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Aims: This study aimed to identify and evaluate tools and resources used to support the implementation of workplace healthy food and drink policies, primarily in Australia and New Zealand. Methods: A scoping grey literature review included searches of government agencies and non‐governmental organisations' websites in six English‐speaking countries, public health nutrition intervention databases and Google search engine queries. Paper‐based and digital tools were included if they were written in English, referred to within a policy or on a policy's website, and primarily targeting supply‐side stakeholders. Tools were evaluated on two domains: 'Features' (summarised descriptively) and 'Usability and Quality' (with inter‐rater reliability scores calculated using an intraclass correlation coefficient). Results: Twenty paper‐based tools were identified relating to Australian (n = 14) and New Zealand (n = 6) policies, and a further six digital tools were identified from Australia (n = 3) and Canada (n = 3). Target audiences included workplace managers, food providers and suppliers. The paper‐based tools focused on general implementation guidance. In contrast, digital tools tended to support specific elements of policy implementation. 'Usability and Quality' scores ranged from 2.9 to 4.5 (out of 5.0) for paper‐based tools, and 3.9 to 4.2 for digital tools, with a moderate agreement between reviewer scores (intraclass correlation coefficient 0.523, p = 0.010). Conclusions: A range of tools have been developed to support the implementation of workplace healthy food and drink policies. Understanding the strengths and limitations of current tools will assist in developing improved aids to support policy implementation. [ABSTRACT FROM AUTHOR]

Aim: Funding cuts to the aged care industry impact catering budgets and aged care staffing levels, which may in turn affect the nutritional status of aged care residents. This paper reports average food expenditure and trends in Australian residential aged care facilities (RACFs). Methods: This is a retrospective study collecting RACFs’ economic outlay data through a quarterly online survey conducted over the 2015 and 2016 financial years. Results: Data were compiled from 817 RACFs, representing 64 256 residential beds and 23 million bed‐days Australia‐wide. The average total spend in Australian Dollars (AUD) on catering consumables (including cutlery/crockery, supplements, paper goods) was $8.00 per resident per day (prpd) and $6.08 prpd when looking at the raw food and ingredients budget alone. Additional data from over half the RACFs (n = 456, 56%) indicate a 5% decrease in food cost ($0.31 prpd) in the last year, particularly in fresh produce, with a simultaneous 128% ($0.50 prpd) increase in cost for supplements and food replacements. Current figures are comparatively less than aged care food budgets internationally (US, UK and Canada), less than community‐dwelling older adults ($17.25 prpd) and 136% less than Australian corrective services ($8.25 prpd). Conclusions: The current spend on food in RACFs has decreased compared with previous years, reflecting an increasing reliance on supplements, and is significantly less than current community food spend. [ABSTRACT FROM AUTHOR]

Aim: To inform future training and professional development for individuals who measure, analyse and interpret dietary intake data. Methods: A cross‐sectional online survey was distributed via e‐newsletter to members of Dietitians Australia, Dietitian Connection and Nutrition Society Australia. The survey included 37 questions on three key areas of practice: (a) methods used to assess dietary intake, (b) barriers faced when conducting dietary intake assessment and (c) resources needed to optimise collection, analysis and interpretation of dietary intake data. Results: Of 173 responses, 103 respondents provided complete data over 2 weeks. Of these, 76% were APDs. The majority (90%) indicated that dietary assessment was important in their role. Respondents (63%) undertook dietary assessments to inform individual/patient care. When assessing intakes, the majority (79%) were interested in examining food/food group intakes. Paper based methods were most commonly used and diet histories, food frequency questionnaires and 24‐hour recalls were the most frequently used methods. The biggest barrier identified to implementing dietary assessment methods into practice was participant burden. Over a third of respondents reported they had received specific training on selecting an appropriate dietary assessment method. The majority of respondents (83%) believed having access to a dietary assessment methods toolkit would be useful. Conclusion: Survey findings provide insight into the need for further capacity building strategies, including professional development to improve collection, analysis and interpretation of dietary intake for Australian nutritionists and dietitians. The creation of online resources could help overcome identified barriers and provide a link to best practice methodologies and contemporary tools. [ABSTRACT FROM AUTHOR]

Aim: This paper provides an overview of the consumption of dairy foods by Australian children and their contribution to nutrient intake, diet quality and optimal health. Practical approaches to meet the recommended intake of dairy foods are also presented. Methods: A computerised search was conducted of English language papers on PubMed. Additional papers were identified by searching references in relevant papers and book chapters. Results: A high proportion of Australian children do not meet the dietary requirements for calcium or the recommended intake of dairy foods. The consumption of dairy foods is critical for meeting calcium requirements while providing significant amounts of other nutrients. Studies demonstrate that dairy food consumption is important for growth, building peak bone mass and prevention of osteoporosis and bone fracture. While there is evidence that dairy food consumption may play a role in other diseases, that is, obesity and hypertension, there are limited studies in children. Various barriers may limit intake thus effective behavioural interventions need to be developed. Conclusions: Diets including recommended amounts of dairy foods can help maximize peak bone mass, minimize bone loss and promote overall health. Dieticians are integral in educating children and their parents and caregivers who are key in encouraging children to consume recommended amounts of dairy foods. [ABSTRACT FROM AUTHOR]

Aim: To measure the amount of different types of food and food packaging waste produced in hospital foodservice and estimate the cost associated with its disposal to landfill. Method: A foodservice waste audit was conducted over 14 days in the kitchens of three hospitals (15 wards, 10 wards, 1 ward) operating a cook‐chill or cook‐freeze model with food made offsite. The amount (kg) of plate waste, trayline waste and packaging waste (rubbish and recycling) was weighed using scales and the number of spare trays and the food items on them were counted. Waste haulage fees ($AU0.18/kg) and price per spare tray item were used to calculate costs associated with waste. Results: On average there was 502.1 kg/day of foodservice waste, consisting of 227.7 kg (45%) plate waste, 99.6 kg (20%) trayline waste and 174.8 kg (35%) packaging waste. The median number of spare trays was 171/day, with 224 items/day on them worth $214.10/day. Only 12% (20.4 kg/day) of packaging waste was recycled and the remaining 88% (154.4 kg/day) was sent to landfill along with food waste at two hospitals. Overall 347.3 kg/day was sent to landfill costing $62.51/day on waste haulage fees, amounting to 126.8 tonnes and $22 816.15 annually. Conclusion: A substantial amount of waste is generated in hospital foodservices, and sending waste to landfill is usual practice. Australia has a target to halve food waste by 2030 and to achieve this hospital foodservices must invest in systems proven to reduce waste, solutions recommended by policy advisors (e.g., waste auditing) and waste diversion strategies. [ABSTRACT FROM AUTHOR]

Aim: This research aimed to use a consensus process to develop a framework and definition for nutrition and dietetic research, and to identify dietetic research priorities for Australia for the period 2020 to 2030. Methods: A three‐round Delphi process was selected to enable dietitians with demonstrated research expertise to contribute to the national priority development. All Fellows of the Dietitians Association of Australia, Advanced Accredited Practising Dietitians and research leaders were invited to participate (n = 84). The questionnaire was distributed electronically using a 7‐point Likert scale. Rounds 1 and 2 asked participants to comment on the proposed research framework, definition of dietetic research and to rate a set of priorities categorised within seven themes. Fields were available for comments for revisions to each section. Approval was considered when ≥70% of participants ranked priorities as Agree or Strongly agree. In Round 3, participants were asked to rank the resultant priorities within themes. Results: Through this Delphi process, Australian dietitians with demonstrated expertise contributed to and confirmed a framework and definition for dietetic Research. A ranked list of 15 priorities within five themes for dietetic Research in Australia for the period 2020‐2030 was developed: Healthy ageing; Vulnerable populations; Food systems and health/nutrition promotion; Informatics and evidence based practice and Achieving a balance between prevention and treatment approaches. Conclusions: It is anticipated that results will lead to the development of a research strategy to focus future dietetic research efforts, including the development of professional position papers as well as informing research competencies for dietetic education. [ABSTRACT FROM AUTHOR]

