Search

Background: A lifelong gluten‐free (GF) diet to manage coeliac disease is recognised to be challenging. This paper comprises two studies: study one aimed to report the opinions of adults with coeliac disease on review provision and explore factors influencing dietary adherence. Study two aimed to report dietetic provision for adults with coeliac disease. Methods: A cross‐sectional online survey was completed by 722 adults with coeliac disease, including validated dietary adherence, health literacy and quality‐of‐life questionnaires. An online and paper survey designed to capture the provision of dietetic services to adults with coeliac disease was completed by 88 dietetic departments within the United Kingdom. Results: Only 26% of adults with coeliac disease were offered annual reviews. In contrast, 85% considered reviews important, with 62% preferring dietetic provision. Those who considered reviews important had lower health literacy, greater dietary burden, poorer GF dietary adherence and lower GF food knowledge (all p < 0.05) compared with those who did not consider reviews important. GF dietary adherence was associated with health literacy, self‐regulatory behaviours, dietary burden and GF food knowledge; 53% agreed with the 'cost of GF food restricts what I eat'; they had poorer GF dietary adherence compared with those who disagreed (p < 0.001). More than 72% of dietetic coeliac review provision provided content on improving access to GF foods and eating out of the home. Conclusions: A subpopulation of adults with coeliac disease have a greater need for support and guidance, which supports the viewpoint that limited resources should be targeted towards patients with the most need for support to enable successful disease management. Key points: The majority of adults with coeliac disease were not receiving healthcare reviews for coeliac disease, whereas 85% would like to have reviews.Adults living with coeliac disease who had lower health literacy, poorer gluten‐free (GF) food knowledge and poorer GF dietary adherence score rated healthcare reviews as important.A varied provision of dietetic services for coeliac disease reviews was evident across the United Kingdom. [ABSTRACT FROM AUTHOR]

Background: As a nutritious food‐providing protein, essential fatty acids, vitamin D, iodine and choline eggs have historically been central to an infant weaning diet. However, food poisoning scares and allergy concerns have contributed to low consumption among infants aged 6–12 months. Methods: This paper presents a secondary data analysis of infant egg exposure and intake using three weaning data sets: a 7‐day food frequency questionnaire (n = 297), a 24‐h recall (n = 180) and a 3‐day weighed food diary (n = 71). Egg introduction, frequency of consumption and intake in grams were analysed for infants aged 6–8, 9–10 and 11–12 months). Comparisons were made by whether infants were following a baby‐led approach to weaning (where infants self‐feed family foods) or a traditional approach where pureed foods are given alongside finger foods. Data were collected in the United Kingdom between 2015 and 2018. Results: Our data showed that despite introduction being recommended from the start of weaning at 6 months of age by the Department of Health, just 54% of infants aged 6–8 months had ever been offered eggs. Average egg intake was one to two times per week, increasing with age. However, in terms of frequency and grams consumed, our data suggest a small increase in consumption compared with previous research, although limitations of our smaller sample size should be noted. Finally, a baby‐led approach was associated with increased exposure and consumption; baby‐led infants consumed eggs twice as frequently as spoon‐fed infants. Conclusions: The findings have important implications for public health messaging and for supporting families in introducing solid foods. Key points: Despite introduction being recommended from the start of weaning at age 6 months, just 54% of infants aged 6–8 months had ever been offered eggs.Only 40% of infants aged 6–8 months and about two‐thirds of those aged 9–12 months had consumed eggs in the last week. Those who had consumed eggs most commonly did so once or twice a week.Infants following a baby‐led weaning approach who self‐feed family foods were introduced to eggs at an earlier stage of weaning and consumed eggs twice as frequently as spoon‐fed infants. [ABSTRACT FROM AUTHOR]

Background Estimates of energy requirements are needed in weight management and are usually determined using prediction equations. The objective of these two systematic reviews was to identify which equations based on simple anthropometric and demographic variables provide the most accurate and precise estimates of (1) resting energy expenditure (REE) and (2) total energy expenditure ( TEE) in healthy obese adults. Methods Systematic searches for relevant studies in healthy adults with body mass index ( BMI) ≥25 kg m−2 and published in English were undertaken using Cinahl, Cochrane Library, OpenGrey, PubMed and Web of Science (completed March 2014). Search terms included metabolism, calorimetry, obesity and prediction equations. Data extraction, study appraisal and synthesis followed guidelines from PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Results From 243 REE papers and 254 TEE papers identified, 21 and four studies, respectively, met the inclusion criteria. (1) The most accurate REE predictions varied with BMI subgroup: WHO (weight and height) ≥25 and ≥30 kg m−2; Mifflin 30-39.9 kg m−2; Henry ≥40 kg m−2. The most precise REE predictions were obtained using Mifflin in BMI 30-39.9 and ≥40 kg m−2, where approximately 75% of predictions were within 10% of measured REE. (2) No accurate or precise predictions of TEE were identified. Conclusions No single prediction equation provides accurate and precise REE estimates in all obese adults. Mifflin equations are recommended in this population, although errors exceed 10% in 25% of those assessed. There is no evidence to support the use of prediction equations in estimating TEE in obesity. [ABSTRACT FROM AUTHOR]

Background Each year, 15 million people worldwide and 110 000 people in England have a stroke. Having a stroke increases the risk of having another. There are a number of additional known risk factors that can be modified by diet. The present study aimed to systematically review key nutrients and diets and their role in secondary prevention, as well as provide evidence-based guidelines for use in clinical practice. The work was conducted as part of the process to develop the 4th edition of the Royal College of Physicians' ( RCP) National Clinical Guideline ( NCG) for Stroke. Methods Questions were generated by the research team, in consultation with the Virtual Stroke Group, an online professional interest group, and the RCP Intercollegiate Stroke Working Party Guideline Development Group. Nine questions covering several individual nutrients and diet combinations were defined and searches conducted up until 31 October 2011 using five electronic databases ( Embase, Medline, Cumulative Index to Nursing and Allied Health Literature ( CINAHL), Cochrane Library and Web of Science). All included studies were assessed for quality and risk of bias using van Tulder criteria for randomised controlled trials ( RCTs) and Quality of Reporting of Meta-analyses (QUORUM) criteria for systematic reviews. Results Of 4287 abstracts were identified, 79 papers were reviewed and 29 systematic reviews and RCTs were included to provide evidence for the secondary prevention components of the guidelines. For each question, evidence statements, recommendations and practical considerations were developed. Conclusions This systematic review process has resulted in the development of evidence-based guidelines for use in clinical practice and has identified areas for further research. [ABSTRACT FROM AUTHOR]

Background Both the prevalence of childhood obesity and the consumption of sugar-sweetened beverages ( SSBs) have increased globally. The present review describes interventions that reduce the consumption of SSBs in children and determines whether this leads to subsequent changes in body fatness. Methods Three databases were searched from 2000 to August 2013. Only intervention control trials, ≥6 months in duration, which aimed to reduce the consumption of SSBs in >100 children aged 2-18 years, and reporting changes in body fatness, were included. The quality of selected papers was assessed. Results Eight studies met inclusion criteria. Six interventions achieved significant ( P < 0.05) reductions in SSB intake, although this was not always sustained. In the two interventions providing replacement drinks, significant differences in body mass index (12- or 18-month follow-up) were reported ( P = 0.001 and 0.045). The risk of being overweight/obesity was reduced ( P < 0.05) in three of the five education programmes but in one programme only for girls who were overweight at baseline and in one programme only for pupils perceived to be at greater risk at baseline. In the one study that included both provision of water and education, the risk of being overweight was reduced by 31% ( P = 0.04) in the intervention group. Conclusions The evidence suggests that school-based education programmes focusing on reducing SSB consumption, but including follow-up modules, offer opportunities for implementing effective, sustainable interventions. Peer support and changing the school environment (e.g. providing water or replacement drinks) to support educational programmes could improve their effectiveness. Home delivery of more suitable drinks has a big impact on reducing SSB consumption, with associated reductions in body weight. [ABSTRACT FROM AUTHOR]

