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Background: A dedicated intensive care dietitian, as part of the intensive care unit (ICU) multidisciplinary team, contributes to improved delivery of nutrition support. The Paediatric Critical Care Society recommends a minimum dietetic staffing to critical‐care bed ratio of 1:10, led by an Agenda for Change (AfC) Band 7. Methods: A cross‐sectional study was conducted using an electronic survey that was available for 12 weeks. The Paediatric Intensive Care Audit Network database was used to identify all hospitals with paediatric intensive care unit (PICU) beds (n = 28). Results: Only 14% (n = 4/28) of trusts met the recommended 1:10 dietitian to bed ratio. PICU dietetic whole time equivalent was 0.7 ± 0.4, with a staff to bed ratio of 1:23.7 ± 10.7, compared to adult staff to bed ratio of 1:24.7. Some 92.8% (n = 26/28) had a AfC Band 7 Lead and only 7% (n = 2/28) had an AfC Band 8a Lead compared to adult services where 12.5% (n = 15/122) had an AfC Band 8a (p < 0.05). Conclusions: There is a significant disparity between adult versus paediatric services with regard to seniority of dietitians. Dietitians in well‐resourced centres were more likely to review patients without the need for a referral, which may improve nutrition outcomes. Highlights: Having a paediatric dietitian as part of a multidisciplinary team in paediatric intensive care units (PICU) predicts optimal enteral energy and protein intake.PICUs within the UK and Republic of Ireland do not meet minimum dietetic staffing standards.There is a significant disparity in seniority levels between adult and paediatric dietetic staff in critical care. [ABSTRACT FROM AUTHOR]

Background: The Manual of dietetic practice ('Manual') is the core textbook for qualified and student dietitians. A survey was conducted to explore views on the scope, content and presentation of the Manual to inform the forthcoming edition. Methods: The survey comprised of questions on demographics, structure, content, access (print/digital), missing topics, strengths and weaknesses. It was distributed to members of the British Dietetic Association (BDA) and other relevant groups in August 2022. Responses are presented as frequencies and free text as themes. Results: Of 1179 responses, 91% were from professionals, of whom 72% were registered dietitians with a mean of 12.7 years (range: 1–44) in practice: 60% worked in the United Kingdom with 52% based in a clinical setting. The printed version was preferred: 59% professionals, 60% students, 94% professionals and 88% students were satisfied with the structure; however, 26% professionals and 22% students identified content that was lacking or outdated, including mental health and sustainability. The strengths were its comprehensive coverage and respected contributing authors. Weaknesses included the cost, size, lack of visual aids and currency. Professionals indicated the seventh edition should focus on more practical information required for clinical practice, whereas students wanted more emphasis on summarised information and visual formats. Conclusions: The survey proved a valuable method to engage with the readership to ensure the next edition reflected their requirements. Although nearly all respondents were satisfied with the scope and content, the results highlighted those topics lacking and/or outdated. Results also showed that the next edition should focus on practical information required for clinical practice, with more summarised and visual formats. Key points: This article presents the results of an online survey to explore views on the scope, content and presentation of the UK Dietetic profession's core text, Manual of dietetic practice.The survey was initiated by the editorial team who felt it important to explore ways in which the new edition of the Manual could be updated to meet the emerging needs of readers, namely qualified dietitians and students of dietetics.Over 1100 respondents completed the survey comprising 91% professionals, 72% of whom were registered dietitians who had been practicing in the UK healthcare system for an average 12 years.Thematic analysis revealed readers felt the Manual to be a highly respected text, regarded as the 'go‐to' source for guidance on the practice of clinical dietetics with comprehensive coverage and extremely knowledgeable contributing authors.However, despite its positive qualities, the Manual suffered from cumbersome updating processes meaning that its content lagged behind real‐life clinical practice.The survey proved a valuable method to engage with the readership to ensure the next edition reflected readers' requirements for updated Manual content, style and format.The editors will ensure the forthcoming seventh edition focuses on practical information required for clinical practice, with more summarised form and visual formats.Further, moving forward it is hoped that there will be more aggressive promotion of the online version of the Manual as it is a format which facilitates content update and is likely to become more widely accessed in the future. [ABSTRACT FROM AUTHOR]