Aim: Poorly controlled gestational diabetes mellitus can result in negative pregnancy and delivery outcomes. A reduced need for insulin was documented in the validation of American gestational diabetes Nutrition Practice Guidelines, which recommend at least three dietitian visits. No Australian gestational diabetes mellitus nutrition guidelines exist. This paper evaluates the implementation of a dietetic model of care based on the American guidelines in an Australian hospital. Methods: The implementation plan consisted of a nine‐month pre (usual care)/post (new model of care) design with a month for ‘integration’ across 2012–2013. Primary outcomes were uptake of the new dietetic model of care and requirement for pharmacotherapy. Results: Both phases ran for seven months; integration required four months. Pre‐intervention, only one woman received a review appointment. Significantly more women received best‐practice care post‐implementation (P = 0.02); of the 162 women seen, 50.6% received two review appointments. As a result of heavy clinical demand, only 31.5% of the women seen post‐implementation received an individual dietitian assessment and education session, deviating from best practice. Clinically relevant changes were seen in medication requirements with a decrease in women requiring pharmacological treatment (31.1% (pre); 26.9% (post)). The difference was more pronounced in women who received best‐practice care (27.2% (no) vs 25.0% (yes)). Conclusions: This project successfully increased the proportion of women seen according to best practice. Service limitations impaired the delivery of optimal care. The present study illustrates the opportunities and challenges of conducting evidence‐based implementation research in routine clinical care. [ABSTRACT FROM AUTHOR]

Aim: Regulation on food marketing to children is a recommended response to childhood obesity rates. Policy requires country‐relevant criteria to determine which foods are eligible to be advertised. This study aims to compare six nutrition profiling models for use in food marketing regulation in Australia. Methods: Advertisements on the outside of buses in five suburban Sydney transport hubs were photographed. Food and beverages advertised were analysed using the Health Star Rating; three models developed for food marketing regulation: the Australian Health Council guide and two World Health Organization models; the NOVA system; and the Nutrient Profiling Scoring Criterion used in Australian advertising industry codes. The proportion and types of products advertised on the buses that would be permitted by each of the six models were then analysed. Results: A total of 603 advertisements were identified. Of those, over a quarter of the advertisements were for foods and beverages (n = 157, 26%) and 2.3% (n = 14) for alcohol. Among the food and non‐alcoholic beverage advertisements, 84% were for unhealthy foods according to the Health Council guide. The Health Council guide would permit 31% unique foods to be advertised. The NOVA system would permit the least proportion of foods to be advertised (16%), while the Health Star Rating (40%), and Nutrient Profiling Scoring Criterion (38%) would permit the most. Conclusion: The Australian Health Council guide is the recommended model for food marketing regulation because it aligns with dietary guidelines by excluding discretionary foods from advertising. Australian governments can use the Health Council guide to develop policy in the National Obesity Strategy to protect children from marketing of unhealthy food. [ABSTRACT FROM AUTHOR]

Aims: To investigate whether members of the public read blogs for the purpose of accessing healthy eating information; examine demographic predictors of healthy eating blog readership, specifically education, gender, age, body mass index, and residential location; and explore the reasons for reading, and not reading, healthy eating blogs. Methods: This study used a cross‐sectional online self‐reported survey design collected over three time points (round 1: December 2017–March 2018, round 2: August 2018–December 2018, round 3: December 2021–March 2022). The total sample of participants comprised of 238 respondents with a mean age of 46 years old, who mostly reported gender as female (82%), being educated with a university degree (69%), and predominantly resided in urban and city areas (84%). Results: Fifty‐one percent of respondents reported reading healthy eating blogs, suggesting that consumers were proactively seeking healthy eating information through this avenue. Participants who identified as female were 3.2 times more likely to read healthy eating blogs. Commonly, healthy eating blogs were read to receive practical information that aligned with current food choices. The main reason participants reported not reading healthy eating blogs was not thinking about using them (29%). Conclusions: Understanding who is seeking healthy eating information through blogs, and their reasons doing so, is important to continue research into the potential effectiveness of blogs as a platform to communicate healthy eating and nutrition messages. This study provides direction for further investigation into how dietetics professionals could effectively use blogs to disseminate healthy eating information and positively influence consumer food choices and dietary intake. [ABSTRACT FROM AUTHOR]

Aim: To develop and pilot a tool to evaluate Australian dietitians' and student dietitians' ethical and professional practice using social media. Methods: A Social Media Evaluation Checklist was developed based on checklist development literature with a four‐staged process. Stage one included a literature review and input from an expert panel to ensure content validity. Stages two and three were to ensure face validity by categorising the checklist and pilot testing the tool. Instagram profiles and posts were audited by two authors using the checklist in the final stage to analyse ethical and professional use. An account purposely created for this study was used, and the first 25 dietitian and first 25 student dietitian profiles identified using the key words 'dietitian', 'student dietitian' and 'dietitian student' and the hashtag '#australiandietitian' were reviewed. Results: A total of 50 Instagram profiles and 250 posts were audited based on seven categories; (1) financial disclosure, (2) cultural awareness, (3) evidence‐based information, (4) transparency, (5) privacy/confidentiality, (6) professionalism and (7) justifiability. Areas for improvement included advertising transparency which was met in only 12% of dietitian posts, and the provision of evidence‐based information, which was met in 56% of dietitian posts and 72% of student dietitian posts. Conclusions: This study provides insight into the ethical and professional use of social media by Australian dietitians and dietetics students. With the evolving nature of social media, guidance is required. This will ensure dietitians remain, now and in the future, the credible source of nutrition information for the public. [ABSTRACT FROM AUTHOR]

Aims: To identify the origin of fresh and minimally processed foods served to hospital patients, and explore the challenges and enablers to local food procurement in hospitals. Methods: A mixed methods study was conducted in a healthcare network in Victoria, Australia. Packaging labels and product information were used to audit fresh and minimally processed foods purchased in 1 week. Processed food items and meals made offsite were not audited. Interviews were conducted with patients, staff and suppliers to explore their perspectives towards local food in hospitals. Framework analysis was used to identify themes. Results: Of 105 food products audited, 32% were imported, 25% were 'local' from Victoria and the remaining 43% were from within Australia (excluding Victoria). Qualitative interviews revealed several challenges including: increased cost of local food items, inconsistent supply and variable quality of local produce, difficulty accessing origin information, and lack of autonomy for hospitals to make food procurement choices. Enablers included: conducting a food origin audit to increase awareness, group purchasing organisation prioritising local food suppliers, and suppliers valuing local produce. Conclusion: A food origin audit and interviews with stakeholders provided a rich understanding of current practices and how to increase local food procurement. [ABSTRACT FROM AUTHOR]

Aim: To (i) describe the prevalence of malnutrition among a cohort of central Australian, predominantly Indigenous, haemodialysis patients and (ii) determine the sensitivity and specificity of the Patient Generated Subjective Global Assessment total score for identification of malnutrition in these patients. Methods: Cross‐sectional observational study of all patients attending haemodialysis units within the Central Australia Health Service. Patients were assessed using the Patient‐Generated Subjective Global Assessment. Chi‐Square tests were used to determine the association between nutritional status and location, age and gender. Receiver Operator Characteristic curves were used to ascertain the predictive validity for malnutrition of the total score. Results: Indigenous patients comprised 98% of study haemodialysis patients (n = 249/253). One third were male, and 72% were aged between 30 and 59 years. Approximately 29% (74/253) were malnourished, and 93% (69/74) had a total score ≥ 4. The most frequently reported problems that kept malnourished patients from eating were early satiety (32%), no appetite (31%), diarrhoea (26%) and dental problems (24%). Money problems were reported by 32%, as were transport (20%) and depression (19%). The traditional tool cut off score of ≥9 had low sensitivity (50%) for detecting malnutrition. Instead, a score ≥ 3 is suggested due to a higher sensitivity (96%) and specificity (45%). Conclusion: Malnutrition was found to be common, and we suggest using a Patient‐Generated Subjective Global Assessment total score of ≥3 to improve the identification of malnourished individuals in this cohort of predominantly Indigenous haemodialysis patients. This will significantly increase referrals for dietetic intervention. [ABSTRACT FROM AUTHOR]

