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Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects approximately 10% of the population. Diet triggers symptoms in the vast majority of individuals with IBS. In view of this, there has been a focus on the role of diet in IBS. The diets currently being headlined for IBS include (i) traditional dietary advice, (ii) the low fermentable oligo-, di-, mono- saccharides and polyols (FODMAPs) diet and (iii) the gluten-free diet (GFD). Although traditional dietary advice is considered as the first-line dietary therapy, its evidence base is variable, with a few randomized controlled trials (RCTs) exploring the efficacy of this approach, other than for fibre. There are now a growing number of RCTs demonstrating the efficacy of the low FODMAP diet in the short-term, with some emerging data on the long-term 'adapted' low FODMAP diet. There are also several RCTs showing the benefits of a GFD in IBS; however, this concept is hampered with uncertainty as to the mechanism of action. Nevertheless, all of these dietary therapies are viable options for individuals with IBS, with the dietitian and patient engagement at the forefront of achieving success. However, future pragmatic studies are needed to clarify the comparative efficacy and convenience of implementing these various diets into routine life. Moreover, it is imperative to better delineate the concern that restrictive diets - such as the low FODMAP and GFD - may promote nutritional inadequacies, disordered eating behaviours, and lead to detrimental alterations to the gut microbiota.

Background Dietary modification is an integral part of chronic kidney disease (CKD) management. However, adherence to the renal diet is often suboptimal. Methods The aims of this study were to (i) describe the experiences of patients with CKD and their carers in their process of interpreting and implementing renal dietary advice; (ii) to explore strategies they used to make sense of and apply renal diet information and (iii) to develop recommendations for improved clinical practice. To achieve these aims, individual semi-structured interviews with 26 patients and 10 carers were conducted, using interview questions guided by Sensemaking theory. Findings Six themes emerged from the data which did not differ according to CKD stage, geographic location or renal replacement therapy (RRT) type. The renal diet was perceived by patients and carers to be overwhelming, frustrating and emotionally demanding; as well as being complex and challenging. To help make sense of and apply renal dietary advice, participants highly valued the input of the dietitian; and patients believed that their carer support was important. Individual problem-solving strategies were developed by participants to help them make sense of the renal diet, and many of them expressed a desire for additional resources and/or support. Conclusions This study highlights that learning to make sense of renal diet information is an emotionally challenging journey for patients and carers. In addition to utilising the expertise of dietitians, carer support was perceived to be integral to learning and using renal dietary advice. The study describes a number of important problem-solving strategies utilised by patients and carers, as well as recommendations to help improve sensemaking and adherence to the renal diet.

Objective Tonsillectomy is a common operation; however, there are controversial opinions regarding the posttonsillectomy diet. The aim of this study was to compare the effects of cold/liquid diet vs regular diet on posttonsillectomy pain and bleeding. Study Design Prospective randomized controlled trial. Setting Tertiary referral center. Subjects and Methods In total, 194 children who underwent tonsillectomy (with or without adenoidectomy) were randomly allocated into 2 groups. A total of 100 patients were allocated in the cold/liquid diet, and 94 patients were allocated in the regular diet group. Pain score was recorded for the first 7 days, and rate of hemorrhage was recorded for 10 days after surgery. Results The participants' age range was 3 to 17 years. The mean pain score level in the regular diet group after breakfast, lunch, and dinner was not statistically significant in comparison with the cold/liquid diet group. One patient in the regular diet group was admitted to the hospital due to secondary bleeding, but it stopped without any intervention. Conclusion Most otolaryngologists believe in dietary restrictions following tonsillectomy. However, there is much controversy regarding posttonsillectomy dietary advice in the literature. In addition, only a few randomized clinical trials have focused on this subject. We found that there was no difference between regular diet and cold/liquid diet in terms of posttonsillectomy pain and bleeding. Hence, we do not recommend a limited posttonsillectomy diet.

BACKGROUND AND AIM Recent evidence indicates that new approach of the diet with low fermentable oligo-di-mono-saccharides and polyols (FODMAPs) may have an effective role in management of the patients with irritable bowel syndrome (IBS). We compared the results of low FODMAP diet with current dietary treatment, general dietary advices (GDA), on the clinical response in patients with diarrhea subtype of IBS (IBS-D). METHODS In this randomized, controlled, single-blind trial, we included 110 patients with IBS-D in two intervention groups. Participants were randomly assigned to the low FODMAP diet (n = 55) and GDA (n = 55) for 6 weeks after a 10-day screening period. Gastrointestinal symptoms and bowel habit status were evaluated using a symptom severity scoring system and Bristol stool form scale pre-intervention and post-intervention. Patients completed 3-day food diary before and after the intervention. RESULTS Of 110 patients, 101 completed the dietary interventions. At the baseline, the nutrient intake, severity of symptoms, and demographic data were similar between two groups. After 6 weeks, the low FODMAP diet improves significantly overall gastrointestinal symptoms scores, stool frequency, and consistency versus GDA group (P