Background Crohn's disease is a debilitating chronic inflammatory bowel disease. Appropriate use of diet and nutritional therapy is integral to the overall management strategy of Crohn's disease. The aim was to develop evidence-based guidelines on the dietary management of Crohn's disease in adults. Methods Questions relating to the dietary management of Crohn's disease were developed. These included the roles of enteral nutrition to induce remission, food re-introduction diets to structure food re-introduction and maintain remission, and dietary management of stricturing disease, as well as whether probiotics or prebiotics induce or maintain remission. A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic database search engines CINAHL, Cochrane Library, EMBASE, MEDLINE, Scopus and Web of Science. Evidence statements, recommendations, practical considerations and research recommendations were developed. Results Fifteen research papers were critically appraised and the evidence formed the basis of these guidelines. Although corticosteroids appear to be more effective, enteral nutrition (elemental or non-elemental) can be offered as an alternative option to induce disease remission. After a course of enteral nutrition, food re-introduction diets may be useful to structure food re-introduction and help maintain disease remission. Dietary fibre is contraindicated in the presence of strictures as a result of the risk of mechanical obstruction. The use of probiotics and prebiotics is not currently supported. Conclusions As an alternative to corticosteroids, evidence supports enteral nutrition to induce disease remission. Food re-introduction diets provide structure to food re-introduction and help maintain disease remission. These guidelines aim to reduce variation in clinical practice. [ABSTRACT FROM AUTHOR]

Background Orofacial granulomatosis ( OFG) is a rare disease of unknown cause. A cinnamon- and benzoate-free diet is successful in up to 72% of patients. Phenolic acids are among the chemical constituents restricted in this diet, which avoids some but not all of these structurally similar compounds. The present study aimed to: (i) develop a novel diet low in phenolic acids; (ii) implement this in a small clinical trial; and (iii) assess its nutritional adequacy. Methods A literature review identified 10 papers quantifying phenolic acids from which 91 10-mg phenolic acid exchanges were devised. A phenolic acid exclusion diet with precautionary micronutrient supplementation was designed and implemented in 10 patients. Phenolic acids were excluded for 6 weeks and were reintroduced at a rate of one exchange every second day for 6 weeks. Wilcoxon matched pairs tests analysed disease outcomes measured by an oral disease severity scoring tool at weeks 0, 6 and 12. Nutritional adequacy was assessed, excluding micronutrient supplementation, at weeks 0 and 6, and compared intakes with dietary reference values. Results The diet was nutritionally inadequate for a range of micronutrients. Seven of 10 patients responded. Mean [standard deviation (SD)] severity scores improved from week 0-6 [20.8 (9.39) and 10.1 (5.72); P = 0.009] and were maintained in five patients who completed the reintroduction [6.6 (3.13) and 7.2 (5.54); P = 0.713]. Conclusions A low phenolic acid diet with micronutrient supplementation holds promise of a novel dietary treatment for OFG. Further work is required in larger studies to determine long-term outcomes. [ABSTRACT FROM AUTHOR]

Background A substantial proportion of individuals who live in community settings in the UK experience malnutrition. Routine screening for malnutrition by healthcare practitioners has been recommended in many regions. The present study aimed to understand community nurses' perceptions of barriers and facilitators to undertaking nutritional screening. Methods A qualitative study was undertaken with a purposive sample of community nurses working in one UK healthcare organisation. Semi-structured interviews were used to elicit perceptions of barriers and facilitators. Interviews were digitally recorded, anonymised and transcribed. Initial codes were assigned for salient constructs identified in the transcripts, refined by grouping, and a thematic list was developed. Results Twenty district nurses and community matrons were interviewed at which time saturation of the data was achieved. Six themes emerged: supportive organisational culture, time and resource to screen and intervene, ease and acceptability of the screening tool, professional judgement as good as screening, the need for training and sharing good practice, and enhancing communication between care settings. Conclusions The findings of the present study suggest that screening is more likely to be completed where an organisation is perceived to have a clear expectation that it is undertaken and also demonstrates this through training and availability of resources. The need for a process or tool that nurses find easy to use and relevant to their practice area was highlighted. Further research should examine the effect of the use of a nutritional screening tool by community nurses on nutritional care planning and intervention. [ABSTRACT FROM AUTHOR]

Background: Dietary guidelines for type 2 diabetes mellitus (T2DM) emphasise weight management and individualised total carbohydrate intake. Evidence on the most effective dietary patterns (DPs) for T2DM management is mixed, potentially leading to variations in the advice that dietitians provide. The present study aimed to explore dietitians' practice of DP advice provision to adults with T2DM, as well as understand their views when advising their patients on the DPs deemed effective for glycaemic management or recommended by current guidelines. Methods: Semi‐structured interviews were conducted with 12 UK‐registered dietitians, with experience in consulting adults with T2DM. Dietitians were asked for their views on five DPs recommended for glycaemic management of T2DM. Interview transcripts were analysed using deductive and inductive thematic analysis. Results: Nine themes were identified that draw attention to DP advice provision practices, the five DPs (low‐carbohydrate, low‐fat, low‐glycaemic index, Mediterranean diet and Dietary Approaches to Stop Hypertension diet), other DPs, the barriers and facilitators to DP advice provision and following this advice, and the factors affecting the provision of DP advice. Participants' current practice of DP advice provision to patients with T2DM was perceived to be individualised and patient‐centred. Participants discussed their current practice and perceptions of available evidence and how patients respond to advice on the DPs shown to be effective for glycaemic management. Several barriers to providing advice on specific DPs, including safety and compliance challenges, were identified. Participants also highlighted factors that would facilitate the provision of advice on specific DPs and would help patients to follow this advice, including social support, educational resources and more robust scientific evidence. Conclusions: The findings of the present study provide important insights regarding dietitians' views of promoting whole DPs to patients with T2DM. Emerged barriers and facilitators should be considered when developing future guidance for dietetic practice to support patients with following whole DPs for T2DM management. [ABSTRACT FROM AUTHOR]

Background: In 2007, a survey of UK dietitians identified that dietitians were positive about the use of Communication Skills for Behaviour Change (CSBC) in practice, although barriers to the implementation of skills were acknowledged. This follow‐up survey aimed to explore current perceptions of CSBC and compare them with the previous survey. Methods: A cross‐sectional online survey of British Dietetic Association (BDA) members' views of CSBC was undertaken. The results for full members are presented. Quantitative data were analysed descriptively. Qualitative data were subject to either content, or inductive thematic analysis. Results: A response rate of 9.4% (n = 729) was achieved. Respondents were predominately female (n = 684; 95.1%) and worked in the National Health Service (n = 634; 87.4%). They were positive about the importance of CSBC in practice (n = 714; 99.5%). Pre‐registration training had been completed by 346 respondents (48.7%). Post‐registration training had been undertaken by 520 (74.7%) respondents and 514 of these (99.6%) had implemented training into practice, with few barriers identified. Perception of ability to use skills had increased, with 513 (83.6%) respondents rating their skills as excellent/very good compared to 62% previously. The majority (n = 594; 93.7%) reported that post‐registration training was necessary, with the need for skills to be regularly reviewed (n = 456; 74.5%), and 235 (51.9%) respondents suggested this be mandatory. By contrast, some suggested that a skill review was not a priority, and would be difficult to administer and stressful. Conclusions: Perception of the importance of CSBC remains high. Although the perceived ability to apply CSBC has increased, the perceived need for post‐registration training is high, with respondents' favouring mandatory training. [ABSTRACT FROM AUTHOR]

Background Existing nutritional guidelines suggest that protein requirements of adults with stage five chronic kidney disease undergoing haemodialysis ( HD) or peritoneal dialysis ( PD) are increased as a result of protein losses during dialysis. The present review aimed to update previous guidance and develop evidence-based practice guidelines on the protein requirements of adults undergoing maintenance dialysis. Methods Following a PICO approach (Participants or Population, Intervention or Exposure, Comparison and Outcome), four research questions were formulated to investigate the total protein requirement and protein quality required by adults undergoing HD and PD. A comprehensive, systematic review was undertaken using the databases Medline, EMBASE and the Cochrane Library from 2005 to September 2009 for HD studies and from 1997 to September 2009 for PD studies. Results The literature search yielded 2931 studies, which were assessed for inclusion. Following appraisal, 19 studies in HD and 18 studies in PD met the inclusion criteria and were systematically reviewed. Limited good quality evidence supports the recommendations that: (i) adults undergoing maintenance HD require a minimum protein intake of 1.1 g kg−1 ideal body weight ( IBW) per day; and (ii) adults undergoing maintenance PD require a minimum protein intake of 1.0-1.2 kg−1 IBW per day, in conjunction with an adequate energy intake. There were no studies that addressed the quality of protein for either HD or PD. Conclusions Evidence suggests that nutritional status may be maintained with lower protein intakes than previously recommended. However, the evidence base is limited and further randomised controlled trials are required to establish the optimal protein intake for dialysis patients. [ABSTRACT FROM AUTHOR]