Background: Hyperemesis gravidarum (HG) is severe pregnancy sickness, often leading to dehydration, weight loss and electrolyte disturbances. Little is known about nutritional intake and its consequences in those affected. The aim of this study was to explore the first trimester nutritional intake and clinical characteristics in those with severe sickness. Method: Recruitment was via the social media accounts of national pregnancy charities. The eligibility criteria were as follows: between 6 and 11 weeks pregnant, age ≥18 years and residing in the UK. Participants completed a self‐report online questionnaire including the Pregnancy Unique Quantification of Emesis 24 (PUQE24) score and a 3‐day online diet diary. Groups were compared by PUQE24 categories. Nutritional intakes were compared to dietary reference values. Results: One hundred sixty‐six participants took part in the study: 36 categorised with mild, 109 with moderate and 21 with severe symptoms at a median gestation of 8.1 (interquartile range [IQR] 3) weeks. Those in the severe category had significantly higher weight loss (3.0 kg, IQR 3.5) than the mild category (0.0 kg, IQR 0.9). In those who completed the diet diary (n = 70), intakes of energy, carbohydrate, protein, fat, fibre, calcium, iron, zinc, thiamine, riboflavin, folate and vitamin C were all significantly lower in the severe category (p < 0.05). The severe group consumed only 39.5% and 41.6% of energy and protein needs, respectively, and were more likely to stop taking micronutrient supplements (p < 0.05). Conclusion: Nutritional and supplement intake in those with severe pregnancy sickness was poor; however, intake across all participants was suboptimal. Future research should investigate how to improve nutritional intake across all categories of pregnancy sickness. Key points: Hyperemesis gravidarum causes severe pregnancy sickness, affecting ~1%–2% of pregnancies.This study indicates that nutritional and supplement intake in those with severe pregnancy sickness was poor; however, intake across all participants was suboptimal.Future research should investigate how to improve nutritional intake across all categories of pregnancy sickness. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to understand the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings. Methods: A cross‐sectional study was conducted using data collected from an anonymous online survey. Participant agreement was measured using five‐point Likert scale (strongly disagree to strongly agree) against 38 belief statements informed by the Theoretical Domains Framework (TDF) of behaviour change. Results: From the complete responses (n = 119), 65% worked shifts without nights, 27% worked mixed shift rota including nights and 8% worked only night shifts. The statements ranked with the highest agreements were in the TDF domains: Environment Context/Resources (ECR) – mainly identified as a barrier to healthy eating, Behaviour Regulation (BR) and intention (IN) – identified as enablers to healthy eating. For the belief statement 'the available options for purchasing food are too expensive' (ECR), 80% of night workers and 75% non‐night workers agreed/strongly agreed. Taking their own food to work to prevent making unhealthy food choices (BR) had agreement/strong agreement in 73% of non‐night and 70% night workers; 74% non‐night workers and 80% of night workers agreed/strongly agreed with the statement 'I would like to eat healthily at work' (IN). Mixed shift workers agreed that following dietary advice was easier when working a non‐night compared to a night shift (p = 0.002). Conclusions: Access and affordability of food were identified as important determinants of dietary behaviour during shifts. The findings support interventions targeting the food environment for shift workers with T2D. Key points: The present study investigated the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings.The findings support previous findings from semi‐structured interviews, with the main domain influencing dietary behaviours being Environmental Context and Resources (i.e., physical and economic availability of food during shifts). The findings support interventions targeting the food environment across shift workers living with T2D. [ABSTRACT FROM AUTHOR]

