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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were satisfied with the structure; however, 26% professionals and 22% students identified content that was lacking or outdated, including mental health and sustainability.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nearly all respondents were satisfied with the scope and content, the results highlighted those topics lacking and/or outdated.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: Breastfeeding is an important public health priority and may be particularly beneficial for medically complex infants and children. However, childhood illness and disability are associated with increased challenges and lower breastfeeding rates. The Baby Friendly Initiative has been shown to increase initiation of breastfeeding and improve health professional skills although as yet the standards have not been adopted in paediatrics. Previous studies have found breastfeeding knowledge gaps among paediatric nurses, and a recent systematic review highlighted insufficient lactation support, discouragement by healthcare professionals and lack of resources. The aim of this survey of UK paediatric professionals was to establish their self‐defined confidence and skills supporting breastfeeding. Methods: An online survey was developed to explore associations between level of training and staff confidence and perceived skill, to establish whether there is evidence that more training and/or higher breastfeeding training credentials improve skill. In total, 409 professionals, including paediatric doctors at all grades, paediatric nurses and allied health professionals, were included in the analysis. Results: This study identified specific skill gaps among professionals. Many healthcare professionals felt that different skills and specific training are required to support medically complex children. Several professionals noted that existing breastfeeding training focuses on establishing breastfeeding in healthy newborns rather than sick children in paediatrics. Participants were asked about 13 clinical competencies, and an aggregate skill score was calculated. Multiple univariate analysis of variance found that more extensive training and higher credentials are correlated with higher skill scores (p ≤ 0.001), whereas type of professional was not. Conclusions: Despite this being a relatively motivated sample of healthcare professionals, the findings of this study suggest that breastfeeding skills are patchy and inconsistent, and particularly lacking when it comes to more complex clinical scenarios. This is significant, because it may mean that children who have more significant illness or medical complexity are disproportionately affected by gaps in knowledge and skill. Medically complex children encounter many barriers to optimal feeding − including absence of designated paediatric lactation staff, resources and support − and may have challenges such as low tone, higher calorie need and transitioning to the breast after ventilation or enteral feeding. Current skill gaps indicate that existing training would be insufficient, and bespoke paediatric breastfeeding training based on identified clinical challenges is thus justified. Key points: Currently, there is no mandatory undergraduate breastfeeding training for paediatric healthcare professionals. Current optional training is weighted towards the initiation of breastfeeding in healthy term infants and supporting breast milk feeding in preterm infants, rather than sick infants and children admitted to paediatrics.Breastfeeding skill gaps in paediatric multidisciplinary healthcare professionals are widespread even in a relatively motivated sample.More extensive breastfeeding training is significantly associated with greater confidence and higher self‐defined skills.Mandatory breastfeeding training for paediatric healthcare professionals should include not only basic breastfeeding principles but also additional training that is nuanced for the needs of the paediatric population. [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 Bioelectrical impedance analysis would be a more practical tool to measure body composition in clinical settings, dietetic practice and epidemiological studies if patients/subjects did not have to fast before measurements. The present study assessed whether the ingestion of food or drink had any biologically significant effect on bioimpedance measurements and body composition by the foot-to-foot method. Methods Fifty-five healthy adults [30 males and 25 females; mean (SD) age 27.7 (7.1) years; mean (SD) body mass index 24 (3.8) kg m−2] were randomly assigned to a 2-day food trial (high-fat meal or high-carbohydrate meal) or a 2-day drink trial (water or high electrolyte drink). Body composition measurements were carried out in the fasting state, immediately after meal consumption and every 30 min for 2 h by the foot-to-foot single frequency bioimpedance technique. Results Bioimpedance increased significantly after the ingestion of food and fluid, although the changes were small. The electrolyte drink, high-fat and high-carbohydrate meals significantly increased the percentage body fat and fat mass. In all cases, the median percentage changes from baseline were approximately 1% in body fat percentage units. Conclusions Although there were statistically significant changes in body composition estimates after food or drink consumption, these were small and within the imprecision of the impedance technique, and so are unlikely to be of clinical significance. The present study suggests that impedance measures of body fatness in clinical settings do not require strict adherence to fasting, and this should increase the opportunities for clinical application. [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 compare the nutritional quality ( NQ) and energy costs ( EC) (£ MJ-1) of own brand ( OB) versus market brand ( MB) foods in 2010 and 2012. Methods A list of processed foods ( n = 32) was identified based on the most frequently consumed foods in the UK. Total fat, saturated fat, sugars, salt and energy density (ED) ( kJ g−1) in 2010 and 2012 were compared for six OB and one MB version of each food using a NQ scoring method based on the Food Standards Agency's Traffic Light System (TLS). Additional information (fruit, vegetable and nut content; protein; fibre and sodium) was recorded in 2012, and NQ was assessed using the Food Standards Agency's nutrient profiling model (NPM). The EC of the food baskets (FB) was compared in 2010 and 2012. Results There were no differences in overall NQ between OB and MB FB in 2010 ( TLS, P = 0.978) or 2012 ( TLS, P = 0.840; NPM, P = 0.696). However, the MB FB was highest in EC in 2010 and 2012 (both P < 0.001). There was an inverse relationship between the ED and EC of the MB foods in 2010 ( r = −0.484; P = 0.005) and 2012 ( r = −0.452; P = 0.009). Conclusions The MB FB was higher in EC than the OB FB in 2010 and 2012 but not superior in overall NQ based on both the TLS and NPM. [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]

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 Effective approaches are needed to address the increasing prevalence of overweight and obesity. The present study investigated whether all meal provision was a more effective and acceptable method for weight loss than a self-directed diet. Methods This randomised controlled trial recruited 112 men and women with a body mass index in the range 27-35 kg m-2, who had no comorbidities, from the local area of Hull. Participants were randomised to receive either meal provision or follow a self-directed diet for a 12-week period that resulted in an estimated 2928 kJ day−1 (700 kcal day−1) deficit. A dietitian supervised both dietary interventions. Results At 12 weeks [mean (SEM)], percentage weight loss in the meal provision group was 6.6% (0.5%) compared to 4.3% (0.6%) for those on the self-directed diet. In terms of clinically relevant weight loss, 61% of participants lost 5% or more of their body weight with meal provision compared to 22% on the self-directed diet ( P < 0.001). Weight loss was associated with wellbeing in both groups. Attrition was less apparent with 7% of those participants receiving meal provision withdrawing from the study compared to 41% of those following the self-directed diet ( P < 0.001). Conclusions Meal provision was a more effective and accepted method for weight loss over a 12-week period compared to a self-directed diet. This may in part represent the difference between being given the meal provision food free of charge. However, longer-term maintenance studies need to be undertaken to ascertain their effects on the maintenance of weight loss. [ABSTRACT FROM AUTHOR]

