ORCID Profile
0000-0003-2947-4130
Current Organisation
Queensland University of Technology
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Publisher: Springer Science and Business Media LLC
Date: 08-04-2009
DOI: 10.1038/EJCN.2009.19
Abstract: Most dietary interventions have metabolic effects in the short term, but long-term effects may require dietary fat changes to influence body composition and insulin action. This study assessed the effect of sustained high polyunsaturated fatty acids (PUFA) intake through walnut consumption on metabolic outcomes in type II diabetes. Fifty overweight adults with non-insulin-treated diabetes (mean age 54+/-8.7 years) were randomized to receive low-fat dietary advice +/-30 g per day walnuts targeting weight maintenance (around 2000 kcal, 30% fat) for 1 year. Differences between groups were assessed by changes in anthropometric values (body weight, body fat, visceral adipose tissue) and clinical indicators of diabetes over treatment time using the general linear model. The walnut group consumed significantly more PUFA than the control (P=0.035), an outcome attributed to walnut consumption (contributing 67% dietary PUFA at 12 months). Most of the effects were seen in the first 3 months. Despite being on weight maintenance diets, both groups sustained a 1-2 kg weight loss, with no difference between groups (P=0.680). Both groups showed improvements in all clinical parameters with significant time effects (P<0.004), bar triacylglycerol levels, but these were just above normal to begin with. The walnut group produced significantly greater reductions in fasting insulin levels (P=0.046), an effect seen largely in the first 3 months. Dietary fat can be manipulated with whole foods such as walnuts, producing reductions in fasting insulin levels. Long-term effects are also apparent but subject to fluctuations in dietary intake if not of the disease process.
Publisher: Wiley
Date: 05-10-2021
DOI: 10.1111/JHN.12819
Abstract: Elective surgery in obese adults carries a higher risk of post-operative infection and prolonged hospital stays, and surgeons may postpone surgery for patients with obesity until they lose weight. The present study aimed to determine the efficacy of a dietitian-led very low calorie diet (VLCD)-based model of care with respect to achieving weight loss for obese patients prior to surgery. This mixed-methods study included a medical chart audit of patients referred to a VLCD-based model over 23 months, as well as a survey of recently treated patients and surgeons who utilised the model. Preoperative weight loss targets were set by surgeons, and the dietitian prescribed in idualised VLCD-based treatment. Efficacy was determined as weight loss considered sufficient for surgery, clinical safety of VLCD-based treatment, feasibility, and stakeholder value. Pre ost-intervention differences in clinical measures were explored by paired t-test or Wilcoxon tests as appropriate. Data on seventy-eight eligible patients [mean (SD) 45 (13) years, 90% female, body mass index 44.3 (6.2) kg m A dietitian-led VLCD-based model achieved sufficient weight loss to facilitate elective surgery for most patients. The approach was feasible, highly valued by patients and surgeons, and resulted in perceived surgical benefits.
Publisher: Wiley
Date: 09-01-2020
Abstract: Research is needed to support the long-term benefits of lifestyle interventions for management of high-risk patients with different BMI classifications. This prospective multicentre study assessed two-year outcomes of hospital-referred patients (BMI 25-61 kg/m Bodyweight, quality of life (Short Form-12) and intuitive eating (Intuitive Eating Scale) data were collected at pre-intervention, post-intervention and 2 years. Outcomes were reported in BMI classes. At pre-intervention (n = 493), 11% had pre-obesity, 25% obesity class I, 30% obesity class II and 34% obesity class III. Characteristics of participants with available data at post-intervention (n = 290) and 2 years (n = 178) were comparable (P > .05). Significant mean weight loss was seen at post-intervention (-2.0 ± 0.4 kg, P < .001, n = 290) and 2 years (-4.3 ± 0.5 kg, P < .001, n = 178). All BMI classes had significant weight losses (P < .05). Participants with higher obesity (classes II and III) had greater improvements in mental quality of life (P < .05) and initial weight reductions (P < .05) than those with lower classes. However, those with obesity class I had the greatest long-term weight reductions and significant improvements in physical quality of life at 2 years (P .05). The results support dietitian-led multidisciplinary lifestyle interventions for multidisciplinary management of high-risk patients of all BMI classes.
Publisher: Wiley
Date: 06-12-2021
Publisher: Wiley
Date: 16-06-2016
DOI: 10.1111/JAN.13027
Abstract: To determine whether applying forced air warming attenuates the impact of sedation-induced impairment of thermoregulation on body temperature of patients who are sedated during interventional procedures in the cardiac catheterization laboratory. A moderate proportion of sedated patients who undergo procedures in the cardiac catheterization laboratory with only passive warming become hypothermic. Hypothermia in the surgical population is associated with increased risk of adverse cardiac events, infections, thrombotic and haemorrhagic complications and prolonged hospital stay. For this reason, investigation of the clinical benefits of preventing hypothermia in sedated patients using active warming is required. Randomized controlled trial. A total of 140 participants undergoing elective interventional procedures with sedation in a cardiac catheterization laboratory will be recruited from two hospitals in Australia. Participants will be randomized to receive forced air warming (active warming) or usual care (passive warming with heated cotton blankets) throughout procedures. The primary outcome is hypothermia (defined as temperature less than 36°C) at the conclusion of the procedure. Secondary outcomes are postprocedure temperature, postprocedural shivering, thermal discomfort, major complications, disability-free survival to 30 days postprocedure, cost-effectiveness and feasibility of conducting a larger clinical trial. The results from this study will provide high-level evidence for practice in an area where there is currently no guidance. Findings will be easily translatable into clinical practice because most hospitals already have forced air warming equipment available for use during general anaesthesia. ACTRN12616000013460.
Publisher: Oxford University Press (OUP)
Date: 2010
DOI: 10.1002/IBD.20968
Abstract: The inflammatory bowel diseases (IBDs) are a group of heterogeneous disorders characterized by acute and chronic inflammatory changes in the small or large bowel, or in both. Increasing incidence and prevalence figures for IBD both in the developed and developing world indicate that environmental factors are at least as significant in IBD as genetic susceptibility. Of these, diet and the host microbiota are likely to play important but as yet poorly defined roles. The major constituents of a standard "Western" diet may contribute to, or protect against, intestinal inflammation via several mechanisms. These include the effects of insulin resistance and short-chain fatty acids such as butyrate, modification of intestinal permeability, the antiinflammatory role of polyunsaturated fatty acids, and the effect of sulfur compounds from protein on host microbiota. This detailed review critically assesses the evidence for the role of diet in the development of IBD and examines the evidence for obesity as a contributing factor to IBD pathogenesis. Particular attention is focused on methodological issues including suitability of cases and controls, confounders such as smoking, and total energy expenditure.