Aim: Australian children consume 35% of energy from discretionary food and beverages which increases their risk of non‐communicable diseases like type 2 diabetes. Despite this concerning statistic, broad analysis of the profile of discretionary food intake has not been fully undertaken. This study asks: what is the discretionary food and beverage intake profile, contribution to nutrient intakes, and associations with demographic and health characteristics? Methods: Cross‐sectional data from the 2011–12 National Nutrition and Physical Activity Survey (n = 2812, 2–18 years) were used to profile discretionary food consumption. Dietary intake was assessed by 24‐h recall. General linear models tested the difference in respondent characteristics by age group, sex, and quartiles of discretionary food energy contribution. Results: Ninety‐nine percent of respondents consumed discretionary foods, 74% exceeded the maximum discretionary food recommended serves. Among 10 eating occasions available to select: snack, dinner, lunch and morning tea appeared to contribute 76% of discretionary food energy, with snack and dinner contributing 24% each. Age and frequency of discretionary food consumption were positively associated with energy intake from discretionary foods (p < 0.001); while sex, socio‐economic status, physical activity and body composition had no association. High discretionary food consumers chose specific discretionary food items in a large quantity (1.0–3.5‐serves/discretionary food) compared to low discretionary food consumers (0.4–1.4‐serves/discretionary food). Conclusions: Nearly all Australian children and adolescents consumed discretionary food daily. No demographic or anthropometric characteristics beyond increasing age were associated with higher discretionary food. Targeted public health policy and community interventions are required to focus on addressing the largest contributors to discretionary food intake in terms of equivalent serve sizes, popularity, and eating occasion. [ABSTRACT FROM AUTHOR]

Aim: The application of behaviour change science is fundamental to the role of dietitians. This study aimed to describe how behaviour change science is embedded within the curricula of accredited/registered dietetics programs in Australia and New Zealand. Methods: A descriptive study triangulated quantitative document analysis of curricula content from university websites (Part 1) with qualitative, structured interviews with dietetics academics (Part 2). Part 2 verified and advanced upon information captured in Part 1 and was analysed using thematic content analysis. Results: Twenty‐five courses from 18 university programs (15 Australia and 3 New Zealand) were synthesised. Fifteen interviews (12 Australia, 3 New Zealand) were conducted. Behaviour change science was taught and assessed at varying levels across all programs. It was taught primarily within lectures or workshops where students apply skills learnt in practical case‐based activities, and assessed through small group education planning or demonstrating communication and counselling skills. Five themes were identified from the interviews: (1) behaviour change science should be foundational; (2) integrate and scaffold within curricula; (3) structural limitations within curricula; (4) challenging for students and (5) recommendations for competencies. Conclusion: Behaviour change science is clearly of value to the dietetics profession. Core content appears to be embedded across all university programs; however, the level and depth of the content varied. The knowledge gained from this study provides direction for curricular improvements. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to describe the quantity and cost of in‐person and telehealth dietetics services reimbursed under Australia's Medicare Benefits Scheme, before and during the coronavirus pandemic. Methods: Publicly available Medicare Benefits Scheme dietetics service activity data were extracted from an online database, between January 2019 and June 2021. For allied health telehealth items, it was assumed that between 10% and 20% of all consults were dietetic related. Results: Dietetics service claims reimbursed through the Medicare Benefits Scheme averaged 115 thousand per quarter in 2019. In quarter 2 of 2020, service delivery dropped by 25% compared to quarter 1 of 2020 and 32% compared to 2019. This drop recovered in quarters 3 and 4, with dietetic consultations claimed through the Medicare Benefits Scheme remaining relatively comparable to 2019 data. Dietetics services cost AUD 5,868,021 in quarter 1 2019 and AUD 5,742,632 in quarter 1 2020. Since the introduction of allied health telehealth items, the number of consultations claimed per quarter has accounted for between 17.7% (quarter 2 2020) and 4.5% (quarter 2 2021) of all consultations per quarter. Conclusions: The provision and costs of dietetics services in Australia have remained relatively constant compared to 2019 data, indicating telehealth was being used for substitutive rather than additive care, apart from an initial reduction of 25% between March and June 2020. The introduction of telehealth items for dietitians has been modest, peaking at 17.7% and now consistently averaging 5% of total dietetics services. The permanent implementation of telehealth items is unlikely to cause significant increases in cost or access and will assist Australians to eat better to support improved chronic disease outcomes. [ABSTRACT FROM AUTHOR]

Aim: This scoping review aimed to explore the extent of the evidence of experimental studies evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. Methods: Five databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Scopus) were searched to October 2020 for cost‐analysis studies of interventions aiming to improve dietary intake in people with mental disorders. No restriction was placed on participant age, mental disorder type or intervention design. Results are presented narratively. Results: Of 2753 articles identified, 13 articles reporting on eight studies were included. Studies were RCTs (n = 5), cluster RCT (n = 1), cluster preference RCT (n = 1), and pre‐post test (n = 1). Seven studies were in community settings (eg, outpatient clinics), and one study in the community housing setting. All studies were in adults, seven included male and female participants, and one included only females. Defined mental disorder diagnoses included serious/severe mental disorders (n = 3), major depression (n = 2), schizophrenia, schizoaffective disorder or first‐episode psychosis (n = 1), any mental disorder (n = 1), and bulimia nervosa (n = 1). Five interventions were multi‐behaviour, two were diet only and one was eating disorder treatment. Cost analyses included cost‐utility (n = 3), cost‐effectiveness (n = 1), cost‐utility and cost‐effectiveness (n = 3), and a costing study (n = 1). Two studies (25%) reported positive results in favour of cost effectiveness, and four studies reported a mix of positive and neutral results. Conclusions: There is limited evidence evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. Additional studies in various settings are needed to confirm cost effectiveness of different interventions. [ABSTRACT FROM AUTHOR]

Aim: Evidence‐based guideline translation to practice can improve outcomes but is often impaired by poor implementation. This project aimed to evaluate the implementation of the Evidence‐based guidelines for the nutritional management of adult patients with head and neck cancer among Australian dietitians providing clinical care to this population. Methods: A questionnaire was developed, with face and content validity confirmed by an expert panel (n = 13), to gauge participant perceptions of the guidelines against an implementation evaluation framework. Dietitians were identified through Dietitians Australia and by contacting experts in the field. Eligibility was determined by questionnaire completion and prior guideline awareness. Responses were provided using a 5‐point Likert scale. Results were analysed using descriptive statistics; with inferential analysis to determine if demographic information could reveal trends in guideline use and perception. Results: Of the 43 initial respondents, n = 28 completed the questionnaire, with n = 24/28 (86%) meeting full eligibility criteria for analysis. Median (range) scores for all four domains were high: awareness (4.0 [3.2‐4.8]), agreement (4.4 [4.1‐4.7]), adoption (3.5 [3.1‐3.9]), and adherence (4.3 [4.1‐4.9]). However, perception of guideline awareness and use among multidisciplinary team colleagues was low (mean 3.2/5.0 and 3.1/5.0, respectively). Dietitians with <10 years' experience had significantly higher perceptions of the guidelines' ability to positively influence practice; support evidence‐based practice; and enhance dietitian credibility (P = 0.04) vs dietitians with ≥10 years' experience. Conclusion: Dietitians demonstrated high rates of guideline implementation and positive perceptions for its use in clinical practice. Future implementation strategies and evaluation should expand to engage the wider multidisciplinary team and more experienced clinicians. [ABSTRACT FROM AUTHOR]

Aim: The COVID‐19 pandemic has disrupted the Australian food supply with potential ramifications on food security. This scoping review aimed to synthesise current evidence on the prevalence of food insecurity and changes to factors related to food insecurity during the COVID‐19 pandemic in Australia. Methods: A comprehensive search strategy was used to search seven databases (MEDLINE, CINAHL, Embase, Global Health, Cochrane Database of Systematic Reviews, PsycINFO, Informit Online) and Google Scholar. Included studies were written in English, published in 2020–2021 and examined food security status in Australia during the COVID‐19 pandemic and/or factors associated with food insecurity in free‐living Australian residents. Articles with participants residing in institutional settings, where meals were supplied, were excluded. Results: A total of 700 records were identified from database, grey literature and hand searching, and nine articles were included. All studies indicated that the prevalence of food insecurity had increased due to negative changes to food availability, accessibility, usability and stability. The downturn in employment and economic circumstances following the onset of the COVID‐19 pandemic appeared to create a new group of food‐insecure Australians consisting of newly unemployed, and international students. Conclusion: COVID‐19 has exacerbated vulnerabilities in the Australian food supply and food security. Suggested actions include ongoing data collection on the long‐term impact of COVID‐19 on food supply and security in addition to coordinated national and community responses that improve the stability of the local food supply and address underlying determinants of food insecurity. [ABSTRACT FROM AUTHOR]