Background The results of weight maintenance after initial weight loss are reported infrequently, although, when they have been reported, the outcomes are generally poor and weight regain is common. Methods After an initial 12-week randomised intervention comparing all meal provision against a self-directed energy restriction, participants re-consented to participate in a follow-on study. Participants were given the option to choose to continue with the same dietary intervention (either all meal provision (provided free of charge) or self-directed diet) or change to the other diet for a further 12 weeks. Participants were followed up at 4-weekly intervals during both intervention periods (a total of 24 weeks), with a final follow up at 12 months. Results Eighty-five out of 86 individuals who completed the original 12-week randomised phase chose to continue on to the follow-up study. No significant differences in further weight loss between groups ( P = 0.138) [mean (SEM): −3.4% (1.1%) for all meal provision only; −3.4% (0.6%) self-directed then all meal provision; −1.1% (1.2%) all meal provision then self-directed] were seen after a further 12 weeks. Meal provision for a total of 24 weeks resulted in 67% of individuals losing at least 10% body weight. The groups switching from self-directed dieting to meal provision (or vice versa) were the only groups to have a lower mean weight at 12 months than at the start of the follow-on study. Conclusions Structured support for 24 weeks followed by 28 weeks of self-care can result in weight maintenance, with initial weight loss maintained at 12 months from enrolling on a 12-week weight loss intervention, with a 12-week follow-on period. [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]

Objectives There is a lack of published data about the food intake of patients with type 2 diabetes and the changes that they make in response to patient-centred dietary advice. The present study describes the changes reported in response to a nonprescriptive dietary intervention based upon UK dietary guidelines. Methods Two hundred and sixty-two patients (87 women and 175 men) from the Early ACTivity in Diabetes (ACTID) trial who received the dietary intervention returned 4 days food diaries at baseline and 6 months. Nonparametric tests were used to examine changes in meal patterns, total energy intake and energy from food groups between baseline and 6 months. Results Mean (SD) number of reported meals day-1 was 3.0 (0.3) and mean (SD) number of snacks was 1.1 (0.6) at both baseline and 6 months for men and women. Men reported decreasing energy intake by a mean (SD) of 912 (1389) KJ/day [218 (332) kcal day-1] ( P < 0.001) and women by 515 (1130) KJ/day [123 (270) kcal day-1] ( P < 0.001). Men reported reducing energy from alcoholic drinks [−234 (527) KJ day-1; P < 0.001], white bread [−113 (402) KJ day-1; P = 0.001], biscuits [i.e. cookies −67 (205) KJ day-1; P < 0.001] and cakes [−50 (410) KJ day-1; P = 0.0012]. Women reported reducing energy from mixed main meals [−134 (456) KJ day-1; P = 0.036], pasta and rice [−79 (326) KJ day-1; P = 0.019], high-energy drinks [−59 (159) KJ day-1; P = 0.001] and white bread [−59 (368) KJ day-1; P = 0.042]. Conclusions Men and women in the Early ACTID study reported small changes in higher-energy and lower-fibre foods and drinks in response to patient-centred dietary advice. [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 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 There is an increasing emphasis on the development of communication skills for dietitians but few evidence-based assessment tools available. The present study aimed to develop a dietetic-specific, short, reliable and valid assessment tool for measuring communication skills in patient consultations: DIET- COMMS. Methods A literature review and feedback from 15 qualified dietitians were used to establish face and content validity during the development of DIET- COMMS. In total, 113 dietetic students and qualified dietitians were video-recorded undertaking mock consultations, assessed using DIET- COMMS by the lead author, and used to establish intra-rater reliability, as well as construct and predictive validity. Twenty recorded consultations were reassessed by nine qualified dietitians to assess inter-rater reliability: eight of these assessors were interviewed to determine user evaluation. Results Significant improvements in DIET- COMMS scores were achieved as students and qualified staff progressed through their training and gained experience, demonstrating construct validity, and also by qualified staff attending a training course, indicating predictive validity ( P < 0.05). An acceptable level of intra-rater reliability ( rs = 0.90) and a moderate level of inter-rater reliability ( r = 0.49) were demonstrated. Interviews identified many positive features and possible uses for DIET- COMMS in both pre- and post-registration settings. The need for assessor training was emphasised and how readily qualified dietitians would accept assessment of skills in practice was questioned. Discussion DIET- COMMS is a short, user-friendly, reliable and valid tool for measuring communication skills in patient consultations with both pre- and post-registration dietitians. Additional work is required to develop a training package for assessors and to identify how DIET- COMMS assessment can acceptably be incorporated into practice. [ABSTRACT FROM AUTHOR]

Background Being underweight or overweight and obesity at diagnosis may all worsen prognosis in childhood acute lymphoblastic leukaemia ( ALL), although no studies have estimated the prevalence of an unhealthy weight status at diagnosis in large representative samples using contemporary definitions of weight status based on body mass index ( BMI) for age. Methods The present study comprised a retrospective study that aimed to estimate prevalence of being underweight and overweight and obesity at diagnosis for patients with childhood ALL on three successive UK treatment trials: UKALL X (1985-1990; n = 1033), UKALL XI (1990-1997; n = 2031), UKALL 97/99 (1997-2002; n = 898).The BMI for age was used to define weight status with both UK 1990 BMI for age reference data and the Cole-International Obesity Task Force ( IOTF) definitions. Results The prevalence of being underweight was 6% in the most recent trial for which data were available. The prevalence of being overweight and obesity was 35% in the most recent trial when expressed using Cole- IOTF definitions and 41% when expressed relative to UK 1990 reference data. Conclusions Even with highly conservative estimates, >40% of all UK patients with ALL were underweight, overweight or obese at diagnosis in the most recent trial for which UK data are available ( UKALL 97/99, 1997-2002). [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 Accurate estimates of energy expenditure are required in clinical nutrition in order to determine the requirements of individuals and to inform feeding regimes. Calorimetry can provide accurate measurements but is often impractical in clinical or community settings; prediction equations are widely used to estimate resting energy expenditure ( REE) but have limited accuracy. A portable, self-calibrating, handheld calorimeter ( HHC) may offer an alternative way of determining REE. The aim of the study was to evaluate whether estimates of REE derived using an HHC are closer to accurate measurements than values calculated using selected prediction equations. Methods REE was measured in 36 healthy adults aged 21-58 years using a flow-through indirect calorimeter ( FIC) and HHC. Estimated REE was calculated using three predictive equations ( Harris & Benedict; Schofield; Henry). Differences in REE between the 'gold standard' values derived using the FIC and those derived using the HHC and equations were examined using paired t-tests and Bland Altman plots. Results Mean REEHHC was significantly lower than mean REEFIC [4556 ± 1042 kJ (1089 ± 249 kcal) versus 6230 ± 895 kJ (1489 ± 214 kcal), P = 0.000] and also significantly lower than mean values calculated using all three equations. The mean difference between REEHHC and REEFIC [1674 ± 908 kJ (400 ± 217 kcal)] was significantly greater ( P = 0.000) than the mean differences between the values calculated using the three prediction equations [272 ± 490 kJ (65 ± 117 kcal) (Harris-Benedict), 264 ± 510 kJ (63 ± 122 kcal) (Schofield), 84 ± 502 kJ (20 ± 120 kcal) (Henry)]. Conclusions The HHC provides estimates of REE in healthy people that are less accurate than those calculated using the prediction equations and so does not provide a useful alternative. [ABSTRACT FROM AUTHOR]

