital Solutions’ that offered service delivery advantages. Motivation was characterised by dietitians exhibiting strong ‘Professional Drive’ and commitment to ‘Client-centred Strategies’.

Conclusion

Supporting primary care dietitians requires targeted interventions across all COM-B components. Potential approaches include enhancing capability through behaviour change counselling training, improving opportunity with integration of digital technologies, and sustaining motivation through established clinical pathways that align with dietitians’ client-centred values.

Background

Healthcare workers are at elevated risk for metabolic disorders due to occupational stress, irregular eating habits, frequent consumption of takeout food, and limited physical activity. Despite this, the link between dietary inflammatory potential and cardiometabolic health in this population remains underexplored. This study is the first to examine the association between the energy-adjusted Dietary Inflammatory Index (E-DII) and metabolic health indicators among healthcare professionals in China.

Methods

A total of 427 healthcare workers from a tertiary hospital participated in this cross-sectional study. Demographic and physical activity data were collected via structured questionnaires. Biochemical markers—including lipid profiles, glucose, liver enzymes, and uric acid—were obtained through standard blood tests. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while dietary intake over the past 3 months was evaluated with a 25-item Food Frequency Questionnaire (FFQ-25). E-DII scores were calculated to reflect the inflammatory potential of participants' diets. Logistic and linear regression models were used to assess associations between E-DII scores and dyslipidemia and body composition parameters, adjusting for potential confounders.

Results

Participants in the highest E-DII tertile had an approximately twofold increased risk of dyslipidemia compared to those in the lowest tertile (OR = 2.163, 95% CI: 1.209–3.868). Each one-unit increase in E-DII score was associated with a 47% higher odds of dyslipidemia (OR = 1.470, 95% CI: 1.100–1.966). Higher E-DII scores were also positively associated with LDL cholesterol, fasting glucose, uric acid, BMI, body fat percentage, visceral fat area, and sleep disturbances.

Conclusion

Diets with a higher inflammatory potential are significantly associated with adverse metabolic profiles and abnormal body composition among healthcare workers. These findings underscore the urgent need for workplace interventions promoting anti-inflammatory diets and healthy lifestyle behaviors to mitigate cardiometabolic risk in this vulnerable population.

Introduction

Although eating behaviour in children, adolescents and adults has been linked to changes in body mass, eating disorders and non-communicable diseases, there is still uncertainty about how this behaviour has been measured in populations aged 60 and over, who are often exposed to age-related physiological and cognitive changes, increased malnutrition risk and underrepresented in psychometric research.

Aim

To analyse how eating behaviour has been investigated in people aged 60 and over.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN), three independent researchers selected articles from four databases from 2000 to the present. Inclusion criteria: (1) Studies on adaptation, development, or evaluation of psychometric properties of eating behaviour instruments; (2) Studies with participants aged ≥ 60 years, or with a significant proportion/stratified results for this group; (3) Publications in English, Spanish, or Portuguese; and (4) Articles published from 2000 to 2024. Exclusion criteria: (1) Studies on food consumption; (2) Instruments for diagnosing eating disorders; and (3) Non-original articles.

Results

Eight instruments were identified for assessing eating behaviour in older adults, with the majority developed in Europe. Methodological shortcomings were present across all instruments, particularly in the areas of development, content validity, internal validity and consistency.

Conclusions

All instruments exhibit questionable methodological robustness, highlighting the need for more rigorous and culturally sensitive approaches to the development and adaptation of tools for this population.