Publisher: Wiley
Date: 07-2021
Publisher: Wiley
Date: 08-2019
Publisher: Wiley
Date: 08-2019
Publisher: Cambridge University Press (CUP)
Date: 16-12-2021
DOI: 10.1017/S0007114521004943
Abstract: Diet quality indices (DQIs) are tools used to evaluate the overall diet quality against dietary guidelines or known healthy dietary patterns. This review aimed to evaluate DQIs and their validation processes to facilitate decision making in the selection of appropriate DQI for use in Australian contexts. A search of CINAHL, PubMed and Scopus electronic databases was conducted for studies published between January 2010 and May 2020, which validated a DQI, measuring 1 dimension of diet quality (adequacy, balance, moderation, variety) and was applicable to the Australian context. Data on constructs, scoring, weighting and validation methods (construct validity, criterion validity, reliability and reproducibility) were extracted and summarised. The quality of the validation process was evaluated using COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias and Joanna Briggs Appraisal checklists. The review identified twenty-seven indices measuring adherence to: national dietary guidelines ( n 13), Mediterranean Diet ( n 8) and specific population recommendations and chronic disease risk ( n 6). Extensiveness of the validation process varied widely across and within categories. Construct validity was the most strongly assessed measurement property, while evaluation of measurement error was frequently inadequate. DQIs should capture multiple dimensions of diet quality, possess a reliable scoring system and demonstrate adequate evidence in their validation framework to support use in the intended context. Researchers need to understand the limitations of newly developed DQIs and interpret results in view of the validation evidence. Future research on DQIs is indicated to improve evaluation of measurement error, reproducibility and reliability.
Publisher: American Diabetes Association
Date: 12-2004
DOI: 10.2337/DIACARE.27.12.2777
Abstract: OBJECTIVE—The aim of this study was to examine the effect of a moderate-fat diet inclusive of walnuts on blood lipid profiles in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS—This was a parallel randomized controlled trial comparing three dietary advice groups each with 30% energy as fat: low fat, modified low fat, and modified low fat inclusive of 30 g of walnuts per day. Fifty-eight men and women, mean age 59.3 ± 8.1 years, started the trial. Dietary advice was given at baseline with monthly follow-up and fortnightly phone calls for support. Body weight, percent body fat, blood lipids, HbA1c, total antioxidant capacity, and erythrocyte fatty acid levels were measured at 0, 3, and 6 months. Data were assessed by repeated-measures ANOVA with an intention-to-treat model. RESULTS—The walnut group achieved a significantly greater increase in HDL cholesterol–to–total cholesterol ratio (P = 0.049) and HDL (P = 0.046) than the two other treatment groups. A 10% reduction in LDL cholesterol was also achieved in the walnut group, reflecting a significant effect by group (P = 0.032) and time (P = 0.036). There were no significant differences between groups for changes in body weight, percent body fat, total antioxidant capacity, or HbA1c levels. The higher dietary polyunsaturated fat–to–saturated fat ratio and intakes of ω-3 fatty acids in the walnut group were confirmed by erythrocyte biomarkers of dietary intake. CONCLUSIONS—Structured “whole of diet” advice that included 30 g of walnuts/day delivering substantial amounts of polyunsaturated fatty acid improved the lipid profile of patients with type 2 diabetes.
Publisher: Wiley
Date: 24-06-2022
DOI: 10.1111/NHS.12957
Abstract: In response to growing evidence that student healthcare professionals find professional practicum stressful and that it negatively affects their mental health, a six‐session psychoeducation Resilience and Wellbeing Program was implemented by a professional counselor in Year 3 of the Bachelor of Nutrition and Dietetics at Griffith University, Australia. The aim of this study was to evaluate student dietitians' perceptions of whether the program improved their ability to cope with practicum stressors. The study used a longitudinal cohort design, with students completing surveys at three time points: before and after the program and after the final practicum. The study was completed with two cohorts of students between 2018 and 2020 (n = 111). Most respondents (95%) found their professional practicum to be stressful or challenging on at least some occasions, mostly due to constantly being assessed (56%), finances (40%), and being away from usual supports (38%). Almost all students rated the program as having some value (99%), with the content about stress and self‐care the most highly rated. Qualitative comments revealed the program helped students to manage stress by prioritizing their personal needs. Students used stress management skills during the practicum to achieve balance in their lives, despite pandemic conditions.
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.CLNU.2010.12.007
Abstract: Malnutrition and poor intake during hospitalisation are common in older medical patients. Better understanding of patient-specific factors associated with poor intake may inform nutritional interventions. The aim of this study was to measure the proportion of older medical patients with inadequate nutritional intake, and identify patient-related factors associated with this outcome. Prospective cohort study enrolling consecutive consenting medical inpatients aged 65 years or older. Primary outcome was energy intake less than resting energy expenditure estimated using weight-based equations. Energy intake was calculated for a single day using direct observation of plate waste. Explanatory variables included age, gender, number of co-morbidities, number of medications, diagnosis, usual residence, nutritional status, functional and cognitive impairment, depressive symptoms, poor appetite, poor dentition, and dysphagia. Of 134 participants (mean age 80 years, 51% female), only 41% met estimated resting energy requirements. Mean energy intake was 1220 kcal/day (SD 440), or 18.1 kcal/kg/day. Factors associated with inadequate energy intake in multivariate analysis were poor appetite, higher BMI, diagnosis of infection or cancer, delirium and need for assistance with feeding. Inadequate nutritional intake is common, and patient factors contributing to poor intake should be considered in designing nutritional interventions.