Aim: Water is critical for human survival, yet water intake equations may not reflect contemporary populations. This research aims to determine the total water intake of a representative Australian population, per kilogram of body weight (mL/kg) and stratified by age and sex. Methods: A secondary analysis of the 2011 to 2013 National Nutrition and Physical Activity Survey (n = 10 146) was conducted. Dietary intake from food and beverages was assessed by a 24‐hour recall, with respondent's weight objectively measured. Data were descriptively analysed, with multiple linear regressions used to identify the impact of demographic and physiologic factors on total water intake (mL/kg). Results: The median (interquartile range) daily total water intake per kilogram of body weight for children (2‐8 years), adolescents (9‐18 years) and adults (19+ years) were 77.1 (57.4‐100) mL/kg, 40.4 (29.3‐53.4) mL/kg and 35.5 mL/kg (26.1‐47.8), respectively. Increasing height and waist circumference were associated with reduced total water intake, with a change of −1.03 mL/kg (−1.43, −0.618) [coefficient (95% confidence interval)] in children for height and −0.448 mL/kg (−0.484, −0.412) in adults for waist circumference. Similarly, seasonality decreased intake, with greatest reductions in winter [adolescents: −4.11 mL/kg (−6.83, −1.40)]. In comparison, being male, living in rural areas and having a physical occupation were associated with greater intake, by 1.73 mL/kg (0.347, 3.10), 4.74 mL/kg (3.47, 6.00) and 2.82 (trade workers: 1.08, 4.59) in adults, respectively. Conclusions: Total water intake (mL/kg) decreased with age in both sexes. The results highlight possibilities to incorporate other factors into water intake equations to improve their accuracy. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the nutrition knowledge of elite Australian athletes, and to obtain feedback from sports dietitians on the Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaires' (PEAKS‐NQ) suitability. Methods: Sports dietitians from the National Institute Network across Australia recruited athletes to complete the online, 50‐item PEAKS‐NQ which contained two sections (General Nutrition and Sports Nutrition). Sports dietitians provided feedback on the PEAKS‐NQ using a 14‐item questionnaire (with two open‐ended items). The main outcome measures were nutrition knowledge score and tool suitability (usefulness, acceptability and feasibility) scores. For knowledge scores, independent t‐tests, ANOVA and Chi‐square tests were used to evaluate differences between groups. Suitability was evaluated using descriptive statistics. Results: Twelve sports dietitians from the National Institute Network in Australia recruited a convenience sample of 240 athletes (21.3 ± 4.3 years, 63.5% female, 63.3% competed internationally). Athletes scored 70.7 ± 10.5%, with better general vs sports nutrition knowledge. Females had higher overall scores (P <.001) with no differences for age or sport played. University‐educated athletes scored higher than non‐tertiary educated athletes (P =.004). Knowledge gaps were identified in fats (role and food sources), recovery nutrition and managing body composition. Sports dietitians rated suitability of PEAKS‐NQ positively with complete agreement on 8 of 12 items. Conclusions: Athletes have greater understanding of general nutrition compared to sports nutrition concepts and may benefit from education on applying nutrition in sports‐specific contexts. Sports dietitians' responses showed PEAKS‐NQ was a highly acceptable, feasible and useful measure. [ABSTRACT FROM AUTHOR]

Aim: The 2018 evidence‐based polycystic ovary syndrome (PCOS) guidelines recommend lifestyle management as first‐line treatment. This study aims to understand the preferred intervention characteristics of a PCOS lifestyle program from the perspectives of women with PCOS to inform the translation of the guidelines into practice. Methods: Women with self‐reported PCOS residing in Australia took part in semi‐structured interviews (n = 20) and an online survey (n = 286). The survey and interview schedule were developed using the template for intervention description and replication checklist. Results: Women want to take part in a lifestyle program (94.6%) and use government‐subsidised sessions to attend (83%). Sessions of 45 to 60 minutes (75%) costing less than AUD$50 are preferred (60%). Topics of most interest related to sustainable daily physical activity (58%), overcoming non‐hungry eating (54%), PCOS‐specific diets (51%) and how to overcome barriers to behaviour change (45%). A delivery mode that combines online and in‐person support is preferred (53%). Women are in need of long‐term professional lifestyle support (6‐12 months) that provides evidence‐based, PCOS‐specific, personalised prescription. Multidisciplinary support from a range of PCOS‐trained professions is also preferred to address women's physical, psychological and emotional needs. Conclusion: Women with PCOS are willing to take part in lifestyle programs that are low cost, long term, evidence based, PCOS‐specific and provide practical strategies for nutrition and physical activity changes. Future online and in‐person PCOS programs are strongly recommended to incorporate these findings to improve program engagement and patient satisfaction. [ABSTRACT FROM AUTHOR]

Aim: University students often cite increased monetary cost as a major barrier to improved eating behaviours. Here, we examine food expenditure behaviours in a sample of Australian university students. Methods: Students (n = 147) collected and analysed a 24‐hour food record to determine their food group and nutrient intakes, then costed the food and non‐tap water beverages consumed in the amounts recorded. Diet cost and food group expenditure (absolute and relative to total diet cost) were calculated and compared across socio‐demographic characteristics. Spearman's Rho correlations and partial correlations (controlling for energy intake) were also used to identify associations between diet cost and intake. Results: The median (IQR) 24‐hour diet cost was $12.42 ($7.06). However, students who worked ≥20 h·wk−1 had a higher diet cost than those who worked <20 h·wk−1 (P =.002) or were unemployed (P =.002). Relative food group expenditure also differed by sex, employment status and whether special dietary requirements were reported (P's <.05). For instance, males reported spending a smaller relative amount on the fruit and vegetables food groups and a larger relative amount on discretionary choices than females (P's < 0.05). Higher diet costs were also associated with greater intakes of the fruit, vegetables and lean meat and alternatives food groups, protein, alcohol, water and calcium, and lower intakes of the grain foods food group and carbohydrate (P's <.05). Conclusions: These findings provide insight into university students' food expenditure behaviours and may assist health professionals to develop targeted strategies and tailored advice aimed at improving their dietary behaviours. [ABSTRACT FROM AUTHOR]

Aim: In Australian adults, this study seeks to describe the experiences and factors associated with the perceived outcomes of using a very low calorie diet (VLCD) program for ≥4 weeks. Methods: A mixed method study using the method perspective was conducted to analyse individual semi‐structured interviews conducted via videoconference and cross‐sectional survey data. Australians 18 to 65 years were eligible if they were currently consuming at least one VLCD product daily for ≥4 weeks or had ceased consumption within 4 weeks. Interviews were thematically analysed. Results: Weight loss (19 kg [SD: 18 kg]) and duration (5 months [SD: 5 months]) of VLCD product use of the 31 participants (female: 97%, 44 [SD: 11] years, body mass index >30 kg/m2: 84%) were strongly correlated (r = 0.73, P <.001). Participants' experiences were influenced by a journey of learning from their previous weight loss attempts, discerned the VLCD program as credible, and chose to commence the VLCD due to a convergence of internal motivators. Early health‐related outcomes were a reinforcing stimulus and participants developed new health behaviours but felt dependent on the VLCD long term. Throughout these experiences the participants identified various individual, program structure, and environment related factors which either facilitated their VLCD program use or created barriers to achieving their goals. Health care professionals were minimally engaged. Conclusions: A model of care to support facilitators and overcome barriers would mean more meaningful engagement of health care professionals to ultimately improve the experience and adherence of the VLCD program users in Australia. [ABSTRACT FROM AUTHOR]

