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A healthy lifestyle comprising regular physical activity and an adequate diet is imperative for the prevention of non‐communicable diseases such as hypertension and some cancers. Advances in information computer technology offer the opportunity to provide personalised lifestyle advice directly to the individual through devices such as smartphones or tablets. The overall aim of the PROTEIN project (Wilson‐Barnes et al., 2021) was to develop a smartphone application that could provide tailored and dynamic nutrition and physical activity advice directly to the individual in real time. However, to create this mobile health (m‐health) smartphone application, a knowledge base of reference ranges for macro‐/micronutrient intake, anthropometry, biochemical, physiological and sleep parameters was required to underpin the parameters of the recommender systems. Therefore, the principal aim of this emerging research paper is to describe the process by which experts in nutrition and physiology from the PROTEIN consortium collaborated to develop the nutritional and physical activity requirements, based upon existing recommendations, for 10 separate population groups living within the EU including, but not limited to healthy adults, adults with type 2 diabetes mellitus, cardiovascular disease, excess weight, obesity and iron deficiency anaemia. A secondary aim is to describe the development of a library of 24‐h meal plans appropriate for the same groups and also encompassing various dietary preferences and allergies. Overall, the consortium devised an extensive nutrition and physical activity knowledge base that is pertinent to 10 separate EU user groups, is available in 7 different languages and is practically implemented via a library of culturally appropriate, 24‐h meal plans. [ABSTRACT FROM AUTHOR]

Objective: We aimed to capture General Dental Practitioners' (GDPs) views on delivering dietary advice to older adults in combination with treatment to replace missing teeth and identify solutions to help inform the development and implementation of future dietary interventions within primary dental care. Background: As natural teeth are lost, older adults may need to choose softer, more manageable foods which might be of lower nutrient density. Previous research has indicated that prosthodontic rehabilitation can improve masticatory function but not the intake of nutrients, highlighting a potential need for a combined approach of oral rehabilitation and dietary counselling. Materials and Methods: Semi‐structured telephone interviews were conducted with a purposive sampling strategy of 12 GDPs. Interviews were digitally recorded and transcribed verbatim. An iterative coding process using theme‐analytic methods was used. Results: Twelve interviews were conducted with GDPs in the United Kingdom. The themes that emerged from the interviews included: the awareness of the importance of dietary advice among GDPs; the concerns GDPs had on patients' adherence to dietary advice; uncertainty over roles and responsibilities in the provision of dietary advice; and the limited time and remuneration for dietary advice in dental practice. A minor theme identified was the motivation of GDPs to implement dietary advice alongside oral rehabilitation. All reported that they were already providing dietary advice to their patients but that this was limited to caries prevention. Conclusion: The GDPs interviewed expressed positive attitudes towards providing dietary advice alongside oral rehabilitation for older adults. However, a lack of confidence, awareness, time and remuneration are barriers to its provision in primary dental care. To facilitate the implementation of dietary advice alongside oral rehabilitation, clear guidance on and training in delivering dietary advice and multidisciplinary cooperation are required. [ABSTRACT FROM AUTHOR]

Background: This research aims to systematically review a comprehensive sample of websites (English‐language) that provide information on nutrition after cancer treatment. Methods: In consultation with cancer survivors and experts, we developed search strings for an internet search (incognito mode in Google Chrome) to be completed in six English‐speaking countries (Ireland, the United Kingdom, Australia, New Zealand, Canada and the United States); the first 10 results were chosen for each search). Websites/web pages were included if the links related to sites/content that provided information on health post‐treatment in English and aimed at adults (aged above 18 years). Several tools were applied to test the quality, readability and usability of the websites/weblinks. Results: Initially, 720 links were found, with 159 eligible for inclusion. Those eligible for review were charity/support/non‐governmental organisation weblinks (49.1%) that originated in the United States (42.8%) and did not specify a particular cancer type (65.4%). One‐third (n = 59, 37.1%) of these links contained nutrition guidance; however, these lacked practical implementation strategies. Most of the websites/web pages were not Health On the Net certified and lacked overall quality, with a mean International Patient Decision Aids Standards score of 20.4/40 and a Journal of the American Medical Association score of 1/4. Readability failed to meet ideal levels. Only 32.5% (n = 13) of the web pages/weblinks met the benchmark for usability. Conclusion: Cancer survivors seeking nutrition information online may encounter difficulty locating advice, and where they do, it is unlikely to contain guidance on implementation into day‐to‐day life. This is concerning, given the important role nutrition can play in cancer survivorship. Key points: Only one‐third of the eligible websites contained any nutrition guidance, and for the most part, they did not contain details and did not include practical strategies for implementation.The majority of the websites/web pages lacked overall quality, with a mean IPDAS score of 20.4/40 and a JAMA score of 1/4. Readability also failed to meet ideal levels.Regarding usability, only 32.5% (n = 13) of the web pages/weblinks met the benchmark for usability (29).We would recommend reliable websites to enhance their search engine optimisation, by incorporating keywords outlined in our search strategies (Supporting Information) as developed by cancer survivors and reflecting typical searches undertaken.These findings have identified areas for improvement in providing online information for cancer survivors and providing guidance for those developing and managing websites with health and cancer‐related content. [ABSTRACT FROM AUTHOR]

