Search

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]

Arctic populations are amongst the highest exposed populations to long-range transported contaminants globally, with the main exposure pathway being through the diet. Dietary advice is an important immediate means to address potential exposure and help minimize adverse health effects. The objective of this work is to enable easier access to dietary advice and communication guidance on contaminants with a focus on the Arctic. This manuscript is part of a special issue summarizing the Arctic Monitoring and Assessment Programme’s Assessment 2021: Human Health in the Arctic. The information was derived with internet searches, and by contacting relevant experts directly. Results include risk communication efforts in European Arctic countries, effectiveness evaluation studies for several Arctic countries, experience of social media use, and the advantages and challenges of using social media in risk communication. We found that current risk communication activities in most Arctic countries emphasize the importance of a nutritious diet. Contaminant-related restrictions are mostly based on mercury; a limited amount of dietary advice is based on other contaminants. While more information on effectiveness evaluation was available, specific information, particularly from Arctic countries other than Canada, is still very limited.

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]

Copyright of Przegląd Socjologii Jakościowej is the property of Redakcja Przegladu Socjologii Jakosciowej and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The chatbot Chat Generative Pretrained Transformer (ChatGPT) is becoming increasingly popular among patients for searching health-related information. Prior studies have raised concerns regarding accuracy in offering nutritional advice. We investigated in November 2023 ChatGPT's potential as a tool for providing nutritional guidance in relation to different non-communicable diseases (NCDs). First, the dietary advice given by ChatGPT (version 3.5) for various NCDs was compared with guidelines; then, the chatbot's capacity to manage a complex case with several diseases was investigated. A panel of nutrition experts assessed ChatGPT's responses. Overall, ChatGPT offered clear advice, with appropriateness of responses ranging from 55.5% (sarcopenia) to 73.3% (NAFLD). Only two recommendations (one for obesity, one for non-alcoholic-fatty-liver disease) contradicted guidelines. A single suggestion for T2DM was found to be "unsupported", while many recommendations for various NCDs were deemed to be "not fully matched" to the guidelines despite not directly contradicting them. However, when the chatbot handled overlapping conditions, limitations emerged, resulting in some contradictory or inappropriate advice. In conclusion, although ChatGPT exhibited a reasonable accuracy in providing general dietary advice for NCDs, its efficacy decreased in complex situations necessitating customized strategies; therefore, the chatbot is currently unable to replace a healthcare professional's consultation. [ABSTRACT FROM AUTHOR]

Abstract Background Hyperemesis gravidarum (HG) affects about 2% of pregnancies and is at the severe end of the spectrum of nausea and vomiting of pregnancy. HG causes severe maternal distress and results in adverse pregnancy outcomes long after the condition may have dissipated. Although dietary advice is a common tool in management, trial evidence to base the advice on is lacking. Methods A randomized trial was conducted in a university hospital from May 2019 to December 2020. 128 women at their discharge following hospitalization for HG were randomized: 64 to watermelon and 64 to control arm. Women were randomized to consume watermelon and to heed the advice leaflet or to heed the dietary advice leaflet alone. A personal weighing scale and a weighing protocol were provided to all participants to take home. Primary outcomes were bodyweight change at the end of week 1 and week 2 compared to hospital discharge. Results Weight change (kg) at end of week 1, median[interquartile range] -0.05[-0.775 to + 0.50] vs. -0.5[-1.4 to + 0.1] P = 0.014 and to the end of week 2, + 0.25[-0.65 to + 0.975] vs. -0.5[-1.3 to + 0.2] P = 0.001 for watermelon and control arms respectively. After two weeks, HG symptoms assessed by PUQE-24 (Pregnancy-Unique Quantification of Emesis and Nausea over 24 h), appetite assessed by SNAQ (Simplified Nutritional Appetite Questionnaire), wellbeing and satisfaction with allocated intervention NRS (0–10 numerical rating scale) scores, and recommendation of allocated intervention to a friend rate were all significantly better in the watermelon arm. However, rehospitalization for HG and antiemetic usage were not significantly different. Conclusion Adding watermelon to the diet after hospital discharge for HG improves bodyweight, HG symptoms, appetite, wellbeing and satisfaction. Trial registration This study was registered with the center’s Medical Ethics Committee (on 21/05/2019; reference number 2019327–7262) and the ISRCTN on 24/05/2019 with trial identification number: ISRCTN96125404 . First participant was recruited on 31/05/ 2019.

Tea is one of the most popular drinks in the world. Dark tea is a kind of post-fermented tea with unique sensory characteristics that is produced by the special fermentation of microorganisms. It contains many bioactive substances, such as tea polyphenols, theabrownin, tea polysaccharides, etc., which have been reported to be beneficial to human health. This paper reviewed the latest research on dark tea's potential in preventing and managing cancer, and the mechanisms mainly involved anti-oxidation, anti-inflammation, inhibiting cancer cell proliferation, inducing cancer cell apoptosis, inhibiting tumor metastasis, and regulating intestinal flora. The purpose of this review is to accumulate evidence on the anti-cancer effects of dark tea, the corresponding mechanisms and limitations of dark tea for cancer prevention and management, the future prospects, and demanding questions about dark tea's possible contributions as an anti-cancer adjuvant. [ABSTRACT FROM AUTHOR]

BackgroundIn a 12-week randomised controlled trial, personalised nutrition delivered using a metabotype framework improved dietary intake, metabolic health parameters and the metabolomic profile compared to population-level dietary advice. The objective of the present work was to investigate the patterns of dietary advice delivered during the intervention and the alterations in dietary intake and metabolic and metabolomic profiles to obtain further insights into the effectiveness of the metabotype framework.MethodsForty-nine individuals were randomised into the intervention group and subsequently classified into metabotypes using four biomarkers (triacylglycerol, HDL-C, total cholesterol, glucose). These individuals received personalised dietary advice from decision tree algorithms containing metabotypes and individual characteristics. In a secondary analysis of the data, patterns of dietary advice were identified by clustering individuals according to the dietary messages received and clusters were compared for changes in dietary intake and metabolic health parameters. Correlations between changes in blood clinical chemistry and changes in metabolite levels were investigated.ResultsTwo clusters of individuals with distinct patterns of dietary advice were identified. Cluster 1 had the highest percentage of messages delivered to increase the intake of beans and pulses and milk and dairy products. Cluster 2 had the highest percentage of messages delivered to limit the intake of foods high in added sugar, high-fat foods and alcohol. Following the intervention, both patterns improved dietary quality assessed by the Alternate Mediterranean Diet Score and the Alternative Healthy Eating Index, nutrient intakes, blood pressure, triacylglycerol and LDL-C (p ≤ 0.05). Several correlations were identified between changes in total cholesterol, LDL-C, triacylglycerol, insulin and HOMA-IR and changes in metabolites levels, including mostly lipids (sphingomyelins, lysophosphatidylcholines, glycerophosphocholines and fatty acid carnitines).ConclusionThe findings indicate that the metabotype framework effectively personalises and delivers dietary advice to improve dietary quality and metabolic health.Clinical trial registrationisrctn.com, identifier ISRCTN15305840.

