164 Medical Nutrition Therapy and Simple Interventions Can Improve Intake in Patients Who Eat Poorly in Hospital

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1Centre for Dietetics Research, The University of Queensland, Brisbane, QLD 4072, Australia

2Princess Alexandra Hospital, Brisbane, QLD 4102, Australia

3Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia

The Australasian Nutrition Care Day Survey (ANCDS) reported two-in-five patients in Australian and New Zealand hospitals consume ≤50% of the offered food. The ANCDS found a significant association between poor food intake and increased in-hospital mortality after controlling for confounders (nutritional status, age, disease type and severity)1. Evidence for the effectiveness of medical nutrition therapy (MNT) in hospital patients eating poorly is lacking. An exploratory study was conducted in respiratory, neurology and orthopaedic wards of an Australian hospital. At baseline, 24-hour food intake (0%, 25%, 50%, 75%, 100% of offered meals) was evaluated for patients hospitalised for ≥2 days and not under dietetic review. Patients consuming ≤50% of offered meals due to nutrition-impact symptoms were referred to ward dietitians for MNT with food intake re-evaluated on day-7. 184 patients were observed over four weeks. Sixty-two patients (34%) consumed ≤50% of the offered meals. Simple interventions (feeding/menu assistance, diet texture modifications) improved intake to ≥75% in 30 patients who did not require further MNT. Of the 32 patients referred for MNT, baseline and day-7 data were available for 20 patients (68 ± 17 years, 65% females, BMI: 22 ± 5 kg/m2, median energy, protein intake: 2250 kJ, 25 g respectively). On day-7, 17 participants (85%) demonstrated significantly higher consumption (4300 kJ, 53 g; p < 0.01). Three participants demonstrated no improvement due to ongoing nutrition-impact symptoms.

“Percentage food intake” was a quick tool to identify patients in whom simple interventions could enhance intake. MNT was associated with improved dietary intake in hospital patients. Further research is needed to establish a causal relationship.

Funding source: Ekta Agarwal is a recipient of the Australian Post-Graduate Award (APA) and the Small Research Grant (2010) from The Australasian Society of Parenteral and Enteral Nutrition (AuSPEN). The authors acknowledge AuSPEN for organising webinar-based training sessions in 2009-10.

Contact author: Ekta Agarwal –


Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, et al. Malnutrition and decreased food intake are associated with prolonged length of hospital stay, frequent hospital readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010. Clinical Nutrition In Press.

136 Shortfalls in Malnutrition Coding: A Mandate for Action

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1Centre for Dietetics Research, The University of Queensland, Brisbane, QLD 4072, Australia

2Princess Alexandra Hospital, Brisbane, QLD 4102, Australia

3Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia

The International Classification of Diseases, Version 10, Australian modification (ICD-10-AM) is commonly used to classify diseases in hospital patients. ICD-10-AM defines malnutrition as “BMI <18.5 kg/m2 or unintentional weight loss of ≥ 5% with evidence of suboptimal intake resulting in subcutaneous fat loss and/or muscle wasting”. The Australasian Nutrition Care Day Survey (ANCDS) is the most comprehensive survey to evaluate malnutrition prevalence in acute care patients from Australian and New Zealand hospitals1. This study determined if malnourished participants were assigned malnutrition-related codes as per ICD-10-AM. The ANCDS recruited acute care patients from 56 hospitals. Hospital-based dietitians evaluated participants' nutritional status using BMI and Subjective Global Assessment (SGA). In keeping with the ICD-10-AM definition, malnutrition was defined as BMI <18.5 kg/m2, SGA-B (moderately malnourished) or SGA-C (severely malnourished). After three months, in this prospective cohort study, hospitals' health information/medical records department provided coding results for malnourished participants. Although malnutrition was prevalent in 32% (n = 993) of the cohort (N = 3122), a significantly small number were coded for malnutrition (n = 162, 16%, p < 0.001). In 21 hospitals, none of the malnourished participants were coded. This is the largest study to provide a snapshot of malnutrition-coding in Australian and New Zealand hospitals. Findings highlight gaps in malnutrition documentation and/or subsequent coding, which could potentially result in significant loss of casemix-related revenue for hospitals. Dietitians must lead the way in developing structured processes for malnutrition identification, documentation and coding.

Funding source: Ekta Agarwal is a recipient of the Australian Post-Graduate Award (APA) and the Small Research Grant (2010) from The Australasian Society of Parenteral and Enteral Nutrition (AuSPEN). The authors acknowledge AuSPEN for organising webinar-based training sessions in 2009-10.

Contact author: Ekta Agarwal –


Agarwal E, Ferguson M, Banks M, Bauer J, Capra S, Isenring E. Nutritional status and dietary intake of acute care patients: Results from the Nutrition Care Day Survey 2010. Clinical Nutrition 2012; 31 (1): 4147.

215 Nutrition Support During Stem Cell Transplantation, a Randomised Controlled Trial

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Royal Brisbane & Women's Hospital, Brisbane, QLD 4029, Australia

Nutritional support during allogeneic haematopoietic progenitor cell transplantation (HPCT) is imperative to prevent malnutrition and poorer patient outcomes. However, there is currently no good evidence as to the most efficacious approach, leading to wide variation in practice in use of enteral (EN) and parenteral (PN) feeding across HPCT units. To determine the tolerability and efficacy of EN versus PN in patients undertaking allogeneic HPCT an RCT was conducted at our institution from September 2011 to January 2013. Patients were enrolled before commencing conditioning and randomized to receive either EN (nasogastric) or PN, if nutrition support was required (oral intake <60% requirements for 3 days). Patients with severe gastro-intestinal toxicity, including severe mucositis, were excluded from randomisation. If patients did not tolerate the type of feeding given they were swapped to the alternate route. 38 patients were enrolled onto the study, 19 (50%) required nutrition support, 9 (47%) were able to be randomized between EN (n = 5) and PN (n = 4), with 10 patients being excluded. The 5 patients randomized to EN met on average 74% of their goal nutrition and 100% required changing to PN due to gastro-intestinal intolerance. The 4 patients receiving PN met on average 91% of requirements, with none requiring changing to EN. This study has shown that due to the presence of significant gastrointestinal toxicity EN is not feasible to commence when oral intake becomes inadequate. Further research is needed to investigate whether prophylactic nasogastric tube placement would improve the feasibility and tolerance of EN in this population.

Funding source: The Royal Brisbane and Women's Hospital Foundation

Contact author: Sarah Andersen –

144 Improving Working Relationships within Patient Food Services: Development of a Governance Matrix

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Royal Brisbane & Women's Hospital, Brisbane, QLD 4029, Australia

In hospitals where dietitians are not accountable for the provision of patient food services, they still play a significant role, particularly in quality and safety. However, roles and responsibilities for various aspects of a patient food service are often not clear, resulting in a lack of single point accountability, and ‘finger pointing’ when things go wrong. At our hospital, Food Services reports through Corporate Services, while Dietetics report through Allied Health Professions Services. There was a requirement for a number of improvements to occur in the food service but it was unclear whose responsibility it was to undertake these. To provide clarity around roles, responsibilities and accountability for various aspects of the patient food service a Governance Matrix was developed through consultation with all key stakeholders in the hospital and approved by the relevant Executive Directors. The matrix details all aspects of the food service (e.g. budget, diet information, menu, purchasing, production, distribution, accuracy, clean up, various quality activities, food safety including allergen management and texture) against the agreed positions whom are: primarily accountable, have secondary responsibility, have an advisory/ consultant role, operationalise or ‘sign off’ roles. Positions represented in the matrix include Executives, nursing, speech pathology as well as various food service and dietetic positions. The matrix identified dietitians having primary accountability for one third of the identified areas. The matrix proved very useful in a recent major review of the patient menu, and provides a platform for working relationships and accountability for other quality and safety projects underway.

122 Challenge of Achieving Patient and Carer Involvement in Clinical Handover: Reflections of a Shared Process

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1The Wesley Hospital, Brisbane, QLD 4066, Australia

2Centre for Dietetics Research, University of Queensland, Brisbane, QLD 4072, Australia

Clinical handover is one of the ten National Safety and Quality Health Service Standards developed by the Australian Commission on Safety and Quality in Healthcare. Key aspects of the new Standard are 1) organisation governance and leadership for effective handover 2) clinical handover processes and 3) patient and carer involvement in clinical handover. A challenge for dietetic practice is implementation of mechanisms to involve patient and carer in clinical handover. The aim of this project was to implement the new standard in a Dietetic Department of a tertiary private hospital (530 beds). Methodology involved interviews with Accredited Practising Dietitians (APD's), gap analysis of current practice and the Standard, development of a new clinical handover policy, training, an implementation period of nine months, and evaluation surveys. The handover procedure adopted the SHARED framework including clinical information related to situation, history, assessment, risk, expectation and documentation. Feedback surveys were completed by all APD's (n = 8). Six APD's reported the bedside handover process effectively conveys patient information in a timely manner for transfer of patient care. Most clinicians (n = 7) were confident in undertaking bedside handover, and six clinicians prefer this method compared to a written handover. Qualitative feedback highlighted advantages to be greater patient involvement, improved communication and greater continuity of care. It is envisaged that time efficiency and familiarity with the SHARED framework will enhance future implementation. This project has demonstrated a patient-focussed, comprehensive and accountable process for transfer of patient care, and is an innovative model for dietetic practice in acute care.

Contact author: Melanie Bannister –

228 Innovations in Clinical Education – the Dietetics E-Portfolio for Competency Assessment

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Centre for Dietetic Research, University of Queensland, St Lucia, QLD 4067, Australia

One of the major challenges of dietetics clinical education relates to competency assessment in each of the domains of professional practice. The dietetics e-portfolio is a web-based electronic portfolio facilitating competency assessment and professional practice workload management. It allows students to self-assess each of the elements of competence by providing statements of evidence and includes a reflective practice component. Supporting documents such as nutrition care plans, nutrition assessment forms, audit results, photographs, etc can be uploaded. The placement site clinical educator and/or University course co-ordinator provide feedback on the self-assessment. The evidence supports that self-assessment is reliable and can be more severe than that provided by clinicians. It results in deeper learning for students and can open productive student-clinical educator dialogue. Self-assessment allows a more complete picture of the students work and is not reliant on intermittent observation. The students gain an in-depth understanding of each of the elements of competence and the self-reflections skills are important for lifelong learning. Competencies are signed electronically and this may be achieved prior to completion of placement. For individual case management, students document all cases allowing workloads and case variety to be determined by clinical educators/University staff. The workload and progress of students is easily tracked and potential issues resolved quickly. The system was introduced in 2012 across all areas of dietetics placement and has received excellent feedback from stakeholders. The e-portfolio is an evidence-based innovation in dietetics clinical education.

Contact author: Judith Bauer –

151 Nutritional Assessment of Hospitalised Infants

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1School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia

2Nutrition and Dietetics, Royal Children's Hospital, Brisbane, QLD 4029, Australia

3Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, QLD 4029, Australia

Accurate assessment of nutritional status is vital for the management of hospitalised infants; however, there is currently no gold standard method. This study aimed to determine the nutritional status of hospitalised infants using both the Paediatric Subjective Global Nutrition Assessment (PSGNA) and Body Mass Index (BMI)-for-age z-score cut offs; and to determine the ability of a series of Malnutrition Screening Questions (MSQ) to identify infants at risk of malnutrition. A total of 23 inpatient infants (57% male) aged 31 days to 24 months (ca) during September and October 2012, with a length of stay greater than 24 hours (mean = 24 days), were enrolled in the study. Bare weight was measured using infant scales and length was measured using a flexible measuring matt. All questionnaires were administered by a single observer. Statistical comparisons were made using Cohen's k statistic. The most common reason for admission was infection (40%) followed by neurological (22%) and gastrointestinal (22%). The PSGNA categorised 61% of infants as well nourished and 39% as moderately malnourished. BMI-for-age z-scores categorised 74% as well nourished, 17% as mildly malnourished and 9% as moderately malnourished. Agreement between the two methods was poor (k = 0.13 ± 0.20; 95%CI −0.27, 0.53).The MSQ was able to identify 90% of infants considered malnourished according to the PSGNA and was 100%accurate for identifying infants considered to be well nourished. Statistical agreement between the two methods was very good (k = 0.91 ± 0.09; 95%CI 0.74, 1.08). Further research is required to determine sensitivity and specificity of the MSQ against the PSGNA.