Background: There is limited understanding of patients' and healthcare professionals' perceptions and experiences of receiving and delivering dietetic care, respectively. This systematic review of the literature used qualitative synthesis to explore the perceptions and experiences of multiple stakeholders involved in the delivery of nutrition care and dietetic service. Methods: MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, ISI Web of Science, PsycINFO and ProQuest were systematically searched. Study characteristics and perceptions of stakeholders regarding nutrition care services were extracted. Qualitative synthesis was employed and thematic analysis conducted. Results: Five themes were identified from 44 studies related to stakeholders' perceptions of dietetic services. Studies included quantitative, qualitative and mixed methods involving patients, families, dietitians and other healthcare professionals. The themes were (1) patients desiring a personalised approach to nutrition care; (2) accessing dietetic service; (3) perceived impact of nutrition care on the patient; (4) relationships between stakeholders; and (5) beliefs about nutrition expertise. Two themes were specific to patients; these were the desire for individualised care and the impact of nutrition care. Within each theme perceptions varied with patients' views often contrasting with those of dietetic service providers. Conclusions: Experiences of dietetic service do not always meet stakeholder expectations which impacts on patient engagement. Seeking stakeholder input is imperative to design dietetic services that engage patients in positive and supportive clinical partnerships. Key points: Stakeholder perceptions of dietetic service and care delivery included themes around a need for a personalised approach to nutrition assessment and intervention, enablers and barriers to accessing dietetic services, the importance of relationships between stakeholders and a range of beliefs about nutrition expertise.Experiences of dietetic services did not always meet stakeholder expectations which impacted on patient engagement.Stakeholder perceptions of dietetic service and care delivery provide valuable insights which can be used to better meet patient, healthcare service and community needs, as well as inform dietetic curricula to prepare graduates for authentic patient‐centred care. [ABSTRACT FROM AUTHOR]

Background: Eggs are an affordable food providing many shortfall nutrients with the potential to improve cognitive health. We assessed the relationship between whole egg consumption and cognitive functioning among a US nationally representative sample of older adults. Methods: Individual‐level data (2816 adults, aged ≥ 60 years) were obtained from the National Health and Nutrition Examination Survey (NHANES) 2011–2012 and 2013–2014 waves. Cognitive assessments included the Consortium to Establish a Registry for Alzheimer's Disease Word List Learning Test (CERAD‐WL), Word List Recall Test (CERAD‐DR), Animal Fluency Test (AF) and Digit Symbol Substitution Test (DSST). A composite cognitive z‐score was constructed based on the individual tests to represent one's overall cognitive functioning. Multiple linear and logistic regressions were performed to examine the effect of whole egg consumption on cognitive functioning, adjusting for individual characteristics and survey design. Results: Approximately 57% of older adults consumed whole eggs, with an average daily intake of 34 g of whole egg equivalent among consumers. The average z‐scores of the CERAD‐WL, CERAD‐DR, AF and DSST tests were −0.08, 0.23, 0.37 and 0.42, respectively, and the overall composite cognitive z‐score was 0.24 among older adults. Regression analyses found that neither whole egg consumption status, nor daily intake quantity was associated with cognitive test scores. Conclusions: No association was found between whole egg consumption and cognitive functioning among US older adults. Study limitations included cross‐sectional study design and measurement errors. Future studies with longitudinal or experimental design are warranted to examine the possible link between egg consumption and cognition in older adults. Key points: In a large sample of 2816 adults aged ≥ 60 years in the 2011–2014 US National Health and Nutrition Examination Survey (NHANES), we report that no statistically significant association was found between whole egg consumption and cognitive function.Neither whole egg consumption status, nor daily intake quantity measured by the NHANES 24‐h dietary recall was found to be associated with the multidomain cognitive performance nor the overall cognitive score.Although egg consumption contributes to the intake of nutrients potentially beneficial to cognitive health, the quantity consumed remains modest and may not be sufficient to lead to measurable changes in cognitive functioning.Future studies should adopt longitudinal or experimental study designs to further examine the relationship between egg consumption and cognition in older adults. [ABSTRACT FROM AUTHOR]

Background: After a positive food challenge (FC), patients receive dietary advice regarding avoidance of the culprit food. We examined the frequency and variables associated with dietary adherence after a positive FC in adults. Methods: In this prospective daily practice study, adults with a positive FC were included. After every FC, dietary advice was given consisting of three options: (1) strict avoidance, (2) avoidance but products with precautionary allergen labelling (PAL) allowed and (3) (small) amounts allowed. Questionnaires about dietary adherence and associated variables were completed prior to and 6 months after the FC(s). Results: 41 patients (with 58 positive FCs) were included. Overall, patients adhered to the advised diet after 31% of the FCs. After 33 FCs, the advice was strict avoidance, whereof 82% followed a less strict diet. After 16 FCs, the advice was avoidance but products with PAL allowed, whereof 19% followed a less strict and 25% a stricter diet. In 9 FCs with the least strict advice, "(small) amounts allowed", 67% followed a stricter diet. Three variables were associated with adherence: misremembering dietary advice, impaired health‐related quality of life (HRQL) on domain "Emotional impact" and the need for dietary change after the FC. Conclusion: After one third of the positive FCs, patients adhered to the dietary advice. Variables associated with adherence were misremembering dietary advice, impaired HRQL on domain "Emotional impact" and the need for dietary change after the FC. It seems important that healthcare professionals should more frequently apply adherence‐enhancing strategies to improve dietary adherence. [ABSTRACT FROM AUTHOR]

Summary: The elemental composition and bioaccessibility of the Azorean macroalgae Petalonia binghamiae, Osmundea pinnatifida and Halopteris scoparia were studied. H. scoparia had the highest Cr, Mn, Co and Ni contents. Iodine content was also the highest in H. scoparia, 1098 ± 54 mg kg dw−1. Content reductions due to rehydration were in the 75%–90% range. Steaming led to similar reductions with exception of Cr, Mn, Co, Ni and Zn in O. pinnatifida. For P. binghamiae and O. pinnatifida, bioaccessibility percentages varied between elements. Variation due to rehydration and culinary treatment was narrower, particularly for P. binghamiae. Whereas I bioaccessibility was low in O. pinnatifida, 11%–14%, it reached 57%–69% in P. binghamiae. On the basis of bioaccessibility, to meet the I DRI, 2.7 g dried P. binghamiae, 16.9–23.8 g rehydrated P. binghamiae and 12.7 g steamed P. binghamiae everyday are required. For O. pinnatifida, 5.0 g, 19.0–33.3 g and 12.9 g of dried, rehydrated and steamed red seaweed, respectively, are needed. [ABSTRACT FROM AUTHOR]