This scoping review assessed the knowledge, attitudes, and practices of general practitioners (GPs) regarding dietary advice for weight management. A systematic search of PubMed, EMBASE, CINAHL, and MEDLINE was conducted for any qualitative, quantitative, and mixed-methods studies published in the past five years that informed GPs' dietary advice for weight control. Thirteen studies were included in the analysis after screening 881 papers. These studies tended to focus mostly on GPs' practices rather than their knowledge and attitudes. The most frequently mentioned dietary advice was to reduce calorie intake; however, 32 different types of dietary advice were identified in the literature, including approaches such as intermittent fasting and a ketogenic diet that are not recommended in current guidelines. GPs showed varying levels of knowledge and attitudes regarding the best dietary advice for patients. Further research is needed to better understand GP perspectives, with efforts to assist GPs in providing tailored advice based on the latest evidence to improve patient outcomes required. [ABSTRACT FROM AUTHOR]

In Norway, Food and Health (FH) is taught throughout compulsory school. Data acquisition for this study consists of 15 interviews with teachers and 26 focus group interviews (FGI) with 4 th grade students (9-10 years), from eleven different schools in five regions in Norway. The data provides insight into experiences with FH, perceptions of the health aspect of FH, and learning activities to achieve the subject’s competence aims. Students divided FH into "practical sessions”, consisting of preparing, cooking, and eating food, and "health sessions", consisting of theory related to different health aspects of food and lifestyle habits. Most students reported that they had few FH sessions at school. Instead, they referred to activities at home, in after-school care, and what parents and grandparents had told them about the subject. High-quality education in school, focusing on dietary advice, food groups, and supporting physical health is important to promote healthier dietary habits in young students. [ABSTRACT FROM AUTHOR]

Background: Hyperemesis gravidarum (HG) affects about 2% of pregnancies and is at the severe end of the spectrum of nausea and vomiting of pregnancy. HG causes severe maternal distress and results in adverse pregnancy outcomes long after the condition may have dissipated. Although dietary advice is a common tool in management, trial evidence to base the advice on is lacking. Methods: A randomized trial was conducted in a university hospital from May 2019 to December 2020. 128 women at their discharge following hospitalization for HG were randomized: 64 to watermelon and 64 to control arm. Women were randomized to consume watermelon and to heed the advice leaflet or to heed the dietary advice leaflet alone. A personal weighing scale and a weighing protocol were provided to all participants to take home. Primary outcomes were bodyweight change at the end of week 1 and week 2 compared to hospital discharge. Results: Weight change (kg) at end of week 1, median[interquartile range] -0.05[-0.775 to + 0.50] vs. -0.5[-1.4 to + 0.1] P = 0.014 and to the end of week 2, + 0.25[-0.65 to + 0.975] vs. -0.5[-1.3 to + 0.2] P = 0.001 for watermelon and control arms respectively. After two weeks, HG symptoms assessed by PUQE-24 (Pregnancy-Unique Quantification of Emesis and Nausea over 24 h), appetite assessed by SNAQ (Simplified Nutritional Appetite Questionnaire), wellbeing and satisfaction with allocated intervention NRS (0–10 numerical rating scale) scores, and recommendation of allocated intervention to a friend rate were all significantly better in the watermelon arm. However, rehospitalization for HG and antiemetic usage were not significantly different. Conclusion: Adding watermelon to the diet after hospital discharge for HG improves bodyweight, HG symptoms, appetite, wellbeing and satisfaction. Trial registration: This study was registered with the center's Medical Ethics Committee (on 21/05/2019; reference number 2019327–7262) and the ISRCTN on 24/05/2019 with trial identification number: ISRCTN96125404. First participant was recruited on 31/05/ 2019. [ABSTRACT FROM AUTHOR]

Background and purpose: There are many studies on the health effects of dietary advice and physical activity in pregnancy while only a few reported the effects of simultaneous administration of motivational interviewing, dietary advice, and physical activity on neonatal outcome in pregnant women with metabolic syndrome (MetS). This study was designed to examine the effects of these interventions on fetal-neonatal outcome in pregnant women with MetS. Materials and methods: A randomized, single‑blind, controlled clinical trial was performed in 120 pregnant women with metabolic syndrome at 15- 20 weeks of gestation in two hospitals in Babol, north of Iran, 2018. The participants were allocated into two groups (n= 60 per group) using blocking randomization and were followed up until the end of pregnancy. Fetal-neonatal outcomes were compared between the two groups from week 32 of pregnancy. The interventional program included one motivational interview, two nutrition consultation sessions, and three sessions of physical activity (per week). The control group received routine care. Demographic and fertility characteristics, anthropometric measurements, and biochemical and pregnancy outcomes were recorded. Data analysis was done applying independent t test, ANOVA, and logistic regression. Results: The incidence of respiratory distress syndrome was found to be significantly lower in intervention group (3.7%) compared with the control group (14.5%) at the end of the pregnancy (P=0.01). Conclusion: Dietary recommendations, motivational interviewing, and physical activity in pregnant women with MetS during prenatal care can be used as safe and practical interventions to prevent respiratory distress syndrome. (Clinical Trials Registry Number: IRCT2017042333070N1)

Abstract Background Canadian sodium intakes remain high despite population-wide sodium reduction initiatives, highlighting the need for personal action in reducing dietary sodium. eHealth interventions support patients in dietary change and assist clinicians in decision-making and delivering care, including provision of advice. To date, impact of diet-focused eHealth tools, like the Sodium Calculator (SC) dietary screening tool, on clinical outcomes has received minimal examination. This study assessed feasibility of a randomized controlled trial (RCT) protocol to examine the impact of the SC, a physician-focused intervention, on the quality of dietary sodium reduction advice provided by physicians to their patients with hypertension. Methods Primary care physicians from community-based primary care clinics were randomized to one of two groups: (1) ‘usual care’ for dietary sodium counselling or (2) dietary sodium counselling using the SC (‘experimental group’). The primary endpoint was protocol feasibility defined by the following outcomes: process (e.g. recruitment, retention, protocol adherence, acceptability of intervention), resources (e.g. needs, impact on workflow), and management (e.g. staff requirements). Outcomes were assessed using direct observation, interviews, and questionnaires with patients, physicians, and clinic staff. Results Seven physicians (n = 4 in experimental group, n = 3 in usual care group) and 65 patients with hypertension (48.5% men, 69.8 ± 10.1 years) successfully participated. The main challenges identified is related to recruitment rate (48% for patients, 20% for physicians) and physician protocol adherence (76%). These improved with minor protocol modifications. There were several areas of protocol success such as no disruption to physician workflow, hiring clinic nurses as research staff, having a physician site lead to support physician recruitment, and a ‘Protocol Prompt Form’ to increase physician protocol adherence. Importantly, there was a high degree of acceptability of the SC intervention among experimental group physicians [n = 3 (75%)]. Conclusions The modified RCT protocol was considered feasible. The identified successes can be leveraged, and the risks can be mitigated, during implementation of a full-scale RCT. Assessment of this RCT protocol is an important step in understanding the effectiveness of diet-focused eHealth tools to supporting physician self-efficacy in assessing, monitoring, and implementing dietary advice in routine clinical practice and supporting patients in effective behaviour change.