Background Research has suggested that patients and treatment providers hold different beliefs and models of obesity. This could impact upon the consistency and quality of interventions for weight management. The present study investigated the attitudes and beliefs of health professionals, commercial weight management advisors (expert patients) and overweight and obese dieters, towards obesity. Methods Data were collected using a self-administered questionnaire from 287 health professionals, 85 expert patients and 116 dieters. Respondents gave their views on obesity causation and consequences, and the most efficacious means to manage obesity. Demographic data and self-reported height and weight were also collected. Factor analysis, analysis of variance and t-tests were used to analyse the data. Results Health professionals, expert patients and dieters held similar models of obesity, identifying the same causes (lifestyle causes), consequences (medical consequences) and treatments (current recommended options) of obesity/overweight. Conclusions The findings of the present study indicate a broader similarity between beliefs and attitudes of those involved in obesity treatment and those that they aim to treat than was previously assumed. The concordance of beliefs between patients and treatment providers is an encouraging finding and may have important implications for public health strategies in this area. [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 In a recent study, we showed that nonfood incentives combined with taste exposure increase children's acceptance of vegetables. However, the impact of children's previous experience of receiving food rewards is unknown. The present study investigated whether the experience of food rewards affects responses to an exposure-plus-reward intervention. Methods One hundred and thirty-seven parents of 4-6-year-old children taking part in an exposure-based intervention study completed an instrumental feeding (IF) questionnaire aiming to assess their use of food rewards. Based on these scores, children were categorised as frequently or rarely instrumentally-fed. Intervention groups were given 12 daily tastes of a target vegetable combined with no reward, a tangible reward, (sticker) or a verbal reward (praise). A no-treatment control group received no tastings. Liking and intake of a target vegetable were measured at baseline and post-intervention. Results Irrespective of experience of IF, children in all intervention groups increased liking compared to controls (all P < 0.001) and both reward groups increased intake compared to controls (both P < 0.05). However, in the nonrewarded exposure group, only children with a limited experience with food rewards increased consumption ( P < 0.05). Conclusions Experience of IF may limit the benefits of 'mere exposure'. However, exposure with nonfood rewards can increase the acceptance of vegetables, regardless of previous experience. [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 There is an increasing number of adults with phenylketonuria ( PKU) on a low phenylalanine diet. In the general population, an increasing body mass index ( BMI) in the UK is a major problem with associated co-morbidities. The present study aimed to identify whether patients with diet-treated PKU have obesity rates comparable to those in the general population. Methods Two hundred and thirty-six PKU subjects (49% male, 51% female), aged >16 years, who were diagnosed by newborn screening and were receiving a low phenylalanine diet, were identified from seven metabolic centres in the UK. Retrospective data were collated on age, sex, BMI and mean phenylalanine concentration over the previous 12 months. Results Mean ( SD) phenylalanine concentration for all 236 subjects was 789 (311) μ m; mean ( SD) BMI was 26 (5.4) kg m−2 [males 25 (4.3) kg m−2, females 27 (6.2) kg m−2]; mean ( SD) age was 26 (7) years; and 55% had a BMI > 25 kg m−2. The percentage of subjects with a BMI >25 kg m−2 and >30 kg m−2, as well as increasing obesity with age, was similar to the UK population. A correlation was observed between increasing BMI and a higher phenylalanine concentration ( r = 0.243, P = 0.001). Conclusions The number of overweight and obese patients with diet-treated PKU in the UK is a concern. This could lead to other obesity-related complications increasing the complexity of diet and the cost of their care. There is a need to educate patients with respect to adopting a healthy, low phenylalanine diet and lifestyle to prevent further rises in BMI. [ABSTRACT FROM AUTHOR]

Background: Variations in the practice of artificial nutrition are partly a result of the judgements of clinicians. Little is known about these judgements, the decision processes used or the quality of the decisions that arise. The methodology of clinical judgement analysis describes and explains judgemental differences between clinicians and offers a window into why clinician choices sometimes fail to correspond with current best practice guidelines. Methods: A clinical judgement analysis with 27 clinicians using two judgement tasks was carried out. Clinicians expressed their 'likelihood of feeding' and 'whether or not they would initiate artificial nutrition support' in response to 54 patient scenarios. Measures of agreement between clinicians, the degree of linear reasoning employed, their judgemental consistency and concordance with National Institute for Health and Clinical Excellence (NICE) guidelines were assessed. Results: Clinicians' judgements varied substantially both in the amount of information employed and the weighting given to information. Clinicians had only moderate agreement with NICE recommendations and overestimated the need for artificial nutrition support. Suboptimal judgements were consistently applied by clinicians. When clinicians reasoned in more linear ways, their judgements and decisions improved. Conclusions: Overestimating the need for artificial nutritional support may inflate health service costs and increase risks for patients unnecessarily. A better understanding by clinicians of the information needed (as well as how to use it) for artificial nutrition support initiation may help improve clinical decision-making. [ABSTRACT FROM AUTHOR]

Background Fruit and vegetable-rich diets are associated with a reduced cardiovascular disease ( CVD) risk. This protective effect may be a result of the phytochemicals present within fruits and vegetables ( F&V). However, there can be considerable variation in the content of phytochemical composition of whole F&V depending on growing location, cultivar, season and agricultural practices, etc. Therefore, the present study investigated the effects of consuming fruits and vegetables as puree-based drinks ( FVPD) daily on vasodilation, phytochemical bioavailability, antioxidant status and other CVD risk factors. FVPD was chosen to provide a standardised source of F&V material that could be delivered from the same batch to all subjects during each treatment arm of the study. Methods Thirty-nine subjects completed the randomised, controlled, cross-over dietary intervention. Subjects were randomised to consume 200 m L of FVPD (or fruit-flavoured control), daily for 6 weeks with an 8-week washout period between treatments. Dietary intake was measured using two 5-day diet records during each cross-over arm of the study. Blood and urine samples were collected before and after each intervention and vasodilation assessed in 19 subjects using laser Doppler imaging with iontophoresis. Results FVPD significantly increased dietary vitamin C and carotenoids ( P < 0.001), and concomitantly increased plasma α- and β-carotene ( P < 0.001) with a near-significant increase in endothelium-dependent vasodilation ( P = 0.060). Conclusions Overall, the findings obtained in the present study showed that FVPD were a useful vehicle to increase fruit and vegetable intake, significantly increasing dietary and plasma phytochemical concentrations with a trend towards increased endothelium-dependent vasodilation. [ABSTRACT FROM AUTHOR]