Background: Increased resting energy expenditure (REE) has been hypothesized to be a potential cause of weight loss in individuals with Crohn's disease (CD). This study aimed to develop and validate new predictive equations for estimating REE in adults with CD.Methods: Adults, ages 18-65 years, with CD were recruited. Anthropometry, indirect calorimetry, and bioimpedance analysis were performed in all patients. Disease activity was assessed by Crohn's Disease Activity Index. The new predictive equations were generated using different regression models. Prediction accuracy of the new equations was assessed and compared with the most commonly used equations.Results: A total of 270 CD patients (159 males, 111 females) were included and randomly assigned to the calibration (n = 180) and validation groups (n = 90). REE was directly correlated with weight and bioimpedance index, whereas the relation with both age and disease activity was inverse. The new equations were suitable for estimating REE at population level (bias: -0.2 and -0.3, respectively). Individual accuracy was good in both models (≥80%, respectively), especially in females; and similar results were shown by some of the selected equations. But, when accuracy was set within ±5%, the new equations gave the highest prediction.Conclusion: The new, disease-specific, equations for predicting REE in individuals with CD give a good prediction accuracy as far as those proposed in the literature for the general population. However, the new ones performed better at the individual level. Further studies are needed to verify the reliability and usefulness of these new equations. [ABSTRACT FROM AUTHOR]

Background: Blood donors with a relatively low haemoglobin (Hb) level at their previous donation attempt have an increased risk of Hb deferral at the subsequent donation attempt. The aim of this study was to investigate whether the interventions prolongation of donation interval and/or a dietary advice decrease the Hb deferral rate. Methods: 11 897 whole blood donors with Hb levels from below to 0·2 mmol/l above the cut‐off level for donation received either no intervention, a prolongation of the donation interval to six or twelve months, a dietary advice, or both. Deferral rates for low Hb levels at the subsequent donation attempt were compared in the different intervention groups. Additionally, the effects of the interventions on Hb deferral risk and donor return for a subsequent donation attempt were analysed using generalized estimating equations. Results: The Hb deferral rate was substantially lower in the group that received a prolongation of the donation interval to six months than in the Control Group (12·9% vs. 6·3% in men and 20·4% vs. 13·4% in women). However, the additional benefit of twelve over 6‐month interval prolongation was small, and no benefit of a dietary advice showed up. On the other hand, receiving a dietary advice increased the likelihood of donor return for a subsequent donation attempt. Conclusion: Implementation of a protocol for the prolongation of donation intervals to six months for donors with Hb levels from below to slightly above the cut‐off level for donation may reduce the deferral rate for low Hb levels while keeping donor lapse at a minimum. [ABSTRACT FROM AUTHOR]

Background: Dietary advice combined with prosthetic treatment could improve dietary intake earlier than prosthetic treatment only. This early improvement might signify early adaptation to new prostheses. Therefore, dietary advice might affect functional adaptation to new prostheses. Objective: The aim was to clarify the influence of simple dietary advice on masticatory function of elderly individuals with new complete dentures. Methods: A randomised controlled trial was performed on 59 edentulous elderly individuals who had received new complete dentures. Participants were randomly divided into an intervention group (received simple dietary advice: 15 men and 15 women, mean age: 74.8 ± 8.0 years) or a control group (received denture care advice: 15 men and 14 women, mean age: 78.6 ± 6.8 years). Masticatory function was assessed using colour‐changeable chewing gum for mixing ability and test gummy jelly for shearing ability. Mixing and shearing ability were assessed at pre‐treatment, and 3 and 6 months post‐treatment. At each assessment time, mixing ability was compared using Student's t test and shearing ability using Mann‐Whitney's U test. Within‐group differences in mixing ability were analysed using repeated‐measures one‐way analysis of variance and those in shearing ability were analysed using Wilcoxon signed‐rank test with Bonferroni correction. Results: At each assessment time, there was no significant difference in mixing or shearing ability between groups. In the intervention group, mixing and shearing ability significantly increased at 3 and 6 months post‐treatment. In the control group, mixing ability significantly increased at 6 months post‐treatment. Conclusion: Simple dietary advice might lead to relatively early improvements in masticatory function. [ABSTRACT FROM AUTHOR]

Abstract: Background: Evidence from healthcare professionals suggest that consumer compliance to healthy diet and lifestyle changes is often poor. The present study investigated the effect of advice provided by a physician or dietitian on consumer adherence to these measures combined with consuming foods with added plant sterols (PS) with the aim of lowering low‐density lipoprotein cholesterol (LDL‐C). Methods: One hundred mildly‐to‐moderately hypercholesterolaemic individuals were enrolled into a parallel, randomised, placebo‐controlled study. Dietitians (dietitian group; DG) advised 50 individuals in six weekly face‐to‐face behavioural therapy sessions, whereas the other 50 received standard advice from physicians (physician group, PG). Both groups consumed foods with added PS (three servings a day) for 6 weeks. Subsequently, all individuals were followed‐up for another 6 weeks under real‐life conditions. Blood lipids were measured at baseline and weeks 6 and 12 and 3‐day diet diaries were taken at weeks 1, 6 and 12. Results: Individuals in the DG significantly improved their dietary habits, physical activity and increased PS intake compared to the PG. After 6 weeks, LDL‐C decreased in both groups compared to baseline without any significant differences between groups. At week 12, LDL‐C was further significantly improved only in the DG (P = 0.006) compared to week 6. Total cholesterol, LDL‐C and triglycerides were significantly lower in the DG compared to the PG at week 12 after adjusting for levels at week 6 (P < 0.001, P < 0.001 and P = 0.009, respectively). Conclusions: Although structured counselling by dietitians and common standard advice by physicians were equally effective with respect to improving blood cholesterol after 6 weeks, dietitians were more effective in the longer‐term (i.e. 6 weeks after the end of the intervention period). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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