Background: Snacking is associated with a higher daily energy intake and dietary guidelines recommend snacks of no more than 200 kcal for adults and 100 kcal for children. The present study examines the energy content, nutritional quality and price of single‐serving snack food products sold by major supermarket and coffee shop chains in the UK. Methods: Energy content, nutritional content and price of single‐serving snack products were recorded in 2019 via the websites of 14 major chains (seven supermarkets; seven coffee shops). Results: The mean energy content of all eligible snack products (n = 2283) was 186 kcal [95% confidence interval (CI) = 182–190]. The mean energy content of the snack products sold at coffee shops (n = 379; 282 kcal [95% CI = 269–295]) was significantly higher than the energy content of the snack products sold at supermarkets (n = 1904; 167 kcal [95% CI = 164–170]). Seventy nine % of supermarket snacks exceeded energy recommendations for children and 32% for adults. In coffee shops, 91% exceeded recommendations for children and 73% for adults. Forty one % of snacks were high in fat, 42% were high in saturated fat, 39% were high in sugar and 7% were high in salt. Cheaper snack products were more likely to be of lower nutritional quality. Conclusions: The high proportion of snack products that do not meet public health recommendations for energy content may contribute to the association between snacking and increased energy intake. Public health measures to increase the availability and reduce the price of snack products that meet public health energy content recommendations may reduce population‐level obesity. [ABSTRACT FROM AUTHOR]

Background: Breast milk is the feed of choice for premature infants, although its nutritional composition is not always sufficient to meet their raised nutritional requirements. The addition of a multi‐nutrient breast milk fortifier (BMF) to breastmilk is recommended; however, international guidelines on the use of BMF are inconsistent. The present study aimed to explore the use of BMF in preterm infants by paediatric dietitians in the UK. Methods: A questionnaire was designed and sent to members of the British Dietetic Association neonatal specialist group (n = 100) using a secure online platform. Descriptive statistics were calculated. Results: Forty dietitians completed the survey, all of whom used BMF. Local hospital BMF guidelines were available to 77.5% (n = 31). The most commonly used criteria for commencing BMF were: tolerating a feed volume of 150 mL kg−1 day−1 (72.5%, n = 29), a gestational age <34 weeks (67.5%, n = 27) and a birth weight <1500 g (60%, n = 24). The primary contraindication for the use of BMF was necrotising enterocolitis (NEC). The majority of respondents used standard fortification, with individualised fortification available to only 12.5% (n = 5). The most common indicators for discontinuing BMF were on discharge home (67.5%, n = 27), satisfactory growth (65%, n = 26) or feeding directly from the breast (62.5%, n = 25). Conclusions: Although BMF is used more proactively in UK neonatal units than previously, variation in practice remains. Individualised fortification is very uncommon and caution remains regarding risk of NEC. The development of national guidelines on the use of BMF would help to standardise nutritional care in neonatal units. [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: 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 Price promotions are a promising intervention for encouraging healthier food purchasing. We aimed to assess the impact of a targeted direct marketing price promotion combined with healthy eating advice and recipe suggestions on the purchase of selected healthier foods by low income consumers. Methods We conducted a randomised controlled trial ( n = 53 367) of a direct marketing price promotion (Buywell) combined with healthy eating advice and recipe suggestions for low income consumers identified as 'less healthy' shoppers. Impact was assessed using electronic point of sale data for UK low income shoppers before, during and after the promotion. Results The proportion of customers buying promoted products in the intervention month increased by between 1.4% and 2.8% for four of the five products. There was significantly higher uptake in the promotion month ( P < 0.001) for the intervention group than would have been expected on the basis of average uptake in the other months. When product switching was examined for semi-skimmed/skimmed milk, a modest increase (1%) was found in the intervention month of customers switching from full-fat to low-fat milk. This represented 8% of customers who previously bought only full-fat milk. The effects were generally not sustained after the promotion period. Conclusions Short-term direct marketing price promotions combined with healthy eating advice and recipe suggestions targeted at low income consumers are feasible and can have a modest impact on short-term food-purchasing behaviour, although further approaches are needed to help sustain these changes. [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 The first British Dietetic Association ( BDA) guidelines for the dietary management of irritable bowel syndrome ( IBS) in adults were published in 2012. Subsequently, there has been a wealth of new research. The aim of this work was to systematically review the evidence for the role of diet in the management of IBS and to update the guidelines. Methods Twelve questions relating to diet and IBS were defined based on review of the previous guideline questions, current evidence and clinical practice. Chosen topics were on healthy eating and lifestyle (alcohol, caffeine, spicy food, elimination diets, fat and fluid intakes and dietary habits), milk and dairy, dietary fibre, fermentable carbohydrates, gluten, probiotics and elimination diets/food hypersensitivity. Data sources were CINAHL, Cochrane Register of Controlled Trials, Embase, Medline, Scopus and Web of Science up to October 2015. Studies were assessed independently in duplicate using risk of bias tools specific to each included study based on inclusion and exclusion criteria for each question. National Health and Medical Research Council grading evidence levels were used to develop evidence statements and recommendations, in accordance with Practice-based Evidence in Nutrition Global protocol used by the BDA. Results Eighty-six studies were critically appraised to generate 46 evidence statements, 15 clinical recommendations and four research recommendations. The IBS dietary algorithm was simplified to first-line (healthy eating, provided by any healthcare professional) and second-line [low FODMAP ( fermentable oligosaccharides, disaccharides, monosaccharides and polyols) to be provided by dietitian] dietary advice. Conclusions These guidelines provide updated comprehensive evidence-based details to achieve the successful dietary management of IBS in adults. [ABSTRACT FROM AUTHOR]

Background Probiotics are often taken by individuals with irritable bowel syndrome ( IBS). Which products are effective is unclear, despite an increasing research base. This project will systematically review which strain- and dose- specific probiotics can be recommended to adults with IBS to improve symptoms and quality of life (QoL). It is part of a broader systematic review to update British Dietetic Association guidelines for the dietary management of IBS in adults. Methods CINAHL, Cochrane, Embase, Medline, Scopus and Web of Science were searched for systematic reviews ( SRs) of randomised controlled trial ( RCT)s recruiting adults with IBS comparing probiotic intervention with placebo. AMSTAR, risk of bias and diet bias tools were used to appraise methodological quality. Symptom and QoL data were appraised to develop probiotic-specific evidence statements on clinically meaningful and marginal outcomes in various settings, graded clinical practice recommendations and practical considerations. Results Nine systematic reviews and 35 RCTs were included (3406 participants) using 29 dose-specific probiotic formulations. None of the RCTs were at low risk of bias. Twelve out of 29 probiotics (41%) showed no symptom or QoL benefits. Evidence indicated that no strain or dose specific probiotic was consistently effective to improve any IBS symptoms or QoL. Two general clinical practice recommendations were made. Conclusions Symptom outcomes for dose-specific probiotics were heterogeneous. Specific probiotic recommendations for IBS management in adults were not possible at this time. More data from high-quality RCTs treating specific symptom profiles are needed to support probiotic therapy in the management of IBS. [ABSTRACT FROM AUTHOR]