Background: Manipulation of dietary fibre intake represents a longstanding treatment for patients with irritable bowel syndrome (IBS), particularly for those with constipation. Linseeds are often recommended by both clinicians and dietitians as a source of dietary fibre to alleviate symptoms. Recent guidance on the management of irritable bowel syndrome (IBS) advises that linseeds may reduce wind and bloating, although there is limited clinical evidence to support this recommendation. The present pilot study aimed to compare the clinical effectiveness of: (i) whole linseeds versus ground linseeds; (ii) whole linseeds versus no linseeds; and (iii) ground linseeds versus no linseeds in the management of IBS symptoms. Methods: In an open randomised controlled trial, subjects with IBS ( n = 40) were allocated to one of three intervention groups: two tablespoons of whole linseeds per day ( n = 14), two tablespoons of ground linseeds per day ( n = 13) and no linseeds as controls ( n = 13). Symptom severity (primary outcome) and bowel habit were assessed before and after a 4-week intervention and statistical differences between the groups were compared. Results: Thirty-one subjects completed the present study. Between-group analysis comparing the improvement in symptom severity did not reach statistical significance for whole linseeds ( n = 11) versus ground linseeds ( n = 11; P = 0.62), whole linseeds versus controls ( n = 9; P = 0.12) and ground linseeds versus controls ( P = 0.10). There were no significant changes in stool frequency or stool consistency for any of the groups. Conclusions: Linseeds may be useful in relief of IBS symptoms. Further research is needed to detect clear differences between the effects of whole and ground linseeds. [ABSTRACT FROM AUTHOR]

Background: Women of lower educational attainment tend to have poorer quality diets and lower food involvement (an indicator of the priority given to food) than women of higher educational attainment. The present study reports a study of the role of food involvement in the relationship between educational attainment and quality of diet in young women. Methods: The first phase uses six focus group discussions ( n = 28) to explore the function of food involvement in shaping the food choices of women of lower and higher educational attainment with young children. The second phase is a survey that examines the relationship between educational attainment and quality of diet in women, and explores the role of mediating factors identified by the focus group discussions. Results: The focus groups suggested that lower food involvement in women of lower educational attainment might be associated with negative affect (i.e. an observable expression of negative emotion), and that this might mean that they did not place a high priority on eating a good quality diet. In support of this hypothesis, the survey of 1010 UK women found that 14% of the effect of educational attainment on food involvement was mediated through the woman's affect ( P ≤ 0.001), and that 9% of the effect of educational attainment on quality of diet was mediated through food involvement ( P ≤ 0.001). Conclusions: Women who leave school with fewer qualifications may have poorer quality diets than women with more qualifications because they tend to have a lower level of food involvement, partly attributed to a more negative affect. Interventions to improve women's mood may benefit their quality of diet. [ABSTRACT FROM AUTHOR]

McCarthy H., Dixon M., Crabtree I., Eaton-Evans M. J. & McNulty H. (2012) The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) for use by healthcare staff. J Hum Nutr Diet. 25, 311-318 Abstract Background: The early identification of malnutrition and nutrition risk through nutrition screening is common practice in adult clinical care but, in children, this has been hampered by the lack of an appropriate nutrition screening tool. The present study aimed to develop and evaluate a simple, child-specific nutrition screening tool for administration by non-nutrition healthcare professionals. Methods: In a two-phase observational study, significant predictors of nutrition risk were identified using a structured questionnaire. These were then combined to produce a nutrition screening tool. For evaluation purposes, the reliability, sensitivity and specificity of the newly-developed Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) were estimated by comparing the classification of nutrition risk using the tool with that determined by a full nutritional assessment by a registered dietitian. Results: A total of 122 children were recruited for development phase and a separate cohort of 238 children was recruited for the evaluation phase. Low percentile weight for age, reported weight loss, discrepancy between weight and height percentile and recently changed appetite were all identified as predictors of nutrition risk. These predictors, together with the expected nutrition risk of clinical diagnoses, were combined to produce STAMP©. Evaluation of STAMP© demonstrated fair to moderate reliability in identifying nutrition risk compared to the nutrition risk classification determined by a registered dietitian (κ = 0.541; 95% confidence interval = 0.461-0.621). Sensitivity and specificity were estimated at 70% (51-84%) and 91% (86-94%), respectively. Conclusions: The present study describes the development and evaluation of a new nutrition screening tool specifically for use in a UK general paediatric inpatient population. [ABSTRACT FROM AUTHOR]

How to cite this article Wiskin A.E., Owens D.R., Cornelius V.R., Wootton S.A. & Beattie R.M. (2012) Paediatric nutrition risk scores in clinical practice: children with inflammatory bowel disease. J Hum Nutr Diet. 25, 319-322 Abstract Background: There has been increasing interest in the use of nutrition risk assessment tools in paediatrics to identify those who need nutrition support. Four non-disease specific screening tools have been developed, although there is a paucity of data on their application in clinical practice and the degree of inter-tool agreement. Methods: The concurrent validity of four nutrition screening tools [Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), Screening Tool for Risk On Nutritional status and Growth (STRONGkids), Paediatric Yorkhill Malnutrition Score (PYMS) and Simple Paediatric Nutrition Risk Score (PNRS)] was examined in 46 children with inflammatory bowel disease. Degree of malnutrition was determined by anthropometry alone using World Health Organization International Classification of Diseases (ICD-10) criteria. Results: There was good agreement between STAMP, STRONGkids and PNRS (kappa > 0.6) but there was only modest agreement between PYMS and the other scores (kappa = 0.3). No children scored low risk with STAMP, STRONGkids or PNRS; however, 23 children scored low risk with PYMS. There was no agreement between the risk tools and the degree of malnutrition based on anthropometric data (kappa < 0.1). Three children had anthropometry consistent with malnutrition and these were all scored high risk. Four children had body mass index SD scores < −2, one of which was scored at low nutrition risk. Conclusions: The relevance of nutrition screening tools for children with chronic disease is unclear. In addition, there is the potential to under recognise nutritional impairment (and therefore nutritional risk) in children with inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