Obesity and metabolic syndrome are two important health problems that have increased in incidence in recent years in all around world. Stone occurrence and recurrence risks are increased in these diseases. Apart from general dietary recommendations for stone patients, metabolic evaluation and personalized dietary recommendations are important in these patients. Achieving a normal BMI also reduces the risks of stone occurrence and recurrence. In these patients, the Mediterranean diet and DASH diet, in which the lower animal protein intake and the higher consumption of vegetables and fruits, can be considered as suitable options in the diets to be applied to lose weight. [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]

Although nutrient profiling systems can empower consumers towards healthier food choices, there is still a need to assess diet quality to obtain an overall perspective. The purpose of this study was to develop a diet profiling algorithm (DPA) to evaluate nutritional diet quality, which gives a final score from 1 to 3 with an associated color (green-yellow-orange). It ranks the total carbohydrate/total fiber ratio, and energy from saturated fats and sodium as potentially negative inputs, while fiber and protein are assumed as positive items. Then, the total fat/total carbohydrate ratio is calculated to evaluate the macronutrient distribution, as well as a food group analysis. To test the DPA performance, diets of a lactating women cohort were analyzed, and a correlation analysis between DPA and breast milk leptin levels was performed. Diets classified as low quality showed a higher intake of negative inputs, along with higher energy and fat intakes. This was reflected in body mass index (BMI) and food groups, indicating that women with the worst scores tended to choose tastier and less satiating foods. In conclusion, the DPA was developed and tested in a sample population. This tool can be easily implemented in digital nutrition platforms, contributing to real-time dietary follow-up of patients and progress monitoring, leading to further dietary adjustment. [ABSTRACT FROM AUTHOR]

Congenital alpha-1 antitrypsin deficiency (AATD) is a rare inherited disorder caused by the mutation of the SERPINA1 gene on chromosome 14. At pulmonary level, AAT deficiency leads to an increased risk of chronic obstructive pulmonary disease (COPD) and emphysema, starting from the third-fourth decade of life. At hepatic level, some variants of the allelic, in particular PI*Z, cause a conformational change of the AAT molecule, which polymerizes within the hepatocytes. Excessive hepatic accumulation of these abnormal molecules can lead to liver disease in both adults and children, with clinical presentation ranging from cholestatic jaundice in the newborn to abnormal blood indices of liver function in children and adults, up to fatty liver, cirrhosis and hepatocarcinoma. Nutritional interventions in AATD aim to provide the necessary calories, stop protein catabolism, prevent and treat malnutrition as in the case of common COPD, and even take into account any liver disease that is a distinctive trait, compared to common COPD. Actually, there is a lack of formal research regarding the effects of specific nutritional recommendations in patients with AATD, proper eating habits may help to preserve lung and liver function. For practical dietary advice in patients with AATD and COPD, recently a food pyramid proposal has been published. It has been observed that there is a marked overlap between AATD liver disease and obesity-related liver disease, suggesting shared molecular basis and, therefore, similar nutritional strategies. In this narrative review dietary advice for all possible stages of liver disease have been reported.

IntroductionAn accessible and affordable way to deliver behavior change programs to a large proportion of the growing community of cancer patients and survivors is through web-based methods of nutritional counselling.ObjectiveThe aim of this systematic review was to evaluate the effectiveness of web-based nutritional therapies targeting physical activity, diet, and/or weight control for cancer patients or survivors, primarily disseminated via modern technologies (mobile phone applications) or online.Materials and methodsThe authors conducted a structured search of the PubMed database. Studies that have focused on physical activity (PA) and dietary change and/or weight control in adolescent and adult cancer patients and survivors have reported outcomes conducted via a broad modality.ResultsNine articles focused on web-based nutrition for patients with cancer and cancer survivors. They were conducted in the United States, Australia, Korea, China, and in the United Kingdom, and were published between 2018 and 2022 in a variety of scientific journals. The number of participants ranged from 20 to 159.ConclusionWeb-based nutrition counselling helps cancer patients and survivors improve their dietary intake, impacts their weight and quality of life, and promotes a healthy lifestyle. Future research should evaluate (1) the differences in cost and coverage between face-to-face and web-based nutrition, (2) long-term outcomes, (3) cost-effectiveness, and last but not least, (4) the effectiveness of web-based nutrition in adolescents and children who suffer from cancer or who survived cancer, as nutritional status and body composition have a marked impact on clinical outcomes during and after treatment. The strength of this review lies in the large number of randomized controlled trials, which offer a guarantee of effectiveness and objectivity compared to cross-sectional studies.

The chatbot Chat Generative Pretrained Transformer (ChatGPT) is becoming increasingly popular among patients for searching health-related information. Prior studies have raised concerns regarding accuracy in offering nutritional advice. We investigated in November 2023 ChatGPT’s potential as a tool for providing nutritional guidance in relation to different non-communicable diseases (NCDs). First, the dietary advice given by ChatGPT (version 3.5) for various NCDs was compared with guidelines; then, the chatbot’s capacity to manage a complex case with several diseases was investigated. A panel of nutrition experts assessed ChatGPT’s responses. Overall, ChatGPT offered clear advice, with appropriateness of responses ranging from 55.5% (sarcopenia) to 73.3% (NAFLD). Only two recommendations (one for obesity, one for non-alcoholic-fatty-liver disease) contradicted guidelines. A single suggestion for T2DM was found to be “unsupported”, while many recommendations for various NCDs were deemed to be “not fully matched” to the guidelines despite not directly contradicting them. However, when the chatbot handled overlapping conditions, limitations emerged, resulting in some contradictory or inappropriate advice. In conclusion, although ChatGPT exhibited a reasonable accuracy in providing general dietary advice for NCDs, its efficacy decreased in complex situations necessitating customized strategies; therefore, the chatbot is currently unable to replace a healthcare professional’s consultation.