Many and complex factors underlie seemingly simple decisions about what to eat. This is particularly so for foods such as fish, which present consumers with both risks and benefits. Advice about what type of and how much fish to consume is abundant, but that advice is often confusing or contradictory, reflecting the differing mandates and orientations of those advising. We survey a range of issues that can and should be incorporated into dietary advice, and offer tools for health agencies tasked with providing it. We argue that risks and benefits should not be limited to direct physical health. Rather, socioeconomic and community factors, unintended or indirect effects, and nonhuman-health outcomes such as animal welfare and planetary health should also be considered and weighed. We provide examples of existing fish consumption guidance to highlight the conflicting messages that emerge when different sources of advice with singular aims of avoiding risk, gaining nutritional benefit, or sustaining fish populations are juxtaposed. We then offer tools borrowed from health and other fields to guide health agencies toward developing more comprehensive advice and targeting that advice for specific populations.

Objectives Effective dietary counselling in a dental setting can significantly reduce the risk of oral disease. However, studies suggest that dental professionals are not instigating dietary advice on a regular basis, and there is a lack of current information of the barriers experienced that limit the delivery of dietary advice. The aim of this study was to investigate the current attitudes and practice behaviours of dental hygienists and oral health therapists in NSW, Australia, regarding dietary advice, and identify the barriers that limit its delivery. Methods A convenience sample of dental hygienists and oral health therapists were surveyed using a mail-out questionnaire. The questionnaire investigated the demographic data of participants, the attitudes and practice behaviours of participants, the perceived barriers and current dietary resources accessed by participants. Results Of 987 dental hygienists and oral health therapists, 426 participants responded. The study results suggest that many dental hygienists and oral health therapists have positive beliefs regarding the importance of dietary counselling. However, there are a multitude of barriers preventing the delivery of dietary advice; these include time, patient compliance, patient knowledge of nutrition topics, personal counselling skills and practitioners’ knowledge of nutrition. Conclusion Whilst dental hygienists and oral health therapists recognize the importance of diet and have positive attitudes towards providing dietary advice to patients, this study identified many barriers preventing implementation in practice. This information may be used to develop targeted strategies aimed at overcoming these barriers and improving behaviours.

Summary Exertional rhabdomyolysis represents a syndrome of typically recurrent exercise-associated muscle damage in horses that arises from a variety of aetiologies. Major advances have been made in recent years in our understanding of the pathophysiology of equine rhabdomyolysis syndrome (ERS), and a few specific causative genetic defects have been identified. Despite the fact that there is no single procedure or set of procedures (including diet and management) that can guarantee against further episodes of ERS, appropriate management of susceptible individuals, including nutrition, may help to reduce the likelihood, severity or frequency of future episodes. Whilst the dietary advice can be more specific and targeted for those with a known intrinsic muscle problem, for all affected individuals, regardless of the underlying cause, a balanced diet (which is suitable for the individual), together with a well-designed exercise programme, should be the initial management target. This paper will briefly review the condition and give general nutrition and management advice.

A variety of different dietary patterns can achieve the nutrient goals for a given population and therefore be considered as healthful. This means that guidelines for a healthy diet can be tailored to suit different cultures and food preferences. Although food-based dietary guidelines are used worldwide, there is also authoritative dietary advice in relation to single nutrients, especially those of public health relevance. This includes recommendations to eat less salt, free sugars and ‘saturates’ as well as more fibre. However, it can be difficult for consumers to make simultaneous reductions in salt, sugars and saturated fatty acids as well as increases in dietary fibre, given that food choices are made according to a variety of considerations, including taste preferences, culture, convenience and cost, as well as health. In addition, media coverage of new scientific findings, especially those that challenge current dietary guidelines, can confuse consumers and hamper efforts to eat healthfully. Both food-based dietary guidelines and recommended nutrient intakes can help consumers eat healthfully, providing they are supported by sound nutrition science, communicated well and delivered in a way that promotes beneficial changes in behaviour.

