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Objective: Adherence to high quality dietary patterns is associated with lower risk of disease progression and all-cause mortality in chronic kidney disease (CKD). Self-efficacy and health literacy are recognised as factors that may lead to better adherence to high quality diets. However, these associations are not well studied in CKD. This study aims to explore the relationship between health literacy, self-efficacy, and diet quality in CKD., Methods: Participants with CKD stages 3a-5 recruited from three large tertiary hospitals were assessed using the Self-Efficacy for Managing Chronic Disease 6-item scale (SEMCD-6), the Health Literacy Questionnaire (HLQ) and the Australian Eating Survey (AES) Food Frequency Questionnaire. Diet quality was measured using the Australian Recommended Food Score (ARFS). Associations were examined using multivariable linear regression models, adjusted for sex and type 2 diabetes (T2D) diagnosis., Results: Sixty participants were included in the analysis. Mean age of participants was 74.5 years old and 58% were male. The mean ARFS was poor (Mean=29.9±9.1/73) and characterised by high intake of processed foods and animal protein, and low intake of fruit and vegetables. Mean SEMCD-6 was high (7.12±2.07/10). Self-efficacy and health literacy domains 6 - Actively engage with healthcare providers and 7 - Navigating healthcare system independently predicted diet quality in the adjusted model for sex and T2D., Conclusion: Adults with CKD report suboptimal diet quality. The results suggest that self-efficacy and aspects of health literacy should be considered when designing interventions aimed at improving diet quality in people with CKD., (Copyright © 2024. Published by Elsevier Inc.)

Context: Fish and seafood consumption makes an important but often under-recognized contribution to dietary patterns and nutrition, particularly in low- and middle-income countries (LMICs). Therefore, valid, and reliable dietary assessment tools (DATs) and methods to measure seafood consumption in resource-poor settings are needed., Objective: To review the available DATs that have been used to measure fish and seafood consumption in LMICs and to assess their quality., Data Sources: A systematic search of the electronic databases Scopus, Embase, and Medline was conducted, identifying 1541 initial articles, of which 122 eligible full-text articles were reviewed., Data Extraction: Data extraction focused on the purpose of dietary assessment, setting, target population group, DAT type, administration mode, type of fish and seafood assessed, specific measure of food intake, use of a portion-size-estimation aid, and details of validity, reliability, and pilot testing of the DATs., Data Analysis: The most common DATs used were food frequency questionnaires (n = 80; 58%), of which 36 (25%) were semi-quantitative. The majority of tools (n = 107; 78%) included measurement of consumption frequency; only 41 studies (30%) measured frequency, quantity, and type of seafood consumed. Only 41 DATs (30%) solely focused on fish or seafood intake. Most DATs were interviewer administered (n = 80; 58%), 23 (16%) mentioned the use of a portion-size-estimation aid, and validity was tested for only 13% of DATs (n = 18)., Conclusion: This systematic review reveals a lack of sufficient detail in the use of standard DATs to fully capture the contribution of fish and seafood to diets in LMICs. Consequently, the need to develop or adapt existing DATs to capture frequency, quantity, and type of fish and seafood intake with consideration of cultural eating practices has been highlighted. This is essential for informing appropriate interventions to leverage the nutritional benefits of seafood consumption in LMICs., Systematic Review Registration: PROSPERO registration no. CRD42021253607., (© The Author(s) 2023. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Context: Diet quality indices (DQIs) were developed to score and rank adherence to dietary patterns in observational studies, but their use to measure changes in diet quality in intervention trials is becoming common in the literature., Objective: This systematic review and meta-analysis aimed to assess the effectiveness of DQIs to measure change in diet quality in intervention trials., Data Sources: MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials databases were searched from January 1994 to June 2020. Two reviewers independently completed full-text screening. Eligible studies were randomized controlled trials that used validated a priori DQIs to measure change in diet quality in adults., Data Extraction: Data were extracted by an independent reviewer and reviewed by the research team. Risk of bias was assessed by the Cochrane Collaboration's Risk of Bias 2.0 tool., Data Analysis: The 34 included studies (52% of reviewed studies, 0.6% of initially identified studies) used 10 different DQIs, 7 of which were able to measure significant change in diet quality. Meta-analyses of pooled results demonstrated change in the Healthy Eating Index (MD 5.35; 95%CI, 2.74-7.97; P < 0.001) and the Mediterranean Dietary Adherence Screener (MD 1.61; 95%CI, 1.00-2.23; P < 0.001) scores. DQIs were more likely to measure change in diet quality if they reflected the diet pattern being implemented, if the intervention was significantly different from the baseline and control diets, and if the study was adequately powered to detect change., Conclusion: DQIs are responsive to change in diet quality in intervention trials when the index used reflects the dietary changes made and the study is adequately powered. The appropriate selection of a DQI to suitably match dietary changes and study populations is important for future dietary intervention trials., Systematic Review Registration: PROSPERO registration no. CRD42020181357., (© The Author(s) 2022. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In our initial analysis of the Australian Vegan Study we estimated the mean daily intake of vitamin B12 of each participant and compared this to the Recommended Dietary Intake (RDI). However, the proportion of vitamin B12 that can be absorbed from large doses typically contained in oral supplements is considerably lower than the amount absorbed from food. In this analysis we took into account the estimated absorption from supplements in order to compare adequacy of vitamin B12 intake to the RDI. A cross-sectional online survey was used to obtain information from women (N = 1530) of reproductive age on a vegan diet in Australia. Vitamin B12 intake from food was estimated using a validated food frequency questionnaire and detailed questioning was used to estimate supplemental intake. We used published data on dose-dependent absorption rates to estimate amount of the vitamin absorbed to enable comparison to the RDI. Supplementation practices varied widely. Based on estimated amount absorbed, 39% of participants had an estimated total intake of vitamin B12 below RDI equivalency, compared to 26% based on mean daily intake. The potential absorption of vitamin B12 needs to be considered when estimating adequacy of intake and recommending supplementation.