We analysed data on 2842 subjects aged ≥40 years enrolled in the National Diet and Nutrition Survey (NDNS 2008–2019). Based on serum 25(OH)D concentrations, study subjects were grouped in three categories: vitamin D deficiency (<25 nmol/L), vitamin D insufficiency (25–49 nmol/L) and vitamin D sufficiency status (≥50 nmol/L). Differences in CVD risk factors between vitamin D deficiency or insufficiency and vitamin D sufficiency status were expressed in standard deviation scores (SDS) and estimated through weighted multiple linear regression models. Key points: Nationally representative data source UK National Diet and Nutrition Survey (2008–2019) is analysed.Vitamin D status is determined according to serum concentration of 25(OH)D deficiency: <25 nmol/L; insufficiency: 25–49 nmol/L; sufficiency: ≥50 nmol/L.Cardiovascular risk factors are compared between individuals with vitamin D deficiency and those with vitamin D sufficiency.Differences are expressed in standard deviation scores.Vitamin D deficiency is associated with a higher cardiovascular risk profile. [ABSTRACT FROM AUTHOR]

Background: Fruit intake, including consumption of 100% fruit juice, is generally associated with a better diet quality and overall health. However, fruit and vegetable intakes are below recommendations in many countries. Methods: The present study examined fruit juice intake and total energy and nutrient intakes according to juice consumption or non‐consumption in participants in the National Dietary and Nutrition Survey Rolling Programme 2014–2016 in the UK (n = 2723) and the Individual and National Study on Food Consumption 2006–2007 (n = 4079) in France. Total energy and nutrient intakes were also estimated for scenarios in which orange juice with pomace was either added to the daily diet or replaced 100% orange juice or beverages containing fruit juice. Results: Fruit juice consumers had higher intakes of fruits and vegetables than non‐consumers, were more likely to reach 5‐a‐day targets for fruit and vegetable consumption, and had significantly higher intakes of folate, vitamin C, potassium, magnesium, and fibre. Juice consumers also had higher total energy and sugar intakes, but lower body mass index than non‐juice consumers. Modelling consumption of orange juice with pomace increased fibre and potassium intakes in orange juice consumers, and also increased fibre, most micronutrients, and 5‐a‐day achievements in non‐juice consumers. Conclusions: These national survey results demonstrate that fruit juice consumers in the UK and France had higher intakes of fruits and vegetables than fruit juice non‐consumers, and significantly higher intakes of several micronutrients and fibre. Furthermore, modelling of consumption of orange juice with pomace increased fibre and select micronutrient intakes, particularly among fruit juice non‐consumers. Key Points: Fruit intake is associated with better diet quality and overall health, but fruit and vegetable intakes are below recommendations in many countries. These national survey results from the UK and France show that fruit juice consumers had higher intakes of fruits and vegetables, several micronutrients (folate, vitamin C, potassium, magnesium) and fibre than non‐juice consumers. Modelling of consumption of orange juice with pomace, an edible byproduct of orange juice production that includes segments, broken pulp sacs, and a centre core, increased fibre and micronutrient intakes, especially among fruit juice non‐consumers. [ABSTRACT FROM AUTHOR]

Background: People living with amyotrophic lateral sclerosis (ALS) face many challenges with respect to taking adequate nutrition. Growing evidence links weight loss with negative prognostic outcomes. We aimed to explore the practice of dietitians in the UK with regard to the nutritional management of ALS. Methods: A national online survey was disseminated via professional groups, social media and newsletters to UK healthcare professionals between September and November 2018. The survey examined the nutritional management of ALS. Dietitian responses are reported in the present study. Results: In total, 130 dietitians responded to the survey. Two‐thirds reported that ALS comprised less than 20% of their total patient caseload. Forty‐two percent reported that nutritional screening took place in their organisation. One‐half of dietitians reported that patients were referred for dietetic assessment at 'about the right time', although 44% reported referrals were made too late. The majority (83%) of dietitians used resting energy expenditure predictive equations not validated in ALS. When setting weight goals, dietitians reported most frequently recommending weight maintenance if the patient's body mass index was 18.5–25 kg m−2 (72%), 25–30 kg m−2 (98%), and > 30 kg m−2 (79%). In addition, 43% reported that people with ALS were not weighed sufficiently frequently. Conclusions: Although the importance of early nutritional assessment is recognised, the timeliness of dietetic input and on‐going monitoring of nutritional status in ALS care might not currently be ideal. Dietitians report using energy requirement predictive equations and setting weight goals that may not promote positive outcomes. Further research is required to understand the optimal nutritional management of ALS. [ABSTRACT FROM AUTHOR]