Background In phenylketonuria ( PKU), little is known about the effect of bitter-tasting phenylalanine-free l-amino acid exposure on taste preference development. The present prospective study aimed to determine the flavour preferences of children with PKU versus healthy control children. Methods Thirty-five children with PKU and 35 age/gender-matched controls, aged 4-13 years, tasted 10 blinded puree foods in random order. They were rated using a seven-point pictorial hedonic scale (super yummy to super yucky) and ranked in preferential order. Caregivers completed a neophobia and food frequency questionnaire on behalf of their children. Results Both PKU and control groups rated sweet foods higher than savoury, bitter and sour foods. However, control children ranked fruits as a group higher than PKU children (mean 3.7 versus 4.6; P = 0.03), whereas PKU children ranked vegetables as a group higher than controls (mean 5.6 versus 6.3; P = 0.05). Children with PKU had more neophobia and were untrusting/fearful of new foods. Conclusions Although there was some evidence to suggest that children with PKU aged ≥4 years prefer savoury foods (vegetables) more than control children, they did not prefer bitter-tasting foods, and so early and persistent administration of bitter-tasting l-amino acids was not associated with apparent taste imprinting. Neophobia appears to play significant part in food refusal in PKU, perhaps more so than taste preferences. [ABSTRACT FROM AUTHOR]

Background In order to achieve metabolic stability, dietary treatment of inborn errors of metabolism may require restriction of protein, fat or carbohydrate. Manipulation of dietary intake potentially reduces micronutrient status, and provision of a comprehensive vitamin and mineral supplement becomes an essential adjunct to dietary treatment. Aim To review the efficacy of a new complete vitamin and mineral supplement [Fruitivits, Vitaflo Ltd] in 14 subjects in an open prospective 26-week study. Method All subjects had dietary restrictions: low protein diets (57%, n = 8), regular daytime cornstarch and overnight glucose polymer tube feeds (29%, n = 4), low fat diet (7%, n = 1) and modified Atkins diet (7%, n = 1). Plasma nutritional biochemistry, anthropometry and food frequency questionnaires were collected at week 0, 12 and 26 weeks respectively. Results Five nutritional parameters showed a significant improvement from baseline (week 0) to study end (week 26): folate ( P = 0.01), vitamin E ( P = 0.04), plasma selenium ( P = 0.002), whole blood selenium ( P = 0.04) and total vitamin D ( P = 0.008). All the other nutritional markers did not significantly change. Even with regular monitoring, 37% of the product remained unused. Conclusions Despite improvements in some nutritional markers, overall use of the vitamin and mineral supplement was less than prescribed. New methods are needed to guarantee delivery of micronutrients in children at risk of deficiencies as a result of an essential manipulation of diet in inborn disorders of metabolism. [ABSTRACT FROM AUTHOR]

Background Ageing is a multifaceted and inevitable process involving a decline in health and well-being that could be ameliorated by dietary modification. We review and discuss the evidence for nutritional interventions that may support healthy ageing. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( PRISMA) guidelines were used to identify randomised controlled trials investigating the role(s) of fatty acids and micronutrients in relation to markers of healthy ageing. Results European dietary surveys suggest that diets in elderly people are generally high in saturated fat, whereas intakes of vitamin D, magnesium, potassium, zinc and copper are below recommended levels. Thirty-four studies meeting the criteria were found, with 12 of these investigating the role of fatty acids and 22 considering intakes of micronutrients in relation to healthy ageing. Overall, these studies suggested that certain nutrients were consistent with healthy ageing; for example, omega-3 fatty acids were helpful for cognitive health, whereas combinations of calcium, vitamin D and K were linked with better bone health. Conclusions Vitamin, mineral and fatty acid intakes are in need of improvement to help elderly populations achieve optimal diet quality and support healthy ageing. This could involve the judicious use of supplements alongside dietary advice. Additional research is needed to determine optimal nutrient doses, combinations and forms in relation to desired health outcomes. [ABSTRACT FROM AUTHOR]

Background Government and health organisations worldwide have recently reviewed the evidence on the role of dietary sugars in relation to health outcomes. Hence, it is timely to review current intakes of dietary sugars with respect to this guidance and as a benchmark for future surveillance. Methods This review collates data from nationally representative dietary surveys across the world and reports estimates of intakes of total and added sugars, and sucrose in different population subgroups. Total sugars includes all mono- and disaccharides; namely, glucose, fructose, lactose, sucrose and maltose. Added and free sugars differ in the quantity of natural sugars included in their definitions. Free sugars include sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates, whereas added sugars typically only refer to those added during processing. Results Most countries reported intakes of total sugars, with fewer reporting intakes of added sugars and sucrose. No country reported intakes of free sugars. The available data suggest that total sugars as a percentage of energy were highest in the infant (<4 years), with mean values ranging from 20.0% to 38.4%, and decreased over the lifespan to 13.5-24.6% in adults. Intakes of added sugars were higher in school-aged children and adolescents (up to 19% of total energy) compared to younger children or adults. Conclusions Further research into the dietary patterns contributing to added sugars intake in children and adolescents is warranted. It would also be beneficial to policy guidance if future dietary surveys employed a uniform way of expressing sugars that is feasible to measure and has public health significance. [ABSTRACT FROM AUTHOR]

Background Dietary intakes of vitamin D are very low in the UK. Dietary calcium is also necessary to promote bone health. The fortification of foods with vitamin D could be a safe and effective way of increasing intake. Methods Diets of preschool children, 755 at 18 months and 3.5 years, from the Avon Longitudinal Study of Parents and Children were assessed using dietary records completed by parents. Energy, vitamin D and calcium intakes were calculated. Multinomial logistic regression was used to estimate the odds ratio for being in the highest/lowest quartile of intake. Intakes were recalculated to test different fortification regimes. Results Vitamin D intakes were low; all children were below the UK and US dietary recommendations. Calcium intakes decreased between the two ages as a result of reduced milk consumption. Children in the lowest quartile for vitamin D intake at 18 months were twice as likely to remain in that quartile at 3.5 years ( odds ratio = 2.35; 95% confidence interval = 1.56-3.55). The majority of foods provide no vitamin D with fat spreads and milk as the main sources. The contribution from breakfast cereals increased, from 6% to 12%, as a result of the increased consumption of fortified cereals. Dairy foods provided the highest contribution to calcium at 18 months but were less important at 3.5 years. Theoretical intakes from different fortification regimens suggest that milk fortified at 2 μg 100 g-1 vitamin D would provide most children with adequate but not excessive intakes. Conclusions Dietary vitamin D intakes were very low and calcium intakes were mostly adequate. Fortification of milk with vitamin D could be a good way to boost intakes. [ABSTRACT FROM AUTHOR]

Background Supportive interventions for enhancing dietary intake in malnourished or nutritionally at risk adults are frequently recommended. A recent systematic review of randomised controlled trials identified limited and poor quality evidence to support their use. Observational studies have been shown to compliment and extend their evidence. This review aimed to synthesise evidence from nonrandomised studies aiming to improve nutritional intake in nutritionally vulnerable individuals and to describe their effects on cost, nutritional, clinical and patient centred outcomes. Methods Systematic searches of 10 electronic databases were undertaken to May 2013. Reference lists of identified studies and systematic reviews were scrutinised and hand searching of relevant meeting abstracts was undertaken. Titles and abstracts were reviewed, data extracted by two research-ers working independently and summarised using a structured narrative format. Results Forty-one studies ( n = 3751 participants) were identified for inclusion. Interventions identified included changes to the organisation of nutritional care ( n = 15), changes to the feeding environment ( n = 11), modification to meals ( n = 6), supplementation of meals ( n = 7) and recipients of home delivered meals ( n = 2). Eighteen of 23 studies reported improvements in nutritional intake; however, effects on nutritional status, clinical outcomes and costs were reported in few studies and findings were inconsistent. Eighteen studies reported patient experience, highlighting benefits to nutritional status most commonly as judged by the carers but the methods used lacked rigour. Conclusions This systematic review describes a range of interventions that may be implemented in clinical practice. A limited range of outcomes are reported and it is difficult to draw any meaningful conclusions on the effect of the different methods. [ABSTRACT FROM AUTHOR]