Objective: (i) To examine demographic and health characteristics of women of reproductive age on a vegan diet in Australia and compare these to the general population; (ii) to identify sources and intake of vitamin B12 and compare intake to current recommendations and (iii) examine associations between participant characteristics and adequacy of vitamin B12 intake., Design: In this cross-sectional study, data were collected via an online survey. Demographic and health characteristics of women on a vegan diet were compared with women in the general population (using Australian Bureau of Statistics data). Intake of vitamin B12 was estimated using a FFQ and estimation of supplemental intake., Setting: Australia., Participants: Participants (n 1530) were women aged 18-44 years who had been on a vegan diet for at least 6 months., Results: While BMI, smoking habits and intakes of fruit and vegetables compared favourably with the general population, 26 % of respondents had estimated intakes of vitamin B12 below recommendations. Analyses of relationships between vitamin B12 intake and participant characteristics revealed that the strongest predictor of intake was supplementation (P < 0·001); however, 25 % had not supplemented with vitamin B12 in the past 3 months., Conclusions: The vitamin B12 intakes of a substantial proportion of Australian women of reproductive age consuming a vegan diet do not meet the recommended intake, which could adversely affect their health, and, if they are pregnant or lactating, that of their infants too. There is a need for further research in this area to identify effective strategies to address this situation.

Background: Studies amongst older people with acute dysphagic stroke requiring thickened fluids have assessed fluid intakes from combinations of beverage, food, enteral and parenteral sources, but not all sources simultaneously. The present study aimed to comprehensively assess total water intake from food, beverages, enteral and parenteral sources amongst dysphagic adult in-patients receiving thickened fluids., Methods: Patients requiring thickened fluid following dysphagia diagnosis were recruited consecutively from a tertiary teaching hospital's medical and neurosurgical wards. Fluid intake from food and beverages was assessed by wastage, direct observation and quantified from enteral and parenteral sources through clinical medical records., Results: No patients achieved their calculated fluid requirements unless enteral or parenteral fluids were received. The mean daily fluid intake from food was greater than from beverages whether receiving diet alone (food: 807 +/- 363 mL, food and beverages: 370 +/- 179 mL; P < 0.001) or diet with enteral or parenteral fluid support (food: 455 +/- 408 mL, food and beverages: 263 +/- 232 mL; P < 0.001). Greater daily fluid intakes occurred when receiving enteral and parenteral fluid in addition to oral dietary intake, irrespective of age group, whether assistance was required, diagnosis and whether stage 3 or stage 2 thickened fluids were required (P < 0.05). After enteral and parenteral sources, food provided the most important contribution to daily fluid intakes., Conclusions: The greatest contribution to oral fluid intake was from food, not beverages. Designing menus and food services that promote and encourage the enjoyment of fluid dense foods, in contrast to thickened beverages, may present an important way to improve fluid intakes of those with dysphagia. Supplemental enteral or parenteral fluid may be necessary to achieve minimum calculated fluid requirements.