Background: Oral health is affected by dietary practices and may impact quality of life. Collaboration between dietetics and dental professionals for oral health promotion and disease prevention is recommended. The present study aimed to determine the knowledge and practice of dentists and dietitians on diet and dental health. Methods: The study comprised a cross‐sectional online questionnaire, which was disseminated electronically to dentists and dietitians in the UK and Ireland, via national networks. Questions assessed participants' knowledge of the cariogenicity of different foods, snacking behaviours, familiarity with UK dietary guidelines, dietary advice and their recommendations for cross‐professional consistency. Results: In total, 418 responses were received (60% dentists, 40% dietitians). Inter‐profession knowledge differences were observed for the cariogenicity of sports drinks (p < 0.001), chocolate/confectionary (p < 0.001), yoghurt (p < 0.001) and sugar‐coated breakfast cereals plus milk (p < 0.0001). Dentists showed greater concern over the timings and frequency of food consumption than dietitians. A greater proportion of dentists felt nutrition and oral health counselling is a key component of regular patient care (58.4% versus 8.2%, p < 0.001). Only 18% of dietitians, compared to 56% of dentists, considered that they had received sufficient training about diet and dental health. Both professions indicated the need for multi‐disciplinary training. Conclusions: Dietitians and dentists differ with respect to their knowledge about the effects of snacks and snacking behaviours on dental health, as well as how they prioritise this in their clinical practice. Both professions show a willingness to work collaboratively to ensure accurate and consistent advice‐giving and expertise‐sharing. [ABSTRACT FROM AUTHOR]

Background: The present study assessed the quantity and quality of nutritional advice and support given to colorectal cancer survivors in the UK. Methods: A descriptive cross‐sectional survey was completed by 75 colorectal cancer survivors recruited through social media and bowel cancer support groups in the UK. The survey consisted of open‐ended and closed questions that aimed to explore the nutritional needs, nutritional advice given and other sources of information accessed by colorectal cancer survivors. Results: Sixty‐nine percent of respondents reported that they did not receive any nutritional advice or support from their healthcare team throughout diagnosis, treatment and post‐treatment. Colorectal cancer survivors accessed nutritional advice from a variety of sources, mainly cancer charity websites. Respondents expressed their desire for individualised advice relating to their nutritional problems. Conclusions: The results obtained in the present study indicate that a high proportion of colorectal cancer patients are not receiving the nutritional support that they need to overcome nutritional difficulties. There is an urgent need to improve clinical practice to ensure colorectal patients receive nutritional advice that is both consistent between healthcare professionals and personalised throughout each stage of diagnosis, treatment and post‐treatment. [ABSTRACT FROM AUTHOR]