Background Restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is an effective dietary treatment for irritable bowel syndrome ( IBS). Patient dietary education is essential but labour intensive. Group FODMAP education may alleviate this somewhat but has not previously been investigated. The present study aimed to investigate the clinical effectiveness of low FODMAP group education in patients with IBS and to explore the cost of a group pathway. Methods Patients with IBS ( n = 364) were assessed for their suitability to attend dietitian-led group education or traditional one-to-one education in a novel group pathway. Clinical effectiveness (global symptom question, symptom prevalence, stool output) were compared at baseline and follow-up using the chi-squared test. The costs of the novel group pathway were assessed using a decision model. Results The global symptom question indicated more patients were satisfied with their symptoms following dietary advice, in both group education [baseline 48/263 (18%) versus follow-up 142/263 (54%), P < 0.001] and one-to-one education [baseline 5/101 (5%) versus follow-up 61/101 (60%), P < 0.001], with no difference between group and one-to-one education at follow-up ( P = 0.271). Overall, there was a significant decrease in symptom severity from baseline to follow-up ( P < 0.001 for both groups) but no difference in symptom response between group and one-to-one education. The cost for the group education pathway for all 364 patients was £31 713.36. Conclusions The present study shows that dietitian-led FODMAP group education is clinically effective and the costs associated with a FODMAP group pathway are worthy of further consideration for routine clinical care. [ABSTRACT FROM AUTHOR]

Muscle wasting during critical illness impairs recovery. Dietary strategies to minimise wasting include nutritional supplements, particularly essential amino acids. We reviewed the evidence on enteral supplementation with amino acids or their metabolites in the critically ill and in muscle wasting illness with similarities to critical illness, aiming to assess whether this intervention could limit muscle wasting in vulnerable patient groups. Citation databases, including MEDLINE, Web of Knowledge, EMBASE, the meta-register of controlled trials and the Cochrane Collaboration library, were searched for articles from 1950 to 2013. Search terms included 'critical illness', 'muscle wasting', 'amino acid supplementation', 'chronic obstructive pulmonary disease', 'chronic heart failure', 'sarcopenia' and 'disuse atrophy'. Reviews, observational studies, sport nutrition, intravenous supplementation and studies in children were excluded. One hundred and eighty studies were assessed for eligibility and 158 were excluded. Twenty-two studies were graded according to standardised criteria using the GRADE methodology: four in critical care populations, and 18 from other clinically relevant areas. Methodologies, interventions and outcome measures used were highly heterogeneous and meta-analysis was not appropriate. Methodology and quality of studies were too varied to draw any firm conclusion. Dietary manipulation with leucine enriched essential amino acids ( EAA), β-hydroxy-β-methylbutyrate and creatine warrant further investigation in critical care; EAA has demonstrated improvements in body composition and nutritional status in other groups with muscle wasting illness. High-quality research is required in critical care before treatment recommendations can be made. [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 Patients with liver disease frequently have nutritional problems but intervening to improve these is challenging. Healthcare interventions that respond to patients' needs are associated with better health outcomes but no studies investigating patients' preferences for nutrition-related outcomes in liver disease have been published. The present study aimed to identify nutrition-related health outcomes that are important to patients with liver disease. Methods An electronic questionnaire was devised and reviewed by patients and dietitians with relevant experience. It comprised a Likert scale and open questions focussing on six domains considered pertinent to patients with liver disease. An invitation to participate was posted on the website of a national liver charity and sent to liver patient support groups. Results Fifty-one patients participated (22 men and 29 women). Responses indicated a wide range of preferred nutrition-related outcomes, with those identified as very important most frequently focussing on gaining knowledge about which foods to eat more or less of, as well as on understanding why nutrition is important in liver disease. Women tended to score outcomes as more important than did men. Participants who considered themselves overweight scored outcomes on body size and shape as more important than those with other nutritional problems. Additional outcomes were identified and included an increased knowledge of healthy eating, interactions between medication and food, and supplementation. Conclusions The present study identified a wide range of nutrition-related outcomes that were important to this small sample of patients with liver disease and these may be useful to guide the direction of future nutrition-related management. [ABSTRACT FROM AUTHOR]

Background The present study aimed to explore parental perceptions of overweight children and associated health risks after receiving National Child Measurement Programme (NCMP) weight feedback. Methods Fifty-two parents of overweight and obese children aged 4-5 years and 10-11 years enrolled in the NCMP programme in England in 2010-2011 participated in qualitative, semi-structured interviews about their perceptions of their child's weight and health risk after receiving weight feedback. Interviews were audio tape recorded and were conducted either by telephone ( n = 9) or in the respondents' homes ( n = 41). Interviews were transcribed verbatim and analysed using interpretative thematic analysis. Results Parents who received NCMP written feedback informing them that their child was overweight disregarded the results because they viewed 'health and happiness as being more important than weight'. The feedback was viewed as less credible because it did not consider the individual child's lifestyle. 'Broad definitions of healthy' were described that did not include weight, such as reference to the child having good emotional and physical health and a healthy diet. Parents attributed weight to 'inherited/acquired factors' such as genetics or puppy fat, or did not regard their child's 'appearance' as reflecting being overweight. 'Cultural influence' also meant that being overweight was not viewed negatively by some non-white parents. Conclusions After receiving written weight feedback, parents use methods other than actual weight when evaluating their child's weight status and health risks. Parents' conceptions of health and weight should be considered when communicating with parents, with the aim of bridging the gap between parental recognition of being overweight and subsequent behaviour change. [ABSTRACT FROM AUTHOR]

Background The present study was undertaken to review how much time paediatric dietitians spend in direct contact with patients and to determine what levels of staffing are available throughout paediatric dietetic departments in Ireland and the UK. Methods A work sampling tool was devised to capture paediatric dietetic activity for a period of 1 day. A semi-structured questionnaire was sent to paediatric dietitian managers to provide demographic information on their facility. Results Fourteen questionnaires were returned by paediatric dietitian managers and 86 work sampling tools were returned for analysis by dietitians working in the various departments. Paediatric dietitians spend 23% of the working day in direct patient contact, although up to 58% of the day in direct patient-related activities, of which communication comprised 25.2%. Staffing levels are below clinical recommendations in four out of five specialties. National activity reports focus on the number of patient contacts but do not include information on the complexity of patient care. Conclusions Work sampling is a useful tool in the assessment of activity in healthcare. Inadequate staff levels and limitations in activity reporting in paediatric dietetics will affect estimations for future service developments. Information obtained from the present study could contribute to the supply analysis of a workforce planning exercise in paediatric services in the future. [ABSTRACT FROM AUTHOR]

Background Childhood obesity is a sensitive subject and barriers exist with respect to accessing weight management programmes. Social marketing insight gathering provides an opportunity to understand behaviours and address these challenges. This project gained insight into the views of parents/carers on triggers and barriers to entering a childhood weight management service. Methods Participants were identified from the public using marketing recruitment. Four focus groups were conducted with parents of school aged children ( n = 27) by an experienced interviewer. Twenty two mothers, three fathers and two grandmothers participated, with half describing their child as overweight. Groups discussed health behaviours; attitudes to health messages and weight issues; and motivations, benefits and barriers with respect to accessing weight management services. Discussions were taped and transcribed. Themes were identified using framework analysis of content matrix data analysis. Results Participants were aware of healthy lifestyle messages, although the ability to implement these was variable. Triggers to seeking help included bullying, health concerns and inability to participate in school activities. Barriers included feeling a lack of control, desire to avoid conflict and no proven case that weight was a problem. Parents wished to be given information regarding their child's weight by a trusted person. The Internet and word of mouth were identified as methods of recruitment into a weight management service, with a focus on fitness, fun and friendliness and being free-of-charge. Conclusions Insight gathering can be used to establish parental/carer opinion regarding engaging in childhood weight management services. A fun, friendly programme that is free of charge appealed to parents. Local community involvement around normalising child weight issues may boost referrals into child healthy weight interventions. [ABSTRACT FROM AUTHOR]