Aim: Misreporting of energy intake is a common source of measurement error found in dietary surveys, resulting in biased estimates and a reduction in statistical power. The present study aims to refine the conventional cut‐off methods and to examine the extent to which Australian adults misreport their energy intake, and the characteristics of under‐reporters between two time points. Methods: A revised Goldberg cut‐off approach was used to identify those who reported implausible intake amounts in a secondary analysis of two large cross‐sectional surveys. Identified low energy reporters were then used as the outcome variable in Poisson regressions to examine association with sex, age, body mass index (BMI), weight perceptions, education, relative household income, geographic remoteness and relative socioeconomic disadvantage. Results: The prevalence of under‐reporting increased from 32% in 1995 to 41% in 2012, most of which can be attributed to an increase in men. Under‐reporting has a positive association with BMI and relative socioeconomic disadvantage, but an inverse association with age, education, relative household income and residence in inner regional areas. Conclusions: Under‐reporting of energy intake is high in Australian adults, and appears have worsened over time in men, which could be partly explained by the upward trend in obesity. The use of conventional Goldberg method to identify under‐reporters can greatly underestimate the prevalence of under‐reporting, future studies should consider selecting a lower critical value to improve accuracy. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the information sources that are used and preferred by Australian athletes and to assess if preferences influence nutrition knowledge (NK). Methods: Elite and non‐elite Australian team sport athletes, playing Australian football (AF), cricket, lawn bowls, soccer or hockey, were recruited via the sporting organisations' qualified sports dietitians or club presidents. Athletes completed one of two online, validated sports NK questionnaires. Frequency analysis on previous sources of advice, preferred sources of information and preferred type of support were assessed. Differences in NK scores (%) based on previous sources of dietary advice and preferences for obtaining information were assessed using t test or Mann‐Whitney U test. Results: Demographic and information source questions were completed by 410 athletes; 331 also completed NK questions. Athletes were mostly non‐elite (76%) and AF players (79%). Forty‐four per cent of athletes reported having previously received advice from a dietitian. Twenty per cent, 19% and 16% of athletes chose "dietitian," "internet" and "nutritionist" as their preferred source of nutrition information, respectively. Athletes preferred information on sports nutrition (35%), individual consultations (33%), and information on general healthy eating (33%), over cooking classes (4%) and group presentations (3%). There were no significant associations between preferred and previous information sources and NK scores. Conclusions: Australian athletes prefer dietitians, the internet and nutritionists for sports nutrition information. There is an interest in and need for access to a qualified sports dietitian and reputable internet‐based nutrition information. Education programs and advice given to athletes need to be evaluated. [ABSTRACT FROM AUTHOR]

Aim: To describe client expectations and the experience of nutrition care provided by personal trainers and explore factors that influence expectations of nutrition care. Methods: A cross‐sectional survey identified expectations of nutrition care provided by personal trainers. Likert scales explored expected nutrition care, nutrition knowledge of personal trainers and experiences of those who had received nutrition care from a personal trainer. Expectations were evaluated using descriptive statistics. Associations between expectations and participant characteristics were explored with Pearson chi‐squared tests. Results: Six hundred twenty‐seven Australian residents participated (77% female; 16–74 years of age). Participants frequently expected personal trainers to be knowledgeable about and discuss general healthy eating, muscle gain and weight loss. Half of the participants expected personal trainers to discuss and be knowledgeable about nutrition for chronic disease. Of the 334 participants who had engaged a personal trainer, 98% received nutrition care. Half of these participants (n = 167) were satisfied with the nutrition care they received, and 40% reported positive dietary changes because of their personal trainers' nutrition care. Tertiary education and perceived healthfulness of diet lowered expectations of nutrition care from personal trainers (P < 0.001). Engagement of a personal trainer did not influence expectations of nutrition discussions (P > 0.01) but increased expectations of personal trainer nutrition knowledge (P < 0.01). Conclusions: Clients expect personal trainers to provide nutrition care. Client expectations may compel personal trainers to provide nutrition care beyond the recommended scope of practice. Strategies to manage client expectations, including awareness of the personal trainer scope of practice, are needed to ensure safe and effective nutrition care from personal trainers. [ABSTRACT FROM AUTHOR]

Aim: To explore dietitians' perspectives on the eHealth readiness of Australian dietitians, and to identify strategies to improve eHealth readiness of the profession. Methods: Dietitians who met the criteria for nutrition informatics experts participated in semi‐structured interviews between June 2016 and March 2017. The interviews were recorded and transcribed verbatim. Thematic analysis using coding was undertaken until consensus was reached by the researchers regarding key themes, topics and exemplar quotes. Results: Interviews with 10 nutrition informatics experts revealed 25 discussion topics grouped into four main themes: benefits of eHealth for dietitians; risks of dietitians not being involved in eHealth; dietitians are not ready for eHealth; and strategies to improve eHealth readiness. The strategies identified for improving eHealth readiness included: collaboration and representation, education, offering of incentives and mentoring, as well as development of a national strategy, organisational leaders, nutrition informatics champions and a supportive environment. Conclusions: These findings suggest that dietitians may not be ready for eHealth. Strategic leadership and the actioning of other identified strategies will be imperative to preparing dietitians for eHealth to ensure the profession can practice effectively in the digital age, optimise nutrition care and support research for eHealth. If dietitians do not engage in eHealth, others may take their place, or dietitians may be forced to use eHealth in ways that are not the most effective for practice or maximising patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: Dietary modification is integral to the management of end stage kidney disease. However, adherence to the renal diet is poor. Few studies have explored the perspectives of renal dietitians and how they work with patients to facilitate dietary change. The objectives of this study were to explore the experiences of renal dietitians about educating patients with end stage kidney disease; and to describe the strategies perceived to help patients understand the renal diet. Methods: Semi‐structured interviews based on Sensemaking theory were conducted with renal dietitians (n = 27) working in Australia and New Zealand from a range of metropolitan, regional and remote areas. Results: Five major themes across two categories were derived from the data. The renal dietitians in this study experienced feelings of frustration, frequently worked in practice environments with limited or inadequate resources and perceived that establishing trust and demonstrating empathy were important to sense making. Renal dietitians helped patients make sense of and understand the diet by clarifying ambiguities and conflicting information; and simplifying complexity by using simple explanations, individualised advice and practical support. These strategies were considered critical to the renal diet sense making process. Conclusions: The experience of providing renal diet advice to adults with end stage kidney disease was emotionally and professionally challenging. Alternative approaches to patient education may help dietitians to empower patients to better understand the renal diet. Further research exploring the experiences of learning about the renal diet from the patient and carer perspective would also help to inform future alternative approaches. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Describe the type and amount of beverages consumed by Australian children at age 2, 3.7 and 5; investigate the longitudinal relationship between intake of sweet beverages with fruits and vegetables or milk/alternatives, and body mass index (BMI) z‐score. Methods: Mothers in the NOURISH trial completed a single 24‐hour recall of their child's intake, at age 2 (n = 515), 3.7 (n = 426) and 5 (n = 405). Anthropometry was measured by study staff. At each time point, proportion of children consuming at least one beverage on 24‐hour recall from the following groups was determined; essential—cow's milk/alternatives, breast milk; non‐essential—formula, sweet beverages. For consumers, intake (grams) of each beverage and proportion total estimated energy intake was calculated. The longitudinal relationship between intake of sweet beverages, and fruit and vegetable intake (g/kg body weight), with BMI z‐score at 2, 3.7 and 5 years was examined using structural equation modelling. A second model investigated relationship with intake of milk/alternatives. Results: Sweet beverages were consumed by 38, 55 and 47% of children at each time point. Intake of sweet beverages strongly correlated between two and five years; however, intake was not associated with BMIz and did not appear to displace fruit and vegetable intake. Intake of cow's milk declined over time and was negatively associated with intake of sweet beverages at two and five years. Conclusions: Tracking of intake over time supports the notion that children's early experience of sweet tastes is a strong predictor of future intake. Limiting exposure to sweet beverages in early childhood remains an important strategy in the development of healthy food preferences and promotion of dietary quality. [ABSTRACT FROM AUTHOR]

Aim: Health professionals seeking employment in foreign countries are commonly required to undertake competency assessment in order to practice. The present study aims to outline the development and validation of a written examination for Dietetic Skills Recognition (DSR), to assess the knowledge, skills, capabilities and professional judgement of overseas‐educated dietitians against the competency standards applied to dietetic graduates in Australia. Methods: The present study reviews the design, rationale, validation and outcomes of a multiple choice question (MCQ) written examination for overseas‐educated dietitians based on 5 years of administration. The validity of the exam is evaluated using Messick’s validity framework, which focuses on five potential sources of validity evidence—content, internal structure, relationships with other variables, response process and consequences. The reference point for the exam pass mark or “cutscore” is the minimum standard required for safe practice. Results: In total, 114 candidates have completed the MCQ examination at least once, with an overall pass rate of 52% on the first attempt. Pass rates are higher from countries where dietetic education more closely reflects the Australian model. While the pass rate for each exam tends to vary with each cohort, the cutscore has remained relatively stable over eight administrations. Conclusions: The findings provide important data supporting the validity of the MCQ exam. A more complete evaluation of the validity of the exam must be sought within the context of the whole DSR program of assessment. The DSR written component may serve as a model for use of the MCQ format for dietetic and other professional credentialing organisations. [ABSTRACT FROM AUTHOR]