Publisher: Wiley
Date: 12-2001
Publisher: Wiley
Date: 07-2021
Publisher: Springer Science and Business Media LLC
Date: 17-07-2021
DOI: 10.1186/S12909-021-02756-Y
Abstract: Clinical placement models that require students to relocate frequently can cause stress, which may impact the student experience and development of work-readiness skills. A blended placement, where placements are undertaken concurrently at one location has potential to address these issues by providing a positive placement experience. Blended long-stay placements undertaken in rural communities increase consistent service provision and may help encourage students to work rurally, with potential to reduce workforce shortages. The aim of this study was to pilot test the feasibility of blended placement models and explore the student experience and skills development. A secondary aim was to explore a fully blended long-stay rural placement and the benefits to the rural community. An exploratory qualitative design was used. Focus groups were conducted with dietitian student who participated in usual placements ( n = 14) or blended placements ( n = 9). In idual semi-structured interviews were conducted with five student supervisors who participated in blended placements. Focus groups and interviews were recorded, transcribed verbatim and analysed together using inductive thematic analyses. The overarching theme across all blended model placements was ‘enhanced work-readiness’, including increased flexibility, organisational skills and better preparedness for mixed roles. Enhanced work-readiness was influenced by three themes: stress and wellbeing impacts learning, working in two areas of practice concurrently allows for deeper learning, and blended placements meet supervisor needs. Fully blended long-stay rural placements revealed additional benefits. Firstly, in relation to the overarching theme ‘enhanced work-readiness’: students on these placements also developed extra skills in innovation, social accountability, interprofessional collaboration, conflict resolution and teamwork. Secondly, a new overarching theme emerged for fully blended long-stay rural placements: ‘increased community connections’ which included additional health services delivery, deeper personal experience and more rewarding student-supervisor relationships. Thirdly, two extra themes emerged that influenced work-readiness and community impact: ‘local organisational support and resources’ and ‘enhanced innovative and interprofessional learning opportunities’. Blended placements enhance work-readiness skills by providing an alternative model to that commonly applied, and providing flexibility in education programs. Additionally, fully blended long-stay rural placements positively influence the local community through impacting the student experience as well as providing more dietetics services and may therefore assist in reducing dietetics workforce shortages and health inequity.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.NUTRES.2011.08.008
Abstract: Dietary trials may link macronutrient intakes to health outcomes, but adherence to dietary targets requires advice based on an understanding of food composition and consumption patterns. Using data from a weight loss trial, we hypothesized that structured advice would be required for significant fat modification to occur. We compared participants' food choice patterns in response to advice based on a structured "whole-of-diet" model vs a general approach to healthy eating. Overweight participants (n = 122) were randomized to 2 advice arms (saturated fat [SFA] < 10% energy [E]): (1) general low fat (LF) control-(a) isoenergy, (b) -2000 kJ and (2) structured LF high polyunsaturated fat (PUFA) (∼10% energy PUFA PUFA to SFA ratio ≥1) (LF-PUFA)-(a) isoenergy, (b) -2000 kJ. Intakes of E and fat and fat from food groups (percentage of total fat intake) were compared at baseline, 3 months, P < .05. Baseline diets were similar, with most fat from high-SFA foods (59%): meat and milk-based staple meals and high-fat snacks. By 3 months, all groups reduced E and met the SFA target. Polyunsaturated fat targets were met by the LF-PUFA groups only (P < .001), enabling targeted between-group differences. In response to general advice, LF groups simply switched to LF alternatives of the same foods (P < .05). In comparison, LF-PUFA groups shifted fat intake to high-PUFA choices (54%), consuming more fat than controls from nuts (P < .001), whole grains (P < .001), and oils and spreads (P < .05). Significant reductions in E were achieved regardless of advice, but significant shifts in dietary fat profile relied on structured whole-of-diet advice on a range of meal and snack food sources of fat subtypes.
Publisher: Wiley
Date: 04-09-2020
DOI: 10.1111/JHN.12808
Abstract: Healthcare placements in dietetics education contribute significantly to student learning. Exploring students' self-conceptualisation of placement experiences may provide insights to better support learning. Self-determination theory (SDT) has been used to seek insight into clinical and educational settings but has not yet been applied to dietetic placement learning. The present study investigated dietetics students' reflections of key influences on placement learning experiences and their alignment with an SDT framework. A post-placement two-stage critical incident debrief was conducted with seven successive cohorts (168 students) of dietetic undergraduate students on final placement. In debriefs, students' anonymous themes were collected and discussed, inductively analysed, and then mapped against an SDT framework of psychological and motivational constructs. Nine key themes were identified that impacted upon placement experiences. Four themes related to framework constructs: (1) Supervisor (and Peer) Autonomy Support (2) Perceived Competence (3) Relatedness and (4) Autonomy and Intrinsic Motivation. Non-SDT themes were also present, including: (5) Learning Environment and Experience as well as themes about professional behaviours and identity: (6) Teamwork and Interactions (7) Managing Emotions and Self-Care (8) Dietetic Communications and Behaviours and (9) Developing a Professional Identity. Embedding a structured debrief in the curriculum and using a psychological motivational SDT framework to analyse themes arising can provide valuable information about the learning needs of students on placement with potential for wider application in dietetic learning and teaching and workforce employability. The current findings may have application in university curricula before and after professional placement.
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1016/J.JADA.2004.09.021
Abstract: Abstract Women with gestational diabetes mellitus (GDM) have a greater risk of developing type 2 diabetes mellitus (DM) and heart disease than pregnant women without GDM. Advice given during the GDM pregnancy provides an opportunity to develop protective dietary patterns for the long-term management of this risk. Dietary guidelines for the prevention and management of type 2 DM support the inclusion of unsaturated fats, but food advice needs to target this outcome. The aim of this study was to compare the dietary intakes of women with GDM given general low-fat advice (control group) to women with GDM given the same advice with additional targets for food sources of unsaturated fats (intervention group). After approximately 6 weeks, the intervention group reported more ideal dietary fatty acid intakes than the control group, with polyunsaturated:saturated fat ratios of 1:1 and 0.4:1, respectively ( P < .001), assessed using repeated measures analysis of variance. These results confirm the need to include food sources of unsaturated fats in advice strategies to assure optimal protective eating habits in this at-risk group.
Publisher: Springer Science and Business Media LLC
Date: 12-04-2016
DOI: 10.1007/S11695-016-2167-3
Abstract: This systematic review assessed feasibility and effectiveness of preoperative meal replacements to improve surgical outcomes for obese patients. PRISMA guidelines were followed and electronic databases searched for articles between January 1990 and March 2015. Fifteen studies (942 participants including 351 controls) were included, 13 studies (n = 750) in bariatric patients. Adverse effects and dropout rates were minimal. Ten out of 14 studies achieved 5-10 % total weight loss. Six of six studies reporting liver volume achieved 10 % reduction. Endpoints for perioperative risks and outcomes were too varied to support definitive risk benefit. Commercial meal replacements are feasible, have minimal side effects and facilitate weight loss and liver shrinkage in free-living obese patients awaiting elective surgery. A reduction in surgical risk is unclear.
Publisher: Wiley
Date: 06-02-2015
DOI: 10.1111/JPC.12828
Abstract: Ataxia-telangiectasia (A-T) is a rare genomic syndrome resulting in severe disability. Chronic childhood disorders can profoundly influence growth and development. Nutrition-related issues in A-T are not well described, and there are no nutritional guidelines. This study investigated the nutrition-related characteristics and behaviours of Australian A-T patients attending a national clinic. A cross-sectional analysis of 13 A-T patients (nine females aged: 4-23 years): nutritional status was assessed by anthropometric and body cell mass (BCM) calculations. Parents reported their child's diet history and physical and behavioural factors that affect nutrition including fatigue and need for assistance. Ten (77%) had short stature (height for age z scores <-1), and seven (54%) were underweight for height (weight/height z scores <-1). Significant malnutrition (BCM z scores <-2) was detected in nine (69%) including the one adult who was severely malnourished. Malnutrition increased significantly with age (BCM for height z scores and age, r = -0.937, P < 0.001). Eight (62%) patients ate poorly compared with estimated energy requirement for weight. Poor diet quality was characterised by high fat and sugar choices. Parents reported significant nutritional barriers as chronic tiredness and the need for care giver assistance with meals. This study confirms profound malnutrition in Australian A-T patients. Poor intakes and diet quality suggest the need for early nutrition intervention. Ongoing support for families and early discussions on tube feeding are required to address changing needs in childhood and likely nutritional decline into adulthood. A prospective study is required to assess feasibility and effectiveness of nutrition interventions in young people with A-T.