Contact author: Kristie Bell –

157 Impact of a Nutrition Award Scheme, Start Right-Eat Right, on the Food Intake of Children Attending Long Day Care

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1Sansom Institute for Health Research, University of South Australia, SA 5001, Australia

2Southern Primary Health, Morphett Vale, SA 5162, Australia

With increasing numbers of children attending child care where they consume approximately half of their daily food intake, child care settings offer a unique opportunity to intervene to improve children's nutrition. Start Right-Eat Right (SRER), a nutrition incentive award scheme, has been shown to improve Long Day Care Centre's (LDCC) nutrition policies, menus, and nutrition environments. We aimed to determine whether these translate to improvements in children's dietary intake. Twenty South Australian LDCC's undertook SRER training (9 hours). Pre- and post-intervention training, centre nutrition policies, menus and nutrition environments were assessed by direct observation and document auditing and children's (2–4 years) dietary intake (morning/afternoon tea, lunch)measured using the plate wastage method. Preliminary analysis (n = 17) showed significant improvements in the number of serves provided to children per day of vegetables (0.5 ± 0.5, p < 0.001) and meat/meat alternatives (0.4 ± 0.4, p = 0.001). Non-significant improvements (pre v post) were observed for fruit (0.7 ± 0.2 v 0.8 ± 0.4), dairy (2.2 ± 0.8 v 2.6 ± 0.5), cereals (2.7 ± 0.7 v 2.4 ± 0.4), and fats and oils (1.1 ± 0.6 v 1.1 ± 0.2). All centres (n = 17) met 100% nutrition policy, menu and meal time environment criteria for award status post-intervention compared to none pre-intervention (average 34/60 items met). Dietary data will be analysed at the group level using SPSS. Food group servings provided to and consumed by children will be compared pre- and post-intervention using repeated measures ANCOVA. The findings of this study will provide insight into the SRER's effectiveness in improving children's dietary intake and can inform future interventions in the early childcare setting.

Funding source: This project was supported by funds from a UniSA Division of Health Sciences Research Development Scheme Grant. RKG is supported by a National Heart Foundation Fellowship.

Contact author: Lucinda Bell –

132 Malnutrition Prevalence and Recognition by Medical and Nursing Staff on an Australian Gastroenterology Unit

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1Department of Nutrition and Dietetics, Monash University, Clayton, VIC 3168, Australia

2Nutrition Department, St Vincent's Hospital, Fitzroy, VIC 3065, Australia

3Gastroenterology Department, St Vincent's Hospital, Fitzroy, VIC 3065, Australia

Malnutrition in hospital patients is associated with increased morbidity and mortality. Patients with gastrointestinal diseases are thought to be at high risk. This study aimed to determine the prevalence of malnutrition and management on an Australian Gastroenterology Unit, and identify nursing and medical staff awareness of the signs and risk of malnutrition. Consecutive patients (n = 51) over a 5 week period were assessed for malnutrition on admission using a validated tool and their medical history was audited for nutrition screening and dietitian involvement. An anonymous survey (n = 24) assessed medical and nursing staff knowledge of malnutrition risk factors. Thirty-five percent of patients (n = 18) were found to be malnourished, the highest level observed in oesophageal diseases (67%). The median length of stay (LOS) was 4 days. Nutrition screening by nursing staff was completed on 65% patients and 78% of patients were weighed on admission. The dietitian was referred 78% of malnourished patients. Sixty-three percent of doctors and 100% of nurses reported they would assess a patient's nutritional status on admission. However, doctor and nurse recognition of loss of weight as a key indicator of nutritional status was poor. This study identified a high level of malnutrition on admission to an Australian Gastroenterology Unit. Further education is required to improve staff knowledge, screening, and referral practices to ensure all malnourished patients are identified on admission and have dietetic input. Further research is warranted to investigate optimal dietetic intervention given the short LOS of patients.

Funding source: St Vincent's Hospital (Melbourne) Research Endowment Fund.

Contact author: Lina Breik –

175 Determining the Reach and Capacity of Aboriginal Community Food Programs in Victoria

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1SecondBite, Kensington, VIC 3031, Australia

2Victorian Aboriginal Community Controlled Health Organisation, Collingwood, VIC 3066, Australia

Aboriginal and Torres Strait Islander Victorians are almost four times more likely than their non-Aboriginal counterparts to experience at least one episode of food insecurity. In recognition of this critical need to improve the food security for Aboriginal people, SecondBite and Victorian Aboriginal Community Controlled Health Organisation (VACCHO) partnered to implement an Aboriginal Food Security work plan for Victoria. Although Aboriginal people are more likely to experience food insecurity, anecdotal evidence suggests that participation in mainstream Community Food Programs, an umbrella term used to describe any program that provides free or subsidised food to vulnerable people, is low. Until now, very little formal research has been completed to document how many Community Food Programs specifically cater for Aboriginal people living in Victoria, their geographical reach, their service delivery, strengths, challenges and training needs. In December 2012 a survey was distributed to key stakeholders from Aboriginal Community Food Programs, recruited via snowball sampling. Results indicate that the challenges for Aboriginal Community Food Programs are similar to non-targeted programs, there are key strategies which improve the community engagement and program operations and unmet training needs exist to increase the dissemination of fruit and vegetables. By collating this data, SecondBite and VACCHO can introduce services to each other to promote collaboration and provide evidence on to how Aboriginal food security could be improved. Further research is required to repeat this methodology in other states and territories of Australia to ensure food insecure Aboriginal people have access to emergency food relief across the nation.

Contact author: Liza Wallis –

208 Evaluation of the Nutrition Support Provided at the 2010 Delhi Commonwealth Games: Western Versus Non-Western Perspectives

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University of the Sunshine Coast, Maroochydore, QLD 4556, Australia

In the main dining hall of major international sporting events, it is standard practice to provide some nutrition support, commonly nutrition labeling and dietetic consultations, for attendees. Although this may assist athletes and officials to make optimal food choices, the level and type of support varies between events and may not be suitable for individuals from different regions. Therefore, the aim of this study was to investigate the opinion and usage of nutrition support by athletes and officials from Western and Non-western regions at the 2010 Delhi Commonwealth Games. Dietitians (n = 4) recorded occasions of service (n = 443) at a nutrition kiosk during the games period (23rd September – 14th October), while a questionnaire was randomly distributed to individuals (n = 503) in the main dining hall. Of all enquiries, 57% (n = 251) were from Western attendees, mainly for food provision (81%, n = 153) and special/therapeutic dietary requirements (79%, n = 56). Non-western attendees had more performance nutrition (69%, n = 52) and weight management enquiries (93%, n = 53) and requested the majority of consultations (86%, n = 51). Nutrition labels were used all or some of the time by 75% (n = 380) of attendees, however Non-western athletes reported more frequent use (p ≤ 0.001). Western attendees rated label presentation (p = 0.047), allergen information (p = 0.028) and the overall label format (p = 0.012) significantly lower than Non-western attendees. These findings suggest that although nutrition support at this event was viewed as adequate, improvements could be made to labels. Dietitians working at these events should be adequately trained in large scale food service operation and capable of consulting on food allergy/intolerance.

Contact author: Sarah Burkhart –

204 The Challenge of Building a Dietetic Service to Meet the Needs of Chronic Kidney Disease Patients: CKD.QLD Nutrition Study

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1Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia

2University of Queensland, St Lucia, QLD 4067, Australia

3Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia

4Townsville Hospital and Health Service, Townsville, QLD 4818, Australia

Chronic Kidney Disease (CKD) is associated with increased cardiovascular disease and a myriad of nutrition-related risk factors. This investigation aims to define the nutritional needs of patients undergoing early CKD care to inform future models of care. 146 consecutive CKD patients were recruited across geographically diverse CKD.QLD study centres (South-East (metropolitan) n = 46, Southern (regional) n = 48 and North Queensland (regional/remote) n = 50). Dietitians undertook a full nutrition (BMI, waist circumference, 6-month weight history and subjective global assessment (SGA)), dietary (standardised 24-hour recall and Dietary Habits Questionnaire (DHQ)) and quality of life (EQ-5D) assessment. Average (SD) age 70.8 (12.1) years, BMI 30.9 (7.3) kg/m2 and glomerular filtration rate was 32.2 (11.9) mL/min. The vast majority of patients were overweight or obese (82% by BMI and 89% by waist circumference) with 37% reported recent weight gain; whilst 11% were malnourished (SGA B) and 25% reported recent unintentional weight loss. Over 90% of patients were deemed to require further intervention for sodium, fat and fibre intake according to the DHQ (score ≤ 4), with mean energy (90.7 (28.0) kJ/kg) below and protein (1.07 (0.36) g/kg) intake above estimated requirements. Over 50% reported limitations in mobility and 60% moderate-severe pain or disability. This is the largest in-depth nutrition profile of CKD patients in Australia highlighting a significant challenge to service provision. Balancing high rates of obesity and poor diet quality with specific dietary needs and malnutrition risk prior to end-stage is considerable. Future work will investigate the implications of these nutrition parameters on long-term clinical outcomes.

Funding source: University of Queensland (CKD.QLD Research Grant)

Contact author: Katrina Campbell –

225 Self-Reported Appetite and Adequacy of Energy and Protein Intakes in Patients with Non-Dialysis Chronic Kidney Disease

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1St George Hospital, Kogarah, NSW 2217, Australia

2University of New South Wales, NSW 2217, Australia

3University of Wollongong, Wollongong, NSW 2522, Australia

Subjective assessment of appetite using the Appetite and Diet Assessment Tool (ADAT) with 5-point Likert scales: (1) very good, (2) good, (3) fair, (4) poor and (5) very poor has been useful in screening patients for suboptimal intake and predicting hospitalization rate in patients on maintenance dialysis. This study examined the relationships between self-reported appetite score and the estimated energy and protein intakes in a cohort of non-dialysis ESKD patients. Patients were asked to rate their appetite using the ADAT and their dietary intake was assessed by the dietitian using a structured diet history method. Of the 205 patients assessed, 60.5% were male; mean age was 65.7 ± 13.6 years and mean GFR was 17.3 ± 6.5 ml/min. 69.5% of patients rated their appetite as (1) or (2) = combined “good appetite”, whereas 30.5% rated their appetite as (3) or (4) or (5) = combined “reduced appetite”. Intakes of >25 kcal/kg IBW/d and > 0.75 g/kg IBW/d were considered adequate for energy and protein respectively. The mean energy and protein intakes rated by the “good” vs. “reduced” appetite scores were 24.7 ± 6.5 vs. 21.1 ± 6.7 kcal/kg IBW/d, P = 0.001 and 1.24 ± 0.42 vs.1.06 ± 0.42, P = 0.006 respectively. The positive predictive value (95%CI) of appetite rating for energy and protein were 0.41 (0.32–0.45) and 0.92 (0.88–0.95) respectively. In conclusion, while self-reported appetite scores were useful in ranking energy and protein intakes, subjective reporting of good appetite was associated with adequate protein but not energy intake in non-dialysis ESKD patients with high symptom burden.

Contact author: Maria Chan –

226 Nutritional Characteristics and Dietary Intake of Patients at Enrolment to the Pre-Dialysis Assessment Clinic

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1St George Hospital, Kogarah, NSW 2217, Australia

2University of New South Wales, NSW 2217, Australia

3University of Wollongong, Wollongong, NSW 2522, Australia

Poor nutrition status at the start of dialysis is associated with morbidity and mortality. The aim of this retrospective cross-sectional study was to examine the baseline nutritional status and dietary intake of patients attending the pre-dialysis assessment clinic. Of the 210 patients assessed, 60.5% were male; mean age was 65.7 ± 13.6 years with a mean GFR of 17.3 ± 6.5 ml/min/1.73 m2. 17.1% were underweight (BMI <23 kg/m2) while 62.5% were overweight or obese (BMI >26 kg/m2). 40.5% were rated as malnourished (SGA score B&C) and 19.0% were overweight/obese and malnourished. 26.7% had MAMC 10% less than 50th percentile of the standard. Mean energy and protein intakes were 23.7 ± 6.7 kcal/ kg IBW/d and 1.18 ± 0.42 g/kg IBW/d with 65.6% and 13.1% did not meet the recommended intake of energy and protein respectively. 51.0% of patients experienced symptoms (e.g. poor appetite and nausea) affecting dietary intake while 15.7% of patients self-imposed dietary restriction inappropriately due to misconception of nutrition requirements in ESKD. 41.4% and 85.2% did not consume adequate fruit and vegetables of 2 and 5 serves per day respectively based on the Australian Guide to Healthy Eating. Nutrient intake (prevalence %) below the Recommended Daily Intake (RDI) levels were: VitB1 (36.5%), VitB2 (43.5%), Niacin (3.9%), VitC (20.2%), VitE (41.0%), folate (83.2%), VitA (50.5%), Mg (94.5%), Fe (36.1%), Zn (70.8%) and dietary fibre (83.3%). In conclusion, patients attended the current pre-dialysis assessment clinic presented with parameters indicative of poor nutritional health. This clinic may provide an opportunity to optimise nutritional status of ESKD patients before dialysis is required.