Background: Caries prevention is paramount in safeguarding the life quality of head and neck cancer patients and is dependent on patient compliance with caries preventive protocols. The purpose of this study was to examine this compliance.Methods: All records of patients referred to one public oral medicine clinic servicing a head and neck oncology unit of one major Western Australian hospital, between January 2005 and December 2011, were examined. Data extracted included patient and cancer characteristics and compliance with dietary advice, dental care, oral hygiene instruction and fluoride use over a follow-up period of at least 12 months. Compliance was assessed against various oral health outcomes and patient characteristics.Results: Of the 116 participants, 75.9% complied with all caries preventive measures over a mean follow-up period of 45 months. Non-compliance with regular dental attendance (P = 0.004), oral hygiene instruction (P = 0.009), dietary advice (P = 0.034) and daily fluoride use (P = 0.018) were associated with the development of dental caries post-treatment. The presence of dental caries at the time of cancer diagnosis was predictive of poorer compliance.Conclusions: High compliance with caries preventive measures is attainable in the head and neck cancer patient group. Factors other than fluoride use seem important in caries prevention. [ABSTRACT FROM AUTHOR]

Background Diet and body composition play unclear roles in the pathogenesis, activity and symptoms of inflammatory bowel disease (IBD). Evidence-based guidance regarding dietary modification in IBD is lacking. We aimed to determine the attitudes of IBD patients and clinicians to diet. Methods The present cross-sectional study comprised an online questionnaire distributed to members of a national IBD patient organisation, assessing demographics, anthropometry, disease phenotype and dietary beliefs. Dietitians, gastroenterologists and surgeons were targeted for a similar questionnaire as a result of membership of national professional bodies. Results Nine hundred and twenty-eight patients (72.2% female; mean age 39.5 years; age range 5-91 years) responded. Two-thirds of the patients had Crohn's disease. The mean reported body mass index was 24.9 kg m-2 and was significantly skewed to the right. Patients who had taken >10 courses of steroids were had a greater probability of being overweight or obese, independent of disease complications. Most patients (71%) assumed that their diet affected their IBD; 61% considered their IBD specialist disregarded the importance of diet. Of the 136 clinicians who responded, the majority felt that diet was a factor in symptoms and intestinal microbiota. More gastroenterologists (44%) than dietitians (17%) considered that diet had a role in the pathogenesis of IBD ( P = 0.003). Twenty-six percent of patients reported receiving dietary advice from their IBD specialist, whereas 98% of gastroenterologists reported advice provision. Patients received diverse advice. Half of the patients followed recommendations provided by a clinician. Conclusions The present study demonstrates that IBD patients consider diet to be important in their disease. IBD clinicians from different disciplines have diverse views of the role of diet. Advice given to patients is heterogeneous, often perceived as inadequate and poorly followed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Understanding patients' experiences and preferences for health care is important with respect to informing how to provide best-practice, patient-centred care. The present study aimed to explore the perceptions of patients who have been recently diagnosed with type 2 diabetes regarding nutrition care received from dietitians. Methods Ten individuals recently diagnosed with type 2 diabetes participated in three individual semi-structured qualitative telephone interviews: at baseline, then at 3 and 6 months after recruitment. Data were analysed using content analysis at each time point and meta-synthesis of findings over time. Results Participants' initial interactions with dietitians were challenging and overwhelming as a result of the instructional nature of consultations. Many participants questioned the use of dietary guidelines to inform nutrition care because this was not adapted to the individual. Some participants valued receiving education on topics such as label reading and serving sizes; however, others considered that the nutrition care was rushed and overly directive. Very few participants perceived that an ongoing relationship with a dietitian would be useful, and limited interaction was planned beyond 6 months after diagnosis. Conclusions These findings suggest that there is considerable opportunity for dietitians to enhance the nutrition care provided to patients with type 2 diabetes. Tailoring of dietary guidelines to individuals, utilising supportive counselling styles, and focusing on open communication in consultations that facilitate ongoing, useful care for patients, may help patients with type 2 diabetes achieve and maintain healthy dietary behaviours. [ABSTRACT FROM AUTHOR]

Background A healthy diet is the cornerstone of type 2 diabetes (T2 DM) self-management. Carbohydrate is of particular interest as the nutrient with the greatest direct effect on blood glucose ( BG) levels. The present study aimed to explore T2 DM patients' understanding of carbohydrate and beliefs around the role of carbohydrate in T2 DM management. Methods Fifteen semi-structured interviews were conducted with T2 DM patients. Interviews were audio-recorded and transcribed, and a deductive thematic approach to analysis was employed using the Framework method. Results Four significant themes emerged: (i) a naïve conceptual understanding of carbohydrate and sugar-centric specificity to dietary behaviours; (ii) a narrow focus on BG management to the neglect of overall dietary balance; (iii) positive reception of moderate dietary advice focused on portion control from healthcare professionals ( HCPs); and (iv) the impact of external moderators of dietary choices, including the influence of significant others, emotional and opportunistic eating and budgetary constraints. Conclusions Participants' beliefs and understanding of carbohydrate led to an overemphasis on sugar restriction for blood glucose control to the neglect of their overall dietary balance. Diabetes educators need to place greater emphasis on the role of various types of carbohydrate foods for glycaemic control, as well as on concepts of wider metabolic health, during T2 DM dietary education. Participants placed a high level of trust and value on practical, moderate portion control advice from HCPs regarding carbohydrate foods. However, HCPs need to be cognisant of external moderators of behaviour, such as the influence of family and friends, budgetary constraints and environmental eating triggers. [ABSTRACT FROM AUTHOR]