Background Widespread subclinical iodine insufficiency has recently been reported in Europe, based on urinary iodine using World Health Organization/ Food and Agriculture Organization criteria, in particular among young women. Although urinary iodine concentration ( UIC) is a useful measurement of the iodine status in a population, it does not provide an insight into the habitual iodine intake of this population. This is compounded by the fact that very few iodine-specific food frequency questionnaires ( FFQ) have been validated so far. The present study aimed to develop and validate a new, simple, rapid survey tool to assess dietary iodine exposure in females of childbearing age. Methods Iodine was measured in a duplicate 24-h urine collection. Iodine intake was measured with duplicate 4-day semi-quantitative food diaries and the FFQ. Correlation, cross-classification and Bland-Altman analyses were used to estimate agreement, bias and the reliability of the method. The triangular (triad) method was used to calculate validity coefficients. Results Forty-three women, aged 19-49 years, took part in the validation of the 17-items FFQ. Median ( interquartile range) UIC was 74 (47-92) μg L−1, which is indicative of mild iodine insufficiency. The FFQ showed good agreement with food diaries with respect to classifying iodine intake (82% of subjects were classified in the same or adjacent quartile). The FFQ was moderately correlated with the food diaries ( rs = 0.45, P = 0.002) and urinary excretion in μg L−1 ( rs = 0.34, P = 0.025) but not in μg day−1 ( P = 0.316). The validity coefficients were 0.69, 0.66 and 0.52 for the food diaries, FFQ and urinary iodine excretion, respectively. Conclusions The FFQ provides a rapid and reliable estimate of dietary iodine exposure to identify those population subgroups at risk of iodine deficiency. [ABSTRACT FROM AUTHOR]

Background Migrants from the Indian subcontinent comprise the largest minority group in the UK. With the process of migration come alterations in lifestyle and eating habits. The present study aimed to disseminate the valuable information, experiences and challenges faced by researchers who conduct studies with ethnic minority groups in the area of diet and nutritional surveys, with an emphasis on migrant South Asians. Methods The findings reported are the result of research carried out during 2008-2012, involving 1100 face-to-face dietary recalls conducted in the UK among South Asian children (aged 1.5-11 years; n = 300) and adults (≥30 years; n = 100). Results Factors to consider when planning and carrying out diet and nutrition survey studies among migrant South Asians were identified and include the employment of culture-specific tools, visual aid reinforcement and the involvement of key community members and translators to facilitate recruitment and data collection. One of the best practices found when working with minority groups was the use of incentives and tangible benefits to reward study participants. It was also found that constant communication and follow-up of the study participants improved the quality of the data and the likelihood of maintaining links with community members for future studies. Conclusions From the results of in-house studies and a revision of practices reported in earlier literature, two 24-h face-to-face dietary recalls are recommended as the optimal method for the dietary assessment of migrant South Asians. To complement this assessment, ethnic-specific food frequency questionnaires such as that developed and successfully implemented among South Asians in the present study must be employed. [ABSTRACT FROM AUTHOR]

Background Snack foods are often high in fat and sugar. Thus, reducing snack consumption may be a useful weight management strategy. However, individuals may snack for a variety of reasons with different implications for intervention. The present study examined the perceived reasons for eating main meals, 'unhealthy' snacks (i.e. snacks high in fat or sugar) and 'healthy' snacks in overweight and obese participants. Methods Over a period of 5 days, 28 males and 27 females completed a food diary every time they ate. As well as providing details about the type of eating episode and food eaten, they also rated their agreement with 13 different reasons for eating (identified from relevant literature and a pilot study). Results Across a total of 1084 eating episodes, 358 were coded as snacks, 79% of which were high in either fat or sugar. The results showed that hunger and temptation (external eating) were reported as a reason for eating unhealthy snacks in 49% and 55% of all episodes, respectively. Eating because the individual was feeling fed up, bored or stressed (emotional eating) was given as a reason in 26% of episodes. Conclusions These findings point to the potential utility of intervention strategies that target cravings, enhance self-control or promote stimulus control. [ABSTRACT FROM AUTHOR]

Background The increased availability of caffeinated drinks raises questions about the level of caffeine that is appropriate for children, as well as the benefits and risks associated with their consumption. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines, this systematic review evaluates evidence from randomised controlled trials investigating the effects of caffeine on cognition, behaviour, mood and exercise performance in children. Observational studies and expert panel guidelines are also discussed. Results One hundred and nine studies were found, with 11 randomised controlled trials and 13 observational studies meeting the criteria. High caffeine intakes (e.g. >5 mg kg-1 body weight day-1) were associated with an increased risk of anxiety and withdrawal symptoms. However, smaller amounts were not linked with such effects and may benefit cognitive function and sports performance based on adult studies. The evidence suggests that children and adolescents should limit daily caffeine consumption to 2.5 mg kg-1 body weight day-1, equating to one or two cups of tea or one small cup of coffee. Lower contributors of caffeine, such as tea, may be more appropriate for children because they contribute to daily fluid intakes and provide flavonoids. By contrast, caffeinated soft drinks may be less suitable options for children as a result of their acidity, higher caffeine content, presence of added sugar (in some cases) and absence of bioactive compounds. Conclusions More studies are needed to determine the intakes that represent a risk and whether there may be benefits for alertness and sports performance with moderate intakes of caffeine. [ABSTRACT FROM AUTHOR]

Background Overweight or obese individuals with type 2 diabetes are encouraged to lose weight for optimal glucose management, yet many find this difficult. Determining whether alterations in dietary patterns irrespective of weight loss can aid glucose control has not been fully investigated. Methods We conducted a systematic review and meta-analysis aiming to determine the effects of a Mediterranean diet compared to other dietary interventions on glycaemic control irrespective of weight loss. Electronic databases were searched for controlled trials that included a Mediterranean diet intervention. The interventions included all major components of the Mediterranean diet and were carried out in free-living individuals at high risk or diagnosed with type 2 diabetes. Network meta-analysis compared all interventions with one another at the same time as maintaining randomisation. Analyses were conducted within a Bayesian framework. Results Eight studies met the inclusion criteria, seven examined fasting blood glucose ( n = 972), six examined fasting insulin ( n = 1330) and three examined Hb A1c ( n = 487). None of the interventions were significantly better than the others in lowering glucose parameters. The Mediterranean diet reduced Hb A1c significantly compared to usual care but not compared to the Palaeolithic diet. Conclusions The effect of alterations in dietary practice irrespective of weight loss on glycaemic control cannot be concluded from the present review. The need for further research in this area is apparent because no firm conclusions about relative effectiveness of interventions could be drawn as a result of the paucity of the evidence. [ABSTRACT FROM AUTHOR]

Background The mainstay of dietary management of food allergies remains the elimination diet. However, the removal of major food groups may predispose children to an inadequate nutrient intake. We therefore set out to establish growth status in food allergic children receiving dietetic input in the UK. Methods Dietitians were approached via the Food Allergy and Intolerance Specialist Group from the British Dietetic Association and asked to submit anthropometrical data for children with food allergies. Data collected related to the systems involved and number of foods excluded. Malnutrition was defined according to World Health Organization standards. Results Data from 13 different centres yielded 97 patients (51 male and 46 female) of which 66 excluded ≤2 foods and 31 excluded ≥3 foods. Data indicated that 8.5% had a weight for age ≤ −2 Z-score and, conversely, 8.5% were ≥2 Z-score. For height for age, 11.1% were ≤ −2 Z-score and, for weight for height, 3.7% were ≤ −2 Z-score and 7.5% ≥2 Z-score. Type of allergy, system involved and specific food elimination did not impact on the level of malnutrition. However, the elimination of ≥3 foods significantly impacted on weight for age ( P = 0.044). Conclusions The present study demonstrates that children with food allergies are more underweight than the general UK population, which appears to be linked to the number of foods excluded. However, the impact of the disease process itself should not be disregarded. Additionally, obesity can also occur in this population despite dietary elimination. [ABSTRACT FROM AUTHOR]