Publisher: MDPI AG
Date: 18-12-2020
DOI: 10.3390/HEALTHCARE8040575
Abstract: Background: Despite strong evidence for supervised pelvic floor muscle training (PFMT) for women with urinary incontinence (UI), and weight loss and exercise for overweight and obese women with UI, implementation literature on these combined interventions is limited. This paper aimed to describe the rigorous and systematic processes involved in the collaborative development, implementation, refinement and evaluation of a novel, holistic 12 week exercise training and healthy eating group program (ATHENA) for overweight and obese women with UI. Methods/Design: This intervention description paper is part of a larger mixed-methods feasibility study of implementing the ATHENA intervention within a physiotherapy service at a public hospital in Australia. The collaborative intervention design had input from clinicians, researchers and a consumer representative. Results: The intervention involved four evidence-based components—(1) supervised PFMT (2) general exercise training (3) pelvic health education and (4) healthy eating education—delivered face to face over a 12 week period. Supporting resources developed included a Facilitator’s Guide and Participant Workbook. Conclusion: ATHENA is an evidence-based, multifaceted, group-based intervention targeting exercise training and healthy eating for management of UI for overweight and obese women. The structured development process and transparency of intervention content and resources aims to enhance practical application and success in future studies.
Publisher: Springer Science and Business Media LLC
Date: 02-04-2014
DOI: 10.1007/S00520-014-2180-9
Abstract: Head and neck cancer patients have a high risk of malnutrition and swallowing dysfunction. This study reports on adherence and nutrition outcomes with the use of local evidence-based guidelines for the nutrition management of patients with head and neck cancer, including placement of proactive gastrostomy tubes for high risk patients. This study is a prospective observational audit in patients treated for head and neck cancer at a tertiary hospital from 2007 to 2008 (n = 539). Nutrition outcomes (weight, nutritional status and type of nutrition support) were compared for each nutrition risk category. Primary outcome was 10 % or more weight loss at 3 months post-treatment (n = 219). Overall adherence to the guideline tube feeding recommendations was 81 %. High risk patients had mean weight loss of 6 % on completion of treatment and 9 % at 3 months post-treatment, despite the majority having a proactive gastrostomy tube. Medium and low risk patients also lost weight over this time. Univariate analysis found that non-adherence to the guidelines was associated with weight loss at 3 months (p = 0.013). Multivariate analysis found overweight patients had 1.82 greater odds, and obese patients had 3.49 greater odds of losing weight (p = 0.021). Patients with significant weight loss at diagnosis had decreased odds of losing weight later (p = 0.011). Clinically significant weight loss was still prevalent in this population despite proactive interventions. Predictors of weight loss support the evidence-based guidelines' risk categories, and adherence was important to improve outcomes. Further research is required to determine the impact of significant weight loss in patients with high body mass index (BMI).
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.JAND.2019.07.021
Abstract: Women with prior gestational diabetes (GDM) have an increased lifetime risk of developing type 2 diabetes mellitus (T2DM). There are no up-to-date systematic reviews analyzing the relationship of diet with risk of developing T2DM following GDM. To systematically review the evidence from intervention and observational studies on effects of dietary interventions and associations of dietary intake with T2DM outcomes in women with a GDM history. Six electronic databases were searched (Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, Cochrane Central, Proquest, and Scopus) for articles published until May 2019. This review includes intervention and observational studies among women of any age with a history of GDM that reported on the effects of dietary interventions or association of dietary intake (energy, nutrients, foods, dietary patterns) with T2DM, impaired glucose tolerance, impaired fasting glucose, or prediabetes. The systematic review identified five articles reporting results from four intervention studies, and seven articles reporting results from four observational studies. Findings from intervention studies indicated trends toward beneficial effects of a low-glycemic index diet, a low-carbohydrate diet, and a diet in line with general population dietary guidelines, but studies had unclear or high risk of bias. Findings from two cross-sectional and one prospective study indicated poorer diabetes outcomes for women with higher intakes of branched-chain amino acids, total and heme iron, and a diet relatively low in carbohydrates and high in animal fat and protein, and better outcomes among those consuming diets rich in fruit, vegetables, nuts, fish, and legumes, and low in red and processed meats and sugar-sweetened beverages, after adjustment for confounders, including body mass index. Findings from observational studies support current dietary guidelines for the prevention of T2DM. Further dietary intervention studies are needed to confirm whether or not dietary modification following a GDM pregnancy reduces women's risk of developing T2DM.
Publisher: Wiley
Date: 04-2017
Abstract: To develop and test the reliability of a Meal Quality Audit Tool (MQAT) to audit the quality of hospital meals to assist food service managers and dietitians in identifying areas for improvement. The MQAT was developed using expert opinion and was modified over time with extensive use and feedback. A phased approach was used to assess content validity and test reliability: (i) trial with 60 dietetic students, (ii) trial with 12 food service dietitians in practice and (iii) interrater reliability study. Phases 1 and 2 confirmed content validity and informed minor revision of scoring, language and formatting of the MQAT. To assess reliability of the final MQAT, eight separate meal quality audits of five identical meals were conducted over several weeks in the hospital setting. Each audit comprised an 'expert' team and four 'test' teams (dietitians, food services and ward staff). Interrater reliability was determined using intra-class correlation analysis. There was statistically significant interrater reliability for dimensions of Temperature and Accuracy (P < 0.001) but not for Appearance or Sensory. Composition of the 'test' team appeared to influence results for Appearance and Sensory, with food service-led teams scoring higher on these dimensions. 'Test' teams reported that MQAT was clear and easy to use. MQAT was found to be reliable for Temperature and Accuracy domains, with further work required to improve the reliability of the Appearance and Sensory dimensions. The systematic use of the tool, used in conjunction with patient satisfaction, could provide pertinent and useful information regarding the quality of food services and areas for improvement.
Publisher: Oxford University Press (OUP)
Date: 14-09-2023
Abstract: Diet quality indices (DQIs) were developed to score and rank adherence to dietary patterns in observational studies, but their use to measure changes in diet quality in intervention trials is becoming common in the literature. This systematic review and meta-analysis aimed to assess the effectiveness of DQIs to measure change in diet quality in intervention trials. MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials databases were searched from January 1994 to June 2020. Two reviewers independently completed full-text screening. Eligible studies were randomized controlled trials that used validated a priori DQIs to measure change in diet quality in adults. Data were extracted by an independent reviewer and reviewed by the research team. Risk of bias was assessed by the Cochrane Collaboration’s Risk of Bias 2.0 tool. The 34 included studies (52% of reviewed studies, 0.6% of initially identified studies) used 10 different DQIs, 7 of which were able to measure significant change in diet quality. Meta-analyses of pooled results demonstrated change in the Healthy Eating Index (MD 5.35 95%CI, 2.74–7.97 P & 0.001) and the Mediterranean Dietary Adherence Screener (MD 1.61 95%CI, 1.00–2.23 P & 0.001) scores. DQIs were more likely to measure change in diet quality if they reflected the diet pattern being implemented, if the intervention was significantly different from the baseline and control diets, and if the study was adequately powered to detect change. DQIs are responsive to change in diet quality in intervention trials when the index used reflects the dietary changes made and the study is adequately powered. The appropriate selection of a DQI to suitably match dietary changes and study populations is important for future dietary intervention trials. PROSPERO registration no. CRD42020181357.