Background Over the last decade, professional discourse around health ownership has been evolving to recognise an individually-driven wellness/wellbeing approach. Concurrently, dietetic competencies have changed to include client-centred counselling incorporating individual client's perspectives within dietary prescriptions. The present exploratory research aimed to explore how client-centred counselling practice was being represented in the dietetic literature and to examine dietitians' perspectives about working with clients in the current environment. Methods To explore the professional position, a literature search was conducted using keywords encompassing client-centred care and competency within professional dietetic journals (2001-2010). To develop a contextual case study, 10 in-depth interviews with dietitians delivering weight-loss prescriptions within a clinical trial were conducted. Recordings of their perspectives on roles, opportunities/barriers and counselling strategies were transcribed verbatim and examined using inductive thematic and content analysis. Results Eleven articles were incorporated into a narrative review describing practice issues related to traditional forms of consultation and the effectiveness of client-centred approaches. The over-riding theme from the interviews ( Professional Identity Dilemma) highlighted tension felt by dietitians in their dual role as nutrition expert and counsellor, trained to deliver biomedical imperatives (clinical targets), and their challenge to accept client-defined health perspectives. Supporting themes ( Adherence factors and Constructs of health) exposed details on barriers to dietary change and the impact of contextual factors on this change that were linked to wellness and wellbeing concepts. Conclusions Appreciating wellness and wellbeing concepts may add a useful adjunct to client-centred approaches to dietary counselling through building bridges between clinical targets and client health perspectives. [ABSTRACT FROM AUTHOR]

Background Although registered sports dietitians commonly assist athletes with training and competition nutrition advice, an emerging area of practice is focused around food provision and nutrition support provided at major competition events. The present study aimed, first, to identify the dietetic skills and scope of practice that dietitians may require to work in this environment as determined by the occasions of service provided by dietitians at a nutrition kiosk located in the dining hall at a major competition event and, second, to investigate athletes' opinion and usage of the nutrition services and the association with their type of sport and previous source of nutrition information. Methods Dietitians based at a nutrition kiosk recorded all enquiries ( n = 383) and consultations ( n = 60) from 23 September to 14 October 2010. A questionnaire was also distributed to athletes in the main dining hall over this period to investigate their opinion and use of nutrition support, as well as their previous source of nutrition information. Results Although athletes from Western regions made up the majority of the enquiries regarding food provision and special/therapeutic dietary requirements (predominately food allergy and intolerance), athletes from non-Western regions, and those in weight category sports, had more sports nutrition enquiries and were more likely to request a consultation. A number of athletes (32%) reported no previous or one source of nutrition information, whereas only eight of 52 athletes who requested a consultation had prior nutrition assistance. Conclusions In addition to sport nutrition knowledge and experience, dietitians working in this environment are likely to require an understanding of cultural eating styles, food beliefs and customs, large-scale food service operation, and local food availability. [ABSTRACT FROM AUTHOR]

Background Analyses of global trends indicate that childhood undernutrition is more prevalent in rural areas, and also that maternal education and decision-making power are among the key factors significantly associated with child growth. Methods The present study comprised a controlled longitudinal study aiming to assess the effectiveness of nutrition education with respect to improving growth patterns of young children of less-literate, low income caregivers in a rural subsistence farming community. Caregivers in the intervention group ( n = 52) attended a structured nutrition education programme, whereas the control group ( n = 45) participated in sewing classes. Weights and lengths/heights were measured for children in the intervention and control groups every month for 1 year to assess changes in growth patterns. Repeated measures analysis of covariance was used to access differences between the two groups over time and across age groups. Variability in growth patterns of individual children and clustering of caregiver effects were controlled for during the statistical analysis. Results After 12 months, children in the intervention group had significant improvements in weight-for-age compared to the controls [ mean (SD): 0.61 (0.15) versus −0.99 (0.16), P = 0.038]. Changes in height-for-age, weight-for-height and mid-upper arm circumference-for-age showed a positive trend for children in the intervention group. Changes in weight-for-height were statistically significant across age groups and negatively related to caregiver's age. Conclusions Educating caregivers has the potential to improve young children's nutritional status and growth, especially among less literate populations where households subsist on what they produce. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later. Methods: The intervention involved general practitioners (GPs), practice nurses, nurses in local nursing homes and community nurses. It comprised an education programme together with the provision of a new community dietetics service. Changes in health care professionals' nutrition care practices were determined by examining community dietetics records. ONS prescribing volume and expenditure on ONS were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive. Results: Seven out of 10 principal GPs participated in the nutrition education programme. One year later, screening for malnutrition risk was better, dietary advice was provided more often, referral to the community dietetics service improved and ONS were prescribed for a greater proportion of patients at 'high risk' of malnutrition than before (88% versus 37%; P < 0.001). There was a trend towards fewer patients being prescribed ONS (18% reduction; P = 0.074) and there was no significant change in expenditure on ONS by participating GPs (3% reduction; P = 0.499), despite a 28% increase nationally by GPs on ONS. Conclusions: The community dietetics intervention improved ONS prescribing practices by GPs and nurses, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention. [ABSTRACT FROM AUTHOR]