Aim: Food security is defined by four dimensions: food availability, access, utilisation and stability. Resettled refugees face unique struggles securing these dimensions and, thus, food security when moving to a new country. This systematic review aimed to identify the challenges Australian refugees experience in achieving the four dimensions of food security. Methods: The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed; the SPIDER tool was used to determine eligibility criteria. Three databases were searched using terms relating to food in/security and refugees from 2000 to 20 May 2017. Results: Seven articles were retained for analysis. Studies were categorised against the four dimensions, with four studies identifying challenges against all dimensions. Challenges contributing to high levels of food insecurity in each dimension included: availability and cost of traditional foods, difficulty in accessing preferred food outlets, limited food knowledge and preparation skills and food stability due to low income and social support. Conclusions: Food insecurity adversely impacts refugee health and integration. Methodical research framed by the four dimensions of food security is imperative to address challenges to securing food security in refugee groups and assisting in the development of sustainable interventions. [ABSTRACT FROM AUTHOR]

Aim: To determine differences in food and nutrient intakes between Australian‐ and Asian‐born women living in Australia. Methods: Data were obtained from the Australian Longitudinal Study on Women's Health, including 6461 women born in Australia or Asia who completed food frequency questionnaires in 2001 and 2013. Diet was assessed using the Dietary Questionnaire for Epidemiological Studies version 2. Longitudinal generalised estimating‐equation modelling was performed to determine the effect of country of birth and survey year on fruit and vegetable intake. Results: Asian‐born women ate more cereals, soybeans and fish but less vegetables, legumes, dairy, meat and meat products than Australian‐born women both in 2001 and in 2013. Asian‐born women ate less cereals, rice and noodles, meat and its products (P < 0.05) in 2013 than in 2001. The earlier people came to Australia, the less their rice and noodle intake per day. However, the reverse was demonstrated regarding vegetable intake. Asian‐born women had a lower daily intake of fat, calcium, zinc, thiamin, riboflavin, folate and retinol compared with those born in Australia. Conclusions: Asian‐born women living in Australia show different food and nutrient intakes from Australian‐born women, although their diets tend to deviate from typical Asian characteristics and approach a Western diet. [ABSTRACT FROM AUTHOR]

Aim: Packaged foods dominate Australia's food supply and are important contributors to nutrition‐related disease. To help address this problem, the Food and Health Dialogue (FHD) was launched in 2009, setting voluntary sodium reduction targets for various categories of packaged foods. The aim of this study was to examine the food industry's progress and compliance with the FHD sodium reduction targets for soup products. Methods: Nutritional information was collected from product labels of all soup products available from four major Australian supermarkets annually between 2011 and 2014. Products were assigned to categories in line with those in the FHD. The proportion of soup products meeting sodium reduction targets was examined by (i) soup category; (ii) FHD participant status; and (iii) manufacturer. Results: A 6% reduction in sodium levels in soups overall was found from 2011 to 2014 (P = 0.002). Significant reductions were observed for FHD participants (P < 0.05 for all) but not for non‐participants. In 2014, 67% dry soups and 76% of wet soups met national sodium reduction targets. Conclusions: Despite the majority of soup products meeting the sodium reduction targets specified by the FHD, re‐evaluation of the targets may be required to further reduce sodium levels in soups. Manufacturers participating in the FHD are likely to be driving sodium reductions in the Australian soup market, further highlighting the need for continued government leadership in this area to ensure all manufacturers are actively involved in the process. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to describe referral patterns of general practitioner (GP) registrars to dietitians/nutritionists. There is a paucity of research regarding GP referral patterns to dietitians/nutritionists. Limited data show increasing referrals from established GPs to dietitians/nutritionists. There are no data on GP registrar (trainee) referrals. Methods: This was a cross‐sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing, multicentre, prospective cohort study of registrars, which documents 60 consecutive consultations of each registrar in each of the three six‐month GP training terms. The outcome factor in this analysis was a problem/diagnosis resulting in dietitian/nutritionist referral (2010–2015). Independent variables were related to registrar, patient, practice and consultation. Results: A total of 1124 registrars contributed data from 145 708 consultations. Of 227 190 problems/diagnoses, 587 (0.26% (confidence interval: 0.23–0.29)) resulted in dietitian/nutritionist referral. The most common problems/diagnoses referred related to overweight/obesity (27.1%) and type 2 diabetes (21.1%). Of referrals to a dietitian/nutritionist, 60.8% were for a chronic disease, and 38.8% were related to a Chronic Disease Management plan. Dietitian/nutritionist referral was significantly associated with a number of independent variables reflecting continuity of care, patient complexity, chronic disease, health equity and registrar engagement. Conclusions: Established patients with chronic disease and complex care needs are more likely than other patients to be referred by registrars to dietitians/nutritionists. Nutrition behaviours are a major risk factor in chronic disease, and we have found evidence for dietitian/nutritionist referrals representing one facet of engagement by registrars with patients’ complex care needs. [ABSTRACT FROM AUTHOR]

Aim: Assessing changes in dietetic perceptions, attitudes and knowledge regarding the Nutrition Care Process Terminology (NCPT) is important to determine implementation effectiveness. This study aimed to investigate changes in the perceptions and attitudes of Australian dietitians over a three‐year period, identify changes in benefits and barriers to support successful NCPT implementation and determine future directions for NCPT progression. Methods: An online survey was performed in 2011 and repeated in 2014 by recruiting members of the Dietitians Association of Australia (DAA) through an email link. The survey assessed familiarity, knowledge, attitudes, benefits, barriers, concerns and use of educational enablers around the NCPT. Results: The survey was completed by 218 respondents in 2011 and 205 respondents in 2014. Survey respondents from both years were representative of overall DAA membership. Respondent knowledge of NCPT increased significantly over the three‐years, as did confidence, preparation, access to support and training and NCPT usage. Respondent's identification of benefits to implementation increased whilst barriers reduced. Attitudes regarding NCPT implementation were conflicting. Conclusions: Over three years, improvements were evident in NCPT knowledge, attitudes and usage. However, not all dietitians saw reason to implement NCPT in their practice, and some attitudes have become less supportive. A collective vision is required to foster positive attitudes towards the transformational professional benefits possible from NCPT. With ongoing uptake of electronic health records, the potential for NCPT to evaluate and justify dietetic interventions is increasing. [ABSTRACT FROM AUTHOR]

Aim This study aimed to explore the work roles, major tasks and core activities of advanced practice dietitians in Australia to define the Competency Standards for advanced practice. Methods A qualitative approach was used to review advanced dietetic practice in Australia involving experienced professionals, mostly dietitians. Four focus groups were conducted with a total of 17 participants and an average of 20 years experience: 15 dietitian practitioners plus 2 employers (1 dietitian and 1 non-dietitian). The focus groups explored the key purpose, roles and outcomes of these practitioners. Data from the focus groups were confirmed with in-depth interviews about their core activities with a purposive sample of 10 individuals recently recognised as Advanced Accredited Practising Dietitians. Data from both focus groups and interviews were analysed adductively to identify key themes. Results The key theme that emerged to define advanced dietetics practice was leadership, with four subthemes that described in more detail the major work roles and outcomes of advanced practice. These subthemes identified that advanced practitioners were (i) outcome-focused, having impact; (ii) influence others and advocate; (iii) innovate and embrace change; and (iv) inspire others and are recognised for their practice. These outcomes were conceptualised within a broad generalist framework to generate revised Competency Standards. Conclusions This study confirmed that leadership rather than specialist practice skills is the key determinant of advanced practice. [ABSTRACT FROM AUTHOR]

Aim To survey dietitians on their knowledge and practices regarding vitamin D (VitD) intake, sources, supplementation and effect on disease state. Methods An online survey was disseminated to members of the Dietitian Association Australia via the weekly online state newsletter during April 2015. Response rate was 3%, with 134 respondents completing the survey. The survey included questions about knowledge and current practices. Descriptive statistics were used to analyse the results. Results Dietitians have good knowledge regarding dietary sources of VitD and roles in the body, but there is confusion around supplement doses for treatment and prevention of deficiency and sun exposure guidelines. Conclusions Dietitians are well positioned to provide patients with advice on VitD supplementation and sun exposure practices, but not all are confident to provide this care. There is a need for clear and well-disseminated guidelines for VitD management by dietitians. [ABSTRACT FROM AUTHOR]