Contact author: Maria Chan –

101 Improvements in Iodine Status of Pregnant Women 3 Years after Mandatory Iodine Fortification, but Strategies to Increase Iodine Supplementation Still Required

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1University of Wollongong, Wollongong, NSW 2522, Australia

2University of Auckland, Auckland 1142, New Zealand

3Illawarra Shoalhaven Local Health District, Wollongong, NSW 2521, Australia

4University of Western Sydney, Campbelltown, NSW 2560, Australia

Mandatory iodine fortification of salt used in bread-making was introduced in Australia in October 2009. There has been little assessment of the effectiveness of the program to correct iodine deficiency in pregnant women. This study compared median urinary iodine concentration (MUIC) measurements, according to supplement use, in pregnant women attending a public antenatal clinic in a regional area of New South Wales, pre-fortification (2008; n = 139) and 2 years (2011; n = 147) and 3 years (2012; n = 114) post-fortification. Knowledge and practices related to iodine nutrition were investigated using a self-administered questionnaire, and dietary iodine intake evaluated using a validated iodine-specific food frequency questionnaire (2011 and 2012 samples only). Pre-fortification, women had mild to moderate iodine deficiency (MUIC (IQR) = 87.5 (62, 123.5) μg/L). Post-fortification, MUIC improved to 145.5 μg/L (91, 252) in 2011 and 166 (97, 237) in 2012, indicating iodine sufficiency (≥150 μg/L). However, only those women taking supplements containing iodine had MUIC in the replete range in both years surveyed post fortification (178 μg/L vs. 109 μg/L (P < 0.001)in 2011; and 202 μg/L vs. 124 μg/L (P < 0.05) in 2012). Despite bread being the vehicle for iodine fortification, dairy foods remained the major contributor to total iodine intake (58 %). Overall knowledge regarding health implications of iodine deficiency, the need for supplementation, and identification of iodine rich food sources remained poor. Iodine status of pregnant women has improved since the introduction of mandatory iodine fortification, however supplementation is indicated during pregnancy.

Contact author: Karen Charlton –

79 The Effectiveness of Dietary Counselling Versus Oral Nutrition Supplements in Improving Nutritional Intake in Malnourished Patients with Chronic Obstructive Pulmonary Disease (COPD)

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1Institute of Human Nutrition, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK

2Nutrition & Dietetics, School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4059, Australia

3Medical Affairs, Nutricia Ltd, Trowbridge BA14 0XQ, UK

4Respiratory Medicine, Southampton University Hospital, NHS Foundation Trust, Southampton SO16 6YD, UK

The evidence for nutritional support in COPD is almost entirely based on oral nutritional supplements (ONS) yet despite this dietary counseling and food fortification (DA) are often used as the first line treatment for malnutrition. This study aimed to investigate the effectiveness of ONS vs. DA in improving nutritional intake in malnourished outpatients with COPD. 70 outpatients (BMI 18.4 SD 1.6 kg/m2, age 73 SD 9 years, severe COPD) were randomised to receive a 12-week intervention of either ONS or DA (n 33 ONS vs. n 37 DA). Paired t-test analysis revealed total energy intakes significantly increased with ONS at week 6 (+302 SD 537 kcal/d; p = 0.002), with a slight reduction at week 12 (+243 SD 718 kcal/d; p = 0.061) returning to baseline levels on stopping supplementation. DA resulted in small increases in energy that only reached significance 3 months post-intervention (week 6: +48 SD 623 kcal/d, p = 0.640; week 12: +157 SD 637 kcal/d, p = 0.139; week 26: +247 SD 592 kcal/d, p = 0.032). Protein intake was significantly higher in the ONS group at both week 6 and 12 (ONS: +19.0 SD 25.0 g/d vs. DA: +1.0 SD 13.0 g/d; p = 0.033 ANOVA) but no differences were found at week 26. Vitamin C, Iron and Zinc intakes significantly increased only in the ONS group. ONS significantly increased energy, protein and several micronutrient intakes in malnourished COPD patients but only during the period of supplementation. Trials investigating the effects of combined nutritional interventions are required.

Funding source: Unrestricted educational grant by Nutricia Ltd, UK

Contact author: Peter Collins –

167 Can Rural Primary Health Care Develop Entry Level Dietetic Competencies?

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1School of Dentistry and Health Science, Charles Sturt University, Wagga Wagga, NSW 2650, Australia

2Murrumbidgee Medicare Local Ltd, Wagga Wagga, NSW 2650, Australia

Traditionally the setting for the development of the individual case management competencies has been within the dietetic departments of metropolitan teaching hospitals, or large rural referral hospitals. A successful funding submission between Coast City Country General Practice Training and Charles Sturt University (CSU) to Health Workforce Australia was received to investigate multidisciplinary clinical education of dietetic students in primary health care. A pilot study was undertaken which involved third year students completing a two week case management placement under the supervision of an experienced APD. The placements were facilitated by the Murrumbidgee Medicare Local in collaboration with CSU, and occurred in small rural general practices and a regional Aboriginal Medical Services, in late 2012. Following ethics approval from the CSU ethics committee, evaluation was undertaken to determine the range of opportunities the primary health care setting provided to develop entry level dietetic competency. The students collected the number of clients seen and range of case mix during the practicum. Detailed interviews were conducted from the perspective of the supervising dietitian, the medical practices hosting the placements and the student dietitians', and then thematically analysed. The findings identified a number of learning opportunities provided by the rural primary health care setting and rural general practice. The pilot project has provided evidence which may inform the dietetic profession as to the value of rural primary health care as a potential clinical placement setting for the development of entry level dietetic competencies.

Funding source: Grant from Health Workforce Australia

Contact author: Ruth Crawford –

198 Implementing Foodservice & Nutrition Policy: Change, Chance & Challenges

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Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia

The Queensland Health (QH) Foodservice and Nutrition Policy was endorsed December 2012 and requires compliance with the QH Nutrition Standards for Meals and Menus, prepared meal statewide contracts, food safety standards and provision of training in food safety and nutrition for support workers. Implementation of the policy was supported by a program of Statewide Workshops, meetings with Health Service Corporate Services Managers, development of Statewide meal contracts to comply with Nutrition Standards and ongoing provision of evidence and gap assessment tools for dietitians. Major change in the form of a corporate restructure of health and significant budget tightening for Hospital and Health Services changed the focus of implementation from a patient outcome to a cost neutral approach. The policy process for QH also changes with Health Service Directives providing the only mandatory requirements for Health and Hospital Services after July 2013. Combining nutrition and food safety in the one policy proved fortuitous, enabling the combined focus to be included in a Health Service Directive supported by the Chief Health Officer. Challenges implementing policy changes include, supporting rural dietitians in menu redesign and costing, lobbying food companies to provide plated single meals for small rural facilities, providing evidence of cost neutrality and providing alternative food service models for those sites with non-compliant infrastructure. Implementing new menu standards has proved to be cost neutral based on implementing the option of a short stay menu for length of stays less than seven days.

179 Let Them Eat Steak: Food Preferences of Patients in a Tertiary Public Hospital

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1Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia

2Centre for Dietetics Research, University of Queensland, St. Lucia, QLD 4072, Australia

3QueenslandUniversity of Technology, Kelvin Grove, QLD 4059, Australia

Information on foods patients like and dislike is the essential basis for planning menus which are acceptable to patients and promote adequate consumption. The aim of this study was to obtain quantitative data on the food preferences of inpatients at a large metropolitan public hospital for use in menu planning. Methodology was based on a study by Williams et al (1988), and included additional questions about appetite and taste changes. The survey used a 9 point hedonic scale to rate foods listed in random order and was modified to incorporate more contemporary foods than those used in the original Williams study. Surveys were conducted by final year University of Queensland dietetics students on Food Service Practicum at the Royal Brisbane and Women's Hospital (929 beds) in 2012. The first survey (220 questions, n = 157) had a response rate of 61%. The second included more sandwich fillings and salads (231 questions, n = 219, response rate 67%). Total number surveyed was 376. Results showed the most preferred foods were roast potato, grilled steak, ice cream, fresh strawberries, roast lamb, roast beef, grapes and banana. The least preferred foods were grapefruit, soybeans, lentils, sardines, prune juice and grapefruit juice. Patients who reported taste changes (10%) had similar food preferences to those who didn't report taste changes. Patients who reported poor/very poor appetite (10%) generally scored foods lower than those who reported OK (22%), good/very good appetite (65%). The results of this study informed planning for a new patient menu at the RBWH in December 2012.

Contact author: Jennifer Ellick –

126 Food Futures: Is the Food Provisioning Behaviour of Young Adults Healthy and Sustainable? A Pilot Study

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University of Canberra, ACT 2601, Australia

Carbon emissions resulting from the production and transport of food present a significant threat to the Earth's environment. Preliminary research has indicated that the use of cars to transport food home from the place of purchase contributes comparable amounts of emissions as other phases of the system, yet little is known about current transport behaviours or what determines them. This study aims to fill this gap by investigating the food transport habits of young people. University students were recruited to three semi-structured focus groups to obtain information on attitudes toward environmental issues, current food transport behaviours and barriers and enablers to reducing car use for food shopping. A self-report questionnaire was also administered to quantify key characteristics of respondents' weekly shopping habits. Qualitative data was analysed using thematic analysis by two independent researchers. Sixteen students attended three focus groups. Convenience, time constraints, difficulty carrying shopping bags, poor weather, inadequate public transport networks and the low-density design of Canberra were major barriers to reducing car use. Proximity to shops, exercise benefits and positive affect gained from activity and scenery were enablers for reduced car use. Participants expressed concern with environmental issues, but they were not a major influence on food shopping behaviour with 80% of shopping trips taken by car. While these results cannot be generalised to the wider population or other age groups, they suggest that reduction in car use for food shopping requires structural change to reduce the utility of cars and improve the efficacy of alternative transport methods.

Contact author: Scott Fischer –

86 Validation of the MST in Vietnam Using the SGA

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1Queensland University of Technology, Kelvin Grove, QLD 4059, Australia

2Can Tho University of Medicine and Pharmacy, Vietnam

3Ho Chi Minh City Nutrition Centre, Vietnam

The Malnutrition Screening Tool (MST) is currently used within Australian hospitals to identify patients at risk of malnutrition. In Vietnam there is no validated screening tool for malnutrition. A previous study in Vietnam used Subjective Global Assessment (SGA) to determine the prevalence of malnutrition in surgical patients. However the SGA takes a long time to complete compared to the MST. This study aimed to determine the effectiveness of the MST in Vietnam as a screening tool for malnutrition compared to the SGA. This cross-sectional study included 238 inpatients across two different hospitals in Can Tho and Ho Chi Minh City and 89 hospital outpatients in Can Tho. Each patient was assessed by two of the researchers with assistance from a translator for malnutrition using the SGA and MST over a ten day period. The sensitivity and specificity of the MST was then determined by comparison with the SGA. The SGA determined that the prevalence of malnutrition among patients was 29%. After comparing the MST to the SGA there was 78% sensitivity and 86% specificity. The MST score of two or more was used as the reference value for malnutrition risk. These results indicates that the MST is an appropriate screening tool for malnutrition in Vietnam as previous studies have suggested that a sensitivity and specificity >70% indicated that the tool was appropriate for use. However more research is required to determine the best way to implement malnutrition screening and therefore decrease the prevalence of malnutrition in Vietnam hospitals.

Contact author: Kate Glen –

148 Using A Mobile Device to Assess the Intake of Fruit and Vegetables in Young Adults

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1Curtin Health Innovation Research Institute and the School of Public Health, Curtin University, GPO Box U1987, Perth, WA, Australia

2Department of Health, WA, Australia

3Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, United States

4Purdue University, West Lafayette, IN, United States

5School of Engineering and Information Technology, The University of New South Wales at the Australian Defence Force Academy, Canberra, ACT, Australia

6Centre for Behavioural Research in Cancer Control, Curtin University, Perth, WA, Australia

7Cancer Council Western Australia, Shenton Park, WA, Australia

Young adults are often unwilling to participate in traditional dietary assessment methods such as written food records. This study aimed to assess the fruit and vegetable intake of 217 young adults (18–30 years) using a novel method to assess diet. Participants used a specifically designed application running on a mobile device to collect a 4-day image-based food record (74 men and 143 women; BMI of 24.8 kg/m2 ± 4.5 and 23.9 kg/m2 ± 5.7 respectively). Acceptability of using the mobile device to record their dietary intake was high. The mean daily intake of both fruit and vegetables were below the recommended serves. Men recorded only 1.1 ± 1.2 fruit serves (range = 0–5) and 1. 9 ± 1.0 vegetable serves (range = 0.5–5.5) and women 0. 9 ± 0.7 fruit serves (range = 0–3) and 1.9 ± 1.0 vegetable serves (range = 0–5). Twenty seven per cent of participants said they already ate enough fruit which appears realistic as 21% of men and 15% of women recorded ≥2 serves of fruit. For vegetables the perception was less realistic as 28% believed they already ate enough but only 1.3% of males and 1.4% of females recorded ≥5 vegetable serves per day. Over the 4-days of recording 31 (14%) participants recorded no fruit and 14 (6%) recorded one or less serves of vegetables. These findings suggest that accurate and realistic assessment of diet in young adults is feasible using mobile devices but motivation to improve fruit and vegetable intake in young adults remains the priority.