Background: Food bank use has increased significantly in the UK. With the rise in demand, it is imperative that users are receiving food parcels that meet their requirements. The present study aimed to explore whether typical food parcels, supplied by The Trussell Trust and independent food banks, were meeting the daily nutrient and energy requirements of an adult user. Methods: The Trussell Trust (n = 2) and independent food banks (n = 9) were surveyed in Oxfordshire, UK. Data were collected on food bank use, resources, donations and parcel content. The energy and nutrient contents of a representative parcel were compared with the average dietary reference values (DRVs) for an adult. Additional comparisons were made between The Trussell Trust and independent provision. Results: Parcels provided energy, carbohydrate, sugar, protein and fibre contents that significantly exceeded the DRVs. In total, 62.2% of energy was provided as carbohydrate and 569% of the DRV was provided by sugars. The vitamin D and retinol content of the parcels was significantly lower than the DRVs, meeting 25% and 27% of users' needs respectively; provision of all other micronutrients exceeded the DRVs. The Trussell Trust's parcels provided significantly less vitamin D and copper than independent parcels. Conclusions: Food bank parcels distributed in Oxfordshire, UK, exceeded energy requirements and provided disproportionately high sugar and carbohydrate and inadequate vitamin A and vitamin D compared to the UK guidelines. Improved links with distributors and access to cold food storage facilities would help to address these issues, via increased fresh food provision. [ABSTRACT FROM AUTHOR]

Background: In 2012, the National Institute for Health and Care Excellence (NICE) Clinical Guidelines for Epilepsies: Diagnosis and Management (CG137) included, for the first time, ketogenic diets (KDs) as a treatment option for drug‐resistant paediatric epilepsy. The recommendation was made to refer children and young people with epilepsy whose seizures have not responded to appropriate anti‐epileptic drugs to a tertiary paediatric epilepsy specialist for consideration of the use of KDs. We aimed to assess the impact of this change in guidance on the numbers of ketogenic centres and patients following KDs for epilepsy in the UK and Ireland. Methods: An online survey was circulated to ketogenic dietitians from the UK and Ireland. The results were compared with similar surveys published in 2000 and 2010. Results: The number of centres offering KDs for treatment of epilepsy has risen from 22 in 2000, to 28 in 2010, and to 39 in 2017 (77% overall increase). Seven of these centres accept adult referrals, in comparison to only two centres in 2010. Patient numbers have increased from 101 in 2000 to 754 in 2017. In total, 267 patients are waiting to commence KD at 31 centres. Conclusions: Over the last 7 years, the number of patients treated with a KD for epilepsy in the UK and Ireland has increased by 647%, with a 77% increase in the number of centres offering KDs. Despite this rapid growth, there is ongoing demand for patients to be considered for dietary therapy, highlighting the need for continued expansion of KD services nationally. [ABSTRACT FROM AUTHOR]

Background: The prevalence of weight loss attempts has increased worldwide, although the extent to which sustained weight loss is achieved is unknown. There is insufficient research into weight loss maintenance (WLM) in individuals with overweight or obesity who have recently lost clinically significant amounts of weight (≥5%), particularly in the European general population. The present study aimed to determine the prevalence and retrospective predictors of WLM in population‐based samples of European adults with overweight or obesity who had made a recently completed weight loss attempt. Methods: Participants (N = 2000) in UK, Denmark and Portugal completed an online survey about loss and regain in their most recent completed weight loss attempt, features of their attempt (duration, self‐weighing, lapses, strategies), as well as loss of control and binge eating. Multiple regression analysis was used to determine factors retrospectively associated with WLM in those who achieved clinically significant weight loss (n = 1272). Results: Mean (SD) self‐reported weight loss was 9% (8%) and mean (SD) regain was 96.3% (9%) of participants' start weight. Twenty‐three percent of the total sample had maintained weight loss of ≥5% for at least 1 month. Controlling for weight loss and time since attempt, predictors of better WLM were avoidance of a temporary lapse, infrequent/absent loss of control and binge eating, and use of a greater number of dietary strategies for WLM (r2 = 0.338, P < 0.001). Principal conclusions: Factors associated with recent successful WLM indicate the importance of the continued use of dietary and other strategies for WLM, particularly in the face of a lapse, as well as the need to manage dysfunctional eating behaviours. [ABSTRACT FROM AUTHOR]