Aim The National Hemophilia Program Coordinating Center, with the U.S. Regional Hemophilia Network conducted a national needs assessment of U.S. Hemophilia Treatment Center (HTC) patients. The objectives were to determine: (i) To what extent do patients report that they receive needed services and education; (ii) How well do the services provided meet their needs; and (iii) What are the patients’ perspectives about their care. Methods A survey was mailed to active patients of 129 HTCs. Respondents completed the anonymous surveys on line or returned them by mail. Questions focused on management and information, access and barriers to care, coping, resources, and transition. Results Of 24 308 questionnaires mailed, 4004 (16.5%) were returned. Most respondents reported very few gaps in needed services or information and reported that services and information met their needs. Over 90% agreed or strongly agreed that care was patient-centred and rated HTC care as important or very important. Identified gaps included dietary advice, genetic testing, information on ageing, sexual health and basic needs resources. Minority respondents reported more barriers. Conclusion This survey is the largest assessment of the HTC population. Respondents reported that the services and information provided by the HTCs met their needs. Quality improvement opportunities include transition and services related to ageing and sexual health. Further investigation of barriers to care for minorities is underway. Results will help develop national priorities to better serve all patients in the US. HTCs.

Summary Objective The objective of this study was to determine whether parental preferences regarding primary care weight-management strategies differ by child age, gender, overweight severity, race/ethnicity or parental agreement that their child is overweight. Methods A survey was administered to parents of 2- to 18-year-old children who are overweight at an academic primary-care clinic regarding perception of child overweight, helpful/harmfulness of having the child present during weight discussions, and dietary-advice preferences. Multivariable analyses examined factors associated with preferred weight-management strategies, after adjustment for parent/child characteristics. Results Eighty-three per cent of parents agreed that a child's presence during weight discussions is helpful/very helpful, 74% that paediatricians should prescribe specific diets, and 55% preferred specific vs. general dietary advice only (N = 219). In multivariable analyses, characteristics associated with helpfulness of child presence included older child age (vs. 2–5 year olds, 6–11 year olds: odds ratio [OR], 4.6; 95% CI, 1.3–16; 12- to 18-year-olds: OR, 23; 95% CI, 4–136), male gender (OR, 5.0; 95% CI, 1.7–10) and obesity (vs. overweight: OR, 2.8; 95% CI, 1.7–12). Characteristics associated with preferring specific diets included Latino race/ethnicity (OR, 5.3; 95% CI, 3–12), older age (vs. 2–5 year olds, 6–11 year olds: OR, 2.8; 95% CI, 1.1–7; 12–18 year olds: OR, 3.7; 95% CI, 1.5–10) and agreement that the child is overweight (OR, 2.3; 95% CI, 1.1–5) and, for specific dietary advice, older age (vs. 2–5 year olds: OR, 2.3; 95% CI, 1.1–5) and agreement that the child is overweight (OR, 2.1; 95% CI, 1.2–4). Conclusions Findings suggest that weight-management strategies tailored to child age, gender, overweight severity, race/ethnicity and parental agreement that their child is overweight may prove useful in improving child weight status.

SUMMARY Background Individuals on peritoneal dialysis are given dietary advice to help reduce disease morbidity and mortality. However, the experience of people who have been given this advice is not well researched. Objective To understand the experiences of individuals on peritoneal dialysis when following dietary advice. Method A phenomenological approach, using semi-structured in-depth interviews was used to understand the experiences of ten service-users of the renal dietetic service. Data were analysed using Framework Analysis. Findings One theme emerged around difficulty when eating outside the home. Individuals experienced negative emotions when following advice. Individuals ate foods reluctantly, offered excuses as to why meals could not be eaten, or in extreme cases did not attend certain social gatherings in order to avoid the perceived attention and judgement from fellow guests related to their food choices. Conclusion A renal diet for peritoneal dialysis may be difficult to follow outside the home. Further support around eating in social situations may need to be offered when giving dietary advice.

The objective of this study was to test the feasibility and preliminary efficacy of a store-based dietary education intervention against traditional clinic-based advice. Patients with obesity (n = 55, mean [standard deviation, SD] age 44.3[9.2] years, 64% women, 87% non-Hispanic Black) were randomized to receive dietary counselling either in a grocery store or a clinic. Change between groups (analysis of covariance) was assessed for outcomes including: dietary quality (Healthy Eating Index – 2005 [0–100 points] ), and nutritional knowledge (0–65-point knowledge scale). Both groups reported improved diet quality at the end of the study. Grocery participants had greater increases in knowledge (mean [SD] change = 5.7 [6.1] points) than clinic participants (mean [SD] change = 3.2 [4.0] points) (P = 0.04). Participants enjoyed the store-based sessions. Grocery store-based visits offer a promising approach for dietary counselling.

Food preferences and cognitive control influence dietary habits thus affecting compliance with dietary advice and the risk of chronic diseases. A complex mix of genetic and environmental, cultural ...