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

Full-day-care pre-schools contribute significantly to the nutritional intake and acquisition of dietary habits of the pre-school child. The present study investigated nutritional practices in full-day-care pre-schools in Dublin, Ireland, aiming to determine the nutritional support that pre-school managers deem necessary, thereby facilitating the amelioration of existing pre-school nutritional training and practices. A telephone questionnaire completed by pre-school managers ( n = 54) examined pre-school dietary practices, food provision and the association between these and pre-school size, nutritional training attendance, possession of the Food and Nutrition Guidelines for Pre-school Services and having a healthy eating policy. Nutritional training needs were also investigated. Twenty-five pre-schools provided all food for attending children; parents were sole providers in six. Thirty-four pre-schools had a written healthy eating policy. Attendance at nutritional training was reported by 40. Possession of the Guidelines ( n = 40) did not consistently result in their use. Poor parental and staff involvement in policy and menu development was cited. Although the delayed introduction of iron-containing foods and a feeding beaker in infants was clearly evident, inappropriate beverages and snacks were served to children aged 1-5 years in 43 and 37 pre-schools, respectively. Training priorities cited by managers included parental education and the provision of information regarding menu planning and healthy food choices. Nutritional training should advocate whole staff familiarity with and use of current guidelines, in addition to encouraging nutritional policy development and enforcement. Parental education is warranted. Dietary education should focus specifically on appropriate weaning practices, healthy beverage and snack provision and menu planning. [ABSTRACT FROM AUTHOR]

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, ± 15.6, vs. 68.7 ± 15.6 P=0.001), stability (75.8 ± 15.9 vs. 59.5 ± 30.4, P=0.002), and perceived chewing ability (79 ± 30.4 vs. 59.5 ± 30.4, P=0.027) ± 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. To cite this article: Ellis JS, Elfeky AF, Moynihan PJ, Seal C, Hyland RM, Thomason M. The impact of dietary advice on edentulous adults' denture satisfaction and oral health-related quality of life 6 months after intervention. Clin. Oral Impl. Res. 21, 2010; 386–391. doi: 10.1111/j.1600-0501.2009.01859.x [ABSTRACT FROM AUTHOR]

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 < 0.05) and those taking regular medication found that it helped most/all of the time ( P < 0.001). Conclusions: CRE sufferers should be dissuaded from unnecessarily restricting their diet, which may result in malnutrition. Regular follow-up screening should lead to the identification of sufferers and the offer of individual advice if necessary. [ABSTRACT FROM AUTHOR]

Background: The management of Type V hypertriglyceridaemia at some centres involves the use of a very low fat diet (15% energy as fat). There is no published research examining compliance with, or nutritional adequacy, of this treatment. This study assesses the nutritional adequacy of the diet and examines barriers and enablers to adherence. Methods: Fifty-four eligible patients were invited to take part. Eight males and one female agreed to participate. One male later withdrew. The mean age of participants was 49.4 years (SD 12.9 years), their mean BMI was 30.4 kg m−2 (SD 3.4 kg m−2) and their mean triglyceride level was 8.5 mmol L−1 (SD 5.6 mmol L−1). To assess nutritional adequacy and compliance, 3-day dietary records and telephone based diet histories were used and analysed using CompEat. Patients’ experience was investigated using semi-structured telephone based qualitative interviews. Qualitative data was recorded, transcribed and analysed using thematic analysis to allow elucidation of emerging themes. Results: Fat accounted for 22.5% of dietary energy and compliance was considered difficult. Barriers included lack of accessible nutritional information, increased patient burden defined as inconvenience and the persistent awareness of potential or actual ill health, lack of appropriate food choices, other peoples’ ignorance, lack of flavour and variety, a desire to broaden the palate, cost, social pressure and prior negative experiences with dietitians. Enablers to compliance included nutritional awareness, desire to maintain good health, building on their nutritional knowledge base, behaviour and lifestyle modification, developing a routine, the support of family and friends and supportive eating environments. Conclusion: Compliance could be improved through extensive education on labeling, eating during special occasions such as Christmas, birthdays and eating out. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to compare the efficacy of low glycaemic index (GI) vs. conventional carbohydrate exchange (CCE) dietary advice on glycaemic control and metabolic parameters in patients with type 2 diabetes. Methods: A total of 104 patients with type 2 diabetes were randomly assigned to either a low GI (GI) or CCE dietary advice over a 12-week period. The primary end-point was glycaemic control as assessed by glycated haemoglobin A1c (HbA1c), fructosamine level and plasma glucose. The secondary end-points were anthropometric measurements and metabolic parameters that include blood pressure, lipid profile and insulin levels. The oral antidiabetic medications remained unchanged throughout the duration of the study. Results: A low-GI diet was associated with significant changes in the fructosamine level (ΔGI = −0.20 ± 0.03; ΔCCE = −0.08 ± 0.03 mmol/l, p < 0.01) and waist circumference (ΔGI group = −1.88 ± 0.30 cm; ΔCCE group: −0.36 ± 0.4 cm, p < 0.05) at week 4. At week 12, the changes in fasting glucose (ΔGI = −0.03 ± 0.3; ΔCCE = 0.7 ± 0.3 mmol/l; p < 0.05) and waist circumference (ΔGI = −2.35 ± 0.47 cm; ΔCCE group = −0.66 ± 0.46 cm; p < 0.05) in the GI group was significantly lower than the CCE group. With the low-GI diet, the changes in postprandial glycaemia at time 0, 60, 150 and 180 min after consuming the standard test meal was lower than with the CCE diet (p < 0.05). No significant differences were found between the groups for the remaining parameters that were measured. Conclusions: Use of a low-GI diet resulted in significant changes of serum fructosamine level, plasma glucose and waist circumference in Asian patients with type 2 diabetes over a 12-week period compared with those following a CCE diet. The effect on HbA1c and other metabolic parameters was not significantly different between the two study groups but the improvement within the GI group was more pronounced and of clinical benefit. [ABSTRACT FROM AUTHOR]