Background: Many centres across the UK and Ireland anecdotally report using a 'modified ketogenic diet' (MKD) as a treatment for refractory epilepsy. Although a MKD is within the spectrum of ketogenic diets (KDs), there is little literature reporting upon its definition, use or clinical effectiveness. We aimed to understand the core principles of MKD practice and to assess whether and how the MKD differs from other KD protocols. Methods: An online survey, designed by a consensus group of ketogenic dietitians, was circulated to 39 KD centres across the UK and Ireland. It consisted of 35 questions regarding dietetic practice when providing MKD. Results: Eighteen centres completed the questionnaire: 13 paediatric, three adult and two combined centres. All dietitians based MKD 'prescriptions' on estimated total energy requirements. The average macronutrient profile was 75% fat and 5% carbohydrate, with protein ad libitum. Carbohydrate and fat targets were implemented via weighed portions (carbohydrate lists n = 18; fat lists n = 13) and 'household measures' (carbohydrate lists n = 2; fat lists n = 3). Of the centres, 94% (n = 17) adjusted macronutrients over time; these decisions were based on ketone levels and seizures in most cases (83%; n = 14). Ketogenic nutritional products available on prescription were used by 10 centres (56%) when initiating and by all centres when 'fine‐tuning' the MKD. Conclusions: A modified ketogenic diet in the UK and Ireland is a hybrid KD, adopting principles from other established KD protocols and defining new elements unique to the MKD. Further research into the clinical and cost‐effectiveness of MKD would be of benefit. [ABSTRACT FROM AUTHOR]

Background: Guidance on choosing oral nutritional support strategies varies and the evidence for different approaches is discordant. The present study aimed to examine opinion and practice in the use of oral nutritional support amongst UK dietitians and to assess the factors that influence these clinical decisions. Methods: The study comprised a cross‐sectional, anonymous, national survey of UK dietitians. Results: There were 207 completed responses (3% response rate). More dietitians reported using combined approaches (COMB) [n = 129 (62%)] over food‐based (FB) strategies [n = 70 (34%)] or oral nutritional supplements (ONS) alone [n = 8 (4%)] (N = 207, P < 0.001). Intervention choice was associated with clinical setting and clinical speciality; community dietitians reported more frequent use of FB or ONS alone [n = 48 (59%)] versus COMB [n = 34 (41%)] compared to acute dietitians [COMB: n = 83 (78%) COMB versus FB or ONS alone: n = 24 (22%)] (N = 207, P < 0.0001). Specialist nutrition support dietitians reported more frequent use of FB or ONS alone [n = 22 (54%)] versus COMB [n = 19 (46%)] compared to nonspecialists [FB or ONS alone: n = 17 (45%) versus COMB: n = 21 (55%)] and other specialist dietitians [FB or ONS: n = 39 (30%) alone versus COMB: n = 89 (70%)] (P = 0.017). The greatest influences on choice were ease of implementation [n = 192 (93%)], departmental protocols [n = 184 (89%)], professional management pathways [n = 179 (87%)] and published research [n = 165 (80%)]. Patient circumstances [n = 117 (57%) and n = 99 (48%)] and ease of implementation [n = 35 (17%) and n = 48 (24%)] were reported as most influential in the first and second case scenarios, respectively. Conclusions: There is a need for further research on approaches to the dietetic management of adult malnutrition. [ABSTRACT FROM AUTHOR]