The benefits of weight loss for people with type 2 diabetes are well established, but many individuals find dietary energy restriction and weight loss challenging. Conventional dietary advice recommends adopting a low fat, high fibre diet with moderate energy restriction for weight loss, but there are other more popular diets available including the 5:2 or Fast diet, the Paleolithic (or caveman) diet, low glycaemic index (GI) diets, low carbohydrate diets, very low calorie diets and Mediterranean diets. This review explores the evidence for these popular diets and discusses application to clinical practice. There is no evidence for the role of the Fast diet in people with diabetes, and little evidence for the Paleolithic diet, and these diets cannot be recommended currently. Although low GI diets appear to improve glycaemic control in people with diabetes, there is no evidence that they induce weight loss, and they are no longer recommended as a primary strategy by most authorities. There is stronger evidence for the efficacy of both low carbohydrate diets and very low calorie diets showing they are more effective for weight loss over the short term, although this benefit disappears over longer periods of time. Recent evidence suggests that Mediterranean diets are effective for weight loss, improvements in glycaemic control and for reducing cardiovascular risk, although cultural aspects may limit use outside the Mediterranean region. There remains no evidence for the most effective method for weight reduction in people with type 2 diabetes. Copyright © 2014 John Wiley & Sons. Practical Diabetes 2014; 31(5): 187 ‐192

In an attempt to reduce the incidence of coronary heart disease, dietary ‘experts’ advised us to avoid eating fat generally, saturated fat specifically; this led to an unavoidable increase in carbohydrate intake. Zoe Harcombe maintains that this change in dietary advice is the single greatest cause of the recent obesity epidemic.

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

Aim The aim of this study was to survey practice nurses in 2007 and 2012 to ascertain whether they are adequately equipped with knowledge, skills and resources, to provide nutrition education to people with type 2 diabetes in the Wellington region. Methods A self-administered questionnaire was posted to 151 practice nurses in 2007 and a revised questionnaire to 150 practice nurses in 2012. Results Practice nurses continue to provide most of the dietary advice in general practices. Changes over the 5-year period saw more nurses educating on hypoglycaemia, carbohydrate and alcohol. In most cases, appropriate resources are being used, with Diabetes NZ being the most popular source of patient resources. The number of nurses assessing the patients' diet and feeling confident in giving dietary education may have decreased over the 5-year period. Conclusions Areas that could be addressed in future training sessions include giving culturally specific dietary advice, quick nutrition assessment skills, simple nutrition education techniques and ways to support patients to lose weight.

In Haiti initiation of breastfeeding is high but early mixed feeding is the norm. In a situation of crisis mothers worries about insufficiency of breast milk disruption of social networks and free unmonitored distribution of breast milk substitutes impact feeding practices. This study was conducted to explore the attitudes practices and understandings of breastfeeding in the post-earthquake situation in Haiti. A mixed-method study was conducted in Leogane Haiti a town close to the epicentre of the 2010 earthquake. In a household survey 1131 mothers of children under 24 months were interviewed about feeding practices. In the quantitative component we conducted 25 in-depth interviews and seven focus group discussions with mothers grandmothers traditional birth attendants fathers and health care professionals. Mothers described breastfeeding as a challenging responsibility to ensure the infants health. They understood breast milk as a dynamic substance the quality of which would deteriorate if the mothers diet was poor or if the mother was afflicted with a psychosocial condition called move san or colere bad blood. To protect the child in these situations early supplementary feeding is introduced. Only 20% of informants exclusively breastfed infants under 6 months. Because of a lack of confidence in the quality of breast milk Haitian mothers tend to wean children earlier. The abiding concerns of Haitian mothers over the quality of their breast milk suggest a number of ways - such as dietary advice - that post-earthquake aid agencies could enhance breastfeeding support. (c) 2012 Blackwell Publishing Ltd.

The aim of this study was to determine how worthwhile it would be to combine a newly developed topical slimming product with customized dietary habits not based on calorie restriction, so as to improve the cellulite appearance of the skin. At the beginning of the study, a nutritionist recorded the dietary habits of each participant and gave recommendations to each of them according to their food consumption. The chosen methodology was a right/left comparison, one thigh and hip being treated with the new topical slimming product and the other one left untreated to serve as a random control. Objective evaluations were performed by blind assessors. Control of food intake improved the cellulite score after 4 weeks when compared with the base value, but this reduction was significantly greater and earlier on the treated side than on the untreated side, indicating an objective additional benefit derived from the new slimming cream. This result corroborated the slimming effect assessed by measurement in centimetres of the circumference of the upper thighs and the reconstructed volume of the thigh between two fixed horizontal slices. Furthermore, skin tonicity, a major component of cellulite visibility, was also significantly improved on the treated side after only 2 weeks. This new topical cream thus enhances the benefit of a dietetic control for the treatment of the visible aspect of cellulite on the skin.