Background Weight management interventions can be extended using mobile telephone technology to deliver support in real-time, real-world settings. The present study aimed to determine whether text messaging helped patients maintain or lose weight following a weight-loss programme. Methods In this controlled study, overweight and obese [ body mass index ( BMI) >30 kg m-2 or >28 kg m-2 with co-morbidities] adults who completed a weight-loss programme participated in an additional 12-week text message intervention [ Lifestyle, Eating and Activity Programme ( LEAP) Beep]. Patients were allocated goals for steps, fruit, vegetable and breakfast consumption. Patients regularly 'texted' their progress and received tailored practitioner feedback. Pre/post-intervention body weight, waist circumference ( WC), BMI, quality of life ( QOL), anxiety and depression measurements were compared retrospectively with a control group offered weight checks only. Results Compared to control ( n = 17), the intervention group's ( n = 17) body weight, WC and BMI reduced significantly (−1.6 versus 0.7 kg, P = 0.006; −2.2 versus 1.5 cm, P = 0.0005; −0.6 versus 0.7 kg m-2, P = 0.03, respectively). QOL and depression scores also improved (−6.8 versus 1 point, P = 0.134; −0.2 versus 0.2 points, P = 0.228). No difference was observed in anxiety scores between the groups. Intervention versus control group follow-up attendance improved significantly (4.4 versus 1.7 attendances, P = 0.0005). Conclusions LEAP Beep promoted losses in weight, WC and BMI, and improved QOL parameters and follow-up attendance. Text messaging is a cheap, portable, convenient and innovative medium facilitating goal setting, self-monitoring and information exchange. Further improvements to automation at the same time as maintaining individual support are necessary to ease practitioner burden. Text messaging offers cost-efficient dietetic input, opening up possibilities for practitioner-to-patient support and yields positive weight outcomes following initial weight loss. [ABSTRACT FROM AUTHOR]

Background Increasing fruit and vegetable consumption is a goal for the UK. Therefore, the effectiveness of a fruit and vegetable voucher scheme coupled with key 'five-a-day' consumption messages as a brief intervention in primary care consultations was assessed in the present study. Methods One thousand one hundred and eighty-eight vouchers as a prescription for fruits and vegetables were routinely distributed to patients attending a primary healthcare centre in a deprived area, and 124 volunteer patients routinely attending the centre were included. Telephone-based questionnaires were used to examine changes in consumption over the short and medium term. Other key aspects assessed in the evaluation related to fruit and vegetable purchasing behaviour, knowledge relating to what constitutes a portion size, the relationship between food and health, and barriers to consumption. Results Although 76.2% of participants used the prescription vouchers when purchasing fruits and vegetables, a significant change in the consumption or purchasing behaviour was not observed ( P > 0.05). Participants' level of knowledge relating to the number of portions recommended and the portion size of different fruits and vegetables showed a moderate increase from baseline over the short and medium term. The primary barriers to fruit and vegetable consumption were reported as 'the quality of fresh fruits and vegetables' and 'the money available to spend on food'. Conclusions The use of 'the fruit and vegetable on prescription' scheme was an effective method of engaging participants in improving awareness of key diet-related health messages. However, further intervention is required to produce a significant impact on the actual behaviour change. [ABSTRACT FROM AUTHOR]

Background Nutritional assessment and dietary intervention, particularly enteral nutrition, are important in the management of Crohn's disease ( CD). National audits have reported that dietetic resourcing in gastroenterology is inadequate. The present study aimed to identify current practice in the nutritional assessment and dietary management of enteral nutrition in CD, as well as investigate the factors that influenced it. Methods A nationwide questionnaire survey adopting complete population sampling of all 296 UK acute hospitals was undertaken aiming to determine dietetic resourcing for gastroenterology. In addition, the case-note review method was used to investigate approaches to nutritional assessment and dietary management of enteral nutrition as treatment for active CD. Results Data were returned from 149 (56%) hospitals, providing assessment and management information on 190 patients. The median number of dietetic sessions dedicated to gastroenterology was 2 per week ( interquartile range 4). Hospitals with five or more sessions per week dedicated to gastroenterology used a greater number of components in their nutritional assessment [mean (SD) 21.5 ( 5.0)] than those with fewer sessions [mean (SD) 19.6 ( SD) 6.1, P = 0.05]. Enteral nutrition was perceived to be effective in 100 (55%) of 182 patients. The major reasons for limited success were poor compliance and inadequate volumes consumed, as well as insufficient treatment duration. Conclusions The components included in a nutritional assessment of CD patients are significantly lower in hospitals with fewer dietetic gastroenterology sessions. Focus on improving compliance and duration of enteral nutrition is urgently required to maximise the success of enteral nutrition in the treatment of CD. [ABSTRACT FROM AUTHOR]

Background It is not possible to measure the height of a patient with contractures in the normal way. On occasions, health professionals need to measure the height directly of patients with contractures because: (i) the patient is unable to report his/her height as a result of a lack of mental capacity and (ii) there is no-one available to report the height or the reported height is obviously inaccurate. Height derived from ulna length is an option but, in some individuals, it can be conspicuously inaccurate. Therefore, we have attempted to develop and validate a simple bedside method using a tape measure. Methods Twenty-four normal healthy adult volunteers were recruited into the study. They were positioned on a hospital bed in three different standardised positions simulating patients with typical contractures. They were measured in each position by four measurers using blanked out tape measures. The participants were then measured standing giving a 'true' height. Ulna length was also measured. Results The mean of the tape-measured heights was 2.3 cm taller than the 'true' height (95% confidence interval = 4.6−9.3). The measurement in all three positions gave an over-estimate of the height, whereas the ulna-derived height gave an under-estimate (2.2 cm). The estimated reliability between measurers (intraclass correlation coefficient) was 0.94 with a 95% confidence interval (0.91-0.96). Conclusions This new method is giving an acceptable estimate of the height of contracted patients with a good inter-rater reliability. It comprises a useful additional tool for measuring the height of people with contractures. [ABSTRACT FROM AUTHOR]

Background The present study examined temporality in the representation of food in two popular British women's magazines between 1950 and 1998. Methods A quantitative content analysis of (i) prevalence of cooking, slimming, nutrition advice in articles; (ii) prevalence of food advertising by food type; and (iii) likelihood of various nutrition and consumer messages in advertising was performed on a sample comprising 200 magazines, with 3045 advertisements and 88 articles. Results The prevalence of food advertisements decreased ( P < 0.001), whereas food articles increased, across decades ( P < 0.001). Cooking tips dominated 1950s food writing (100%), contrasting with miniscule coverage in the 1990s (5%). Slimming advice was not represented in 1950s articles and was most common in 1970s articles (55% of articles). Food advertising for all food types decreased in the 1990s decade. There were greater bread and cereals ( P < 0.001), protein foods ( P = 0.001) and dairy ( P < 0.001) advertising in later decades; advertising for sugar- and fat-rich foods ( P < 0.001), condiments and baking ingredients ( P < 0.001) and beverages ( P < 0.001) was greater in earlier decades. Odds of advertising claims for energy, easy digestion, nourishment, general health, economy, good for family (all P < 0.01), pleased others ( P = 0.017) and convenience ( P = 0.031) were greater in the 1950s and decreased thereafter. Claims around taste and quality were highest in the 1960s (all P < 0.01). Mineral, additive-free, and protein claims were most likely to be invoked in 1970s advertising (all P < 0.01). Low-fat, low-calorie and fibre claims peaked in the 1980s (all P < 0.01), whereas the odds of specific fat claims was greatest in the 1990s ( P = 0.015). Conclusions Representation of food resonated with prevailing food culture but was not always congruent with nutrition policy. [ABSTRACT FROM AUTHOR]

Background Coeliac disease is an autoimmune disorder that is considered to affect approximately one in 100 people. In the UK, gluten-free (GF) foods can be prescribed by general practitioners ( GPs) to treat this condition and there are national guidelines on the quantities of GF food an individual should receive on prescription. Information on actual prescribing behaviour by GPs, and how this compares with guideline recommendations, is scarce. The present study aimed to describe GPs prescribing practice of GF foods, within one locality in the UK, comparing this with national guidelines. Methods A retrospective evaluation of GP electronic medical records for all patients with a gluten-sensitive enteropathy diagnosis and/or those prescribed GF food between April 2010 and March 2011 was carried out in 16 GP practices in the west of Scotland, serving a total of 85 667 patients. Results Of 175 (0.18% of the total practice population) patients, 152 were identified with coeliac disease, eight with dermatitis herpetiformis and six with both conditions. A further nine patients received GF foods on prescriptions with no recorded diagnosis. There was a positive association between adherence to the prescribing guidelines and female sex ( P < 0.0001) and (for those with a recorded diagnosis) increasing age ( P = 0.001). There was no significant association between either socio-economic deprivation or co-morbidities and adherence to the prescribing guidelines. Conclusions There was significant under prescribing of GF foods in those identified. Further research is required to establish whether these results are representative of wider practice in the UK. [ABSTRACT FROM AUTHOR]