How to cite this article: Halliday V., Porock D., Arthur A., Manderson C. & Wilcock A. (2012) Development and testing of a cancer appetite and symptom questionnaire. J Hum Nutr Diet. 25, 217-224 Abstract Background: Poor appetite and weight loss are common in patients with cancer, contributing to an increase in morbidity and mortality. Early identification of those at greatest risk is problematic. The Council on Nutrition Appetite Questionnaire (CNAQ) is short and easy to use, although it is not specific to cancer populations. The present study aimed to build on the CNAQ to develop a cancer appetite and symptom questionnaire (CASQ) for predicting weight loss in patients with cancer. Methods: The content validity of the CNAQ was assessed by an expert panel ( n = 41) using the content validity index (CVI). The resulting CASQ was tested for reliability among patients receiving radiotherapy ( n = 34). Predictive validity of the CASQ was determined in patients with lung or upper gastrointestinal cancer ( n = 185), comparing CASQ scores (possible range 0-48) recorded at baseline with percentage weight change after 12 weeks. Results: In all but one CNAQ item, the CVI was above the minimum level of agreement (>0.70). Comments from expert panel members led to minor modifications and the introduction of new items resulting in the 12-item CASQ. The intraclass correlation coefficient of the CASQ was 0.80 [95% confidence interval (CI) = 0.68-0.92] and the difference between total scores at two time points was −0.20 (95% CI = −1.21 to 0.80). The optimum cut-off point of the instrument to predict >10% weight loss was 29/30 (area under curve = 0.75; sensitivity 71%, specificity 66%, positive predictive value 19%, negative predictive value 95%) [Correction added on 30 April 2012, after first online publication: in the preceding sentence, <10% was corrected to >10%]. Conclusions: The CASQ can predict weight loss among patients with lung and upper gastrointestinal cancer. Acknowledgment of the low positive predictive value is needed if the instrument is to be used within clinical practice. [ABSTRACT FROM AUTHOR]

How to cite this article Daly A., Gokmen-Ozel H., MacDonald A., Preece M.A., Davies P., Chakrapani A. & McKiernan P. (2012) Diurnal variation of phenylalanine concentrations in tyrosinaemia type 1: should we be concerned? J Hum Nutr Diet. 25, 111-116 Abstract Background: Tyrosinaemia type 1 (HT1) is treated with a tyrosine and phenylalanine-restricted diet, amino acids free of phenylalanine and tyrosine, and nitisinone (NTBC). Treatment guidelines recommend plasma tyrosine between 200-400 μ m and phenylalanine at least >30 μ m. There is little information on the diurnal variation of plasma tyrosine or phenylalanine in HT1. Low plasma phenylalanine <30 μ m may be associated with poor growth and cognitive delay. The present study aimed to document diurnal variation of tyrosine and phenylalanine plasma concentrations and growth in children with HT1. Methods: Median tyrosine and phenylalanine plasma concentrations were reviewed retrospectively over 3 years in 11 subjects (median age 4 years) with HT1. Subjects routinely collected morning fasting blood samples but afternoon nonfasted samples were taken in the clinic (<10% of samples). Growth Z-scores were calculated. Results: The percentage of all plasma phenylalanine concentrations <30 μ m was 8.6% and <40 μ m was 13.6%. Only 2% of fasting morning phenylalanine concentrations were <30 μ m, compared to 83% of nonfasting afternoon samples. All but one child had a height Z-score <0. Conclusions: Blood phenylalanine concentrations were consistently lower in the afternoon. Taking blood samples at variable time points in the day may lead to variation in interpreting dietary control. A detailed study is necessary to examine the 24-h diurnal variation of plasma phenylalanine and tyrosine in HT1. It is possible that phenylalanine concentrations may be very low for a substantive time over 24 h and the potential impact that this may have on cognitive development and growth in children is unknown. [ABSTRACT FROM AUTHOR]

How to cite this article Madden A.M., Tsikoura T. & Stott D.J. (2012) The estimation of body height from ulna length in healthy adults from different ethnic groups. J Hum Nutr Diet. 25, 121-128 Abstract Background: Assessments of nutritional status frequently incorporate a measure of height to evaluate a person's relative thinness or fatness. Because height is often difficult to quantify, it may be predicted from alternative anthropometric measurements, including ulna length. Little information is available about the accuracy of these predictions in an ethnically diverse population. The present study aimed to evaluate published equations for predicting height from ulna length in adults from different ethnic groups. Methods: Ulna length and standing height were measured in a gender-stratified sample of 60 Asian, 69 Black and 65 White healthy volunteers, aged 21-65 years. Height was predicted from ulna length using the Malnutrition Universal Screening Tool (MUST) equations and compared against the measured values. Linear regression analysis was used to develop equations to estimate height from ulna length and to explore the relationship between height and ulna length in subgroups. Results: The mean (SD) age for Asian, Black and White in men was 31.7 (11.0), 32.0 (10.3) and 38.6 (12.5) years and in women was 26.2 (5.4), 32.6 (8.9) and 35.7 (11.7); the mean (SD) height in men was 170.9 (5.2), 178.1 (7.3) and 176.3 (7.7) cm and in women was 157.7 (4.7), 164.0 (5.9) and 163.7 (6.2) cm. Ulna length and measured height were significantly correlated among all subgroups, except Asian women ( r = 0.11, P = 0.57). The mean (SD) difference between predicted and measured height showed significant overestimates for Asian and Black men [4.0 (4.8) and 6.7 (5.3) cm] and Asian and Black women [6.4 (4.9) and 4.4 (4.9) cm] but not for White men and women. Conclusions: The MUST equations for predicting height from ulna length in healthy adults should be used with some caution among ethnically diverse populations, particularly in Asian women. [ABSTRACT FROM AUTHOR]

How to cite this article Power B.T. & Lennie S.C. (2012) Pre-registration dietetic students' attitudes to learning communication skills. J Hum Nutr Diet. 25, 189-197 Abstract Background: Communication is a core skill and a prerequisite for dietitians' clinical competence. It is generally acknowledged that communication skills can be taught and learned. There is a paucity of published work identifying dietetic students' attitudes towards learning communication skills, and understanding this is important. Methods: The present cross-sectional study aimed to address this issue using an adapted version of the Communication Skills Attitude Scale (CSAS), which was designed to capture information concerning positive and negative attitudes to learning communication skills. An online questionnaire was sent to all undergraduate and post-graduate dietetic programmes in the UK. Results: Of the students' solicited for enrolment in the study, 33.4% ( n = 300) completed the questionnaire. A one-way analysis of variance showed attitudes to learning communication skills differed significantly between years of study on both subscales of the CSAS. Subsequent analyses indicated that first-year students' attitudes to learning communication skills were significantly more positive than those of fourth-year students ( P = 0.042). Third-year students had significantly more positive attitudes to learning communication skills than fourth-year students ( P = 0.028). Negative attitudes were also linked to the year of study with fourth-year students having significantly more negative attitudes than third-year students ( P = 0.046). Sex, practice placement experience and parental occupation did not significantly influence attitudes to learning communication skills. Conclusions: These findings indicate that efforts are required to maintain positive attitudes to learning communication skills. Further longitudinal studies are recommended in this respect. [ABSTRACT FROM AUTHOR]