Funding source: Healthway (Western Australian Health Promotion Foundation)

Contact author: Amelia Hanbury –

97 Innovations in Dietetic Training in Foodservice Management – Can Early Exposure to Practice Enhance Final Year Competency Development?

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1Queensland University of Technology, Red Hill, QLD 4059, Australia

2Queensland Meals on Wheels, Strathpine, QLD 4500, Australia

Student engagement in the delivery of theoretical course materials is a current challenge in the tertiary sector including for dietetic training. In 2011 with the creation of a new nutritionist position for Queensland Meals on Wheels (QMOW), a service learning approach to support this organisation was used with third year dietetic students undertaking two days of structured activities at various QMOW sites in South East Queensland, aligned with coursework in Foodservice Management (FSM). This cohort of students was then followed in their final year post successful completion of five weeks professional practice in FSM to see if this experience supported readiness for placement and competency development.

Evaluation was undertaken of eligible students (n = 50) via paper based survey (response rate 94%) with all participating in targeted focus groups. Findings showed that students acknowledged the QMOW experience (on reflection 14 months later) providing opportunity for participation and/or observation in 5 of 12 FSM areas taught in third year, including food safety, meal production, assembly, delivery and dishwashing. Over half the students identified good exposure to FSM competency areas during the QMOW experience, with 83% satisfied with their competency exposure and subsequent practice during final year placements. A consistent theme emerged from focus groups supporting inclusion of practical opportunities with the theoretical component of the FSM subject to highlight relevance to learning. These findings highlight the importance of such teaching initiatives to met student learning preferences, linking theory with practice and supporting competency development in the final year of training programs.

Contact author: Mary Hannan-Jones –

163 Core Food Group and Macronutrient Intakes of Overweight and Obese Pregnant Women with and Without Gestational Diabetes

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1Queensland University of Technology, Kelvin Grove, QLD 4059, Australia

2Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia

Description of the dietary intakes of overweight and obese pregnant women with and without GDM in Australia is lacking and there is little evidence for the best method of addressing key nutritional risk factors in these women. This study aims to describe the dietary intake and gestational weight gain of a sample of overweight and obese women who received standard models of antenatal nutritional advice, either one-off general group education for a healthy pregnancy or individualised dietary counselling for GDM. Dietary and weight gain data were collected at 12 weeks (baseline) and 36 weeks gestation for fifty overweight and obese pregnant women. Dietary data were compared with core food group recommendations current at the time of the study. Changes over time were analysed using paired-samples t-tests, changes between groups used independent samples t-tests, p < 0.05. Twenty-four per cent (n = 12) were diagnosed with GDM. Overall, adherence to core food recommendations was poor. At 36 weeks, women with GDM decreased their consumption of core food subgroups fruit juice, pasta, rice and noodles, and non-core hot chips and takeaway meals (p < 0.05), reduced their total energy intake (p = 0.06) and gained less weight than non GDM women (GDM 7.9 ± 6.9 kg versus non-GDM 11.3 ± 5.7 kg, p = 0.175). Women without GDM did not make any notable dietary changes. The results of this study suggest that individualised dietary counselling may be a more successful approach than one-off general advice to prompt dietary change and may benefit the nutritional management of maternal overweight and obesity from early pregnancy.

Funding source: the Royal Brisbane and Women's Hospital Research Foundation

Contact author: Loretta Howard –

141 Body Composition Changes Following Stem Cell Transplantation: Agreement between Bioimpedance and Air-Displacement Plethysmography

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1Centre for Dietetics Research, University of Queensland, St. Lucia, QLD 4072, Australia

2The Wesley Hospital, Auchenflower, QLD 4066, Australia

3Princess Alexandra Hospital, Brisbane, QLD 4102, Australia

Altered body composition can have important implications on the prognosis and quality of life of cancer patients. Routine assessment of body composition via reference methods like air-displacement plethysmography (ADP) may not be practical due to cost and inconvenience. Inter-changeability between ADP and more practical alternatives such as bioimpedance spectroscopy (BIS) has not been well-explored amongst the cancer population. The aim of this study was to compare the agreement between changes in body composition measured by bioimpedance spectroscopy (BIS) against results of ADP amongst cancer patients undergoing peripheral blood stem cell transplantation. Body composition parameters were assessed using ADP (BOD POD, COSMED, Concord, CA, USA) and BIS (ImpSFB7, Impedimed, Brisbane, Australia) at pre-admission, and three months after the transplant day. Sixty-five adult haematological cancer patients undergoing transplantation were included in the study; 44 patients completed both ADP and BIS assessment at pre-admission and post-transplantation. Agreement was assessed by the Bland-Altman approach using ADP as the reference method. Results showed changes in body composition parameters between pre-admission and post-PBSCT measured by BIS was comparable to ADP (p = 0.41); bias of measured change in lean body mass was clinically acceptable (0.55 kg), but limits of agreement were wide (±8.8 kg). In conclusion, BIS is able to detect changes in body composition over time relative to ADP at a group level amongst cancer patients treated with peripheral blood stem cell transplantation; the methods should not be used interchangeably at the individual level.

Funding source: The Wesley Research Institute for funding the study and the use of the body composition laboratory. Yun-Chi Hung is supported by an APA Scholarship.

Contact author: Yun-Chi Hung –

185 An Examination of Young Women's Weight Loss Expectations

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University of Newcastle, Callaghan, NSW 2308, Australia

Young women are at high risk of weight gain, but traditional weight loss treatment approaches do not meet their needs. Greater consideration of young women's unique needs is required to improve recruitment, retention rates and treatment outcomes in this high risk group. This cross-sectional survey explored young women expectations for weight loss. Young women (n = 570, Mean age 24.2 ± 3.4 years), self-reported via an online survey their current weight, desire for weight change, ideal weight, and the reasons why they want to change their weight. Basic descriptive statistics were used to examine data, with sub-group analyses by body mass index (BMI) category. Half of respondents were a healthy weight, 25% overweight and 20% obese. The majority (79%) wanted to change their weight, with a significantly (p < 0.01) higher proportion of those overweight (94%) and obese (99%) wanting to change their weight than those in the healthy (66%) or underweight range (47%). The mean ideal weight reported was 61.7 ± 8.8 kg, which equates to a mean percentage weight loss of 15.6 ± 11.3%. The mean percentage desired weight loss increased significantly as BMI category increased (Healthy: 8.7 ± 4.1%, Overweight: 14.5 ± 5.0%, Obese: 30.0 ± 12.2%, p < 0.01). Young women's reasons for wanting to change weight differed by BMI category. Healthy weight and overweight women ranked ‘to feel better about myself’ and obese women ranked ‘improving my health’ as the main reasons for wanting to change their weight. These findings highlight the need for weight management interventions for young women that consider their unique reasons for wanting to change their weight and that manage their expectations.

Funding source: Grant from Priority Research Centre in Physical Activity and Nutrition, University of Newcastle

Contact author: Melinda Hutchesson –

78 Does Protected Mealtimes Assist in Reducing Mealtime Interruptions and Improving Eating Assistance in Adult Hospital Inpatients?

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Queensland Health, Logan hospital, Meadowbrook, QLD 4131, Australia

A Protected Mealtimes Program (PMP) encourages staff, volunteers and visitors to assist patients and cease non-urgent clinical activity during mealtimes. Given the limited evidence available establishing the efficacy of PMP, we compared mealtime interruptions, eating assistance received, and proportion of main meals consumed before and after PMP implementation in adult inpatients on acute wards. Data collected on each patient at main meals before and after PMP implementation included: diet code, level of assistance required and received and by whom, time available to consume the meal, position of the patient and tray during eating, type of interruption and by whom, and proportion of foods and drinks consumed. Chi-squared tests, independent samples t-tests and regression analyses were performed to compare outcomes pre- and post-PMP implementation. Over two years, 1632 mealtime observations were conducted on inpatients (65 (18) years, 51%M). While similar proportions of patients received eating assistance when required (∼84%, p > 0.05), feeding assistance nearly doubled post-PMP implementation (15% to 29%, p < 0.05). Regression analysis showed that patients were more likely to receive eating assistance if required post-PMP implementation (B = 11.536, p < 0.05). Interruptions by nursing staff increased from 10% to 18% post-PMP implementation (p < 0.05) and represented 61% of all interruptions. Mealtime consumption may not be influenced by PMP implementation (p > 0.05).

Increased nursing staff availability at mealtimes may increase feeding assistance and mealtime interruptions which may result in no change to inpatient consumption. Strategies that improve eating assistance without increasing interruptions, such as nurse ward champions or nursing staff driving PMP implementation, may be required.

Contact author: Shannon Huxtable –

125 Updated Evidence Based Practice Guidelines for the Nutritional Management of Patients Receiving Radiation Therapy and/or Chemotherapy

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1Centre for Dietetics Research, University of Queensland, Brisbane, QLD 4072, Australia

2Department of Nutrition and Dietetics, Princess Alexandra Hospital, QLD Australia

3Department of Nutrition Services, The Wesley Hospital, QLD Australia

4Department of Nutrition and Dietetics, Royal Brisbane and Womens Hospital, QLD Australia

5Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, NSW Australia

6Department of Nutrition and Dietetics, Peter MacCallum Cancer Centre, VIC Australia

7Cairns Base Hospital, QLD Australia

8Patient Safety & Quality Improvement Service, Centre for Healthcare Improvement, QLD Health, QLD Australia

The aim was to update the Evidence based practice guidelines for the nutritional management of patients receiving radiation therapy1 and broaden the scope to include chemotherapy. The following databases were searched using a range of keywords: Cochrane Database, CENTRAL, MEDLINE (via Ebscohost), EMBASE, CINAHL (Ebscohost), Web of Science, Health Source: Nursing/Academic Edition and PubMed. Relevant papers (N = 47) were reviewed by at least two members of the steering committee and assigned a level of evidence and a quality rating. There were no new published randomised controlled trials (RCTs) of nutrition intervention in radiation therapy. Most statements in the previous radiation therapy guidelines have strong evidence supporting nutrition intervention. There were 12 studies in chemotherapy including 5 RCTs. While these studies provided strong evidence that simple nutrition intervention improves nutritional outcomes such as dietary intake and weight, they did not find an improvement in quality of life or survival. Several RCTs found no benefits of nutrition support in patients undergoing chemotherapy. None of the RCTs in chemotherapy used Medical Nutrition Therapy (MNT) as the intervention, but rather simple dietary advice and/or supplements. In conclusion, the evidence to support nutrition intervention in patients receiving radiation therapy remains strong. However, the benefits of nutrition intervention in chemotherapy are less clear. Further studies are required to evaluate the impact of MNT as opposed to simple dietary advice in chemotherapy patients. This update contributes to a move towards comprehensive evidence based guidelines for the nutritional management of patients with cancer.

Funding source: Dietitians Association of Australia (DAA) small grant scheme

Contact author: Elisabeth Isenring –


Isenring E, Hill J, Davidson W, Brown T, Baumgartner L, Kaegi K, Reeves M, Ash S, Thomas S, McPhee S, Bauer J. Evidence-based practice guidelines for the nutritional management of patients receiving radiation therapy. Nutrition and Dietetics 2008; 65 (Suppl 1): S1S18.

191 Obesity as a Barrier to Kidney Transplantation: A Multidisciplinary Weight Loss Pilot Project

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Barwon Health, The Geelong Hospital, Geelong, VIC 3219, Australia

Obesity in patients with chronic kidney disease (CKD) presents a significant barrier to their acceptance for kidney transplantation. It is recommended that patients have a body mass index (BMI) ≤30 kg/m2 prior to surgery to reduce post-operative complications and the development of chronic co-morbid conditions. Our purpose was to pilot a group weight loss program for CKD patients who had previously failed to lose weight independently. This was a longitudinal, single centre, prospective, cohort study. Nine patients (Age M = 43.2 years, range: 32–56) with a BMI >30 kg/m2 (M = 36.6 kg/m2, range: 33.2–40.7) were enrolled in the study. The group attended regular individual assessments with a dietitian, physiotherapist and social worker and third monthly group education sessions. At baseline, six and twelve months, participants completed the Fatigue Severity Scale, Kidney Disease Quality of Life questionnaire and a six-minute walk test. Seven participants lost weight and reduced BMI. Average individual weight and BMI change was −4.8 kg (range: −11.0 to 0.8) and −1.8 kg/m2 (range: −4.3 to 0.4), respectively, at 12 months. Average waist circumference change was −4.6 cm (range: −12 to 1.5).This was achieved despite a concomitant increase in fatigue scores and reduction in endurance. Implementing a diet and lifestyle modification program using a multidisciplinary approach resulted in successful weight loss and BMI reduction in seven patients. This was despite participants experiencing multiple barriers to weight loss related to disease progression and a high incidence of co-morbidity. One patient has gained a transplant and 3 patients have been made active on the transplant list.