Abstract: Background: Childhood nutrition is important in optimising growth, development and future health. The present study compared dietary intakes of Australian children aged 4–8 years with (i) Australian Guide to Healthy Eating (AGHE) food group recommendations and (ii) age‐specific Nutrient Reference Values (NRVs), in addition to (iii) describing food group intakes of children meeting key NRVs. Methods: Data were obtained from a representative sample of children (n = 789) from the National Nutrition and Physical Activity Survey between May 2011 and June 2012. Parent‐reported 24‐h recall dietary data were disaggregated into five core food groups, along with energy‐dense, nutrient‐poor (EDNP) foods, with intakes being compared with AGHE recommendations. Food group intakes were compared for children meeting the NRVs for 10 nutrients used for the development of AGHE food groups. Chi‐squared and t‐tests were performed to determine differences in food group intakes with P < 0.05 considered statistically significant. Results: Only one child met the recommended daily servings for all AGHE core food groups and none met both core and energy‐dense, nutrient‐poor (EDNP) food group recommendations. The lowest level of alignment (percentage meeting recommendations) was for vegetables (4.6%) and the highest was for fruit (47.7%). Mean (SD) daily intake of EDNP foods [4.7 (3.2) serves day−1] accounted for 38.4% of total energy intakes. Children meeting key NRVs (n = 395) consumed greater daily servings of fruit [2.2 (1.7)], dairy [2.2 (1.2)] and EDNP foods [5.0 (3.4)] compared to the total sample (n = 789). Conclusions: Significant discrepancies exist between contemporary dietary patterns of Australian children and national recommendations. Future AGHE revisions should incorporate greater diversity of consumption patterns, including sub‐categories of EDNP foods. [ABSTRACT FROM AUTHOR]

Background Diets reduced or low in carbohydrates are becoming increasingly popular. The replacement foods and their accompanying nutrients determine the health effects of such diets. However, little is known about the dietary intake of people consuming reduced or low carbohydrate diets. Methods In this cross-sectional study, the dietary and nutrient intake of individuals aged 16-75 years consuming less than 40% of energy from carbohydrate ( n = 430) was compared with individuals consuming equal to or more than 40% energy from carbohydrate ( n = 1833) using the UK National Diet and Nutrition Survey. Results Those consuming less than 40% of total energy from carbohydrate reported a higher consumption of red and processed meat, butter, oily fish and vegetables, as well as a lower consumption of soft drinks and pulses, than those with a normal carbohydrate intake. After adjusting for socio-economic status, only red meat intake was different between the groups, and reached the maximum recommended daily intake daily intake. There were no significant differences in micronutrient intakes between the groups, although magnesium, selenium and potassium, along with fibre, were lower than recommended amounts across the cohort. Conclusions Individuals consuming reduced or low carbohydrate diets could benefit from replacing some red meats with white meats and vegetable sources of protein, and increasing vegetable intake. [ABSTRACT FROM AUTHOR]

Background Carbohydrate is accepted as the principal nutrient affecting blood glucose in diabetes; however, current guidelines are unable to specify the optimal quantity of carbohydrate for glycaemic control. No studies exist that describe current practice amongst healthcare professionals giving carbohydrate advice in type 2 diabetes. The present study aims to improve understanding of the degree of variation in the current practice of UK registered dietitians ( RDs) by describing how RDs advise patients. Methods UK RDs were contacted through national networks and asked to complete an online survey, which was analysed using stata, version 12 (StataCorp, College Station, TX, USA). Three consultations between dietitians and patients with type 2 diabetes were observed, followed by semi-structured interviews with the dietitians. Results In total, 320 complete survey responses were received. Dietitians' advice varied according to expertise, training and confidence, and the complexity of the patient's blood glucose treatment. Some 48% ( n = 154) of respondents advised patients to restrict carbohydrate intake either occasionally or frequently, with 35.6% ( n = 114) considering 30-39% of total energy from carbohydrate to be a realistic expectation. The overall theme from the interviews was 'Conflicting Priorities', with three sub-themes: (i) how treatment decisions are made; (ii) the difference between empowerment and advice; and (iii) contradictory advice. A disparity existed between what was observed and interview data on how dietitians rationalise the type of carbohydrate advice provided. Conclusions Dietitians' advice varies for a number of reasons. Consensus exists in some areas (e.g. carbohydrate awareness advice); however, clear definitions of such terms are lacking. Clarification of interventions may improve the consistency of approach and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background Patients with chemotherapy-induced neutropenia are at increased risk of infection. Historically, dietary restrictions commonly referred to as 'clean', 'low bacteria', 'low-microbial' or 'neutropenic' diets have been prescribed to reduce the risk of foodborne infection. Although research does not support their effectiveness, they continue to be used in clinical practice. The present study aimed to investigate the use of dietary restrictions in patients with cancer in the UK by surveying registered dietitians ( RDs). Methods An online questionnaire was distributed to 573 RDs via local and specialist interest groups of the British Dietetic Association. Results One hundred and ten questionnaires were returned. Of these, 67.8% of RDs prescribed dietary restrictions to patients, with 'neutropenic diet' being the most commonly used term. Specialist oncology or haematology RDs were more likely to use the diet than nonspecialist RDs ( P < 0.005). The variety of foods restricted varied greatly and was often contradicting. Unpasteurised dairy products and raw or lightly cooked meat or fish were most commonly restricted. Less than half (43.6%) of RDs had a policy in place for the use of neutropenic diets, with specialist oncology and haematology RDs more likely to report this ( P < 0.005). Conclusions Neutropenic dietary advice provided by dietitians in the UK varies greatly. Further high-quality research is required to create an evidence base from which national clinical guidelines can be formed. [ABSTRACT FROM AUTHOR]