Background: The risk of nutritional deficiency in children on restrictive dietary treatments and a lack of ketogenic diet (KD)-specific UK supplements raises concerns about micronutrient status. Vitamin A, E, zinc, selenium and magnesium levels were therefore examined in children with intractable epilepsy treated with the KD. Methods: Plasma vitamins A and E, zinc, selenium and magnesium levels were measured at baseline and after 3, 6 and 12 months on the classical ( n = 46) or medium chain triglyceride (MCT) ( n = 45) KD in children aged 2-16 years, as part of a randomised trial, and pairwise comparisons with baseline were performed. Results: Data were available from 91 children. From baseline to 12 months, mean plasma vitamin A decreased from 1.41 μmol L−1 to 1.13 μmol L−1 in the classical group ( P < 0.001) but increased from 1.52 μmol L−1 to 1.81 μmol L−1 in the MCT group ( P < 0.001). Mean plasma vitamin E increased from 22.7 μmol L−1 to 33.2 μmol L−1 in the classical group ( P < 0.001) and from 22.3 μmol L−1 to 23.3 μmol L−1 in the MCT group ( P < 0.05). No significant change in plasma zinc was seen at 12 months, although mean plasma selenium decreased from 0.95 μmol L−1 to 0.88 μmol L−1 in the group as a whole ( P < 0.05). Mean plasma magnesium decreased from 0.87 mmol L−1 to 0.83 mmol L−1 in the group as a whole ( P < 0.001); when subdivided by KD type, this was limited to the classical group. Conclusions: Changes in plasma vitamins A and E and the decline in magnesium status after 12 months of KD treatment suggest that micronutrient status may be suboptimal in this group and that available formulations for KD supplementation may need reviewing. [ABSTRACT FROM AUTHOR]

Background: In children with phenylketonuria (PKU), the daily weighing of the phenylalanine allowance from food is advocated. There is a need to develop nonweighed methods of measuring dietary phenylalanine, aiming to ease caregiver burden and possibly improve dietary adherence. The accuracy of three methods (household measures, digital photographs and weighing) for measuring 50-mg phenylalanine exchanges for PKU was investigated in a randomised, controlled trial. Methods: There were 51 volunteers (32 females; 19 males; median age: 34 years, range 13-77 years), who were all unconnected with PKU. For three consecutive days, all volunteers attended a research centre and, each day, were randomly allocated a different method (household measures, digital photographs and weighing) for phenylalanine exchange measurement. On each day, they measured the amount of food equivalent to one 50-mg phenylalanine exchange for 24 common foods. All phenylalanine exchange samples (3672 samples) were then reweighed by the investigators. Results: No method of measuring 50-mg phenylalanine exchanges was accurate when used by volunteers. The median percentages (range) of all food samples within 10% of target were only 67% (41-98), 44% (4-96) and 41% (4-98) for weighing, household measures and photographs, respectively. The respective median (range) of samples within 20% of the target weights were: 96% (51-100) weighing, 82% (10-100) photographs and 80% (6-100) household measures. No noteworthy difference in accuracy was observed between household measures and photographs. Conclusions: Volunteers not associated with PKU could not measure 50-mg phenylalanine exchanges accurately using weighing, household measurements or photographs. Therefore, it is important to consider developing methods for improving accuracy of measurement of 50-mg phenylalanine exchanges in PKU. [ABSTRACT FROM AUTHOR]

Background: A gluten-free diet is the only treatment for patients with coeliac disease, although it can be burdensome to follow and result in inadequate nutrient intake. The cost and availability of a gluten-free diet has been cited as a cause of incomplete dietary compliance; however, this has not been extensively investigated. The aim was to investigate the availability and cost of gluten-free foods across a wide range of stores. Methods: The availability and cost of 20 foods (both wheat-based and everyday foods) was surveyed at 30 different stores across five different store categories. For each of the 20 foods, four products were selected (branded gluten-free, cheapest gluten-free, branded standard, cheapest standard) resulting in sampling of up to 80 products in each of the 30 stores. Results: In general, there was limited availability of gluten-free foods, with an average of 8.2 of the 20 (41%) foods being available in a gluten-free version per store. Regular supermarkets had a greater availability (18.0/20, 90%), whereas budget supermarkets (1.8/20, 9%) and corner shops (1.8/20, 9%) had almost no gluten-free versions ( P < 0.001). All 10 gluten-free versions of wheat-based foods were more costly than their standard counterparts (76-518% more expensive; P < 0.001). Some gluten-free versions of everyday foods were also more costly than standard counterparts (2-124%). Conclusions: There is limited availability of gluten-free foods and they are generally more expensive than their standard counterparts. This may impact on compliance to a gluten-free diet, with potential nutritional and clinical consequences, together with an increased risk of complications. [ABSTRACT FROM AUTHOR]

Background: Weight loss in patients with cancer is common and associated with a poorer survival and quality of life. Benefits from nutritional interventions are unclear. The present study assessed the effect of dietary advice and/or oral nutritional supplements on survival, nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma. Methods: Participants were randomly assigned to receive no intervention, dietary advice, a nutritional supplement or dietary advice plus supplement before the start of chemotherapy. Patients were followed for 1 year. Survival, nutritional status and quality of life were assessed. Results: In total, 256 men and 102 women (median age, 66 years; range 24-88 years) with gastrointestinal ( n = 277) and lung ( n = 81) cancers were recruited. Median (range) follow-up was 6 (0-49) months. One-year survival was 38.6% (95% confidence interval 33.3-43.9). No differences in survival, weight or quality of life between groups were seen. Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks, although this was independent of nutritional intervention. Conclusions: Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life. Weight gain predicted a longer survival but occurred independently of nutritional intervention. [ABSTRACT FROM AUTHOR]

Mothers who breastfeed use lower levels of control over later child diet. The baby-led nature of breastfeeding may encourage this low control to develop. Alternatively maternal desire for control may drive breastfeeding duration. The present study explored whether differences in maternal control are present during milk feeding and whether these stem from or drive breastfeeding duration. Five hundred and two mothers with an infant aged 6-12 months completed a modified retrospective version of the child-feeding questionnaire adapted to reflect milk feeding during the first 6 months post-partum. Participants were recruited from mother and baby groups and online parenting forums. Mothers recalled their use of encouraging intake and scheduling feeds in relation to their infant's intake of milk. Attitudes towards breastfeeding were also measured, including views that breastfeeding is inconvenient, difficult and that formula-fed infants were more content. Compared to mothers who formula-fed or ceased breastfeeding within 1 week, mothers who breastfed for at least 6 months recalled a lower use of scheduling and encouraging milk feeds. Mothers who initiated breastfeeding but ceased within 1 week reported lower control compared to exclusive formula feeders. A high level of scheduling feeds was associated with considering that breastfeeding was inconvenient and a greater perceived infant size, whereas encouraging feeds was associated with considering that breastfeeding was difficult, low maternal confidence and a smaller perceived infant size. Maternal desire for control may drive breastfeeding duration. A controlling maternal feeding style may therefore be dispositional and present much earlier than current studies suggest. [ABSTRACT FROM AUTHOR]