Funding source: Australian and New Zealand Society of Nephrology – Amgen Grant For Quality Assurance 2010

Contact author: Sarah Jukes –

184 A Snapshot of Malnutrition Prevalence in Five Residential Aged Care Facilities in the ACT Region

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1University of Canberra, ACT, Australia

2LaTrobe University, VIC, Australia

Malnutrition is a health issue in our ageing population that often goes unrecognised. As there are limited Australian data on the prevalence of malnutrition in residential aged care facilities (RACFs), the prevalence of malnutrition was determined in a sample of older adults living in five RACFs in the ACT region. In July/August 2012, the Subjective Global Assessment tool was used to determine the prevalence of malnutrition in 101 aged care residents. In this population, 66% of the residents were women, and 29% of residents were classified as high care. 78% of the residents were classified as well nourished, 20% as moderately malnourished, and 2% severely malnourished. Prevalence of malnutrition was higher in females, in patients receiving high level care, and in residents over the age of 85. The prevalence of malnutrition found in this study is lower than data reported in recent Australian and International studies for residential aged care. Reasons for the lower rate of malnutrition in this sample may be due to the presence of a student-led nutrition and dietetics clinic, previous dietetic intervention, small sample size, and high risk residents (such as cognitively impaired and medically unfit) not participating in the study. With the proportion of Australians over the age of 65 increasing, and with older adults being the largest group of nutritionally vulnerable people in Australia, it is imperative that there is early recognition and awareness of malnutrition in RACFs.

Contact author: Jane Kellett –

96 Pushing Cultural Competence Boundaries in Nutrition and Dietetics Training

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1Queensland University of Technology, Brisbane, QLD 4059, Australia,

2Apunipima Cape York Health Council, Cairns, QLD 4870, Australia,

3Cape York Hospital and Health Service, Cairns, Qld 4870, Australia

A health workforce ready for safe practice is a government priority, and particularly critical to support indigenous communities closing ‘the gap’. Increased pressure exists on dietetic training programs for quality placements, with fewer opportunities for immersion in Aboriginal and Torres Strait Islander communities to demonstrate cultural competence.

In 2012, Queensland University of Technology established a partnership with Apunipima Cape York Health Council with 56 weeks of dietetic placement for 8 students provided to achieve these aims. Clinical practice in Community Public Health Nutrition (CPHN) was structured in a standard 6 week placement, with Individual Case Management (ICM) and Foodservice Management (FSM) integrated across 8 weeks (4 each), with an additional 2 weeks ICM prior in a metropolitan indigenous health service. Students transitioned from urban to rural then remote sites, with new web-based technologies used for support.

Strong learning opportunities were provided, with CPHN projects in antenatal and child health, FSM on standardisation of procedures in a 22 bed health facility, and ICM exposing students to a variety of cases via hospital in/outpatients, general clinics and remote community outreach. Supervisor focus group evaluation was positive, with CPHN and FSM enhancing capacity of service. Student focus group evaluation revealed placements exceeded expectations, with rating high, and strong confidence in cultural competence described. Students debriefed final and third year cohorts on their experiences, with increased awareness and enthusiasm for work with indigenous communities indicated by groups.

With the success of this partnership, placements are continuing 2013, and new boundaries in dietetic training established.

Funding source: SARRAH, Queensland Health Allied Health Scholarship

Contact author: Carolyn Keogh –

182 The Views and Attitudes of Health Professionals Providing Antenatal Care to Women with a High Bmi: A Qualitative Research Study

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1The Department of Nutrition and Dietetics, the University of Canberra, ACT 2617, Australia

2The Centre for Research and Action in Public Health, the University of Canberra, ACT 2617, Australia

3The Department of Nursing and Midwifery, the University of Canberra, ACT 2617, Australia

Obesity is a growing problem for women of child bearing age. Maternal obesity has implications for both mother and baby including increased health risks from gestational hypertensive disorders, caesarian section, gestational diabetes, macrosomia and stillbirth. The prevalence of maternal obesity is increasing, yet little is known of the experiences of treating these women within the health care system. The aim of this research was to investigate the views and attitudes of health providers of antenatal care for women with a body mass index (BMI) of 30 and over. The study design used qualitative methods within a phenomenological framework. Two focus groups were held with midwives (N = 28) and one with obstetricians (N = 5) employed at a large teaching Hospital. Each session was audio recorded, transcribed and cross checked for consistency. Transcriptions were analysed for recurrent themes using Interpretative Phenomenological Analysis. Six dominant themes, common to both midwives and obstetricians, emerged: (1) Weighing women is out of fashion; (2) Weight is an embarrassing topic to discuss; (3) Overweight and Obesity has become the norm; (4) Caregivers, mother and baby's health is at risk; (5) Improved education and support services are required; (6) Obese women find it difficult to eat a healthy diet in pregnancy. Both professions believed that, specialist dietary interventions and evidence-based guidelines for obese women should be a public health priority and that health promotion campaigns should focus on the adverse health effects of obesity for both mother and child. Health professionals require extra support in caring for these women.

Contact author: Catherine Knight-Agarwal –

84 Food Allergy Profile and the Association with Eczema in 0–5 Year Old Children in an Allergy Clinic

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1The University of Sydney, Sydney, NSW 2006, Australia

2Allergy Appointment, Castle Hill, NSW 2154, Australia

3Paediatrix, Castle Hill, NSW 2154, Australia

Food allergy is defined as an abnormal immunological reaction to food proteins causing an adverse clinical reaction. The need for Australian studies in food allergy and the association with eczema has driven this project to be carried out. Although the public awareness of food allergy in Australia has increased, numerous medical practitioners remain sceptical about the role of food allergy in eczema. This study aimed to determine the food allergy profile among 0- to 5-year-old children presenting at a Paediatric and Dietetic Allergy Clinic, a Sydney-based private practice, and the association with eczema, using a retrospective review of the electronic medical records. 55.4% (532/960) of the children that presented at the practice had IgE-mediated food allergy. 6.6% (63/960) had food allergy co-existing with non-IgE mediated food chemical intolerance, with 48.9% (469/960) having food allergy and 21% (202/960) food chemical intolerance only. 66.4% (353/532) of the food allergic children had egg allergy, 44.9% (239/532) had peanut/tree nuts (nuts) allergy, and 31.8% (169/532) had cow's milk allergy. 444 children in this study cohort had eczema, with70.05% (311/444) of them having food allergy. The association between eczema and food allergy was analysed using Chi-square. Egg, nuts, cow's milk, soy, wheat, seafood mix and sesame were found to be associated with eczema. This study also revealed the demands on allergy specialists and paediatric allergy services in Australia and wide scope for future research.

Contact author: Dea Krismarietta –

106 Prevalence of Hospital Malnutrition and Association with Risk Factors in Vietnam

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1Queensland University of Technology, Kelvin Grove, QLD 4059, Australia

2Ho Chi Minh City Nutrition Center, Phu Nhuan District, Ho Chi Minh City, Vietnam

3Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam

Malnutrition is common in hospitals and is associated with poorer prognosis, yet data from Vietnam regarding prevalence or risk factors are lacking. The aim of this study was to determine prevalence of malnutrition according to Subjective Global Assessment (SGA) and evaluate factors associated with malnutrition in two Vietnam hospitals. This cross-sectional study sampled 283 inpatients and 89 outpatients, 57.5% male, median age 67 years. Risk factors including gender, age, length of stay, medical diagnoses and polypharmacy were analysed. Prevalence of malnutrition was 35.7% among inpatients and 9.0% among outpatients, lower than the 50.3–77.7% reported in previous Vietnam inpatients also using SGA1,2. Among inpatients, prevalence was lower in the hospital with a nutrition department (34.6%) compared to the hospital without (38.0%). Forty-one percent of patients ∼75 years old were malnourished compared to only 23.1% of patients <75 years. The highest prevalence of malnutrition was observed in the respiratory ward (65.2%). Patients with length of stay of >15 days had 38% (Odds Ratio (OR) = 1.38, p = 0.346) greater odds to be malnourished than 1–5 days. Every one drug incremental increase was associated with 13.7% higher odds of malnutrition (p = 0.002). Multivariate analysis revealed two independent factors associated with malnutrition: age (OR = 1.03, p = 0.004) and cancer (OR = 19.27, p = 0.010). This study may suggest that presence of a nutrition department could play a role in reducing rates. Further studies are recommended to inform improved nutritional support in hospitals and prepare for the rising double burden of disease emerging as an important challenge of tomorrow for Vietnam.

Funding source: Department of Education, Employment and Workplace Relations (DEEWR) Outward Bound Mobility Grants

Contact author: Bonnie Lau –


Pham NV, Cox-Reijvenb PLM, Grevec JW. Application of subjective global assessment as a screening tool for malnutrition in surgical patients in Vietnam. Clin Nutr 2006; 25: 102108.

Huong PTT, Lam NT, Thu NN, Lien DTK, Anh NQ, Henry EG, Oliver L, Bauchner H, Lenders C. Prevalence of malnutrition among hospitalized patients in Vietnam. Paper presented at the 7thAsia Pacific Conference on Clinical Nutrition (APCCN 2011), June 5–9, 2011, Bangkok, Thailand.

100 Promoting Food Allergy Awareness and Management in ACT Schools: Availability of Food Allergy Awareness Policies and Guidelines

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University of Canberra, Canberra, ACT 2601, Australia

The prevalence of food allergies within children is increasing, with approximately 1 in 20 Australian children exhibiting an immunological response to a food allergen. Effective food allergy management is imperative to preventing an allergic reaction or anaphylaxis. Children spend approximately six hours per weekday in a school environment. It is therefore important that schools effectively manage, educate and promote food allergy awareness. The purpose of this study was to examine the presence, availability and content of food allergy management policies and guidelines in Australian Capital Territory (ACT) schools. The study comprised two empirical stages: completion of an online survey by 27% of ACT school principals, and an audit of 113 ACT school websites. Basic frequency analysis of the survey data and thematic analysis of the website data was undertaken. The study found that 44% of schools have a specific food allergy policy or guideline. A further 37% of schools used the ACT Department of Education and Training Health and Safety-First Aid policy to guide their management of food allergies. Food allergy awareness within schools was directed by parents of children with food allergies (48%). Variations in the type and frequency of staff training were reported between schools. The audit of ACT school websites found that 60% of schools did not have an accessible food allergy or anaphylaxis policy, guideline or statement. This study has found, given the increasing prevalence of food allergies in children, that greater importance of food allergy management and awareness through the development of polices at the school level is required.

Funding source: University of Canberra, Faculty of Health Research Development Support Grant 2012

Contact author: Tanya Lawlis –

114 Are Informal Carers and Community Care Workers Effective in Managing Malnutrition in the Older Adult Community? A Systematic Review of Current Evidence

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1Centre for Dietetics Research, University of Queensland, Brisbane, QLD 4067, Australia

2The Wesley Hospital, Auchenflower, QLD 4066, Australia

3Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland Health, Brisbane, QLD 4102, Australia

Enhancing the effectiveness of the community and aged care workforce to prevent malnutrition and functional decline is important in reducing hospital and aged care facility demand. The aim of this systematic literature review was to investigate the impact of nutrition-related interventions delivered to informal carers and non-clinical community care workers on malnutrition-related health outcomes of community-dwelling older adults (≥65 years). Intervention studies were searched for, using six electronic databases for English-language publications from January 1980 to May 2012. Nine studies were eligible for inclusion. The strength and quality of the evidence was moderate (six studies with level II intervention evidence, five with positive quality). Types of interventions used were highly varied. The majority of interventions were delivered to informal carers (five studies), with three of these interventions also involving older adult care recipients. Five interventions were targeted at identifying, preventing and/or treating malnutrition specifically (two positive quality, three neutral quality, n = 2368). As a result of these targeted interventions, nutritional status improved or stabilized (two positive quality, two neutral quality, n = 2333). No study reported an improvement in functional status but two successfully prevented further decline in their participants (two neutral quality, n = 1097). Interventions targeted at identifying, preventing and/or treating malnutrition were able to improve or prevent decline in nutritional and functional status, without increasing informal carer burden. The findings of this review support the involvement of non-clinical care workers and informal carers as part of the nutritional care team for community-dwelling older adults.

Funding source: Skye Marshall is supported by an Australian Postgraduate Award. This research received no specific funding.