Aim: This study aimed to explore women's perspectives and experiences concerning how culture impacts the lifestyle management of gestational diabetes mellitus (GDM) in women of culturally and linguistically diverse (CALD) backgrounds. Methods: Women of any cultural background diagnosed with GDM within the previous 12 months were purposively recruited from two Australian metropolitan hospitals. Data collected using semi-structured interviews (n = 18) and focus groups (n = 15 women in three groups) were analysed using reflexive thematic analysis. Results: Three themes were generated: "cultural beliefs and obligations impact lifestyle management of gestational diabetes", which describes how some cultures lack awareness about GDM, and modifications or restrictions were viewed as depriving the infant, but sometimes adaptions could be made so that a culturally appropriate meal was suitable for GDM management; "the relationship between cultural foods and gestational diabetes management", which discusses how important cultural foods may be incompatible with appropriate GDM management, so women worked to find solutions; "gestational diabetes education lacks cultural awareness and sensitivity", which illustrates how current education fails to address differences in cultural beliefs, language and eating practices. Conclusion: Cultural beliefs, obligations and food practices must be considered when assisting women of CALD backgrounds using lifestyle modification to manage GDM. GDM education must be culturally sensitive and competent and, where possible, be delivered by health professionals of a shared cultural group. [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]

Abstract Background Constipation constitutes an important part of emergency service applications in our country as well as all over the world. We aimed to illuminate the situation in our regional hospital regarding the increase in the emergency department density and the financial burden of applications due to constipation. Methods This descriptive retrospective study was conducted in a regional tertiary hospital. The medical records of all constipation-related admissions to the emergency department between 01 January 2019 and 31 December 2019 were retrospectively reviewed. The etiology of constipation, complaints, physical examination, imaging studies, treatment modalities, and health expenses costs were recorded. Results A total of 3271 patients aged 0–17 years (mean 4.24 ± 3.56 years) were included in the study. One thousand nine hundred and seventy-six (60.3%) of the patients were male, and 1295 (39.6%) of them were female. The majority of patients (n = 3107, 95%) were discharged without hospitalization. Health expenditure due to constipation was 834.626 Turkish liras. The health cost of the patients who were treated from the emergency room without hospitalization was 780.126 Turkish liras. Conclusions In order to reduce unnecessary constipation applications and costs in emergency services, more detailed information should be given to prevent constipation during outpatient services, and dietary counseling should be provided when necessary.

Background and aimsMultiple sclerosis (MS) is associated with osteoporosis, possibly due to neurological disability and decreased calcium intake. The objective of this study was to evaluate the efficacy of a personalized nutritional advice program by a dietitian compared to the delivery of a standard advice form to optimize dietary calcium intake in outpatients with MS.MethodsWe performed a randomized, controlled, parallel trial comparing the efficacy of a personalized dietary advice (PDA) program to standard advice form (SAF) to increase daily calcium intake in MS patients. The study population was composed by patients with relapsing-remitting MS aged 18–69 years old. PDA program consisted in dietary advice delivered by a dietitian at baseline, 1 month, and 3 months. Calcium and nutrient intake in patients from both groups was evaluated at baseline and 6 months using a dietary survey.ResultsOf the 194 patients screened for inclusion, 182 patients were included (79% female, median age of 42 years, and median EDSS of 2.0), and randomized to SAF (n = 92) or PDA (n = 90). At 6 months, median calcium intake increased by 241 mg/day in the PDA group and decreased by 120 mg/day in the SAF group (p < 0.0001). However, the median calcium intake was 947 mg/day in the SAF group and 778 mg/day in the PDA group at baseline (p = 0.0077), potentially favoring the effect of dietary advice. Complementary analyses focusing on patients with insufficient calcium intakes at baseline revealed comparable values in both groups (p = 0.69). Of those, patients included in the PDA group obtained significantly higher calcium intakes at 6 months than patients from the SAF group (p = 0.0086) independently of EDSS, PASAT, HADS and EQ-5D scores.ConclusionThis work shows the efficacy of dietary management based on personalized advice program over 3 months to durably increase calcium consumption in MS patients with insufficient calcium intake.Clinical trial registrationclinicaltrials.gov, identifier NCT02664623.

Abstract Background For women with gestational diabetes mellitus (GDM) poor dietary choices can have deleterious consequences for both themselves and their baby. Diet is a well-recognised primary strategy for the management of GDM. Women who develop GDM may receive dietary recommendations from a range of sources that may be inconsistent and are often faced with needing to make several dietary adaptations in a short period of time to achieve glycaemic control. The aim of this study was to explore how women diagnosed with GDM perceive dietary recommendations and how this information influences their dietary decisions during pregnancy and beyond. Methods Women diagnosed with GDM before 30 weeks’ gestation were purposively recruited from two GDM clinics in Auckland, New Zealand. Data were generated using semi-structured interviews and thematic analysed to identify themes describing women’s perceptions and experiences of dietary recommendations for the management of GDM. Results Eighteen women from a diverse range of sociodemographic backgrounds participated in the study. Three interconnected themes described women’s perceptions of dietary recommendations and experiences in managing their GDM through diet: managing GDM is a balancing act; using the numbers as evidence, and the GDM timeframe. The primary objective of dietary advice was perceived to be to control blood glucose levels and this was central to each theme. Women faced a number of challenges in adhering to dietary recommendations. Their relationships with healthcare professionals played a significant role in their perception of advice and motivation to adhere to recommendations. Many women perceived the need to follow dietary recommendations to be temporary, with few planning to continue dietary adaptations long-term. Conclusions The value of empathetic, individually tailored advice was highlighted in this study. A greater emphasis on establishing healthy dietary habits not just during pregnancy but for the long-term health of both mother and baby is needed.

Background and purpose: There are many studies on the health effects of dietary advice and physical activity in pregnancy while only a few reported the effects of simultaneous administration of motivational interviewing, dietary advice, and physical activity on neonatal outcome in pregnant women with metabolic syndrome (MetS). This study was designed to examine the effects of these interventions on fetal-neonatal outcome in pregnant women with MetS. Materials and methods: A randomized, single‑blind, controlled clinical trial was performed in 120 pregnant women with metabolic syndrome at 15- 20 weeks of gestation in two hospitals in Babol, north of Iran, 2018. The participants were allocated into two groups (n= 60 per group) using blocking randomization and were followed up until the end of pregnancy. Fetal-neonatal outcomes were compared between the two groups from week 32 of pregnancy. The interventional program included one motivational interview, two nutrition consultation sessions, and three sessions of physical activity (per week). The control group received routine care. Demographic and fertility characteristics, anthropometric measurements, and biochemical and pregnancy outcomes were recorded. Data analysis was done applying independent t test, ANOVA, and logistic regression. Results: The incidence of respiratory distress syndrome was found to be significantly lower in intervention group (3.7%) compared with the control group (14.5%) at the end of the pregnancy (P=0.01). Conclusion: Dietary recommendations, motivational interviewing, and physical activity in pregnant women with MetS during prenatal care can be used as safe and practical interventions to prevent respiratory distress syndrome. [ABSTRACT FROM AUTHOR]

Pharmacists play a prominent role in the counselling and education of patients complementary to provision of medicines. The increase in non-communicable diseases associated with poor quality diets has placed a greater demand on pharmacists to play a role in the provision of nutritional education to patients. This study aimed to investigate pharmacy students' and interns' attitudes, behaviours, and self-reported confidence towards nutritional counselling and to examine factors associated with their intention to counsel patients in nutrition. An online survey was designed using the theory of planned behaviour and was distributed to final-year pharmacy students and interns enrolled at the University of Sydney. Data analysis was conducted to test for correlations between behavioural intentions, attitudes, confidence, subjective norms, and perceived behavioural control. Sixty-six surveys were completed, representing an average response rate of 19.6%. Half of all participants reportedly were providing nutritional advice to patients at least once per week or more often when working in a pharmacy. Participants' intention to counsel patients about nutrition was influenced by preceptors' encouragement. The participants' average level of confidence in having the knowledge and skills to provide nutritional counselling, reported over 13 medical conditions, showed that they were on average "somewhat confident" in providing nutritional counselling, with the level of confidence differing depending upon the specific topic areas. Participants acknowledged the role of pharmacists in the provision of nutritional counselling, but a more comprehensive nutrition curriculum integrated within existing pharmacy curricula is warranted to increase pharmacy students' and interns' confidence. [ABSTRACT FROM AUTHOR]