Many children with rare chronic disorders require home enteral tube feeds (HETF) consisting of multiple modular ingredients. Feeds are often complex and the risk of errors during their preparation is high. The consequences of over- or under-concentration can be critical. The aim of the present prospective observation study was to assess the accuracy, skills and technique of caregivers when preparing and administering HETF. Fifty-two HETF patients (median age 7.5 years, range 0.7-18.0 years) with inherited metabolic disorders (IMD) requiring special feeds were recruited. Using observation and a structured questionnaire, a practical assessment of feed preparation and storage by the main caregiver was undertaken by an independent dietitian and nurse in the child's home, including hygiene practices, accuracy of measuring recipe ingredients, and storage of both ingredients and prepared feeds. The majority (85%; n = 44) of feeds were based on >1 ingredient (median 3; range 1-6). Almost half (48%; n = 25) of caregivers measured feed ingredients inaccurately. Of the 31% ( n = 16) using scoops, 31% used incorrect measuring spoons and 25% did not level scoops appropriately. Some 45% ( n = 20/44) of carers measured liquid ingredients inaccurately. Hygiene practices during feed preparation were poor, including a lack of hand washing (31%: n = 16) and incorrect storage procedures for unused feed ingredients (56%; n = 29). Practices in the preparation of modular HETF for children with IMD were not ideal. A combination of inaccuracy, poor hygiene, inappropriate storage, and long feed hanging times increases both metabolic and microbial risk. Better education, regular monitoring and the development of ready-to-use or preweighed ingredients would be beneficial. [ABSTRACT FROM AUTHOR]

Professional face-to-face contact is known to be beneficial in effective weight management, but costly, in supporting weight maintenance. Within the UK, studies have examined using the Internet to achieve weight loss; however, there is a need to evaluate the use of dietetic intervention via e-mail to support the maintenance of weight loss in a National Health Service (NHS) setting. The present study aimed to assess the effects of dietetic support through e-mail on weight loss maintenance on individuals who were successful in weight loss. Fifty-five patients, who had lost ≥5% body weight, were assigned to either an intervention group (weekly e-mail messages and monthly personal e-mail message with reporting of weight, n = 28) or a control group ( n = 27). The level of weight maintenance, plus dietary changes and the ability to maintain a level of activity, were recorded after 6 months. At 6 months, the e-mail group maintained an average weight loss of 10%, which was significantly ( P = 0.05) greater than the mean percentage weight loss maintained by the control group (7.3%). The control group regained weight at a statistically significant greater velocity ( P = 0.02) than the intervention group. There were correlations between the amount of fruits and vegetables ( P = 0.07) eaten and exercise episodes ( P = 0.01) against weight change in maintenance. The present study showed that dietetic support using e-mail can be used effectively in reducing weight gain velocity and assisting in the maintenance of weight loss. It is a system that can be used in the UK NHS to reach many people. [ABSTRACT FROM AUTHOR]

An abstract of the article "The availability and cost of a milk-free diet for cow's milk protein allergy," by S. P. Shah and R. Towell is presented.

An abstract of the article "A text message-based weight management intervention for overweight adults," by E. L. Donaldson and S. Fallows is presented.

An abstract of the article "The influence of portion size and plate waste on meeting nutrition standards in a day centre for older people," by M. Pudsey, J. Taylor and A. Knight is presented.

An abstract of the article "Estimating energy requirements in obese and non-obese patients: a survey of dietetic practice in the United Kingdom," by D. Judges, E. Graham, A. Knight, and L. Goff is presented.

Weight gain in the first year of university has been consistently reported in the USA. In a recent study, moderate-risk drinkers had a greater increase in BMI during the first semester than low-risk or non-drinkers. Moderate-risk drinkers were also more likely to be overweight compared with low-risk drinkers or non-drinkers (Lloyd-Richardson et al., 2008). However, there has been limited research on British students to date. The aim of this study was to investigate whether alcohol intake affected weight or diet in a sample of first year British university students. An observational prospective cohort study was conducted using a random sample of undergraduate students; randomisation was achieved by approaching every third person on the main university campus to request participation in the study. Participants completed a validated food frequency questionnaire (EPIC-Norfolk, Date Unknown) to assess alcohol intake and diet prior to university and 6 months later. Nutrients were analysed using McCance and Widdowson's: The Composition of Food (2002) and Food Portion Sizes (Crawley, 1994). An analysis of all major macronutrients was undertaken as well as salt and fruit and vegetable intake. Weight and height were measured to assess change in body weight and body mass index. Data analysis was undertaken using excel and SPSS (version 17.0). Change in body weight, dietary intake and alcohol units per week were analysed using paired t-tests to identify within subject difference. Independent t-tests were used to analyse gender differences in weight gain and alcohol intake. Spearman's rank and/or Pearson's correlation co-efficient were used to test the relationship between alcohol intake and change in body weight, dependent on data distribution. Ethical approval was granted by the University of Plymouth's ethics committee. Twenty participants enrolled at baseline and 15 completed both stages of the study. Of the participants who completed both stages of the study, eight were male and seven were female. Mean age of participants was 19.3 years. Eleven students increased their alcohol intake and 13 gained weight. Alcohol intake increased by 19.6 (25.1) units per week ( P = 0.009) and weight increased by 1.99 (3.08) kg ( P = 0.03). Increase in alcohol intake was significantly higher in males compared with females [39.8 (29.2) units per week and 5.6 (7.6) units per week respectively ( P = 0.04). Weight gain was significantly higher in females than males 3.40 (3.09) kg and 0.73 (2.51) kg respectively]. Alcohol intake was not associated with weight gain in this population sample. There were no significant differences between daily total energy, carbohydrate, fat, protein or salt intake at baseline compared to follow-up; the differences were −37.1 (1071.6) kcal; −23.1 (169.5) g; −5.5 (41.5) g; −11.9 (30.0 g); −1.48 (3.7) g respectively. Fruit and vegetable intake decreased by 2.6 (3.4 portions per day ( P = 0.01). Findings from the present study support the trend in student weight gain documented elsewhere (Lloyd-Richardson et al., 2008). Unexpectedly, an increase in alcohol intake was not associated with weight gain in the population studied, which is inconsistent with previous findings (Economas, 2008). However, limitations include a small sample size and potential reporting bias. Therefore, results may not be representative of student populations elsewhere. The observed weight gain could be explained by under reporting or differences in physical activity. Further research with a more comprehensive alcohol estimation questionnaire is recommended to support this evidence. Education about healthy eating and alcohol consumption may also benefit the student population. The observed weight gain in the first 6 months of university was not associated with the observed increase in alcohol intake. Crawley, H. (1994) Food Portion Sizes, 2 edn. London: Stationary Office Books. Economos, C.D. Hildebrandt, M.L. & Hyatt, R.R. (2008) College freshman stress and weight change: differences by gender. Am. J. Health Behav., 16-25. EPIC-Norfolk (Date unknown) 'Food Frequency Questionnaire'. Available at: (Acessed 20 September 2009). Lloyd-Richardson, E.E., Lucero, M.L., DiBello, J.R., Jacobson, A.E. & Wing, R.R. (2008) The relationship between alcohol use, eating habits and weight change in college freshmen. Eating Behav., 504-508. McCance & Widdowson (2002) The Composition of food, 6 edn . UK: Food Standards Agency. Royal Society of Chemistry. [ABSTRACT FROM AUTHOR]