Background Danish adolescents have poor dietary habits compared to current recommendations. The present study aimed to develop a recommended food intake pattern for adolescents consistent with Danish Dietary Guidelines (DDG), Nordic Nutrition Recommendations (NNR) and dietary preferences. Methods The nutrient content of a food intake pattern consistent with DDG was calculated using dietary intake data from a random sample of 11–15-year-old boys ( n = 85) and girls ( n = 70). A recommended food intake pattern was modelled to meet NNR. The discretionary energy allowance was calculated as the difference between the total energy level and the energy needed to meet recommended nutrient needs. The flexibility of the recommended food intake pattern was tested against various energy requirements and with the inclusion of basic foods with higher sugar and/or fat content. Results The developed food intake pattern meets all nutrient goals except for vitamin D. At low energy requirements, the intake of iron and selenium is of concern. To fulfil nutrient recommendations, half of the bread/cereals and vegetables consumed should be fibre-rich, and fats should be of plant origin. Conclusions The recommended food intake pattern meets most nutrient recommendations and makes it possible to advise on discretionary energy. [ABSTRACT FROM AUTHOR]

Background Patients with upper gastrointestinal malignancies have a high incidence of weight loss and malnutrition which has been associated with a reduced quality of life, performance status, increased risk of chemotherapy induced toxicity and decreased response to treatment. Aim The aim of the pilot audit was to identify how many patients attending an upper gastrointestinal oncology outpatient clinic had lost weight or had nutritional problems. Method A short questionnaire on present weight, weight loss and occurrence of symptoms was completed by 40 patients attending an upper gastrointestinal oncology outpatient clinic. Results Nutritional screening, including weight, was not routinely carried out on all patients. Only 40% of patients had been weighed at their clinic visit and 65% self-reported that they had lost weight. The frequency of symptoms in the weight loss group was higher than in the nonweight loss group and the incidence of nausea and dysphagia was significantly higher. Only 35% of patients had received dietary advice, but 68% of the remaining patients would have liked some. Conclusion A significant number of patients reported weight loss and this was linked with a higher occurrence of symptoms influencing appetite and oral intake. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Radiotherapy remains the standard treatment for cervical cancer, especially for more advanced disease. It is estimated that the prevalence of chronic radiation enteritis (CRE) post-radiotherapy is in the region of 5–15% ( ). However, preliminary studies at the study hospital suggest the problem to be more widespread (C. Israel, unpublished data). Aim This qualitative study of 10 cervical cancer patients investigates experiences of CRE and its impact on quality of life. Methods Informed volunteers participated in one-to-one tape-recorded in-depth interviews exploring experiences following treatment. These interviews were transcribed verbatim and analysed using NUD*IST Nvivo. Results The majority of women reported side-effects from radiotherapy, predominantly diarrhoea. CRE had a significant impact upon the physical, psychological and social aspects of life of sufferers, enforcing some to be virtually housebound. Other sufferers were managing their symptoms with regular medication and/or self-imposed restricted diets. Few of these women had ever sought professional help in dealing with their problems because of embarrassment or reluctance to complain. Conclusions If untreated the side-effects of CRE have a disabling affect on sufferers, who may be reluctant to seek help about their symptoms. Health professionals need to be more pro-active in identifying and caring for sufferers of CRE. [ABSTRACT FROM AUTHOR]

Interventions targeting fruit and vegetable consumption report significant increases in consumption but do not detail how increases are achieved. This prospective study explored (i) the changes in daily fruit and daily vegetable consumption of cardiac patients participating in an intervention study and (ii) how participants made these changes.A total of 120 cardiac patients were asked to increase their daily fruit and vegetable consumption by two portions and to maintain this over 3 months. They were telephoned at 7-, 28- and 90-day follow-up to record daily consumption using a dietary questionnaire; 94 participants completed all parts of the study.Mean reported daily fruit and daily vegetable consumption increased by 1.07 (SD = 1.26) and 0.34 (SD = 0.96) portions, respectively, over 3 months. These increases were statistically significant (P < 0.001) and greatest for participants who reported eating low levels of fruit and vegetables at recruitment. Eating fresh fruit as a snack and at mealtimes were preferred choices for participants.Providing information and telephone follow-up could be used by busy healthcare professionals instead of face-to-face contact. Interventions to increase total fruit and vegetable consumption could usefully focus on eating fruit. Interventions to increase vegetable consumption need further investigation. [ABSTRACT FROM AUTHOR]

Diet can play a key role in the management of disorders such as obesity, diabetes and hypertension, conditions highly prevalent in the British African Caribbean population. In this paper, information not previously available is provided on the dietary habits and foods consumed by a British African–Caribbean population representative of the local community. Food frequency questionnaires were obtained from 255 randomly selected subjects in Manchester (78% of Jamaican origin), the nutrient intake results of which are available elsewhere. Here, suggestions are given to ensure that complete and valid dietary assessments (by diet history) are obtained, and the need for the approach to be somewhat different to that used in the White European population, highlighted with examples. Suggestions have also been listed for methods of dietary modification for obesity, diabetes and hypertension, taking into account differences in cultural understanding and food practices. People of Caribbean origin are not from just one territory: food habits and cultural context play an important role in every island, with clear differences between each which persist in first and later generations in Britain. In this paper, we attempt to integrate experience of learning from patients themselves during consultations and from participants in this study, with direct quantitative data on types of foods and their frequency in the local African–Caribbean diet. [ABSTRACT FROM AUTHOR]