Contact author: Skye Marshall –

133 Chemotherapy-Induced Nausea and Vomiting: A Review to Inform Dietetic Practise

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1Centre for Dietetics Research, University of Queensland, Brisbane, QLD 4067, Australia

2National Institute of Integrative Medicine, Melbourne, VIC 3123, Australia

3Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland Health, Brisbane, QLD 4102, Australia

4School of Medicine, Centre for Integrative Clinical and Molecular Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD 4067, Australia

5Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia

6School of Nursing, Queensland University of Technology and Cancer Services Southern Clinical Network, Queensland Health, Brisbane, QLD 4102, Australia

Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect of cytotoxic treatment in oncology patients. Despite the widespread use of anti-emetic medication, CINV continues to affect a significant proportion of patients. This is of particular concern as ongoing nausea and vomiting may result in malnutrition, decreased quality of life and in extreme cases, treatment stoppage. The aim of this paper is to inform dietitians on current literature regarding CINV and review the evidence regarding the efficacy of dietetic strategies in this area. A systematic literature search was conducted using Pubmed, CINAHL, MEDLINE, Embase, and Health Source (Nursing/Academic Edition). Nine studies that investigated the prevalence of CINV were included (n = 2156). These studies found vomiting and nausea were present in 14–23% and 47–73% of chemotherapy patients, respectively. A key finding in this review was that common dietary strategies (e.g. eating slowly, avoiding fatty foods) seem to be solely based on professional opinion as no clinical trials investigating these strategies were identified. The review was also unable to identify studies that measured the impact of CINV on nutrition status. Less utilised, novel interventions such as oral ginger extracts were an effective adjuvant treatment for CINV in five of the seven clinical trials reviewed (n = 970).1 In conclusion, dietetic research on the management and impact of CINV is sparse and requires further investigation.

Funding source: Wolf Marx is a recipient of the Australian Post-Graduate Award (APA)

Contact author: Wolf Marx –


Marx W, Teleni L, McCarthy A, Vitetta L, McKavanagh D, Thomson D, Isenring E. Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting: a systematic literature review. Nutr Rev 2012; In press.

196 Healthy Eating Policy in Local Governments; It's Time for a Change

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Flinders University, Bedford Park, SA 5046, Australia

In South Australia the role of many Councils is extending to include promoting healthy eating and creating healthy eating environments. This will be facilitated by the South Australian Public Health Act 2011 which requires Councils to also address the growing incidence of chronic non-communicable conditions in their community. A review by the Local Government Association (LGA) in late 2011 found that none of the 68 Councils in SA had a healthy eating policy. Healthy Eating Local Programs and Policy (HELPP) has been funded to support the Councils, their peak body (the LGA) and other key stakeholders to develop and implement healthy eating policy. This paper describes the evidence based, collaborative approach taken to develop a healthy eating policy with Councils and the LGA. Initially a state level working group led by the Heart Foundation (SA) with the LGA, HELPP and Council representatives developed a unique, evidence based healthy eating policy framework and template. In another collaborative process, individual Councils complete the healthy eating policy by individualising it to their context. Using feedback from working group members and the results from piloting the policy tool, the framework and template has been finalised. Twenty-two Councils (32% of all Councils) are currently using this to develop their own healthy eating policy, which is underpinned by a ‘step change’ approach and opportunities for Councils to shape the content of the policy themselves. The collaborative and evidence based approach used to develop healthy eating policy in local government will have application in other settings.

Funding source: Project funded from Health Promotion Branch, SA Health, Dept Health & Ageing, South Australia

Contact author: Louisa Matwiejczyk –

109 Patient Nutritional Intake Increases with a Bedside Spoken Meal Ordering System

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1University of Wollongong, Wollongong, NSW 2522, Australia

2The CBORD Group, Chatswood, NSW 2067, Australia

3St. Vincent's and Mater Health, Darlinghurst, NSW 2010, Australia

4Health Services Information Agency (Queensland Health), Fortitude Valley, QLD 4001, Australia

Bedside spoken meal ordering systems (BMOS) have the potential to improve patient nutritional care, but there are few published evaluation studies. This study evaluated the effect of a BMOS compared to a paper menu at a 210-bed tertiary hospital in Sydney during 2011–2012. Paper menu baseline data were collected over 48 hours across five wards from 54 patients (75% response rate) and after BMOS implementation from 65 patients (95% response rate).Independent t-tests and Mann-Whitney tests were applied to identify significant differences (p < 0.05). Pre- and post-patient demographics, self-reported health, appetite, weight, BMI, energy and protein requirements, and foodservice satisfaction remained consistent. However, mean daily energy and protein intakes increased significantly (baseline versus BMOS): 6273 kJ versus 8273 kJ and 66 g versus 83 g protein; both p < 0.05. These intakes also reflected a significant increase in percentage of nutrient goals achieved (86% versus 110% of energy goal and 86% versus 105% of protein goal); both p < 0.05. Food intake was significantly higher at breakfast compared to other meals (71% consumed all of breakfast, compared to 47% and 45% consuming all of lunch and dinner respectively). Mean Nutrition Assistant time with patients increased significantly from 0.33 to 3.5 minutes (p < 0.05). Eighty percent of patients preferred the BMOS, and patient awareness of Nutrition Assistants and their role increased with the BMOS.The utilisation of a BMOS could be an important strategy to enhancing existing work processes and consequently achieving optimal patient nutrition outcomes.

Funding source: Kirsty Maunder was the recipient of the DAA Fay McDonald Scholarship 2012.

Contact author: Kirsty Maunder –

166 Perception of Metallic Taste in End Stage Liver Disease and Its Relationship with Food Choices

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1Princess AlexandraHospital, Brisbane, QLD 4102, Australia

2University of Queensland, Brisbane, QLD 4067, Australia

Taste changes are frequently reported by patients with end stage liver disease. The aim of this study was to determine the prevalence of a perceived metallic taste in patients with end stage liver disease, and to evaluate its relationship with food choices and energy and protein intake. Nineteen consecutive patients (15 male, 4 female, age 44 ± 14 years) awaiting liver transplant were recruited. Participants completed taste identification testingof the five basic tastes (bitter, sour, sweet, salty and umami) in accordance with International Standards Organisation (ISO 3972:2011). Participants were able to select from seven possible responses (including ‘metallic’ and ‘no taste’) for each of the five stimuli. Usual dietary intake was assessed by diet history. Nine patients (47%) perceived metallic taste for at least one of the five known taste stimuli. Metallic taste was not associated with severity or eitiology of disease. When participants who reported metallic taste were compared with those who did not, there was no difference in total energy (8565 ± 2820 kJ vs 9840 ± 3122 kJ; p = 0.39) or protein intake (97 g ± 32 g vs 121 g ± 27 g; p = 0.12) and no difference in total protein serves per day from dairy (p = 0.38), meats (p = 0.37) or alternative (p = 0.73) sources. Perception of metallic taste is common in people with end stage liver disease however does not appear to be associated with differences in total energy and protein intake or food choices. Longitudinal assessment of taste detection and perception after transplant is underway.

Contact author: Simone McCoy –

210 Questioning Our Practice: Do Energy Calculations Underestimate Resting Metabolic Rate in Developing Rugby Players?

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Queensland University of Technology, Kelvin Grove, QLD 4509, Australia

Maintaining energy balance is a nutritional priority for athletes and is crucial to optimising body composition and athletic performance. In the clinical setting, the energy requirements of individuals are routinely estimated using predictive equations. Whilst the use of published energy equations is common practice; there is little current evidence to validate their use with athletic groups. This study examined the body of published prediction equations and tested the hypothesis that energy prediction equations would underestimate Resting Metabolic Rate (RMR) in developing male football players. Anthropometric and metabolic data was collected for 23 developing adult male rugby players. Requirements were estimated using seventeen prediction equations and were compared with values measured by indirect calorimetry. Paired samples t-tests and root mean square prediction error (RMSPE) were used to compare measured and predicted RMR and the Bland-Altman procedure was used to assess the bias for each prediction. Prediction equations significantly underestimated RMR in rugby players for all equations (p = 0.001). The Harris Benedict equation provided the most accurate estimate of RMR and predicted energy requirements within ±189 kcal/d (RMSPE). Bland Altman limits of agreement were broad with mean bias ranging between ±200–300 kcal/d for all equations. In this study predictive equations consistently and systematically underestimated the RMR of rugby players and indirect calorimetry was preferable for assessment of individuals. Where indirect calorimetry is unavailable the Harris Benedict equation may provide the best prediction of RMR in athletic groups similar to rugby players. Further research to develop and validate a population specific equation is recommended.

Contact author: Andrea McDonald –

65 Promoting Environmentally Sustainable Eating – a Challenge of Tomorrow for Private Practice Dietitians

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1Queensland University of Technology, Kelvin Grove, QLD 4509, Australia

2Nutrition Promotion Unit – Queensland Health, Eight Mile Plains, QLD 4113, Australia

As global citizens, we are facing the challenge of feeding nine billion people by 2050 within escalating ecosystem constraints. Private practice dietitians, as food experts with discretion to innovate, are uniquely placed to promote the link between food sustainability and health. This project investigated private practitioners' views on integrating food sustainability into their professional practice. A mixed methods approach was used, with key stakeholder consultations and interviews providing qualitative data to inform the development of an online survey. This was distributed nationwide using existing networks of the Eco-Friendly Food Project. Survey questions covered attitudes, perceptions and beliefs on food sustainability and potential to include sustainability messages into practice. The 25 practitioners who responded were likely to be innovators in this field. While 79% of respondents reported that it was important to integrate environmental sustainability into their practice, 79% of respondents also indicated low confidence in their knowledge to deliver appropriate food messages. This was the main barrier to incorporation for 45% of the respondents. The most frequently reported motivator was personal interest (77%). A practice gap was identified, with scarce professional resources on environmentally sustainable food behaviours to use with clients. Key topics requested included seasonal eating, tips for integrating environmental and nutrition messages and reducing animal product consumption. A draft guide to assist practitioners to include environmental messages into client interactions and a client brochure were produced. Future work on how other areas of nutrition and dietetics practice can incorporate environmental sustainability is recommended.

Contact author: Bonnie Lau –

172 Can the Mini Nutritional Assessment (MNA®) Score be Used as a Nutrition Evaluation Tool for Sub-Acute Inpatients Over an Average Length of Stay?

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1Kingston Centre, Rehabilitation and Aged Care Services, Southern Health, Cheltenham, VIC 3192, Australia

2Allied Health Research Unit, Southern Health & Monash University, Notting Hill, VIC 3168, Australia

The prevalence of malnutrition in sub-acute inpatient settings is well documented and has been reported to be as high as 30–50%.1 However, the use of a validated nutrition evaluation tool to measure changes in nutritional status over an average length of stay for sub-acute inpatients has not as yet been tested. The aim of this prospective study was to determine the potential of the MNA® score to measure change in nutritional status over an average sub-acute inpatient stay. Inpatients with a mean age (± SD) of 83 ± 7 years and an expected length of stay of at least 14 days were assessed on admission using the MNA® and provided with nutrition intervention/diet therapy based on MNA® classification. MNA® score (0–30), anthropometry (weight and height) and biochemistry (serum albumin, transthyretin and C-reactive protein) were compared between admission and day 19 ± 2 (n = 119). Of those diagnosed as being at risk of malnutrition or malnourished (n = 109), there were significant increases in MNA® score (1.5 ± 2.5, p < 0.001), weight (0.6 ± 2.5 kg, p = 0.01) and serum albumin (1.4 ± 4.3 g/L, p = 0.001) over the study period. Further discussion and validation studies are required to determine if these observed changes in nutritional status are clinically significant for inpatients in the sub-acute setting.

Funding source: Lions John Cockayne Memorial Fellowship Trust Fund

Contact author: Karen McDougall –


Dietitians Association of Australia. Evidence Based Practice Guidelines for the Nutritional Management of Malnutrition in Adult Patients Across the Continuum of Care. Journal of Nutrition & Dietetics 2009; 66 (S3): S1S34.

212 Utilising Skype to Treat Individuals with Eating Disorders in Isolated Areas: 3 Case Studies

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BodyMatters Australasia, Neutral Bay, NSW, Australia 2089

Australia is a vast continent and it is well known that access to health care in rural and regional areas is limited. This presentation provides some case studies on how we have effectively utilised Skype to engage and provide treatment for people with eating disorders in rural & remote communities. This has enabled access to specialised treatment without travelling many thousands of kilometres to Sydney-which would often otherwise be required. We go on to explore the practical, legal & ethical issues that provision of treatment via Skype gives rise to.

Contact author: Sarah McMahon –

220 Predictors of Translation of DAA Conference Abstracts to Publication in Peer Reviewed Journals

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Flinders University, Bedford Park, SA 5042, Australia

DAA conferences play a vital role in disseminating research to members. However, unless this research is published, it reaches only a fraction of those people interested, and does not contribute to the body of evidence in the scientific literature. This study aimed to investigate the proportion of DAA national conference abstracts that progress to publication in peer-reviewed journals and to identify predictors of publication. A survey of demographics, authorship and publication status was distributed to authors of abstracts presented from 2006 to 2009. Searches for published articles were conducted for the non-responders. Binary logistic regression analyses were performed to determine the relationship between potential predictors and publication. Six hundred and forty eight abstracts were identified: 42% oral, 58% poster. Response rate was 50.3%. Publication rate in peer reviewed journals was 25%. Of those abstracts with a first author located in Australia (n = 619), the success of translating conference abstracts into publication varied by state/territory of residence, in descending order of success: SA (17/37, 46%), NSW (67/195, 34%); QLD 40/176, 23%); WA (4/22, 18%; VIC (22/146, 15%); TAS (2/15, 13%); ACT (2/20, 10%); NT (0/8, 0%). Predictors of publication included giving an oral presentation (OR 2.1; 95% CI 1.5–3.1) and presence of an academic author (OR 8.7; 95% CI 4.7–16). These findings suggest that the publication rate for DAA conference abstracts (25%) is well below the 44% documented from other professions in a recent Cochrane review. Support and training could potentially assist DAA members to overcome barriers to publication.