Objective The aim of this study was to compare the impact of customised dietary advice on patients' satisfaction with their dentures and oral health-related quality of life (OHRQoL) in patients wearing implant-supported mandibular overdentures (IOD) or conventional dentures (CD). Materials and methods In this prospective cohort study, 28 IOD (two implant-retained mandibular overdenture) and 26 CD patients completed a denture satisfaction scale and the 20-item oral health impact profile (OHIP-20) before and 6 months following provision of customised dietary advice. Results At 6 months following provision of individualised dietary advice, the IOD group showed significantly greater satisfaction than the conventional group for denture comfort (80.6, + or - 15.6, vs. 68.7 + or - 15.6 P=0.001), stability (75.8 + or - 15.9 vs. 59.5 + or - 30.4, P=0.002), and perceived chewing ability (79 + or - 30.4 vs. 59.5 + or - 30.4, P=0.027) + or - when adjusted for baseline scores. Before delivery of the dietary advice there were no significant differences between groups for Satisfaction or OHIP scores. No difference in OHRQoL was seen between groups. Conclusions The delivery of customised dietary advice to edentulous patients impacts differently on their satisfaction with denture comfort, stability and chewing ability depending on the nature of their prosthesis. This re-evaluation of satisfaction occurs when edentulous patients challenge themselves to consume more fruits, vegetables and fibre-rich foods. The IOD group reported an increased level of satisfaction and perceived chewing ability whereas it appeared that CD wearers may have had their awareness of the shortcomings of this sort of prosthesis reawakened.

Background: Approximately 12 000 individuals undergo pelvic radiotherapy in the UK every year and up to 50% may develop symptoms of chronic radiation enteritis (CRE). Health professionals often give inappropriate dietary advice to patients in an attempt to avoid CRE symptoms, such as avoiding fibre, despite a lack of evidence to support this. Methods: The present study aimed to explore dietary advice and changes made to the diet by women treated with pelvic radiotherapy. A questionnaire was distributed to 117 women attending Liverpool Women’s Hospital, exploring symptoms of CRE and asking questions about diet and medication advice received, as well as changes made to the diet. Results: Ninety-five (87.2%) women completed the questionnaire and 47% had changed their diet. No significant relationship was observed between receiving dietary advice and making changes to the diet (P > 0.05), although those advised by a dietitian were more likely to be taking regular anti-diarrhoeal medication (P

Background: The vast majority of children will undergo their first exposure to common allergenic foods at home. However, the first exposure may lead to clinical reactions. It has been proposed to introduce allergenic foods gradually into the diets of children at risk for food allergy, but no practical dietary advice has been devised. Objective: The aim of this study was to devise safe introduction schedules for common allergenic foods for use at home, based on the challenge doses as administered in double-blind, placebo-controlled food challenge (DBPCFCs) in children who were never exposed previously to these foods. Methods: Seventy-two DBPCFCs were performed in 63 children as a first known exposure. The incrementing challenge doses were converted into equivalent portions of these foods in their usual household form and incorporated in introduction schedules. The feasibility of the introduction scales was tested in parents of the children attending our clinic. Results: Based on the results of the positive challenges (37) in which severe reactions did not occur, detailed introduction schedules and a reference photograph of the required increasing amounts of food were devised for use at home. Feasibility testing showed that, when using these introduction schedules, parents portioned the initial doses significantly lower than without detailed instructions. Conclusions: The introduction schedules and reference photograph provide information for parents to introduce the required amounts of allergenic foods in initial low doses at home. This is expected to improve the safety of this procedure.

Objective. The potential role of acidic drinks in the aetiology of dental erosion is well recognized. Whilst the wide-scale consumption of bottled waters is unlikely to contribute significantly to erosion, the role of flavoured sparkling water drinks is unclear. The aim of this study was to determine the pH, titratable acidity and in vitro erosive potential of a selection of these drinks drawn from the UK market to identify what dietary advice would be appropriate in relation to their consumption. Methods. pH was measured using a pH electrode and titratable acidity recorded by titration with 0.1-m NaOH. Erosive potential was assessed using an in vitro dissolution assay with hydroxyapatite powder and electron microscopic examination of surface enamel of extracted human teeth, following exposure to the flavoured sparkling waters for 30 min. Results. All of the flavoured waters tested showed appreciable titratable acidity (0.344–0.663 mmol) and low pH (2.74–3.34). In the hydroxyapatite dissolution assay, all of the waters demonstrated erosive potential (89–143%) similar to or greater than that of pure orange juice, an established erosive drink. Exposure of the extracted teeth to the flavoured waters resulted in surface changes consistent with erosive dissolution. Conclusions. Flavoured sparkling waters should be considered as potentially erosive, and preventive advice on their consumption should recognize them as potentially acidic drinks rather than water with flavouring.