Publisher: Springer Science and Business Media LLC
Date: 11-05-2020
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.NUT.2011.11.003
Abstract: Chronic substance abuse is recognized to affect nutritional status and is associated with nutrient deficiencies and malnutrition. This study aimed to identify the prevalence of malnutrition and nutritional risk factors using a spread of measurements in patients undergoing alcohol and drug treatment. Sixty-seven patients (48 male, 19 female) admitted to a public hospital detoxification unit participated: 49 were alcohol dependent (73%) and the remaining were opiate, benzodiazepine, and/or hetamine dependent. Nutritional status was assessed by the Subjective Global Assessment. An appetite questionnaire (Simplified Nutritional Appetite Questionnaire), a diet-quality questionnaire (Australian Recommended Food Score), and blood biochemistry and hematologic tests were also applied. The prevalence of mild/moderate malnutrition was 24% according to the Subjective Global Assessment. Weight and body mass index were associated with nutritional status (P < 0.05). Appetite and diet quality were poor overall, with 88% of all participants requiring advice and guidance. Blood markers showed that 50% of all subjects were deficient in iron or vitamins (low vitamin A levels in 21%, low iron levels in 18%, low-range potassium in 12%, and low vitamin C levels in 8%). The prevalence of malnutrition in this patient population is likely to underestimate the prevalence of nutritional risk factors and micronutrient undernutrition. Multiple tools assessing nutritional status, appetite, diet quality, and blood test results have different advantages and can further identify the specific needs and appropriateness of nutritional education in patients during treatment for drug and alcohol use.
Publisher: Wiley
Date: 22-01-2019
DOI: 10.1111/JHN.12619
Abstract: Dietetic models of care at Logan Hospital changed from all patients with a confirmed stroke receiving dietitian assessment (Old pathway) to only those patients screened as high-nutritional-risk (Modified pathway). However, it was unknown whether all low-nutritional-risk patients who were indicated for dietitian assessment for nutrition support actually received assessment. This pre-post retrospective study evaluated whether the Old pathway and the Modified pathway were equally effective in identifying low-nutritional-risk stroke patients who were indicated for dietitian assessment and compared the time spent providing Dietetic care. For both pathways, medical charts were reviewed for low-nutritional-risk patients admitted between December 2012 and November 2017 with a confirmed stroke, who were given a standard food and fluid diet code and scored MST < 2 (Malnutrition Screening Tool) on admission. Data collected included demographics, anthropometrics, malnutrition assessment, dietetic intervention and time spent caring for patients. Malnutrition-related clinical indicators were used to classify patients as either Dietitian Assessment for Nutrition Support Indicated or Not Indicated. Low-nutritional-risk patients were similar on the Old (n = 180) and Modified (n = 206) pathways [mean (SD) 66 (13) years, 63% male, 4% malnutrition]. Those classified as Dietitian Assessment for Nutrition Support Indicated (n = 61 of 180) were older, had a longer length of stay (P < 0.05), and were all identified by the Dietitian on both pathways. Ten minutes less dietetic time per patient was required on the Modified pathway (P < 0.001). The Modified Nutrition Stroke pathway performed more efficiently than the Old pathway and was equally effective at ensuring that stroke patients who were determined as being low-nutritional-risk received dietitian assessment during admission if indicated.
Publisher: Wiley
Date: 03-2006
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.JAND.2017.06.364
Abstract: A dietetic consultation is a structured process aimed at supporting in idual patients to modify their dietary behaviors to improve health outcomes. The body of evidence on the effectiveness of nutrition care provided by dietitians in primary health care settings has not previously been synthesized. This information is important to inform the role of dietitians in primary health care service delivery. The aim of this systematic review was to evaluate the evidence of the effectiveness of in idual consultations provided exclusively by dietitians in primary care to support adult patients to modify dietary intake and improve health outcomes. ProQuest Family Health, Scopus, PubMed Central, Medline, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for English language systematic reviews or randomized controlled trials published before October 2016. The key terms used identified the provision of nutrition care exclusively by a dietitian in a primary health care setting aimed at supporting adult patients to modify dietary behaviors and/or improve biomarkers of health. Interventions delivered to patients aged younger than 18 years, in hospital, via telephone only, in a group or lecture setting, or by a multidisciplinary team were excluded. The methodologic quality of each study was appraised using the Cochrane Risk of Bias tool and the body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual. Outcomes included the effectiveness of dietetic interventions in terms of anthropometry, clinical indicators, and dietary intake. A statistically significant between-group difference was used to indicate intervention effectiveness (P<0.05). Twenty-six randomized controlled studies met eligibility criteria, representing 5,500 adults receiving dietetic consultations in a primary care setting. Eighteen of 26 included studies showed statistically significant differences in dietary, anthropometric, or clinical indicators between intervention and comparator groups. When focusing specifically on each study's stated aim, significant improvements favoring the intervention compared with control were found for the following management areas: glycemic control (four out of four studies), dietary change (four out of four studies), anthropometry (four out of seven studies), cholesterol (two out of eight studies), triglycerides (one out of five), and blood pressure (zero out of three) studies. Dietetic consultations for adults in primary care settings appear to be effective for improvement in diet quality, diabetes outcomes (including blood glucose and glycated haemoglobin values), and weight loss outcomes (eg, changes in weight and waist circumference) and to limit gestational weight gain (Grade II: Fair evidence). Research evaluated in this review does not provide consistent support for the effectiveness of direct dietetic counseling alone in achieving outcomes relating to plasma lipid levels and blood pressure (Grade III: Limited evidence). Therefore, to more effectively control these cardiovascular disease risk factors, future research might explore novel nutrition counseling approaches as well as dietitians functioning as part of multidisciplinary teams.
Publisher: Wiley
Date: 08-05-2008
Publisher: Wiley
Date: 04-02-2019
Publisher: KARGER
Date: 2005
DOI: 10.1159/000088301
Publisher: Wiley
Date: 05-2018
Publisher: MDPI AG
Date: 19-11-2018
DOI: 10.3390/NU10111798
Abstract: Prevalence of asthma in Australian children is amongst the highest in the world. Although breastfeeding positively influences infant immunity, early introduction of Milk Other than Breast Milk (MOTBM) may also play an important role in the development of Asthma. The aim of this study was to investigate the association between the introduction of MOTBM in the first six months after birth and the development of reported persistent asthma in 3-year olds. A s le of 1121 children was extracted from the Environments for Healthy Living longitudinal birth cohort study. Introduction of MOTBM during the first six months after birth increased almost two-fold the risk of development of persistent asthma after adjusting for other covariates (Adjusted Relative Risk (ARR): 1.71, 95% CI: 1.03–2.83, p = 0.038). This study indicates that the introduction of MOTBM in the first six months of life is a risk factor for asthma incidence among 3-year old children. This result is important in explaining the benefits of breastfeeding as part of public health interventions to encourage mothers to increase breastfeeding initiation and duration, and avoid the introduction of MOTBM in the first six months after childbirth.