Background: Canadian sodium intakes remain high despite population-wide sodium reduction initiatives, highlighting the need for personal action in reducing dietary sodium. eHealth interventions support patients in dietary change and assist clinicians in decision-making and delivering care, including provision of advice. To date, impact of diet-focused eHealth tools, like the Sodium Calculator (SC) dietary screening tool, on clinical outcomes has received minimal examination. This study assessed feasibility of a randomized controlled trial (RCT) protocol to examine the impact of the SC, a physician-focused intervention, on the quality of dietary sodium reduction advice provided by physicians to their patients with hypertension. Methods: Primary care physicians from community-based primary care clinics were randomized to one of two groups: (1) 'usual care' for dietary sodium counselling or (2) dietary sodium counselling using the SC ('experimental group'). The primary endpoint was protocol feasibility defined by the following outcomes: process (e.g. recruitment, retention, protocol adherence, acceptability of intervention), resources (e.g. needs, impact on workflow), and management (e.g. staff requirements). Outcomes were assessed using direct observation, interviews, and questionnaires with patients, physicians, and clinic staff. Results: Seven physicians (n = 4 in experimental group, n = 3 in usual care group) and 65 patients with hypertension (48.5% men, 69.8 ± 10.1 years) successfully participated. The main challenges identified is related to recruitment rate (48% for patients, 20% for physicians) and physician protocol adherence (76%). These improved with minor protocol modifications. There were several areas of protocol success such as no disruption to physician workflow, hiring clinic nurses as research staff, having a physician site lead to support physician recruitment, and a 'Protocol Prompt Form' to increase physician protocol adherence. Importantly, there was a high degree of acceptability of the SC intervention among experimental group physicians [n = 3 (75%)]. Conclusions: The modified RCT protocol was considered feasible. The identified successes can be leveraged, and the risks can be mitigated, during implementation of a full-scale RCT. Assessment of this RCT protocol is an important step in understanding the effectiveness of diet-focused eHealth tools to supporting physician self-efficacy in assessing, monitoring, and implementing dietary advice in routine clinical practice and supporting patients in effective behaviour change. [ABSTRACT FROM AUTHOR]

Introduction: Protein-Energy Malnutrition (PEM) and prevalence of under-weight children in India, is an important health concern. Aim: To evaluate the effect of Oral Nutritional Supplement (ONS) on growth, overall nutrient intake and frequency of illness in nutritionally at-risk Indian children. Materials and Methods: In this prospective, randomised, gender-stratified, controlled, parallel group, open label study, 216 children (aged 4-6 years with weight-for-age z-score between -2 and -1) were randomised (1:1) to receive either 45 g of ONS {Test product+Dietary advice (T+D)} or control group {Dietary advice only (D-only)} for three months. Primary endpoints included weight-for-age z-score and weight gain in terms of g/kg/day from baseline to three months. Secondary endpoints included change in height-for-age z-scores; frequency of illness, change in dietary nutrient intake and Protein/Energy (P/E) ratio from baseline through three months. Safety endpoint included Adverse Events (AEs). PROC MIXED was used to perform Repeated Measures Analysis Of Variance (RMANOVA) based on the changes in z-scores. The z-scores changes within the group from baseline to the end of three months End-ofStudy (EOS) were compared using paired t-test. Results: At baseline, the mean (SD) weight-for-age z-scores were similar in both the groups {1.50 (0.309) and -1.49 (0.312) in T+D and D-only groups, respectively}. At the EOS, only T+D group showed significant mean (SD) change from baseline in weight-for-age z-score compared to the D-only group {0.59 (0.296), p

This scoping review assessed the knowledge, attitudes, and practices of general practitioners (GPs) regarding dietary advice for weight management. A systematic search of PubMed, EMBASE, CINAHL, and MEDLINE was conducted for any qualitative, quantitative, and mixed-methods studies published in the past five years that informed GPs’ dietary advice for weight control. Thirteen studies were included in the analysis after screening 881 papers. These studies tended to focus mostly on GPs’ practices rather than their knowledge and attitudes. The most frequently mentioned dietary advice was to reduce calorie intake; however, 32 different types of dietary advice were identified in the literature, including approaches such as intermittent fasting and a ketogenic diet that are not recommended in current guidelines. GPs showed varying levels of knowledge and attitudes regarding the best dietary advice for patients. Further research is needed to better understand GP perspectives, with efforts to assist GPs in providing tailored advice based on the latest evidence to improve patient outcomes required.

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 There is limited research in England on the impact and experiences of dietary advice and nutrition-related information for pregnant women. However, overseas research has shown that such information can cause women to feel anxious and confused. This study aimed to analyse the impact and experience amongst primigravids in England. Methodology This was a qualitative study. Twelve semi-structured individual interviews were carried out (videoconference and telephone). Interviews were audio recorded and transcribed verbatim. Inductive thematic analysis was used for data analysis. Data quality measures were adhered to throughout the research process. Results Five major themes were identified: ‘physiological changes and taste preferences’, ‘the health and safety of the baby comes first’, ‘scarcity of nutrition information given’, ‘seeking nutrition information for control’ and ‘every pregnant woman is unique’. Participants put the health and safety of their baby first, and this was amplified due to the COVID-19 pandemic. There was a lack of information given to participants from health care professionals. Information was broadly sought out as a way of exerting control; either to feel informed, or to restrict contact with new information in order to avoid feeling overwhelmed. In both cases, participants expressed that information was abundant. Official dietary guidelines were seen as trustworthy but too generic and not applicable to them. Some participants used multiple pregnancy apps with inaccurate information. Conclusions As nutrition in pregnancy is important for the woman and the growing foetus, midwives are in a critical position to advise primigravids in England. Further research is needed to understand their barriers for doing so. More is needed from the National Health Service to signpost women to using evidenced-based pregnancy apps and to enable a healthy nutrition environment post-pregnancy.

Although nutrient profiling systems can empower consumers towards healthier food choices, there is still a need to assess diet quality to obtain an overall perspective. The purpose of this study was to develop a diet profiling algorithm (DPA) to evaluate nutritional diet quality, which gives a final score from 1 to 3 with an associated color (green-yellow-orange). It ranks the total carbohydrate/total fiber ratio, and energy from saturated fats and sodium as potentially negative inputs, while fiber and protein are assumed as positive items. Then, the total fat/total carbohydrate ratio is calculated to evaluate the macronutrient distribution, as well as a food group analysis. To test the DPA performance, diets of a lactating women cohort were analyzed, and a correlation analysis between DPA and breast milk leptin levels was performed. Diets classified as low quality showed a higher intake of negative inputs, along with higher energy and fat intakes. This was reflected in body mass index (BMI) and food groups, indicating that women with the worst scores tended to choose tastier and less satiating foods. In conclusion, the DPA was developed and tested in a sample population. This tool can be easily implemented in digital nutrition platforms, contributing to real-time dietary follow-up of patients and progress monitoring, leading to further dietary adjustment.