Background Energy density ( ED) is a measure of the energy content of a food component or diet relative to a standard unit of weight. Widespread variation in ED assessment methodologies exist. The present study aimed to explore the feasibility of calculating the ED of the Scottish diet using UK food purchase survey data and to identify the most appropriate method for calculating ED for use in the development of a Scottish Dietary Goal that captures any socioeconomic differences. Methods Energy density was calculated using five different methods [food; food and milk; food, milk and energy containing (non-alcoholic) beverages; food, milk and all non-alcoholic beverages; and all food and beverages]. ED of the Scottish diet was estimated for each of the ED methods and data were examined by deprivation category. Results Mean ED varied from 409 to 847 kJ 100 g-1 depending on the method used. ED values calculated from food (847 kJ 100 g-1) and food and milk (718 kJ 100 g-1) were most comparable to other published data, with the latter being a more accurate reflection of all food consumed. For these two methods, there was a significant gradient between the most and least deprived quintiles (892-807 and 737-696 kJ 100 g-1 for food and food and milk, respectively). Conclusions Because the World Cancer Research Fund recommendations are based on ED from food and milk, it was considered prudent to use this method for policy purposes and for future monitoring work of the Scottish Diet to ensure consistency of reporting and comparability with other published studies. [ABSTRACT FROM AUTHOR]

Background Despite evidence that even mild dehydration is associated with various morbidities, water intake estimates in free-living populations are lacking. The present study aimed to estimate water intakes and dietary sources in a nationally representative sample of the Irish adult population. Methods A 4-day semi-weighed food record was used to collect dietary intake data from 1500 free-living adults aged 18-90 years in the Irish National Adult Nutrition Survey ( NANS) (2008-2010) from which water intake was estimated. To enable fluid intake estimation, additional questions on how water and milk were consumed were incorporated. Total water intake was calculated as drinking water plus water from other beverages and food moisture. Results The mean ( SD) daily total water intake for Irish adults was 2.31 (0.92) L day-1 [males 2.52 (1.00) L day-1; females 2.09 (0.79) L day-1]. Intakes were lowest in elderly adults, as well as in those with less education, a lower social class, less energy expenditure and a higher body mass index and body fat percentage. In total, 67% of water came from beverages and 33% came from food moisture. Alcoholic beverages and teas individually contributed to total water intake in amounts similar to the drinking water contribution. Conclusions These data may be used as a foundation for further research in the area of the effect of under consumption of water on health outcomes to guide public health messages regarding adequate water intakes. [ABSTRACT FROM AUTHOR]