A recent randomized controlled trial demonstrated that DNA-based dietary advice improved dietary compliance to sodium recommendations to a greater extent than general dietary recommendations. While sodium intake is a public health concern, little is known about changes to diet quality when individuals reduce their sodium intake. The objective of the present study was to investigate changes in food group and nutrient intakes following dietary sodium reduction. Subjects aged 20–35 years (n=138) completed a baseline food frequency questionnaire (FFQ) and were randomized to an intervention (I) or control (C) group. Those in the I group were genotyped for the angiotensin-I converting enzyme (ACE) gene, which is associated with salt-sensitive hypertension, and were given DNA-based advice for sodium intake based on their ACE genotype. The C group was given a general recommendation for sodium intake without genetic information. Another FFQ was collected 12 months after the intervention. General linear models with...

Objective: To determine whether analysis of food intake data using different food group classification systems changes the apparent contribution of defined food groups to total daily fat intake. Design: Three food classification systems were used to assess dietary intake of male omnivore subjects from a food frequency questionnaire. Setting: RMIT University, Melbourne, Australia. Subjects: A total of 78 healthy men aged 20–55 years, divided by meat consumption into moderate meat-eaters (n = 60) and high meat-eaters (n = 18). Methods: Dietary intake data were collected as semi-quantitative food frequency questionnaires and analysed using the NUTTAB 95 database. The contribution of food groups to nutrient intakes was determined using three food classification systems. Results: When red meat was grouped with meat, poultry and game products and dishes, ‘meat’ contributed 19.8% of total fat to a diet typical of an adult Australian man. When lean meat cuts were distinguished from meat products or dishes and fast foods, ‘red meat cuts’ provided only 4.3% of the total fat in this diet, whereas ‘fast foods’ provided 18.7%. Conclusions: Food classification systems have a profound impact on the apparent nutrient content of defined food groups, particularly the fat content attributed to meats. Less precise systems may result in provision of misleading dietary advice. Meats such as lean beef and lamb can be a valuable part of a healthy diet by providing important nutrients, especially iron, zinc and vitamin B12, but relatively little fat.

Objective: To describe the development and characteristics of a food categorisation system and its application to guide advice for diabetes treatment. Design and methods: Foods commonly consumed by 16 adults with diabetes were grouped by macronutrient content and type of fat to form a set of reference food groups for dietary advice. Means for energy and macronutrients from individual food groups were then used to construct an overall intake pattern targeting 8000 kJ and relative amounts of carbohydrate, protein and fat (saturated fatty acids (SFA) < 10%E and (polyunsaturated fatty acids) PUFA ∼ 10%E). Variation in energy and macronutrients contributed by all foods partitioned into each food group was assessed by the coefficient of variation of data on the whole diet. Results: To differentiate between sources of fat, 13 food groups emerged and 10 were deemed acceptable to nutritional guidelines for diabetes treatment. The food group pattern was judged adequate for the achievement of dietary recommendations with low-potential variation in total energy (5%) and macronutrient proportions (protein 6%, fat 6%, carbohydrate 3%), but higher for fat types (SFA 22%, (monounsaturated fatty acids) MUFA 11%, PUFA 12%). Targeted proportions for fat types were achieved only when daily servings of PUFA-rich, oils, nuts and oily fish or soy were included in an ideal intake pattern. Conclusions: In theory, a dietary pattern constructed from food group sources of macronutrients and individual fat types results in low-potential variation from recommended nutrient targets and, therefore, is appropriate to guide advice for the treatment of diabetes.

General practice surgeries and health centres often provide patients with healthy eating advice during consultation for specific problems, or in the context of general health monitoring. In some ci ...

(Nutr Diet 2005;62:152–157) Dietary advice in Australia, understood as recommendations as to a ‘better’ way of eating directed to the general population, has changed significantly as a result of advances in nutritional science and, in accordance with the structure of scientific revolutions outlined by Thomas Kuhn, by a series of ‘paradigm shifts’. These occur when the existing theory or paradigm becomes inadequate to explain observations or research findings and is discarded in favour of a new paradigm. In the history of dietary advice in Australia, paradigm shifts are associated with the discovery of vitamins at the beginning of the twentieth century and recognition of the role of fat in heart disease in the second half of the twentieth century. In both instances, a consequence of the paradigm shift was dramatic changes in dietary advice. While research has played, and continues to play, a significant role in the shaping of dietary advice, the direction of nutrition research is increasingly influenced by commercial considerations, which has implications for future dietary advice.