Background The prevalence of obesity in adults with intellectual disabilities ( ID) is rising, although the evidence base for its treatment in this population group is minimal. Weight management interventions that are accessible to adults with ID will reduce the inequalities that they frequently experience in health services. This short report compared the effectiveness of weight management in those with and without ID who completed nine sessions of a multi-component weight management programme. Methods TAKE 5 is a 16-week multi-component weight management intervention for adults with ID and obesity [body mass index ( BMI) ≥30 kg m-2]. This intervention is an adaption of the weight management programme provided by the Glasgow & Clyde Weight Management Service ( GCWMS) for adults without ID and obesity ( National Health Service based). Fifty-two participants of the TAKE 5 programme were individually matched by baseline characteristics (sex, age and BMI) with two participants without ID of the GCWMS programme. Comparisons in terms of weight and BMI change and rate of weight loss were made for those who attended all nine sessions. Results There were no significant differences between the groups in the amount of weight loss (median: −3.6 versus −3.8 kg, respectively, P = 0.4), change in BMI (median: −1.5 versus −1.4 kg m-2, P = 0.9), success of achieving 5% weight loss (41.3% versus 36.8%, P = 0.9) and rate of weight loss across the 16-week intervention. Conclusions A multi-component weight loss intervention can be equally effective for adults with and without ID and obesity. [ABSTRACT FROM AUTHOR]

Background Coeliac disease can be controlled only through adherence to a gluten-free diet. This diet is highly restrictive and can be challenging to maintain. It has been linked with elevated levels of psychological distress, including depression, anxiety and social phobia. Methods Narratives on living with coeliac disease were written by 130 adult members of Coeliac UK (mean age 52.7 years; mean time since diagnosis 10.2 years; 67% sample female; 28% male). Qualitative analysis using grounded theory methods identified five key categories: living with widespread ignorance; social invisibility; creating a coeliac community; a changed identity; grief - and accepting the trade-off. Results A psychosocial model of living with coeliac disease was constructed from the findings, the central category of which was the changed identity of those diagnosed with the condition. Grief was experienced in relation to a loss of the former diet, changed personal and social identities, loss of social confidence and loss of social activities. Grief was generally mitigated over time as adjustments were made to changes in identity and lifestyle. Creating (or becoming part of) a coeliac community was a strategy enabling those with coeliac disease to re-establish their identities and increase social recognition and acceptance of the condition. Conclusions Gluten-free living entails a substantial restriction of food choice. The losses and changes entailed impact on the personal and social identities of those living with coeliac disease, and on the behaviour of others towards them. Psychosocial interventions focussed on facilitating coping and adjustment may benefit those experiencing difficulties. [ABSTRACT FROM AUTHOR]

Background Accurate, reliable and feasible methods of dietary intake and physical activity assessment are required to improve our understanding of the associations between energy balance-related behaviours and health. Methods The Synchronised Nutrition and Activity Program ( SNAP™) was developed to enhance recall in children by integrating new and established methods of dietary intake and physical activity recall. A list of commonly consumed foods ( n = 40), drinks ( n = 9) and physical activities ( n = 29) was used in SNAP™. All foods and drinks were analysed by count (i.e. the number of times a particular food was selected), as a proxy indicator of dietary behaviours. All reported physical activities were assigned an intensity code [in metabolic equivalents (METs)] to determine minutes of moderate-vigorous activity ( MVPA; ≥3 METs). Results Most participants completed a whole day's recall (both dietary intake and physical activities) in less than 25 min. SNAP™ was compared against 24-h multiple pass questionnaire and accelerometry in 121 children (aged 7-15 years old). For dietary variables, the accuracy of SNAP™ (mean difference) was within ±1 count for the majority of food groups. The proportion of the sample with a between-method agreement within ±1 count ranged from 0.40 to 0.99. For MVPA, there was no substantial fixed or proportional bias, with a mean difference between methods ( SNAP™ - accelerometry) of −9 min of MVPA. Qualitatively, participants have indicated that they find SNAP™ easy and fun to use. Conclusions SNAP™ was developed to be a simple, quick and engaging method of assessing energy balance-related behaviours at a group or population level and succeeded because it can collect a whole day's recall (dietary intake and physical activities) in less than 25 min to a reasonable and acceptable degree of accuracy. [ABSTRACT FROM AUTHOR]

Background Trainee dietitians, nutritionists, nurses and doctors will direct the future of obesity treatment and prevention. To do so effectively, they must be willing and able to engage empathically with overweight and obese people. The present study aimed to assess weight bias among UK trainee healthcare professionals and to investigate the factors predicting weight bias, both static and potentially modifiable. Methods A self-completed questionnaire collected data on demographics, weight and height, the Fat Phobia Scale ( F-scale), and the Beliefs about Obese People ( BOAP) scale from 1130 students. Results Overall, participants demonstrated significant levels of fat phobia [F-scale score mean ( SD) = 3.8 (0.5)]. Only 1.4% of participants could be said to have expressed 'positive or neutral attitudes' (i.e. achieved a F-scale score ≤ 2.5). Hierarchical multiple regression revealed that lower fat phobia (as measured by the F-scale) was uniquely predicted by a higher self-reported body mass index, being on the Nursing BSc course and a stronger perception that obesity is not under a person's control (as measured by the BOAP scale). Conclusions There are unacceptable levels of weight bias among UK students training to become nurses, doctors, nutritionists and dietitians. The results of the present study suggest that a promising approach for future interventions would be the provision of balanced education about the controllability of obesity, focusing upon genetic and environmental factors, as well as diet and exercise. [ABSTRACT FROM AUTHOR]

Background Role flexibility is considered central to a health policy agenda stressing workforce redesign measures and professional role boundary change. Extensions in health professionals' role boundaries may involve the incorporation of new or 'vacant' roles, as well as the competitive acquisition of others. In the present study, the experiences of dietitians with extended roles in home enteral tube feeding ( HETF) were explored and considered within the context of workforce role transition. Methods Six semi-structured interviews conducted with dietitians specialising in HETF were undertaken and the emergent role development for dietitians in HETF was explored. Results Dietetic HETF roles emerged as a form of diversification, occupying a task 'vacancy', commonly on an opportunistic basis. Role overlap in these community based tasks was negotiated with community nurses, privately funded industry nurses and other medical staff. Notably, role conflict was encountered only with nutrition nurse specialists. Conclusions To date, a lack of role exclusivity in a small and confined speciality field with multiple potential competitors has resulted in surprisingly little role conflict. Financial constraints within the National Health Service are considered likely to favour a privately funded service model of delivery, and this may have implications for dietitians specialising in this field. Dietitians also perceived an increase in professional status as a result of extended roles. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity has significant impact on future health and economic consequences. Evidence of effectiveness of interventions is developing, although little is known about costs. Therefore, the direct costs to health care and other public sector agencies of a pilot community-based childhood obesity treatment programme were estimated. Methods: The present study comprised a retrospective review of resource use of an intervention drawing resources from local government and primary care sectors and delivered across multiple settings. Ninety-six children, aged 8-16 years old; body mass index (BMI) >98th centile; mean BMI SD 3.1 and low quality of life scores attended a 12-month programme delivered by nonhealth professionals. Direct costs to health care and other public sector agencies were assessed. Results: Total programme direct costs were £82 380 (€94 736, $123 569) in the base case or £120 474 (€138 546, $180 713) when venues were treated as real additional costs, and varied only slightly with the number of participants in the programme. Costs per participant were £858 (€987, $1287) in the base case or £1255 (€1443, $1883) when venues were treated as additional costs. Costs per participant were sensitive to the number of participants, varying between £691 (€795, $1037) and £2026 (€2330, $3039) when venue costs were zero and between £1009 (€1160, $1514) and £2978 (€3425, $4467) with venue costs added. Conclusions: It is possible to provide a community-based service at reasonable cost, and probably less than for health professional delivered services. Further work is required to assess the possible effects of the programme on wider service resource use, on users' costs and on programme effectiveness. [ABSTRACT FROM AUTHOR]