Publisher: Wiley
Date: 05-2018
Publisher: Springer International Publishing
Date: 2019
Publisher: Informa UK Limited
Date: 03-07-2021
Publisher: Wiley
Date: 24-11-2018
DOI: 10.1111/JHN.12526
Abstract: High-quality research methodologies and clear reporting of studies are essential to facilitate confidence in research findings. The aim of the present study was to conduct an in-depth examination of the methodological quality and reporting of studies included in a recent systematic review of dietitians' effectiveness at providing in idualised nutrition care to adult patients. The methodological quality and reporting of 27 Randomised Controlled Trials (RCTs) were appraised using the UK Medical Research Council (MRC) Guidelines for complex interventions and the CONSORT checklist for reporting RCTs. A quality appraisal checklist was developed for each guideline/assessment tool aiming to evaluate the extent to which each study met the designated criteria. Excerpts from studies that best addressed criteria were collated to provide exemplary accounts of how criteria may be achieved in future studies. None of the reviewed studies met more than half of the MRC Guidance criteria, indicating that there is clear room for improvement in reporting the methodological underpinnings of these studies. Similarly, no studies met all criteria of the CONSORT checklist, suggesting that there is also room for improvement in the design and reporting of studies in this field. Dietitians, researchers and journal editors are encouraged to use the results and exemplary accounts from this review to identify key aspects of studies that could be improved in future research. Improving future research will enhance the quality of the evidence-base that investigates the outcomes of dietary interventions involving dietitians.
Publisher: MDPI AG
Date: 02-03-2021
DOI: 10.3390/HEALTHCARE9030265
Abstract: Urinary incontinence (UI) affects many women and impacts quality of life. Group-based interventions may be an effective and efficient method for providing UI care however, interventions must be acceptable to patients to have an impact. This study aimed to explore patients’ perceptions of an exercise training and healthy eating group program (ATHENA) for overweight and obese women with UI. This qualitative descriptive study involved semi-structured interviews with a subset of participants s led from a feasibility study of ATHENA. The ATHENA intervention was co-developed with end-users and implemented in Women’s Health Physiotherapy services at an Australian hospital. Interviews were recorded, transcribed and analysed thematically. Eleven female patients participated (mean ± SD age 54.2 ± 9.9 years body mass index 30.5 ± 3.25 kg/m2). Participants found ATHENA highly acceptable, with three themes emerging from interviews: (1) Participants’ journey of change through ATHENA, describing the shifts in knowledge, attitudes, behaviours and symptoms participants experienced (2) High satisfaction with ATHENA, including educational content, exercise components and delivery style and (3) Group setting integral to ATHENA’s success, with participants providing support, building friendships, and facilitating each other’s learning. Overall, ATHENA was acceptable to participants, who provided each other with peer support an unexpected moderator to ATHENA’s success.
Publisher: Springer Science and Business Media LLC
Date: 17-03-2022
DOI: 10.1007/S00192-021-04743-9
Abstract: Supervised pelvic floor muscle training (PFMT), weight loss and exercise are recommended for overweight/obese women with urinary incontinence (UI). This study aimed to implement and evaluate the feasibility, acceptability and effectiveness of a 12-week group exercise and healthy eating program (ATHENA) for overweight/obese women with UI. This study, using an implementation-effectiveness hybrid type 3 design, was conducted within a Women's Health Physiotherapy outpatient service at an Australian tertiary public hospital. Intervention feasibility and acceptability were assessed through process evaluation of implementation, while clinical effectiveness was assessed via pre- ost-clinical and quality of life surveys. Process data were analyzed using descriptive statistics and effectiveness data were compared pre- ost-intervention using inferential statistics. Of 156 eligible patients, 37 (24%) agreed to participate 29 (78%) completed the ATHENA program. Median (IQR) age and body mass index were 53 (47-65) years and 30.8 (29.1-34.8) kg/m The ATHENA intervention was feasible, acceptable and clinically effective for overweight and obese women with urinary incontinence at a tertiary public hospital in Australia. Further research into longer term outcomes and the cost effectiveness of this group intervention is recommended. N/A. Ethics approval, HREC/2018/QGC/46582, date of registration 14/11/2018.
Publisher: Elsevier BV
Date: 07-2005
DOI: 10.1016/J.JADA.2005.04.007
Abstract: A cardioprotective dietary fat profile is recommended for the treatment of type 2 diabetes. The clinical feasibility of advice strategies targeting specific fatty acid intakes and the extent to which they can be achieved by free-living populations needs to be tested. Walnuts, with high n-3 polyunsaturated fatty acid (PUFA) content, may help optimize fatty acid intakes, but regular consumption might increase total fat and energy intakes. This study examined whether advice that refers to a total dietary pattern inclusive of walnuts would result in low-fat energy-controlled diets with optimal dietary fat proportions for patients with type 2 diabetes mellitus. A parallel-design, controlled trial was completed by 55 free-living men and women with established type 2 diabetes mellitus. Participants were randomly assigned to one of three groups: low-fat (general advice), modified low-fat (total diet advice using exchange lists to differentiate PUFA-rich foods), walnut-specific (modified low fat including 30 g walnuts/day). Dietary intakes and clinical outcomes were measured at baseline, and at 3 and 6 months. Dietary goals were: less than 10% of energy from saturated fat, 7% to 10% of energy from PUFA, adequate n-3 PUFA (>or=2.22 g alpha-linolenic acid, >or=0.65 g eicosapentaenoic acid [EPA]+docosahexaenoic acid [DHA]) and n-6 to n-3 ratio less than 10. The proportion of subjects achieving dietary goals and major food sources of fat were determined. At baseline, dietary intakes were not significantly different between groups. No group and few in iduals (10%) were consuming adequate PUFA, with meat the main source of dietary fat (22% total dietary fat). At 3 and 6 months, energy and macronutrient intakes were similar among groups. The walnut group, however, was the only group to achieve all fatty acid intake targets (P <.01), and had the greatest proportion of subjects achieving targets ( P <.05). Walnuts were the main source of dietary fat (31%) and n-3 PUFA (50%), while 350 g oily fish/day provided a further 17% n-3 PUFA consumed by this group. Specific advice for the regular inclusion of walnuts in the context of the total diet helps achieve optimal fat intake proportions without adverse effects on total fat or energy intakes in patients with type 2 diabetes mellitus.
Publisher: Wiley
Date: 08-08-2022
Publisher: Future Medicine Ltd
Date: 11-2005
Abstract: Type 2 diabetes mellitus is associated with an increased risk of coronary heart disease, reflected in the presence of abnormal lipid profiles. Increasing the intake of polyunsaturated fat at the same time as reducing saturated fat can alleviate these risk factors. Including walnuts in a ‘whole of diet’ approach to managing fat consumption can help to ensure that the desired fatty acid profile is achieved. This comes via a food matrix that also delivers anti-oxidants, fibre and protein that may provide additional nutritional benefits. Thus there is good reason to include walnuts in dietary advice for patients with Type 2 diabetes mellitus.