117 Malnutrition Screening Solutions in a Medical Assessment and Planning Unit

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1Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD 4012


3Occupational Therapy, Princess Alexandra Hospital, Brisbane, QLD 4012, Australia

4University of Queensland, St Lucia, QLD 4067, Australia

Whilst malnutrition within high throughput acute medical (50%) and emergency units (15%) has been clearly identified in the literature, it remains difficult to prioritise as a clinical issue within the fast paced medical model of care. The study aimed to establish an effective malnutrition screening model within a medical assessment and planning unit (MAPU). Two models of Malnutrition Screening Tool (MST) completion were trialled for feasibility as newly designated tasks: i) completion within the nursing admission form and ii) completion by Physiotherapy and/or Occupational Therapy allied health assistants (AHAs). Each model received three dietitian led training sessions. AHAs three sessions included theory, case studies, observation and supervised practice including inter-rater reliability checks. Nursing staff received one theory based training duplicated by the dietitian on three occasions to maximally capture staff on rotational rostering. AHA roles, responsibilities and reporting lines were documented and completion rates were assessed daily during a two week trial period. MST completion with the nursing admission form was assessed on four randomly selected days over a three month period. Training costs were calculated retrospectively. The AHA administered MST completion rate (79%, 102/129) was higher than that of the nursing (29%, 22/75) (p < 0.0001). Training costs for AHAs compared favourably (∼$195; 2 AHAs for 3 sessions) with nurse training (∼$1747.50; ∼10 nurses for 3 sessions). MST completion by AHAs is a feasible option in MAPU as it achieved greater completion rates, improved task accountability, and required lower training costs compared to nursing administered model.

Contact author: Eryn Murray –

135 Nutrition Practices and Malnutrition Documentation on an Australian Gastroenterology Unit

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1Nutrition Department, St Vincent's Hospital, Fitzroy, VIC 3065, Australia

2Department of Nutrition and Dietetics, Monash University, Clayton, VIC 3168, Australia

3Gastroenterology Department, St Vincent's Hospital, Fitzroy, VIC 3065, Australia

Malnutrition is common in hospital patients and gastroenterology patients are particularly at risk. A study conducted at St Vincent's Melbourne in 2011 identified high levels of malnutrition on the gastrointestinal unit with one in three patients malnourished on admission. This study investigated nutrition practices, and documentation and coding of malnutrition for the 51 patients involved in the study. The most common nutrition practice was fasting (67%) which occurred for an average of 2 days (range 1–16 days). The median length of stay was 4 days. Of the 18 patients identified as malnourished on admission, 10 patients were not coded as malnourished due to missed coding or no documentation of their malnourished state. This corresponded to $21,500 of potentially missed hospital reimbursements. Fasting was common on the gastroenterology unit and has the potential to further deteriorate nutritional status in a population that has a high prevalence of malnutrition. The results of this study has assisted in changing fasting practices in the organisation by allowing clear fluids up until 2 hours prior to endoscopy and most radiological procedures. Strategies such as clearer malnutrition documentation and staff education on the importance of identifying and documenting malnutrition are also being trialled. Further research will identify if these interventions increase the identification and documentation of malnourished patients to improve hospital reimbursements and the overall nutrition care of patients.

Funding source: support of the St Vincent's Hospital (Melbourne) Research Endowment Fund.

Contact author: Clara Newsome –

102 Positive Food and Health Messages that Emerge from Alternative Food Networks

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University of Canberra, ACT 2601, Australia

Dietitians play a key role in helping individuals, communities and policy-makers to reduce the financial and social costs incurred by diet-related diseases. The dominant approach taken by dietitians to date has focused on lifestyle change that encourages people to select wisely from the vast array of food on offer. Many people are disconnected from where and how food is produced and they have little knowledge of, or interest in, food. This research explores the possibilities that alternative food networks hold in helping people to learn about food that may help to bring more joy in food, stronger community ties and potentially fewer health problems. It draws on narrative inquiry methodology; twenty participants who were community gardeners, Community-Supported Agriculture (CSA) members or farmers' market attendees, took part in four focus groups. Across all groups, participants told stories of their deep love of food for its aesthetic, sensory qualities. Community gardeners described their immersion in the therapeutic landscape of the garden, where they formed friendships and learnt gardening skills, giving them a sense of well-being. The CSA members and farmers' market attendees enjoyed their shopping experience, forming friendships with farmers, as they learnt about food and how it is grown. They told of their appreciation for the hard work of farmers in producing high quality food, which helped to build trust and community. Dietitians could play a role in encouraging people to reconnect with the joy of food through these alternative food networks, which can contribute to well-being and enhanced community bonds.

Funding source: PhD candidature only

Contact author: Gabrielle O'Kane – Gabrielle.O'

213 Team Based Learning in Dietetics: New Method, Better Outcomes?

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Deakin University, Burwood, VIC 3125, Australia

Team Based Learning (TBL) is an established teaching delivery method that has revolutionised classrooms within business and, recently, medical schools in the USA and other countries. The method shifts the focus of teaching interactions from an instructor conveying core concepts to students applying them in a supportive peer-led environment. For TBL, students prepare for the class through prescribed readings and are then held accountable, using the Readiness Assurance Process (RAP). Following the RAP, the majority of class time is used to practice applying concepts to a series of team application exercises. In 2011 TBL was implemented in Community Nutrition, a core unit in the Master of Dietetics at Deakin University. Over the period of a week, students were introduced to the teaching method, had a familiarisation run and then over 3 intensive days explored and applied concepts critical to community nutrition. An evaluation of student confidence in the application of core concepts, using qualitative and qualitative questions, was conducted pre and post the intensive TBL week. The TBL process resulted in statistically significant increases in measures of student confidence and this translated into increased student and supervisor satisfaction with their learning on placement. As a result of these improvements, the course will be implementing TBL components in all core dietetic units for 2013.

Contact author: Sharleen O'Reilly –

80 Outcomes from Updating Dietetic Triage Guidelines for the Chronic Kidney Disease (CKD) Multi-Disciplinary Clinic

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Logan Hospital, Meadowbrook, QLD 4131, Australia

Given the limited resources available to a burgeoning CKD population, updated Dietetic triaging may assist in prioritising urgent patients in line with evidence-based guidelines. We aimed to assess if updated dietetic triage guidelines would improve the prioritisation of urgent patients attending CKD clinics. Dietetic triaging occurs one week prior to renal physician's clinics. Current triaging procedures were updated in May 2012 based on evidence-based guidelines and Queensland Health outpatient policy. Updated triaging was retrospectively applied to patients booked into renal physician and dietetics clinics over a two week period in July 2011 and June 2012 and compared against dietetic clinic bookings made. Demographics, anthropometry, biochemistry, co-morbidities, adherence to recommendations, attendance, and reason for review were also collected. Descriptive and chi-squared tests were used. 352 patients (n = 30 duplicates) were reviewed (61 ± 17 years, eGFR 41 ± 23 mL/min, 52%M, 33.1 ± 8.8 kg/m2, 46% had diabetes). The proportion of patients who weren't seen in 24 months decreased from 45% to 31% after updated triaging was implemented (p < 0.05). Across 2011 and 2012: 15% of patients assessed as urgent retrospectively were not reviewed by dietitian, 37% were non-compliant or did not attend dietetic appointments, 54% of clinic time was spent on weight management patients who were either aged above 75 years, had an eGFR >60 mL/min or BMI <35 kg/m2. Updated triaging did not increase the capture of urgent patients on clinic days due to lack of information available when triaging (e.g. biochemistry, malnutrition). Processes to allow capture of urgent patients has been refined, including staff in-servicing, weight management groups, and improved multidisciplinary communication.

Contact author: Emma Owers –

221 Sharpening Our Tools – Translating Research into Practice

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1Apunipima Cape York Health Council, Bungalow, QLD 4870, Australia

2Queensland University of Technology, Red Hill, QLD 4059, Australia

3Diabetes Queensland, Milton, QLD 4064, Australia

4Cape York Health and Hospital Service, Weipa, QLD 4874, Australia

Providing culturally appropriate health communication tools at a community level, whilst meeting funding objectives set by Government led initiatives, can be challenging. Literature states that a translational research framework fostering community communication can encourage the development of appropriate communication tools to facilitate transfer of health information between community and researchers. Reflections from initial Need for Feed cooking and nutrition education program trials in remote Indigenous communities across Cape York indicated program resources were neither meeting community nor researchers needs. In response, a translational research framework was modelled with collaborative partnerships formed between researchers and community with the aim of modifying current resources. Local working groups were established to facilitate communication and guide continual remodelling and retrial of resources for successive programs. Feedback from working groups indicated community members wanted resources with more pictures and less words. Partnership with Chronic Disease Resources Online (CDRO) led to the development of pictorial resources including 3 evaluation tools, 27 recipe sets and 10 education support materials. Between June to December 2012 resources were trialled across 4 Cape York communities with 69 school aged children and 4 community elders. Qualitative data has indicated high satisfaction with modified pictorial resources, proving pictorial resources to be an effective and culturally appropriate method to both communicate health messages to community and facilitate flow of evaluation data to researchers. A translational research framework fostering communication between community and researchers can potentially enhance the quality of health communication tools.

Funding source: Diabetes Queensland, Apunipima Cape York Health Council, Queensland Health and SARRAH

Contact author: Cara Polson –

192 Baby Steps – Planning an Evidence-Based Nutrition Service for Pregnant Women within Limited Resources

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1Department of Nutrition and Dietetics, Logan Hospital, QLD, Australia

2Department of Nutrition and Dietetics, Mater Mothers' Hospital, QLD, Australia

3Mater Medical Research Institute, QLD, Australia

There is a demonstrated link between maternal diet and maternal and infant health outcomes during and after pregnancy. With the 2012 introduction of a Dietetic maternity service (0.6 FTE for 3500 births) at our socially disadvantaged hospital, we needed to develop an effective and efficient service within resource limitations. This study assessed nutrition-related issues of our women to inform this process. We surveyed women in the postnatal ward regarding their nutrition-related knowledge, attitudes, behaviour, and nutrition-education preferences. We recorded demographic and anthropometric data. Descriptive, chi-squared and t-tests were used to compare cohorts within the groups. Three hundred and nine eligible women responded (28 ± 6 years, 27 ± 7 kg/m2 pre-pregnancy BMI, 12% gestational diabetes mellitus); this was representative of our hospital's maternity population. Almost half (42%) reported excessive gestational weight gain; this was higher in women with BMIs >30 kg/m2 (65%, p < 0.05), with median (range) of 6(1–26) kg. Only 33% of women achieved correct gestational weight gain. Nearly half of respondents (45% and 43%) were interested in receiving antenatal and postnatal nutrition education, respectively. Women had poor diet quality, despite identifying healthy eating as a personal priority. Nutrition topics of interest, delivery formats and times were identified. Priorities for service development include programs to support healthy eating and gestational weight gain. These will be, tailored to the unique needs of our women to improve their pregnancy outcomes and decrease long term chronic disease risk. We will also investigate maternity staff's nutrition knowledge and confidence in providing support to our hospital's women to inform staff training.

Contact author: Helen Porteous –

171 Food Insecurity Among the Australian Population – Differences in Determinants between Urban and Rural Areas

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Queensland University of Technology, Brisbane, QLD 4059, Australia

Food insecurity occurs when access to or availability of nutritious, safe and culturally-appropriate foods are limited, or when these foods cannot be accessed by socially-acceptable means. Food insecurity is associated with poor diet, obesity and chronic conditions, including diabetes and cardiovascular disease. The determinants of food insecurity, which include low income, lower education, age and household structure, have primarily been investigated in urban locations. Australia boasts an expansive, varying climate, ranging from dense inner-city locations to arid remote areas. The aforementioned factors that impact on food acquisition may vary between locations. No studies have investigated the differences in determinants of food insecurity between urban and rural locations in Australia. Data from 20,000 households in the 2004/05 National Health Survey were analysed using logistic regression to identify the sociodemographic, health and dietary factors associated with food insecurity, and the differences between urban and rural settings. Low household income was the strongest determinant of food insecurity; the strength of the association between low income and food insecurity was two-to-three times higher among rural households compared to their urban counterparts. Unemployment was also associated with food insecurity, with the association stronger among urban households compared to rural. Food insecurity was associated with decreased fruit and vegetable intakes among urban households only. These findings suggest that strategies to alleviate food insecurity may be more effective if tailored to a specific location, for example increased focus on addressing the financial barriers to food acquisition specifically in rural areas.