Aim The gold standard of measurement for net endogenous acid production ( NEAP) is net acid excretion ( NAE), a test that is not readily available, and consequently, estimative equations by Remer and Manz and Frassetto et al. are often used. These equations rely on nutrient databases and it is recommended that their validity be assessed using a country's database before their application in research in that country. We sought to delineate the accuracy and precision of these estimation equations using the Australian food database. Methods In a double blind, randomised, cross-over fashion, healthy participants (n = 13) residing in regional Australia were exposed to varying net acid loads while they collected weighted food diaries and 24-hour urine samples for measurement of NAE. Results In comparison to the Frassetto et al. equations (equation one bias = −57.1 mEq/day, equation two bias = −32.8 mEq/day), only the Remer and Manz equation was accurate (bias = −5.4 mEq/day); however, all equations were imprecise. Conclusions Using the Australian database, the performance of these equations to predict NEAP appears equal to other databases; however, caveats apply in their application. For future research, the equation by Remer and Manz is preferential for group estimates. None of the equations are recommended for individual estimates. [ABSTRACT FROM AUTHOR]

Aim The aim was to evaluate the utility of a brief dietary intake assessment tool in measuring nutritional adequacy of preschoolers and differences in food and nutrient intake between quartiles stratified by overall diet quality. Methods Dietary intakes of preschoolers (n = 146) from the Feeding Healthy Food to Kids trial were reported by parents/caregivers using a 120-item food frequency questionnaire ( FFQ). Diet quality was assessed using the Australian Recommended Food Score for Preschoolers. Analyses were performed using Kruskal-Wallis one-way analysis of variance, adjusted for Type 1 error. Participants were grouped into quartiles by total food score for comparison of subscale scores, food groups and nutrient intakes from the FFQ. Results Participants who scored less than the median total food score of 36 were more likely to have suboptimal micronutrient intakes. Median fruit (9 vs 5, P < 0.0001) and vegetable (14 vs 7, P < 0.0001) subscale scores for preschoolers in the highest quartile were significantly higher than the lowest quartile, indicating much greater fruit and vegetable variety. Statistically significant differences in diet quality score by quartiles ( P < 0.05) were found for total energy and percentage energy from core foods, protein, fibre and 11 micronutrients. Conclusions The Australian Recommended Food Score for Preschoolers is a practical brief diet quality assessment tool to measure food variety and nutritional adequacy in Australian preschoolers. Stratifying children by baseline diet quality in future nutrition interventions is recommended in order to identify those who are likely to benefit or require more targeted approaches to address specific nutritional needs in order to optimise food and nutrient intakes. [ABSTRACT FROM AUTHOR]

Aim The present study investigated the perceived health benefits of specific vegetable consumption to guide the use of nutrition and health claims on vegetable marketing collateral. Methods Free elicitation and consumer ranking data were collected through an online survey of 1000 adults from across Australia and analysed for the perceived importance of vegetables in the daily diet, number of serves consumed per day, knowledge about health-related benefits of specific vegetables and perceived health benefits of vegetable consumption. Results The importance of vegetables in the diet and daily vegetable consumption was higher in people from an English-speaking background, females, people aged 45 years and over and people living in non-metropolitan areas. Digestion was selected as the major health benefit from consumption of specific vegetables. However, understanding of the health benefits of specific vegetable consumption was relatively low among consumers. Half of the respondents were not sure of the health benefits associated with specific vegetables, except for carrots and spinach. Some respondents volunteered nutrient content or other information. Conclusions There was no clear indication that consumers understand the specific health benefits conferred by consumption of vegetables. Nutrient and health benefit labelling therefore has the capacity to enhance knowledge of vegetable consumers. It is recommended that health benefit labelling be tailored to promote greater consumption of vegetables in those demographic groups where vegetable consumption was lower. The present study assists the Australian vegetable industry in helping consumers make more informed consumption choices. [ABSTRACT FROM AUTHOR]

Aim: Children have the highest rates of food ‐ related allergic reactions. While 85% of children outgrow allergies including cow's milk and eggs by five years of age, allergies to peanuts and seafood continue into adulthood. The school setting poses a high ‐ risk environment for allergen exposure. The aim of the present study was to examine the availability, drivers and communication of school food allergy awareness and management policies/guidelines in one Australian education jurisdiction. Methods: A cross ‐ sectional study comprising an online survey of principals on school allergy awareness (n = 100) was conducted in public, catholic and independent primary and high schools in an Australian education jurisdiction between August 2011 and November 2012. Results: Sixty ‐ three per cent (17/27) of schools responding to the survey reported using food allergy management guidelines. An average of 13 students per school were reported to have a food allergy with 93% of schools reported having students with at least one food allergy. Parents, not government policy, were identified as primary drivers of food allergy guideline implementation and a third of schools provided anaphylaxis training annually. Communication of food allergy management was limited with only 42 school websites either providing access to policies/guidelines or providing a food allergy statement. Conclusions: Detailed awareness and management guidelines are integral for schools to adequately manage food ‐ induced allergic reactions, including anaphylaxis, in the school environment. To enable this, national government support through legislation and policy is needed to ensure a consistent, up ‐ to ‐ date and policed approach to food allergy management in the Australian education sector. [ABSTRACT FROM AUTHOR]

Aim: Malnutrition is a concern across all Australian hospitals and is associated with negative clinical outcomes in up to 60% inpatients, with a further 10% exacerbated by the presence of dysphagia. Providing adequate nutrition for patients requiring a texture‐modified diet often results in meals that look and taste less appealing and which are nutritionally diluted. This article aims is to review change in oral intake using food moulding techniques within an acute care institution for patients on Texture C—smooth pureed meals. Methods: This was a 2 week pilot study. Patients were provided smooth pureed lunch either as non‐moulded or a moulded meal. Main meal wastage was weighed and reasons for waste were documented. If patients met the inclusion criteria, a short satisfaction survey was also administered. Results: Analysis using a chi‐squared test comparison saw significance in the proportion of patients increasing oral intake from <1/4 meal eaten to >3/4 meal, when in the moulded form (P = 0.03). Median plate waste was reduced by over 100 g in the treatment group but there was no significant change overall. Limited data for patient satisfaction concluded no significance in meal preference. Conclusions: The pilot study suggests that using a moulded smooth puree diet can increase mean oral intake and reduce main meal wastage, but a larger sample size is required to demonstrate statistical significance. However, the pilot study effect size (0.55) is large enough to warrant further research interest in this area and results do suggest relevancy in clinical practice for replication. [ABSTRACT FROM AUTHOR]

Aim: This study assessed the accuracy (including sources and reasons for errors) and adequacy (of patients’ intakes relative to requirements) among patients prescribed therapeutic diets in the hospital setting. Methods: This observational study was conducted across six wards in a metropolitan tertiary hospital over 14 consecutive days. Meal accuracy was assessed by comparing each individual food or fluid item provided to each patient to items allowed on their specific diet code. Errors were defined by severity (critical or non‐critical threat to patient safety) and source (foodservice system, staff or patient). Nutritional adequacy was determined by comparing patients’ daily energy and protein intakes to individually estimated requirements. Intakes were considered adequate if consumption was ≥75% of requirements. Results: Meals of 67 patients (31 females, aged 60.0 ± 19.4 years) were assessed for accuracy for up to two days. Of the total 347 therapeutic meals observed, 69 (19.9%) were inaccurate. A large proportion of these errors were critical (64.8%). Foodservice errors were the most common source. Of the 48 patients with complete dietary intake data, mean energy and protein intakes were 3192 ± 2220 kJ and 33 ± 27 g protein, respectively. Only five and seven patients consumed adequate energy and protein to meet their estimated requirements, respectively. Conclusion: Patients requiring therapeutic diets during hospitalisation are frequently exposed to food and/or fluid errors that may pose an acute threat to their safety. In addition, prescription of these diets may result in patients being unable to adequately meet their nutritional requirements. [ABSTRACT FROM AUTHOR]