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1053/J.JRN.2013.10.004
Abstract: The study objective was to develop and evaluate the feasibility and validity of a self-administered Scored Sodium Questionnaire (SSQ) for use in the routine clinical care of Australian chronic kidney disease (CKD) patients. The study took place in community-based outreach clinics using a multidisciplinary model of care. Assessment of sources of dietary sodium intake in the target population used comprehensive diet history interviews (Phase 1) to inform development of a 10-item food frequency questionnaire that was scored and validated using 24-hour urinary sodium and 2 alternative dietary intake methods (Phase 2). Subjects were adults with CKD Stages 3 to 5 (Phase 1 n = 30 Phase 2 n = 47). On a single day, participants (n = 47) completed the SSQ, feasibility survey, 24-hour urine collection, and 24-hour food record. A diet history interview was also conducted to confirm sodium intake on the day of data collection reflected habitual intake. Validity of the SSQ score was confirmed by correlation with 24-hour urine sodium. Validity of a cutpoint on the SSQ score to correctly identify high- versus low-sodium consumers was confirmed by receiver operating characteristic curve analysis: area under the curve, sensitivity, and specificity. Total SSQ score correlated significantly with 24-hour urine sodium (r = 0.371 P = .031). Correlation between 24-hour food record and diet history sodium confirmed consumption on the data collection day reflected habitual intake (r = 0.701 P ≤ .001). A cutpoint of 65 or greater on the SSQ score was confirmed as valid to identify high-sodium consumers: area under the curve 0.713, sensitivity 61%, and specificity 82%. The SSQ is feasible and valid to assess habitual sodium intake in the Australian CKD population and to identify high-sodium consumers for referral to in idualized counseling on a low-sodium diet.
Publisher: Wiley
Date: 08-08-2022
Publisher: Wiley
Date: 29-01-2023
Abstract: Globally, sustainability and planetary health are emerging as areas of critical importance. In 2015, the 2030 Agenda for Sustainable Development was adopted by the United Nations member states. Since then, the United Nations Educational, Scientific and Cultural Organization and the Commonwealth Secretariat have published guidelines for educators to embed sustainability content into curricula. This scoping review aims to identify how student dietitians learn about sustainability, how learning opportunities are evaluated, their outcomes, and whether these guidelines have translated into teaching activities contained in dietetic degrees. A scoping review was used to address the aims. Eight electronic databases and Google Scholar were searched from inception to March 2022 for articles describing dietetics students' participation in learning activities focused on sustainability. Data that addressed the research aims were charted independently by two researchers, then narratively synthesised. Twelve articles met the inclusion criteria. A range of teaching approaches and evaluation methods were used, from passive learning in lectures to experiential learning activities. A change in knowledge or behaviour was found for experiential learning activities ( n = 5). For articles published after 2015 ( n = 9), two mentioned the Sustainable Development Goals and no articles referenced the published guidelines. A paucity of evidence exists describing how dietetics students learn about sustainability and their learning outcomes. Of the 12 articles published, varied teaching approaches and evaluation methods have resulted in inconsistencies in the reporting of outcomes. The minimal reference to the Sustainable Development Goals and published guidelines suggests a slow translation of knowledge to practice.
Publisher: Wiley
Date: 22-06-2021
Abstract: There is a need for quick and easy methods to monitor nutritional intake in hospital and identify patients with poor intake. Food record charts are often used in clinical practice, with low levels of accuracy and completion. This study aims to describe the development and evaluate the performance of a new tool to estimate energy and protein intake and identify poor nutritional intake amongst adult hospital patients. Ninety trays were s led and assessed independently using the new tool ‘Meal Intake Points’ and a weighed (reference) method. The performance was tested by measuring association (Spearman's correlation), agreement (proportion of meals within specified limits of reference method), and sensitivity and specificity to identify poor energy and protein intake. This new tool achieved very strong association for energy estimates ( r = .91) and strong association for protein estimates ( r = .86). Estimates for energy and protein were within 450 kJ and 4.5 g of the reference method in 77.8% and 62.2% of meals, respectively. It also displayed excellent performance as a screening tool (sensitivity 100% specificity 76%‐80%). Minor revision of the original tool was needed to optimise performance. Meal Intake Points accurately estimates energy and protein intake and identifies patients with poor nutritional intake, providing a clinically relevant tool for use in hospitals to monitor intake and identify patients for proactive nutrition support. Further validation studies are needed to determine its performance in clinical practice and whether it is useful in predicting hospital‐acquired malnutrition.
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.NUMECD.2019.11.001
Abstract: Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis. Dietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women's Health in 2001 (aged 50-55) and 2013 (aged 62-67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15). Carbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.
Publisher: Mark Allen Group
Date: 02-07-2016
DOI: 10.12968/JOWC.2016.25.7.384
Abstract: To investigate the feasibility of recruitment, retention, intervention delivery and outcome measurement in a nutritional intervention to promote pressure ulcer healing in an acute setting. Some 50 tertiary hospital patients with stage II or greater pressure ulcer were randomised to receive either in idualised nutritional care by a dietitian, including prescription of wound healing supplements or standard nutritional care. Relevant nutritional and pressure ulcer (PU) parameters were collected at day 5, 10, 15, 22 and then weekly or until discharge. The median length of hospital stay was 14 days (1–70) with 29 patients discharged by day 15. There were 24 patients discharged before their PU fully healed. Per cent change in valid PU area and score measures from baseline to day 15 were chosen for outcome data analysis to account for varying initial size and severity of the wound and length of stay. There was a larger percentage reduction in PU measures in the intervention group, but this was not statistically significant. Little difference was found in nutritional intake between the control and intervention groups indicating a requirement to focus on effective delivery of the intervention in future studies. Future studies in the acute setting need to account for length of stay and ideally follow patients until full healing. Results indicate a positive association with nutrition intervention and PU healing and that a rigorously designed and adequately powered study is feasible. This research was supported by a grant from the Queensland Health, Health Practitioner Research Scheme. The authors have no conflicts of interest to declare.
Publisher: MDPI AG
Date: 02-2019
DOI: 10.3390/HEALTHCARE7010020
Abstract: Effective, evidence-based strategies to prevent and treat obesity are urgently required. Dietitians have provided in idualized weight management counselling for decades, yet evidence of the effectiveness of this intervention has never been synthesized. The aim of this study was to examine the effectiveness of in idualized nutrition care for weight management provided by dietitians to adults in comparison to minimal or no intervention. Databases (Cochrane, CINAHL plus, MedLine ovid, ProQuest family health, PubMed, Scopus) were searched for terms analogous with patient, dietetics and consultation with no date restrictions. The search yielded 5796 unique articles, with 14 randomized controlled trials meeting inclusion criteria. The risk of bias for the included studies ranged from unclear to high. Six studies found a significant intervention effect for the dietitian consultation, and a further four found significant positive change for both the intervention and control groups. Data were synthesized through random effects meta-analysis from five studies (n = 1598) with weight loss as the outcome, and from four studies (n = 1224) with Body Mass Index (BMI) decrease as the outcome. Groups receiving the dietitian intervention lost an additional 1.03 kg (95% CI:−1.40 −0.66, p 0.0001) of weight and 0.43 kg/m2 (95% CI:−0.59, −0.26 p 0.0001) of BMI than those receiving usual care. Heterogeneity was low for both weight loss and BMI, with the pooled means varying from 1.26 to −0.93 kg and −0.4 kg/m2 for weight and BMI, respectively, with the removal of single studies. This study is the first to synthesize evidence on the effectiveness of in idualized nutrition care delivered by a dietitian. Well-controlled studies that include cost-effectiveness measures are needed to strengthen the evidence base.