Background and Aims: To investigate the superiority of individualized dietary advice based on dietary assessment for patients with type 2 diabetes.Methods and Results: A total of 136 Japanese adults with type 2 diabetes were randomized into either individualized or conventional dietary advice groups after dietary assessment using a self-administered brief-type diet history questionnaire. Both participants received three 30-min face-to-face dietary advice sessions by dietitians at 1, 3, and 5 months from study entry. The individualized group received dietary advice based on individual dietary intakes. The conventional group received dietary advice using generalized pamphlets. The primary outcome was the change in HbA1c over 6 months, and secondary outcomes were changes in weight, serum triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and dietary intakes. In total, 126 participants were included in the analysis. After adjustment for age, sex, and baseline measurements, HbA1c significantly decreased larger in the individualized group [-1.1%, (95% CI: -1.3 to -0.8)] than the conventional group [-0.7% (95% CI: -1.0 to -0.4)] (P = 0.0495). The individualized group significantly decreased weight, serum triglyceride, and LDL-C, and significantly increased HDL-C, without a significant difference to the conventional group. In dietary changes, the individualized group decreased intakes of energy, confectioneries, meats, oil and fats, and sugar-sweetened beverages. The conventional group decreased alcohol intake and increased total fat and saturated fatty acid intakes.Conclusions: Individualized dietary advice among patients with type 2 diabetes was superior to conventional dietary advice in lowering HbA1c.Trial Registration: UMIN000037268 (https://www.umin.ac.jp/ctr/index.htm) in July 4, 2019. [ABSTRACT FROM AUTHOR]

Weight retention and weight gain during the postpartum and midlife period subsequently increase the risk of chronic health conditions, thereby deteriorating the overall health. Dietary intervention is the pivotal component of sustainable weight management. However, in resource restricted settings, where dietitians may not be present, other healthcare professionals such as physicians, obstetricians, and paediatricians should play a vital role in providing timely weight management advice to these women. Therefore, this article provides dietary advice including the setting of realistic weight loss goals, identifying an individual's calorie needs, distribution of macronutrients and consideration of important micronutrients. Healthcare professionals can follow the stepwise approach to prescribe dietary advice to postpartum and midlife women for their weight management. Various dietary principles such as cultural and regional preferences of an individual, portion size, hypocaloric diets, nutrient-dense meals, eating habits, cultural beliefs and myths along with co-morbid conditions should be taken into consideration by healthcare professionals while providing the dietary prescription. [ABSTRACT FROM AUTHOR]

Introduction: The uptake of the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 chronic kidney disease (CKD) Guideline is not fully described in real-world nephrology practice across the world. Methods: We used baseline data from the CKD Outcomes and Practice Patterns Study (2013–2017), a 4-country cohort of patients with estimated glomerular filtration rate

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]

Malnutrition is common among older adults in health-care settings and is associated with decreased quality of life (QoL). The present study aimed to investigate the effect on health-related QoL (HRQoL) among older adults after 6 months of treatment with individual dietary advice (DA) and/or oral nutritional supplements (ONS), utilising 409 patients included in a multicentre randomised controlled trial of patients ≥ 65 years old, stratified according to nutrition status (malnourished/at risk of malnutrition), admitted to hospital in Sweden 2010–2014. Patients were randomised into four arms: DA, ONS, DA + ONS or routine care (control). The intervention started at discharge from hospital, with HRQoL measured using European QoL five-dimension, three-level (EQ-5D-3L) and European QoL-visual analogue scale (EQ-VAS) at baseline and at 6-month, 1-year and 3-year follow-ups. Data were analysed using the Kruskal–Wallis test and multiple linear regression. Overall, HRQoL increased from baseline to follow-ups, although the magnitude of change in EQ-5D-3L did not differ significantly between the four arms in any of the nutrition groups. However, a significant difference was observed for change in EQ-VAS from baseline to 6-month follow-up in the malnourished group, with mean changes of 22·4 and –3·4 points for the ONS and control groups, respectively (P = 0·009). In the multiple linear regression analyses, participants in the ONS arm had 27·5, 34·4 and 38·8 points larger increases in EQ-VAS from baseline to the 6-month (P = 0·011), 1-year (P = 0·007) and 3-year (P = 0·032), respectively, follow-ups than the control group. The use of ONS improved subjectively assessed HRQoL in these malnourished older adults. [ABSTRACT FROM AUTHOR]

Background: Healthy lifestyle and rehabilitation may mitigate late effects after cancer treatment, but knowledge about lifestyle and rehabilitation information needs among long-term young adult cancer survivors (YACSs) (≥ 5 years from diagnosis) is limited. The present study aimed to examine such information needs among long-term YACSs, and identify characteristics of those with needs. Material and methods: The Cancer Registry of Norway identified long-term YACSs diagnosed with breast cancer, colorectal cancer, non-Hodgkin lymphoma, leukemia, or malignant melanoma at the age of 19–39 years, between 1985 and 2009. Survivors were mailed a questionnaire, in which respondents reported their information needs on physical activity, diet, and rehabilitation services 5–30 years post-diagnosis. Descriptive statistics and logistic regression analyses were used to examine the prevalence of information needs and associated factors. Results: Of 1488 respondents (a response rate of 42%), 947 were included. Median age at diagnosis was 35 years (range 19–39) and median observation time since diagnosis was 14 years (range 5–30). In total, 41% reported information needs for information about physical activity, 45% about diet, and 47% about rehabilitation services. Information needs were associated with higher treatment intensity, increasing number of late effects, and an unhealthy lifestyle. Conclusion: A large proportion of long-term YACSs report information needs regarding lifestyle and/or rehabilitation more than a decade beyond treatment. Assessments of such information needs should become a part of long-term care of these cancer survivors. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to review literature that reports on the perspectives and opinions of Australian and New Zealand primary healthcare practitioners on their role in nutrition counselling of their patients. Methods: A systematic search of relevant articles reporting on attitudes towards nutrition counselling by Australian and New Zealand doctors/physicians, nurses including midwives, pharmacists and dentists was conducted. The search included literature from the past ten years until March 2021 and identified 21 relevant papers, with most of the studies including medical practitioners and nurses. Results: Three main themes were identified from qualitative and quantitative data, which included education and training, practitioner experiences and challenges. Consistent with previous literature, health care practitioners acknowledged their important role in the provision of dietary advice to patients. Challenges that influenced the provision of this advice included insufficient education and training, time constraints and limited knowledge and confidence. Time constraints during normal consultations led to a low priority of nutrition counselling. An absence of assessment opportunities to demonstrate nutrition competence and limited coverage of specific nutrition-related advice during training were also reported. Conclusions: Primary healthcare practitioners acknowledge the importance of playing a role in the provision of nutrition advice but require education and access to evidence-based information that can be utilised effectively within the time constraints of standard consultations. Medical education curricula can be improved to provide more emphasis on nutrition education, including relevant assessment opportunities. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity and an imbalanced diet could lead to some cardio metabolic risk factors. Objective: The objective of this meta-analysis was to investigate the effects of lifestyle modification on inflammatory indicators and waist circumference (WC) in overweight/obese subjects with metabolic syndrome (MS) Data sources: A systematic search was conducted in PubMed, CINAHL, MEDLINE, Cochrane, Google Scholar, and Web of Science. Study selection: The selection criteria were randomized controlled trials (RCTs) investigating the effects of lifestyle interventions on inflammation and WC from inception to 20 December 2020. The weighted mean difference (WMD) and 95% confidence interval (CI) between interventions were computed using a random or fixed-effects model. Results: Six RCTs (including 1246 MS patients who had, on average, overweight/obesity) met all inclusion criteria. Interventions lasted 6 to 12 months (2–5 sessions per week). Lifestyle intervention significantly reduced C-reactive protein (WMD: −0.52 mg/ml, 95% CI: −0.72, −0.33), IL-6 (WMD: −0.50 pg/ml, 95% CI: −0.56, −0.45), and increased adiponectin (WMD: 0.81 µg/ml, 95% CI, 0.64, 0.98). Moreover, lifestyle modification significantly decreased WC (WMD: −3.12 cm, 95% CI, −4.61, −1.62). Conclusion: Our findings provide evidence that lifestyle alterations, including physical activity and diet, can lead to significant improvement in abdominal obesity, measured by WC and some inflammation markers among overweight/obese individuals with MS. Further high-quality research is needed to clarify the mechanisms underlying the effect of such interventions on this population's inflammatory markers. [ABSTRACT FROM AUTHOR]