There is currently much interest in the role of probiotics in the modulation of colonic microflora to improve host health (Parvez, 2006) The probiotic strain Bifidobacterium animalis ( B. animalis) DN-173010 contained in a leading brand probiotic yogurt, claims to exert health benefits with the daily consumption of this product over 2 weeks. The aims of this study are to confirm results of previous studies showing consumption of B. animalis reduces oro-caecal transit time (OCTT) (Agrawal et al., 2008). Secondly to determine whether any change in OCTT occurs during the 3 week consumption of yogurt containing B. animalis. This study was a randomised, controlled, unblinded parallel trial. Participants were recruited via e-mail using convenience sampling. Participants ( n = 9) consumed either Activia containing B. animalis (n = 5) or a non-probiotic yogurt ( n = 4) for 3 weeks. OCTT was measured using a hydrogen breath analyser. Fibre intake, gastrointestinal habits such as stool type and frequency were collected through participant self reporting. Data was analysed using a Mann-Whitney U-test and Paired T-test, possible correlations were investigated using a Spearmans rho test. The control group had a higher mean OCTT (127.5 min) compared with the probiotic group with a mean OCTT of (97.0 min) however this was not a significant difference ( P = 0.381) The control group on average had a higher fibre intake (181 ± 92 g per week) compared with the probiotic group consuming (148.6 ± 32 g per week) however this difference was not significant ( P = 1.000). No correlations were found between OCTT and fibre intake ( P = 0.370) or stool type ( P = 0.310) and frequency ( P = 0.780). No significant change in symptoms between the groups was observed. The findings suggest consumption of B. animalis within this brand of yoghurt had no significant impact on OCTT therefore this study did not confirm findings from other studies. Nonetheless the impact of any probiotic strain on OCTT is still unknown as the microbiota within the caecum is different compared to the colon where the majority of probiotic research is conducted. This study cannot comment into the impact of B. animalis on other transit time parameters. These findings suggest the consumption of B. animalis had no impact on OCTT or any other GI parameter. This study was conducted using a small sample however much of the evidence conducted investigating OCTT used a small sample size, therefore more evidence is required. Agrawal, A., et al. (2008) Clinical trial: the effects of a fermented milk product containing Bifidobacterium lactis DN-173 010 on abdominal distension and gastrointestinal transit in irritable bowel syndrome with Constipation. Aliment. Pharmacol. Ther. , 104-114. Parvez, S., Malik, K.A., Ah Kang, S. & Kim, H.-Y. (2006) Probiotics and their fermented food products are beneficial for health. J. Appl. Microbiol., 11711185. [ABSTRACT FROM AUTHOR]

Subjective Global Assessment (SGA) had been recommended by the Renal Association (Wright & Jones 2010) as an appropriate nutritional screening tool for the detection of malnutrition in haemodialysis (HD) patients. However, it has been criticised for being time consuming (Kondrup et al. 2003) and lacking sensitivity (Kalantar-Zadeh et al.1999). The Patient Generated Subjective Global Assessment (PG-SGA) requires the patient to complete part of the screening tool; thus reducing the amount of time the dietitian spends completing it. A recent pilot project showed that, compared to SGA, PG-SGA was able to distinguish significant differences between several independent measurements of nutritional status (demonstrating construct validity) (Hyam et al., 2010). In contrast the Malnutrition Universal Screening Tool (MUST) did not identify risk of malnutrition in HD patients. The aim of the current project was to assess a greater number and range of patients (with respect to nutritional status) using the three tools, in order to confirm whether PG-SGA was the most appropriate nutritional screening tool for use in HD patients. The nutritional status of 65 HD patients ( n = 43 male; n = 22 female) attending two renal units; St Georges and Canterbury, was assessed by one investigator at each unit (KF and RP respectively). There was no exclusion criteria, however investigators aimed to assess a greater proportion of patients with suspected malnutrition (identified by SN and SR) as this group was possibly under-represented in the previous study. Data included SGA, MUST, PG-SGA, grip strength, anthropometric and biochemical parameters. Construct validity was examined using ANOVA to compare differences between the nutritional values of those patients classified by the nutritional screening tools as being at no risk, moderate risk or high risk of malnutrition. Criterion validity was assessed using the kappa statistic to measure the level of agreement between SGA (as the gold standard), PG-SGA, and MUST. SGA classifications of nutritional status were able to distinguish significant differences in: Albumin ( P = 0.03); CRP ( P = 0.023), hand grip strength ( P = 0.001), average daily energy intake ( P = 0.005), protein intake ( P = 0.01) and haemoglobin ( P = 0.0001). PG-SGA only identified significant differences in hand grip strength ( P = 0.008) and mid arm circumference ( P = 0.024). MUST identified differences in current BMI ( P = 0.04), mid arm circumference ( P = 0.005) and CRP ( P = 0.03). A moderate kappa statistic (0.51) was recorded when comparing the level of agreement between PGSGA and SGA classifications of patients. Virtually no agreement was found between SGA and MUST (( = 0.07). The sensitivity of PG-SGA compared to SGA was 89% and the specificity was 50%. When MUST was compared to SGA the sensitivity was 31% and the specificity was 95%. The majority (63%) of patients were unable to complete the PG-SGA; which were then completed with the assistance of the investigators. MUST poorly identify malnourished HD patients (as found previously by Hyam et al., 2010). However in contrast to the pilot study, this current study which included a larger more nutritionally diverse group of patients, indicated that SGA was more sensitive to changes within independent nutritional parameters than PG-SGA. Over half the patients were not able to complete the PGSGA so, contrary to expectations, there were no time savings. SGA appears to be more sensitive to the nutritional status of HD patients than PG-SGA and additionally a large proportion of HD patients find PG-SGA too difficult to complete. MUST is not a sensitive method for detecting malnutrition in this group of patients. Hyam L., JacksonH., Hart K. & EngelB. (2010) Comparison of the new patient generated subjective global assessment with current established methods in haemodialysis patients. J. Hum. Nutr. Diet., 317-331 (abstract). Kalantar-Zadeh K., Don B. R., Rodriguez R. A. & Humphreys M. H. (2001) Serum ferritin is a marker of morbidity and mortality in haemodialysis patients. Am. J. Kidney Dis. , 564-572. Kondrup J., Allison S. P., Elia M., Vellas B. & Plauth M. (2003) ESPEN Guidelines for nutritional screening. Clin. Nutr. , 415-21. Wright M. & Jones C. (2010) Clinical practice guidelines; nutrition in Chronic Kidney Disease. Available online at: [Accessed on 6 August 2010]. [ABSTRACT FROM AUTHOR]

An abstract of the article "Oily fish consumption in young adults: current intakes, knowledge, barriers and motivations," by K. Adolphus and S. Baic is presented.