Publisher: Wiley
Date: 11-04-2015
DOI: 10.1111/JHN.12234
Abstract: Research has identified associations between serum 25(OH)D and a range of clinical outcomes in chronic kidney disease and wider populations. The present study aimed to investigate vitamin D deficiency/insufficiency in dialysis patients and the relationship with vitamin D intake and sun exposure. A cross-sectional study was used. Participants included 30 peritoneal dialysis (PD) (43.3% male 56.87 ± 16.16 years) and 26 haemodialysis (HD) (80.8% male 63.58 ± 15.09 years) patients attending a department of renal medicine. Explanatory variables were usual vitamin D intake from diet/supplements (IU day(-1) ) and sun exposure (min day(-1) ). Vitamin D intake, sun exposure and ethnic background were assessed by questionnaire. Weight, malnutrition status and routine biochemistry were also assessed. Data were collected during usual department visits. The main outcome measure was serum 25(OH)D (nm). Prevalence of inadequate/insufficient vitamin D intake differed between dialysis modality, with 31% and 43% found to be insufficient (<50 nm) and 4% and 33% found to be deficient (<25 nm) in HD and PD patients, respectively (P < 0.001). In HD patients, there was a correlation between diet and supplemental vitamin D intake and 25(OH)D (ρ = 0.84, P < 0.001) and average sun exposure and 25(OH)D (ρ = 0.50, P < 0.02). There were no associations in PD patients. The results remained significant for vitamin D intake after multiple regression, adjusting for age, gender and sun exposure. The results highlight a strong association between vitamin D intake and 25(OH)D in HD but not PD patients, with implications for replacement recommendations. The findings indicate that, even in a sunny climate, many dialysis patients are vitamin D deficient, highlighting the need for exploration of determinants and consequences.
Publisher: Wiley
Date: 02-05-2017
DOI: 10.1111/JHN.12479
Abstract: Student confidence is an important contributor to a successful professional placement experience. The present study aimed to evaluate a placement preparation program for student dietitians and to assess the impact on self-rated confidence with respect to commencing placements. The present study is part of a design-based research approach that involves students in a cyclic enquiry to evaluate and improve curricula. Nutrition and Dietetics students at an Australian university participated in a 1-week mandatory workshop - Pre-Placement week (PrePW), N = 98 students: in 2015 (n = 54) and 2016 (n = 44). An online survey was conducted before and after PrePW using a five-point Likert scale (1 = not confident 5 = very confident) to assess self-rated confidence to commence placements. Mean (SD) scores were calculated. Paired and independent t-tests evaluated within- and between-group differences, respectively. Before PrePW, the mean (SD) for student confidence to commence placements overall (in all areas of practise) was 'somewhat confident' [2.9 (0.6) in 2015 and 3.0 (0.7) in 2016]. Students were least confident to commence Clinical Practice [2015: 2.5 (0.6) 2016: 2.8 (0.6)] compared to Food Service Management (FSM) [2015: 3.2 (0.9) 2016: 3.1 (0.9)] and Community and Public Health Nutrition (CPHN) [2015: 3.3 (0.9) 2016: 3.2 (0.8)]. Student feedback from PrePW 2015 was used to change the curriculum and PrePW program. The 2016 students reported significantly greater confidence within all areas of practice: Clinical Practice [3.4 (0.6)], FSM [3.7 (0.6)] and CPHN [3.8 (0.6)], including confidence to commence placements overall [3.6 (0.6)] (P < 0.05). Design-based research provides a useful framework for improvement to curricula and, in this case, was successful in enhancing student confidence in preparation for professional placement.
Publisher: Wiley
Date: 13-09-2013
DOI: 10.1002/HED.23146
Abstract: The "Swallowing and Nutrition Guidelines for Patients with Head and Neck Cancer" were developed to guide early identification and management of dysphagia and nutritional risk before, during, and after cancer treatment. The purpose of this study was to validate these guidelines. Patients attending a Combined Head and Neck Clinic at a major tertiary hospital in 2007 to 2008 were assessed using the guidelines, with high-risk category patients recommended for proactive gastrostomy. Data were collected on guideline adherence, gastrostomy tube insertion, and weight. Sensitivity, specificity, and positive predictive value were calculated for validation. Proactive gastrostomy tubes were inserted in 173 of 501 patients (25%). Overall guideline adherence was 87%. High-risk category adherence was 75%. Validation outcomes were sensitivity 54%, specificity 93%, and positive predictive value 82%. The risk categories in the guidelines are valid to assist early identification of swallowing and nutritional risk and guide decision-making on proactive gastrostomy tube insertion.
Publisher: Wiley
Date: 15-04-2021
DOI: 10.1111/JHN.12876
Abstract: Little is known about the nutritional care provided to patients who develop hospital acquired malnutrition (HAM). The present study aimed to describe the quality of nutritional care provided to patients who developed HAM and determine whether this differed by length of stay (LOS). A retrospective medical records audit was conducted on adults with LOS 14 days across five Australian public hospitals from July 2015 to January 2019 who were clinically assessed to have HAM. Descriptors and nutrition‐related care data were sourced. Descriptive statistics were conducted. Chi‐squared and t ‐tests were used to compare patient data by LOS ≤ or 50 days. Eligible patients ( n = 208) were 64% male, with median (range) LOS of 51 (15–354) days, body mass index = 26.8 ± 6.2 kg m −2 and mean ± SD age of 65 ± 17 years. Malnutrition screening was first completed a median (range) of 0 (0–31) days after admission, with weekly screening conducted on 29% of patients. Mean (range) time to initial dietitian assessment was 9 (0–87) days and 27 (2–173) days until malnutrition diagnosis. Thirty‐seven percent of patients were weighed within 24 h of a dietitian requesting it, and 51% had fluid retention that may have masked further weight loss. Most (91%) patients consumed 80% of nutrition requirements for 2 weeks. However, 54% did not receive additional nutrition support (e.g., enteral nutrition), which was not considered by the dietitian in 28% ( n = 31/112) of these patients. Only 40% consumed adequate intake prior to discharge. Those with LOS 50 days (50%, n = 104/208) took 24 days longer to be diagnosed with malnutrition and lost 2.4 kg more body weight during admission ( p 0.010). Opportunities exist to optimise nutritional care to facilitate the prevention and management of hospital acquired malnutrition in long‐stay patients.
Publisher: Wiley
Date: 24-02-2011
Publisher: Wiley
Date: 24-02-2011
No related grants have been discovered for Lynda Ross.