Background: For women with gestational diabetes mellitus (GDM) poor dietary choices can have deleterious consequences for both themselves and their baby. Diet is a well-recognised primary strategy for the management of GDM. Women who develop GDM may receive dietary recommendations from a range of sources that may be inconsistent and are often faced with needing to make several dietary adaptations in a short period of time to achieve glycaemic control. The aim of this study was to explore how women diagnosed with GDM perceive dietary recommendations and how this information influences their dietary decisions during pregnancy and beyond.Methods: Women diagnosed with GDM before 30 weeks' gestation were purposively recruited from two GDM clinics in Auckland, New Zealand. Data were generated using semi-structured interviews and thematic analysed to identify themes describing women's perceptions and experiences of dietary recommendations for the management of GDM.Results: Eighteen women from a diverse range of sociodemographic backgrounds participated in the study. Three interconnected themes described women's perceptions of dietary recommendations and experiences in managing their GDM through diet: managing GDM is a balancing act; using the numbers as evidence, and the GDM timeframe. The primary objective of dietary advice was perceived to be to control blood glucose levels and this was central to each theme. Women faced a number of challenges in adhering to dietary recommendations. Their relationships with healthcare professionals played a significant role in their perception of advice and motivation to adhere to recommendations. Many women perceived the need to follow dietary recommendations to be temporary, with few planning to continue dietary adaptations long-term.Conclusions: The value of empathetic, individually tailored advice was highlighted in this study. A greater emphasis on establishing healthy dietary habits not just during pregnancy but for the long-term health of both mother and baby is needed. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to investigate the effect on survival after 6 months of treatment involving individual dietary advice and oral nutritional supplements in older malnourished adults after discharge from hospital. Methods: This multicentre randomised controlled trial included 671 patients aged 65 years who were malnourished or at risk of malnutrition when admitted to hospital between 2010 and 2014, and followed up after 8.2 years (median 4.1 years). Patients were randomised to receive dietary advice or oral nutritional supplements, separate or in combination, or routine care. The intervention started at discharge from the hospital and continued for 6 months, with survival being the main outcome measure. Results: During the follow-up period 398 (59.3%) participants died. At follow-up, the survival rates were 36.9% for dietary advice, 42.4% for oral nutritional supplements, 40.2% for dietary advice combined with oral nutritional supplements, and 43.3% for the control group (log-rank test p = 0.762). After stratifying the participants according to nutritional status, survival still did not differ significantly between the treatment arms (log-rank test p = 0.480 and p = 0.298 for the 506 participants at risk of malnutrition and the 165 malnourished participants, respectively). Conclusions: Oral nutritional supplements with or without dietary advice, or dietary advice alone, do not improve the survival of malnourished older adults. These results do not support the routine use of supplements in older malnourished adults, provided that survival is the aim of the treatment. Trial registration: ClinicalTrials.gov with ID: NCT01057914

Aim: This study aimed to explore women’s perspectives and experiences concerning how culture impacts the lifestyle management of gestational diabetes mellitus (GDM) in women of culturally and linguistically diverse (CALD) backgrounds. Methods: Women of any cultural background diagnosed with GDM within the previous 12 months were purposively recruited from two Australian metropolitan hospitals. Data collected using semi-structured interviews (n = 18) and focus groups (n = 15 women in three groups) were analysed using reflexive thematic analysis. Results: Three themes were generated: “cultural beliefs and obligations impact lifestyle management of gestational diabetes”, which describes how some cultures lack awareness about GDM, and modifications or restrictions were viewed as depriving the infant, but sometimes adaptions could be made so that a culturally appropriate meal was suitable for GDM management; “the relationship between cultural foods and gestational diabetes management”, which discusses how important cultural foods may be incompatible with appropriate GDM management, so women worked to find solutions; “gestational diabetes education lacks cultural awareness and sensitivity”, which illustrates how current education fails to address differences in cultural beliefs, language and eating practices. Conclusion: Cultural beliefs, obligations and food practices must be considered when assisting women of CALD backgrounds using lifestyle modification to manage GDM. GDM education must be culturally sensitive and competent and, where possible, be delivered by health professionals of a shared cultural group.

Objective: Dietary advice about the potential health risks of unhealthy foods or diets has historically been communicated in terms of nutrients. Recent evidence has shown that the processing of food itself is independently attributable to harmful outcomes, particularly a new category of foods described to be 'ultra-processed'. Dietary guidelines (DG) are a key policy tool to translate and communicate nutrition research; however, there is little research exploring whether and how the harms of food processing are communicated and rationalised in dietary advice. Design: Nineteen publicly available DG were thematically analysed to explore: (1) the diversity of terms used to refer to processed foods and (2) the underlying explanations and rationales provided to reduce consumption of processed foods. Setting: International. Participants: Sample of national dietary guidelines. Results: Seventeen different descriptive terms were used to refer to processed foods, with many countries using a large variation of terms within their DG. Six rationales to reduce consumption of processed foods were identified, which were grouped into four overarching domains: harmful outcomes (disease risk, environmental risk); food quality (food quality, nutrient content); diet quality and food environment. Conclusion: The rationales provided to reduce the consumption of processed foods reflect upstream and downstream determinants of health. However, the persistence of nutrient-based rationales indicate that most DG do not apply an upstream understanding of the issues with ultra-processing. Further, the diversity of terms and foods referenced in DG suggest that the concept of ultra-processing is subject to multiple interpretations. [ABSTRACT FROM AUTHOR]