Background Prevention policies do not have an upper age limit, and as the overwhelming majority of older people continue to reside in the community there is a growing role for community dietetics and primary care team members in the promotion of healthy eating. Method The multi-method project ascertained the dietary beliefs and practices of older people residing in high-income, low-income and rural localities of Scotland. One hundred and fifty-two people aged 75 years and over were interviewed using a semistructured interview schedule and 24-h food recall questionnaire. Results An analysis of the food recall questionnaire demonstrated that the diets of the elderly appear to differ little from the Scottish population as a whole. In all groups there was an under consumption of fruits and vegetables reported. Findings from the interviews demonstrated that dietary beliefs were found to be firmly rooted in childhood and lifetime experiences. Participants defined healthy eating as ‘proper meals’, ‘proper foods’, and a variety of foods eaten in moderation. These definitions were based upon the consumption of fresh foods which would be considered healthy. Changing and conflicting advice on health and nutrition was contrasted with personal experiences. Few knew of the role of the dietitian or community dietitian. Conclusions This study demonstrates a contrast between stated beliefs and actual consumption patterns. Access to food, and the cost and quality of foods impacted upon food practices. The role of the community dietitian should be promoted. Advice on healthy eating must work with contemporary practices and beliefs building upon positive aspects of diet and eating and involving the food industry, retail sector and health services. [ABSTRACT FROM AUTHOR]

Objectives To examine the relationship between 12 macro‐ and micro‐nutrients and the risk of recurrent calcium stone formation by comparing the diets of a large outpatient clinic‐based group of patients who had formed calcium‐based urinary tract calculi with that of a population‐based control group matched for age, gender and body mass index. Patients, subjects and methods The dietary intake of 500 patients (cases) randomly selected from the adult population attending an outpatient renal‐stone clinic and being evaluated and/or treated for biochemically or radiologically diagnosed calcium‐based upper urinary tract calculi were compared with those of 500 control subjects selected to match for age, sex and body mass index from a stratified probability sample of 2212 adults (not institutionalized) living in the same geographical area. Results Comparing the mean nutritional intakes showed a statistically higher consumption of energy, carbohydrates, sodium, fibre, vitamin C, fat and folic acid among cases than in controls. The intake of calcium, alcohol and vitamin A was significantly higher among the controls. There were no significant differences in the intake of protein, niacin or iron. The results of these comparisons varied when the groups were stratified by sex, age and body mass index. Conclusions Dietary risk factors for calcium‐based urinary tract calculi are many and complex, and a detailed consideration of sex, age and body mass index is important in interpreting such data. While it is difficult to draw firm conclusions about causes and effects of individual nutrients from the available data, this study indicates a possibly more important role for dietary fat in stone formation than has been previously recognized. This relationship needs to be further explored in relation to urinary risk factors, as it may be possible to advise patients to reduce dietary fat as a prophylactic measure for stone formation. As dietary fat has been associated with cardiovascular diseases and possibly cancer, an overall recommendation to these patients for a low dietary fat intake may be easier to follow. [ABSTRACT FROM AUTHOR]

Denmark, Iceland, Norway, and Sweden have all had a similar decline in dental caries during the last 20 years, although the decline has come later in Iceland. The purpose of this study was to compare the caries-preventive methods used for children and adolescents in these four countries. Questionnaires were sent to random samples of dentists, dental hygienists, and dental nurses working with children during 1995 and 1996. The results showed that the use of preventive methods was generally consistent between the countries. Nevertheless there were differences between the countries concerning the choice of preventive strategy for risk patients and also in how prevention was implemented. Danish dental care providers chose oral hygiene education as the priority, which they put into practice. Apart from fluoride varnish for some patients, most of them did not use or recommend fluoride except fluoride toothpaste The Norwegian and Icelandic dental care providers chose both oral hygiene education and the use of fluoride as priorities, while most Swedish dental care providers preferred to provide dietary advice and oral hygiene education, and additional fluoride for risk patients. The differences could not be explained by other variables than nationality, implying that there are differences between the dental cultures in the four countries. The informational basis of decisions on preventive strategies varied between the different dental professionals in each country as well as between the countries, indicating that national professional cultures are being shaped differently. Despite the differences in choice of preventive methods, the dental health of children varies little across the frontiers. This raises the question of the significance of the choice of preventive methods to the decline of dental caries and points towards an urgent need to develop evidence-based preventive strategies. [ABSTRACT FROM AUTHOR]

SummaryAim: To identify the roles of food in a day-centre for elderly, mentally ill people, so that dietary recommendations for optimal oral health are made within the overall philosophies of the day-centre. Method: A qualitative approach was adopted. It comprised an observational study of the daily routine and a semistructured interview to examine the attitudes, beliefs and knowledge of the care-staff related to diet, general health and oral health. Results: The use of food was pivotal to the functioning of the centre. Food was used for nutrition, as a focus for communal activities, to express love and caring, and to maintain cognitive, daily living and social skills. All staff considered oral health important and appreciated the link between oral health, general health and diet (primarily sugar consumption). Despite this, one-third of carers considered tooth loss an inevitable consequence of ageing. Sugar was generally regarded as detrimental to general health, but attitudes towards use of sweeteners as an alternative were mixed. However, it was believed that elderly people can adapt to dietary changes. Conclusion: Dietary advice for oral health would be acceptable if put in the context of general health and the changes take account of the overall philosophies of the centre. To this end a ‘Healthy Eating Resource Pack’ was produced for use in the centre. [ABSTRACT FROM AUTHOR]

SummaryAim: 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. [ABSTRACT FROM AUTHOR]

We describe the characteristics of adolescents seeking treatment for obesity via the 'Eat Smart' feasibility study; an intensive 12 week dietitian-led weight management programme with an emphasis on lifestyle change. It was designed to test the feasibility of a structured low-fat diet compared with a semi-structured reduced carbohydrate plan compared with a model of 'standard care'- an unstructured low fat approach. When compared with non-participants, participants were predominantly female and lived in lower socioeconomic areas. When given the choice of dietary approach, 50% elected reduced dietary carbohydrate, 43% structured low fat and 7% chose 'standard care'. Modest weight loss was achieved over 12 weeks, with both the structured low fat and reduced carbohydrate formats. Families showed a strong preference for structured eating plans, in particular seeking assistance with correct portion size. The current standard model of unstructured advice was both unpopular and relatively unsuccessful. [ABSTRACT FROM AUTHOR]