Background When a person becomes ill, traditional food habits may come into conflict with the disease-related recommended diet. Aim The aim was to study perceptions of receiving dietary advice, the occurrence and comprehension of such advice and compliance among older women diagnosed with Parkinson's disease, stroke or rheumatoid arthritis. Methods The study took an ethnographic approach. Fifty-four community-dwelling women, 64–88 years of age, were interviewed using an open-ended interview technique during visits to their homes. Findings Two themes were found: ‘dietary advice – occurrence and comprehension’ describes whether the women had received dietary advice and, if so, how they understood the information. In the theme ‘compliance with dietary advice’, two principal reasons for complying or not complying with advice were found: First, women expressed a ‘food interest’, such that they were either ‘interested in disease-related diet’ or held a general view of the significance of foods and complied with the advice for their own ‘health interest’. Secondly, the women were ‘uninterested in food changes’. This could be because of ‘poor appetite’, ‘food and disease ambivalence’, ‘habitual and preferred foods’. Conclusion Dietary advice should be based on women's food preferences and habitual foods. It is important to inform about known relations between food and disease, but also to support eating favourite foods, thereby facilitating women's well-being.

Summary Background : The general therapeutic approach is the cornerstone in the management of irritable bowel syndrome, but the effect is poorly documented. Aim : To evaluate the effect of the general therapeutic approach for irritable bowel syndrome. Methods : Subjects with irritable bowel syndrome identified in a public screening were included. Scores for abdominal symptom (range 0–12), musculoskeletal pain and mood disorders were calculated. After exclusion of other disorders, a doctor presented irritable bowel syndrome as a positive diagnosis, gave information, reassurance and lifestyle advice, but no pharmacotherapy. A dietician gave dietary advice. There was a follow-up after 6 months. Results : Sixty-five persons (females/males: 44/21) with mean age 49 years (range 31–76) were included, 31 (48%) were recommended dietary changes. Twenty subjects (31%) had satisfactory relief of symptoms after 6 months. The scores for abdominal symptom was reduced from 3.1 to 2.2 (P = 0.007), the reduction was 2.2 in the diarrhoea-predominant group given advice compared with 0.4 in the other subjects (P = 0.035). Previous consultations for the complaints, visits for psychiatric disorders, and presence of mood disorders were predictors of persistent complaints. Conclusions : There was a significant relief of symptoms after 6 months, those with psychological co-morbidity responded less well. The effect of dietary advice was only seen in those with diarrhoea-predominant irritable bowel syndrome.

The science of nutrigenomics allows us to consider not only the response of our genes, proteins and metabolism to diet but also life-stage and lifestyle. Public health messages are failing to change people's behaviour and to counteract the flashy advertising promoting cheap nutritionally-empty foods. Proponents suggest that using the information supplied by nutrigenomics to develop personalised diet and lifestyle regimens would enable consumers to make healthier choices for themselves. For some this will mean accessing new food products and genetic testing but for others it will mean better dietary advice that can be applied in their situation. Opponents argue that this approach merely panders to the worried-wealthy-well – those least in need of intervention because they are already diet and health conscious – and that nutrigenomics fails to address the real issues associated with diet-related disease. Is nutrigenomics another over-hyped science, which will ultimately disappoint, or is it an ideal tool for nutrition research? Copyright © 2007 Society of Chemical Industry

Summary • Insulin-treated diabetic patients with poor glycaemic control are frequently referred to diabetes specialist nurses, but little data exist as to the effectiveness of this practice. • We therefore analysed the progress of 43 prospectively referred insulin-treated patients with glycosylated haemoglobin (HbA1c) levels > 7.5%. • Diabetes nurse intervention involved re-education, dietary advice and insulin dose adjustment. Improvement in control was defined as a final HbA1c 1.0% at 6 months post-intervention. • Almost two-thirds (63%) of patients achieved improvement status, with no increase in body weight or hypoglycaemic episodes. Disappointingly, however, the ‘non-improver’ group (37%) showed a mean deterioration in HbA1c. • In conclusion, diabetes nurse intervention for poorly controlled insulin-treated diabetic patients is generally effective, but intervention may be best targeted to responsive patients. • The factors which influence diabetic patients' ‘responsiveness to change’ require further investigation.

summary The EDTNA/ERCA survey of the provision of dietary advice in renal care was the second project organised through the Collaborative Research Programme (CRP). Data was collected from 51 participating centres in 19 countries. Advice on nutrition was provided by a multidisciplinary team, normally led by a specialist renal dietitian or a medical doctor, in 90% of participating centres. There was a general consensus on the type of advice that should be provided, in that most patients routinely received advice on intake of protein, energy and minerals in over 70% of centres. There was also good agreement on daily protein requirements expressed as g/kg, but considerable variation in the calculation of the body weight that determines the dietary intake for an individual patient. This could lead to significant differences in the advice offered and suggests that guidelines on assessment and use of ideal body weight should be included in the new EDTNA/ERCA Nutrition Guidelines.