Introduction: Protein-Energy Malnutrition (PEM) and prevalence of under-weight children in India, is an important health concern. Aim: To evaluate the effect of Oral Nutritional Supplement (ONS) on growth, overall nutrient intake and frequency of illness in nutritionally at-risk Indian children. Materials and Methods: In this prospective, randomised, gender-stratified, controlled, parallel group, open label study, 216 children (aged 4-6 years with weight-for-age z-score between -2 and -1) were randomised (1:1) to receive either 45 g of ONS {Test product+Dietary advice (T+D)} or control group {Dietary advice only (D-only)} for three months. Primary endpoints included weight-for-age z-score and weight gain in terms of g/kg/day from baseline to three months. Secondary endpoints included change in height-for-age z-scores; frequency of illness, change in dietary nutrient intake and Protein/Energy (P/E) ratio from baseline through three months. Safety endpoint included Adverse Events (AEs). PROC MIXED was used to perform Repeated Measures Analysis Of Variance (RMANOVA) based on the changes in z-scores. The z-scores changes within the group from baseline to the end of three months End-of-Study (EOS) were compared using paired t-test. Results: At baseline, the mean (SD) weight-for-age z-scores were similar in both the groups {1.50 (0.309) and -1.49 (0.312) in T+D and D-only groups, respectively}. At the EOS, only T+D group showed significant mean (SD) change from baseline in weight-for-age z-score compared to the D-only group {0.59 (0.296), p<0.001 vs. 0.04 (0.267), p=0.0974}. Mean rate of weight gain (g/kg/day) was significantly higher in T+D group vs. D-only group (1.12 vs. 0.26, p<0.0001). At baseline, height-for-age z-scores were similar in both the groups {-1.36 (0.668) vs -1.37 (0.638) in T+D and D-only groups, respectively}. At EOS, the mean (SD) change from baseline in height-for-age z-score was -0.02 (0.198), p=0.2389 in T+D group and -0.15 (0.171), p<0.001 in the D-only group. However, the change was not proportionate to weight-for-age z-score. Total absolute number of illness episodes was less in T+D group vs. D-only group (9 vs. 13). Improvement in dietary nutrient intake (carbohydrate, fat, protein and energy) and P/E ratio was significantly higher (p<0.001) in T+D group vs. D-only group. Overall, 8.3% children in T+D group experienced at least one treatment-emergent AE. Conclusion: The ONS helps to improve growth, nutrient intake and reduces frequency of illness in nutritionally at-risk children. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of a nurse‐led personalized telephone lifestyle intervention versus automated SMSs in the reduction of fasting plasma glucose in adults with prediabetes. Design: The PREDIPHONE is a randomized controlled, parallel, two arms, superiority trial with 15 months of follow‐up. Participants will be randomized to either the intervention group (teleconsultations) or the active control group (SMSs). Methods: A total of 428 participants will be randomized in a 1:1 ratio to one of the two arms and followed up during 9 months. The teleconsultations group will receive nurse‐led personalized advice, while the SMSs group will receive 4–5 brief SMSs a week. Participants in both groups will receive evidence‐based recommendations for diet and physical activity (PA). Outcome measures will be collected at baseline, months 4 and 9 and at month 15, to evaluate post‐intervention effects. Discussion: Prevention of diabetes through the implementation of lifestyle interventions remains an important priority. The current pandemic situation has magnified its urgency as it heavily affected the functionality of the healthcare system. Moreover, it created the need of remotely delivering preventative interventions. This study will provide insights on the effectiveness and feasibility of a telephone‐based intervention led by nurses in the amelioration of risk factors associated with diabetes. Impact: Findings from this study will offer health services decision‐makers sound evidence regarding an alternative method to face‐to‐face consultations that could be practical, acceptable and inexpensive, and that concretely answers the need for easily implementable prevention strategies. Trial Registration: NCT04735640 (ClinicalTrials.gov identifier). Protocol version: V1.0, 18/02/2021. [ABSTRACT FROM AUTHOR]

Background: Nutrition transition and recent changes in lifestyle in Middle Eastern countries have resulted in the double burden of malnutrition. In Egypt, 88% of urban women are overweight or obese and 50% are iron deficient. Their energy, sugar, and sodium intakes are excessive, while intakes of iron, vitamin D, and folate are insufficient.Objective: This study aimed to formulate dietary advice based on locally consumed and affordable foods and determine the need for fortified products to meet the nutrient requirements of urban Egyptian women.Methods: Food intakes were assessed using a 4-d food diary collected from 130 urban Egyptian women aged 19-30 y. Food prices were collected from modern and traditional markets to calculate diet cost. Population-based linear and goal programming analyses (Optifood tool) were used to identify "limiting nutrients" and to assess whether locally consumed foods (i.e., consumed by >5% of women) could theoretically improve nutrient adequacy at an affordable cost (i.e., less than or equal to the mean diet cost), while meeting recommendations for SFAs, sugars, and sodium. The potential of hypothetical fortified foods for improving intakes of micronutrients was also assessed.Results: Iron was the most limiting nutrient. Daily consumption of fruits, vegetables, milk or yogurt, meat/fish/eggs, and tahini (sesame paste) were likely to improve nutrient adequacy for 11 out of 12 micronutrients modeled. Among fortified foods tested, iron-fortified rice, milk, water, bread, or yogurt increased the minimized iron content of the modeled diet from 40% to >60% of the iron recommendation.Conclusions: A set of dietary advice based on locally consumed foods, if put into practice, can theoretically meet requirements for most nutrients, except for iron for which adequacy is harder to achieve without fortified products. The acceptability of the dietary changes modeled needs evaluation before promoting them to young Egyptian women. [ABSTRACT FROM AUTHOR]

Abstract Background Diet is a key component of the management of diabetes. Several studies suggest that patients receive insufficient and inadequate information. As a first step for developing an intervention for improving dietary advice in primary care, we aimed to explore patients’ experience of receiving dietary advice; their attitudes towards that advice; their perceived dietary advice needs, and any barriers faced in adopting a diet that supports the management of their diabetes. Methods A qualitative study with three focus groups (20 purposively sampled participants) was conducted with adult primary care patients with Type 2 diabetes in 2016. A semi-structured topic guide was developed from the literature. The focus groups were audio recorded and transcribed. The data were analysed by emergent themes analysis. Data saturation was achieved in the third focus group. Results The majority of participants were given dietary advice in the form of a generic healthy eating leaflet from a Practice Nurse. Participants had their Haemoglobin A1c (HbA1c) reviewed regularly, but the results seemed not to be linked with review of dietary habits. The test was perceived as being a “pass or fail”, judgmental experience. Participants felt tested but not educated. Conclusion Individuals with type 2 diabetes seem not to receive dietary advice according to their expectations. Information collected as part of the study can be used to inform the development of interventions aimed at improving dietary advice in this population.