Aim: This review aimed to identify current research related to the use of school canteens in Australia, with a focus on their food and drink policy. In Australia, approximately 25% of 5–17‐year olds are considered overweight and obese. Up to 41% of energy intake for children aged between 4 and 18 years is found to come from discretionary foods. The structured nature of the school environment provides an ideal environment to address childhood obesity and encourage a culture of healthy eating. Methods: A systematic review of three key nutrition databases: ‘CINAHL’, ‘Academic search complete’ and ‘Medline’ (inception to 2015) was conducted. Inclusion criteria were: Australian, peer‐reviewed studies; studies regarding the purchase of food from school canteens; canteen studies involving students aged 5–18 years, school principals, parents, canteen managers, Parent and Citizen Association members and teachers. Results: The search identified 2741 studies with 12 meeting the inclusion criteria. In the main, studies were descriptive in nature with data summarised into four categories: (i) characteristics of canteens; (ii) canteen use and food availability; (iii) stakeholder perceptions and the role of school canteens; and (iv) compliance with policies and the barriers to healthy food implementation. Overall, compliance with healthy canteen policies was low, guidelines were rarely adhered to in terms of product provision and children had preferences for non‐healthy foods. Conclusions: Strategies to improve compliance, overcome the challenges and encourage stakeholder buy‐in are necessary if food habits are to be changed and healthy cultures developed within the school environment. [ABSTRACT FROM AUTHOR]

Aim: To better understand the income of dietitians delivering Medicare Chronic Disease Management services by comparing the amount of time dietitians spend on activities with remuneration received. Methods: Data were collected on time invested and remuneration received for 179 consultations provided by 20 dietitians through the Medicare Chronic Disease Management initiative. Descriptive statistics and t ‐ tests were used to compare time spent and remuneration received. A mixed effects model was performed to assess the significant factors in predicting the mean hourly rate received for consultations. Results: Consultations accrued an average of $67.32 ± $24.38 (range $0 – $150) in remuneration, and required an average of 44 ± 20 minutes (range 14 – 136 minutes) including over 10 minutes of administration time. The average calculated gross rate of pay was $102.62/hour. Set ‐ fee consultations were longer than bulk ‐ billed consultations (51 minutes vs 39 minutes, P = 0.002), but resulted in greater remuneration ($83.20 vs $52.95, P < 0.001). Initial consultations resulted in greater remuneration than review consultations ($76.52 vs $60.75, P < 0.001). Dietitians without administration assistance spent more total time on consultations compared with dietitians with administration support (54 minutes vs 42 minutes, P = 0.001), but there was no difference in fees charged (P > 0.005). Conclusions: The hourly income received by dietitians providing services under Medicare appears high; however, practice expenditures have not been considered in the present study. Dietitians should consider the logistical and financial outcomes of their practices in order to enhance financial sustainability. [ABSTRACT FROM AUTHOR]

Aim: To describe the level of nutrition knowledge in students undertaking an accredited nutrition and dietetics (ND) undergraduate program in reference to students enrolled in non ‐ accredited nutrition (NUT) or occupational therapy (OT) programs. The secondary aim was to investigate the variation in nutrition knowledge of ND students. Methods: Students enrolled in ND, NUT or OT undergraduate programs at an Australian university were invited to participate in an online survey in August 2013. Nutrition knowledge levels were measured using the validated Re ‐ examined General Nutrition Knowledge Questionnaire (R ‐ GNKQ). Socio ‐ demographic characteristics and sources of nutrition information were also collected. Results: Students in the first year of ND or NUT programs had significantly higher overall scores than the OT students (P = 0.046 and P = 0.005, respectively). Substantially greater overall scores were observed for the students in the second year of the ND program than those in the first year (P = 0.01). The highest level of nutrition knowledge was observed in third year ND students. Overall score for ND students was influenced by year level and previous education, but there were no differences detected for gender, age, living situation or ethnicity. Conclusions: ND students entered the program with high nutrition knowledge levels. The dietetic program appeared to develop the general nutrition knowledge of students to a level comparable to practising dietitians. Research investigating underlying knowledge development is necessary to direct dietetic curriculum design and delivery. [ABSTRACT FROM AUTHOR]

The article discusses a study by Lucinda K. Bell and colleagues which aims to establish the validity of toddler dietary questionnaire (TDQ)-derived dietary risk by establishing the association between risk scores and nutrient intake, weight status, and socio-demographic factors. Topics discussed include assessment of food-group intake, the process of establishing nutrient intake, and the result from linear trend analysis.

Aim: To determine the method and extent of health information technology (HIT) utilisation, roles in relation to HIT in the workplace and perceived barriers and benefits of HIT by dietitians in Australia and provide a comparison with dietitians in the USA. Methods: A survey adapted from the 2011 Academy of Nutrition and Dietetics (Academy) was utilised and circulated electronically to Dietitians Association of Australia members and advertised through a professional nutrition website in 2013. The survey encompassed 25 questions on computer access and use, data sources, experience using HIT, organisational involvement and perceived barriers and benefits to HIT. Descriptive statistics, independent t ‐ tests, chi ‐ square tests and z ‐ tests were computed to investigate and compare responses from the 2013 Australian and 2011 Academy surveys. Results: The survey completion rate represented 14.5% of Dietitians Association of Australia members (747) and 5% of Academy members (3342). The Australian and Academy respondents reported similar high levels of comfort using technology, awareness of workplace HIT benefits (such as enhanced time management and improved ability to access data) and low levels of organisational involvement. However, there were a significantly greater number of Academy organisations utilising electronic health records (P < 0.05), and significantly more Academy respondents (55%) reported ‘no barriers’ to using HIT compared with Australians (37%) (P < 0.05). Conclusions: Educational programmes will be central to ensuring dietitians are equipped with technology and information management skills required to be involved in and make informed decisions about dietetic ‐ related HIT projects as these will soon be fundamental to dietetic practice. [ABSTRACT FROM AUTHOR]

Aim To assess consensus among public health nutrition ( PHN) workforce development stakeholders on the competencies required for effective PHN practice in the Australian workforce context. Methods A modified Delphi study involving two iterative survey rounds among an expert panel of 33 Australian PHN workforce development stakeholders. Surveys tested panellist ratings (essential, useful, irrelevant) of a listing of 143 competency elements derived from the literature and existing competency standards, across two survey rounds, with feedback between rounds. An arbitrary consensus cut-off of 67% was applied with <10% change between rounds or 100% agreement interpreted as agreement stability. Results A total of 109 competency elements from the total list of 143 were rated as essential above the consensus cut-off, representing 76% of the original list. Thirty-three (33) elements were rated as essential by 100% of panellists. Approximately 90% or more of the competency elements tested were retained using the 67% cut-off across nutrition science, nutrition communication, professional communication, capacity building and intervention management competency units. Competency elements rated as essential beyond the consensus cut-off concentrated in the practice competency units of nutrition assessment, monitoring and surveillance, capacity building, and intervention management. Conclusions The results provide an empirical basis for future nutrition curriculum renewal and workforce development innovations and challenge the assumption that existing dietetic workforce preparation based on meeting entry-level competencies is adequate for community and PHN practice. [ABSTRACT FROM AUTHOR]

Aim The aim of this analysis is to establish if dietitians have the knowledge, skills and attitude to provide support to other health professional ( HP) groups in the provision of weight management advice to overweight/obese patients. Methods A secondary data analysis of a cross-sectional survey of HPs was undertaken to perform a gap analysis with regard to practices, knowledge, confidence and attitudes in the provision of weight management advice. Survey responses and additional measures (practice, knowledge, confidence and attitude scores) were compared between dietitians and other HPs. Descriptive statistics were undertaken, and differences between group χ2 tests were performed for nominal data and the Wilcoxon rank sum test for ordinal and non-parametric data. Results About 100% of dietitians had received initial weight management training and 85% had participated in professional development training, compared with 18 and 19% of HPs, respectively, although 70% believed it was within their scope of practice to provide evidence-based advice. Dietitian respondents achieved a higher median score (maximum 10) in the following areas (practice = 6.5, knowledge = 8.0, confidence = 8.3) when compared with HP respondents (practice = 4.2, knowledge = 7.0, confidence = 5.4). The median attitude score for both groups was 6.0. Conclusions HPs are receptive to providing evidence-based weight loss messages to overweight/obese clients in their current practice. However, weight management training is required to enhance HPs' knowledge and skills in order to increase confidence and improve practice skills. Dietitians can assist HPs to ensure that clear, consistent, evidence-based messages are delivered to overweight clients throughout the health-care system. [ABSTRACT FROM AUTHOR]