Summary Aim: To assess the face validity of a food intake questionnaire (FIQ) by comparison to current dietetic practice exemplified by State Registered Dietitians (SRD) working in the North West of England. Methods: 228 questionnaires were posted to 38 dietetic departments in the North West & North Wales branch of the British Dietetic Association. Dietitians were asked to name foods they considered most important when advising clients on four aspects of healthy eating: lowering sugar intake, lowering fat intake, increasing fibre intake and decreasing salt intake; the foods mentioned by most respondents in each category were ranked 1–10. If an FIQ item appeared in the list of ranked foods and was selected by more than 50% of the sample its inclusion in the FIQ was considered face valid. Results: 56 foods out of the 80 ranked 1–10 in the eight categories appeared in the FIQ. Thirty-one of these 56 foods were mentioned by more than 50% of dietitians when considering the four aspects of healthy eating; 27 (87%) of these were included in FIQ items. The study also revealed a surprisingly large number of foods to be mentioned by dietitians for each of the four categories. The list of foods mentioned was extensive; for example, 120 foods were mentioned when considering lowering fat intake. Conclusions: The items chosen for the FIQ can be seen to agree closely with the opinions of practising SRDs, confirming its face validity. The results also suggest there is a need to debate the nature of dietary advice which is given to the public. The findings of the study suggest that translating nutritional guidelines into advice about which foods should be eaten is far from simple. The results may provide one reason for public confusion about healthy eating.

Background: Exercise should play an important part in any weight control programme and swimming/exercise in water has particular advantages for the obese individual. Since 1996 aquafit sessions for the obese have been available in Coventry as an optional adjunct to dietary intervention. Aim: The study aimed to compare outcomes in two groups; one group had received individual dietary advice (GpDO) and the other group had received individual dietary advice and also attended aquafit sessions regularly (GpDAq). Characteristics of groups members were compared and perceived barriers to successful weight loss were considered. Method: The study looked retrospectively at a sample of obese women, aged 18–70 years, with a BMI (kg/m2) of over 35, referred by their general practitioners or consultants, for dietary advice for weight reduction. Participants were interviewed by a dietitian and researcher to gain data on long-term changes in weight, activity, and factors they felt had affected their weight changes. 76 women (54 in GpDO and 22 in GpDAq) were invited to participate in the study. Thirty attended for interview (25 in GpDO and five in GpDAq). The average time since first contact with dietitian to the review for this study (the study period) was 19 months (range 7–39 months). Results: The mean weight loss was 3.8 kg, SD = 5.5 (GpDO mean = 3.3 kg, SD = 4.9, and GpDAq mean = 6.2 kg, SD = 8.2). Two (7%) women (one in GpDO and one in GpDAq) reduced their weight by > 10% over the study period. Twenty-one (70%) participants (68% of GpDO and 80% of GpDAq) did not gain weight over the study period (initial weight > study weight). Nine (30%) participants increased their physical activity by one episode of 30 min per week and maintained this over the study period. Conclusions: The desire of many clients for long-term support and continuity of care from a dietitian was highlighted, as were the perceived difficulties in increasing physical activity. This study demonstrates that weight management interventions that provide dietary advice with and without exercise can help some women to achieve moderate weight loss and maintain this, highlighting areas for further consideration.

Summary Background: Body mass index (BMI) was used to assess the population of Royal Earlswood, a long-stay institution for people with learning disability. Method: Height and weight measurements were taken for each resident. Where available, previous weight records were used to compare the study BMI measurement with that 3 years previously – the time at which the Dietetic Service was first set up. Results: This study indicated that 56.4% of the residents in Royal Earlswood had a BMI that was outside of the ideal range. The Dietetic Service knew of 60% of these residents, and the weight status of over three-quarters of those receiving dietary advice had already been improved. The remaining 40% had not previously been identified as having an unhealthy weight. Conclusions: This paper supports previous research in demonstrating that people with learning disability are more likely than the general population to have a body weight that is outside the healthy range. In this study dietetic input is generally shown to have influenced BMI beneficially.