Contact author: Rebecca Ramsey –

153 The Nutritional Management of Anorexia Nervosa in Children and Adolescent Inpatients: The Current Practice of Australian Dietitians

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1University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia

2Dietitians Association of Australia, Canberra, ACT 2600, Australia

Nutritional rehabilitation in anorexia nervosa (AN) is one of the key steps in overall recovery. However, research on dietetic practice in the management of AN in children and adolescents inpatients is limited. This study aimed to describe the reported practices of Australian dietitians in the nutritional management of AN in this population. A cross-sectional survey was conducted in July-September 2012, using an eight-part questionnaire with single-, multi-, open-ended and Likert scale style questions. Seventeen dietitians from 15 facilities participated in the survey. The results showed that the recommendations for energy intake at the initiation of treatment varied and were dependent on physiological needs of the inpatient. On-going energy requirements were commonly based on individual needs, with interim weight measurements used to determine progress. High-energy supplements and nasogastric feeds were used as an adjunct to food to meet energy needs. The combination of prescribed vitamin and mineral supplements differed between facilities, however multivitamins, thiamin and phosphate were used more frequently than others. Most participants (94%) reported that the current evidence for the nutritional treatment of children and adolescent inpatients with AN was somewhat or insufficient to guide practice. The variation in nutritional management of inpatient children and adolescents with AN, suggested by the results of this study, is congruent with the lack of evidence in the literature. Evaluation of existing protocols and comparative multicenter investigations are needed to inform the development of evidence based guidelines and ensure best practice by dietitians and other practitioners working in this field.

Contact author: Tetyana Rocks –

159 Efficacy and Cost-Effectiveness of a Population-Based Lifestyle Intervention to Promote Healthy Weight and Physical Activity in Urban and Rural People with Cardiac Disease – a Randomised Controlled Trial

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1Murrumbidgee Local Health District, Wagga Wagga, NSW 2650, Australia

2Illawarra Shoalhaven Local Health District, Wollongong, NSW 2500, Australia

3University of Sydney, Camperdown, NSW, 2050, Australia

4University of Technology, Sydney, NSW 2000, Australia

5Heart Foundation NSW Division, Kiama, NSW 2533, Australia

Only one-third of clinically eligible patients attend cardiac rehabilitation (CR), leaving the majority with unmet health needs. Non-attendees are likely to be disadvantaged, have higher cardiovascular risk and live further from health services. Many CR attendees do not achieve their weight or physical activity targets. Innovative models of secondary prevention for cardiac disease are needed to address these gaps. This study examined the efficacy and cost-effectiveness of a pedometer-based telephone coaching intervention to promote healthy weight and physical activity in cardiac patients. Rural and urban patients (n = 313) referred to CR were randomised to a healthy weight (HW) (four telephone coaching sessions on weight and physical activity) or a physical activity (PA) intervention (two telephone coaching sessions on physical activity). Self-reported weight and physical activity were assessed at baseline, short-term (6–8 weeks) and medium-term (6–8 months). A cost-utility analysis was conducted alongside the trial. Medium-term the HW group decreased their weight (p = 0.005) and HW participants with a BMI ≥25 kg/m2 had a mean weight loss of 1.6 kg (p = 0.015), compared to the PA group. Short-term, both groups increased their physical activity time and the PA group maintained this increase longer-term. The cost-utility analysis showed the HW intervention dominated the PA intervention. The average cost was $201 and $138 per HW and PA participant respectively. Low-contact, low-cost, telephone-based interventions are a feasible means of delivering lifestyle interventions for underserved rural communities, for CR non-attendees, or as an adjunct to CR.

Funding source: NSW Health Promotion Demonstration Grant. Janice was supported by a Unilever-DAA Post-graduate research scholarship

Contact author: Janice Sangster –

193 Towards a Methodology: A Survey of Australian Child-Oriented Food Products to Monitor Reformulation from 2009 to 2011

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1Flinders University, Adelaide, SA 5000, Australia

2Heart Foundation South Australia, Adelaide, SA 5000, Australia

Reformulating commonly eaten food products is an emerging strategy to improve the food supply and address rising obesity and chronic disease rates. This study monitored reformulation of Australian child-oriented food products (products marketed specifically to children) between 2009–2011.All child-oriented food products in a large supermarket were identified in 2009 and followed-up in 2011. Nutrient content data were collected at baseline and follow-up. Absolute and percentage change in energy, total fat, saturated fat, sugars, sodium and fibre was calculated. Two methods were used to assess the extent of reformulation: percentage change in single nutrients was assessed over time, and nutrient criteria were used to assess changes in overall healthiness of products over time. Of 120 products, 33% remained unchanged in nutrient composition from 2009–2011 and 67% underwent change. The proportions of positively and neagtively reformulated products were similar for most nutrients surveyed, excluding sodium. Eighteen products (15%) were simultaneously positively and negatively reformulated for different nutrients. Using percentage change in nutrient content to assess reformulation, nearly half (n = 53) of all products were at least moderately reformulated and one third (n = 42) were substantially reformulated. The nutrient criteria method revealed 5 products (6%) were positively reformulated and none that had undergone negative reformulation. Positive and negative reformulation was observed to a similar extent among Australian child-oriented food products between 2009–2011, indicating little overall improvement in healthiness of child-oriented foods. This study highlights the need for comprehensive, targeted and standardised reformulation benchmarks to assess the extent of reformulation occurring in the food supply.

Contact author: Stephanie Savio –

162 Addressing Food and Nutrition Insecurity Through Enhanced Collaborations between Emergency Food Relief Providers

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Queensland University of Technology, Brisbane, QLD 4059, Australia

Food insecurity occurs when access to or availability of nutritious, safe and culturally-appropriate foods is compromised, or when such foods are unable to be accessed by socially-acceptable means. Food insecurity is associated with poor diet, obesity and chronic diseases such as diabetes and cardiovascular disease. The prevalence of food insecurity is estimated to be 6% among the Australian population, however this is increased among vulnerable population subgroups. The predominant strategy to alleviate food insecurity is emergency food relief (EFR), however EFR does not align with the definition of food security or the concept of human dignity. This research investigated potential strategies for the improvement of current EFR services to address food insecurity while maximising human dignity. Data was collected via semi-structured interviews from 29 staff members of Brisbane providers of EFR and analysed using thematic analysis. A majority of service providers identified that the demand for EFR continues to increase, particularly among low-income earners and those with a mental illness of disability. Strengthened collaborations between EFR organisations were identified as having the potential to improve service coordination and allow for the pooling of resources to enhance the nutritional adequacy of food parcels. Nutrition education and budgeting assistance combined with community co-ops or discount supermarkets were identified as strategies to improve food acquisition, create supportive environments and encourage self-sufficiency.

Contact author: Brooke Searle –

230 Scaling Up Efforts to Address Malnutrition in Humanitarian Emergencies and Disasters

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James Cook University, Townsville, QLD, Australia

Protecting the nutritional status of vulnerable groups affected by emergencies and complex disasters is a humanitarian right. A 2005 review, commissioned by the Inter-agency Standing Committee (IASC), identified that a lack of capacity in the humanitarian sector affected the quality and suitability of a humanitarian response and a humanitarian reform was introduced.

One initiative under the reform included the development of the cluster approach which consists of sectoral clusters which aim to strengthen coordination, response capacity, accountability and partnerships in a humanitarian response at a global and country level. In 2007, an in-depth nutrition in emergencies review, commissioned by the IASC Global Nutrition Cluster, identified two key nutrition in emergency (NiE) capacity gaps firstly, inadequate ‘resident’ capacity and secondly, a lack of nutritionists able to work within the complexities of emergencies. These findings led to renewed efforts by UN agencies to ensure that nutrition is brought to a higher platform, both at a global and country level.

In 2010, RedR Australia supported these efforts through the deployment of emergency nutrition specialists to UN agencies. RedR Australia is a not-for-profit organisation which selects, trains, deploys and supports specialists deployed to humanitarian relief operations.

RedR Australia works with countries at the request of UN Agencies, often for an intensive period of one to six months. As part of RedR Australia's ongoing support to humanitarian operations worldwide, RedR is recruiting nutritionists with experience in emergencies to deploy to UN agencies, where requested.

Contact author: Briony Stevens –

197 An Evaluation of Behaviour, Attitude, Knowledge and Barriers Towards a Nutrition Therapy Protocol in an Intensive Care Unit

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1Flinders University, Bedford Park, SA 5042, Australia

2Department of Nutrition and Dietetics, Royal Adelaide Hospital, Adelaide, SA 5000, Australia

3Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia

Critically ill patients are at high risk of malnutrition. Although the enteral route is considered superior to parenteral, enteral nutrition (EN) is commonly interrupted for many reasons including fasting prior to surgery. When patients are underfed they are at risk of suboptimal nutritional and clinical outcomes. Evidence-based feeding protocols have been shown to help change practice and promote the use of EN in the Intensive Care Unit (ICU). The aim of this study was to explore in hospital staff the knowledge, attitude, practice and barriers towards use of a nutrition therapy protocol. Over a two week period a two-page written survey was distributed to ICU nurses, registered medical officers, trainee intensivists, intensivists and anaesthetists. Ninety five out of 406 surveys were completed. Most staff (>70%) excluding anaesthetists, thought an intensivist makes the final decision on fasting a patient for theatre. Professionals working directly with the protocol (i.e. ICU nurses and intensivists) understood more details of the protocol. Inconsistent protocol practice and lack of awareness of the protocol was the foremost barrier to protocol adherence. A majority of anaesthetists (73%) stated to be unaware of the protocol. Education was a key suggestion to improve use of the protocol. Patients continue to be fasted unnecessarily. This is potentially due to the discrepancy between nutrition knowledge and practice of staff. It is important for all relevant staff to be engaged in the development and review of protocols. Ongoing education and auditing may improve protocol adherence and reduce avoidable fasting.

Contact author: Lauren Stribley –

130 Inspiring Change to a Healthy Eating Culture in Disadvantaged Children and their Families – the Challenges

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Foodbank WA, Perth, WA 6106, Australia

The Department of Health and Ageing identifies healthy eating as a national priority, which results in improving nutrition-related health outcomes of vulnerable populations. Being a disadvantaged child further compounds the complex web of social, economic and environmental challenges which influence eating choices. Promoting healthy eating whilst bearing in mind these challenges is crucial in impacting nutrition attitudes, knowledge, skills and behaviours. Showing compassion and care to disadvantaged children whilst focussing on small, realistic and sustainable changes makes this task easier. The Public Health Nutritionists who run Foodbank of Western Australia's Food Sensations® nutrition and cooking program in disadvantaged schools employ these characteristics during every hands-on session. In 2012, a total of 4088 primary and high school students across eight regions of Western Australia participated in a Food Sensations® session. The students were provided with a safe and supportive environment to explore healthy eating via fun, interactive activities followed by hands-on cooking stations where each student contributed to the preparation of simple and healthy recipes. The sense of enjoyment, pride and inclusion was consistently evident as the children sat down together with the healthy feast they prepared; and it was often the most disruptive or disengaged student who contributed and excelled the most. Despite the seemingly endless uphill battle that is nutrition promotion, health professionals must band together to promote a healthy eating culture that impacts families and the wider food environment as well as the individual.

Contact author: Louise Thorne –

224 Effectiveness of Dietitians in Weight Management: The MDP-O Study ‘Building an Evidence-Base from Practice’

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Monash Centre for the Study of Ethics in Medicine and Society, Melbourne, VIC 3001, Australia

As a profession specifically trained in the relationship between food and disease, it is reasonable to expect dietitians can contribute to turning around Australia's ‘obesity epidemic’. A challenge for dietitians is the expectation their service will achieve health benchmarks outlined in the Australian Dietary Guidelines (eg reduce weight to within healthy range). The expectation exists despite the scientific evidence that few or no interventions achieve such health targets. In order to quantify this gap between expected and actual achievements, data collected and reported from dietetic services would make a considerable contribution to a ‘new’ body of evidence: practice-generated evidence. The problem is, little is known about the way weight management services by dietitians are delivered, including data-collection and reporting practices used to make clinical decisions. At minimum, in the absence of data, dietitians will be unable to report the effectiveness of their service, in a sector where resources are scarce. This research set out to investigate the effectiveness of weight management services by dietitians in the Australian community. The aim is to develop a low-cost data-collection tool for dietitians to use as part of every day practice, able to report service effectiveness. This presentation will focus on how far or how close current practice is to what dietitians would need to record to report efficiency and effectiveness of weight management services.

Funding source: Melanie is supported by an NHMRC PhD Scholarship 2010–2013

Contact author: Melanie Voevodin –

158 Food Service Trends in New South Wales (NSW) Hospitals, 2002–2012

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1School of Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia

2Royal North Shore Hospital, St Leonards, NSW 2065, Australia

A survey of NSW Food Service Departments (FSDs) was last completed by Mibey & Wiliams and published as ‘Food Service Trends in NSW hospitals, 1993–2001’ in 2002. Since 2001, there have been significant changes across hospital food services, however there is a paucity of published literature on the topic. This study aimed to report current food service trends in NSW public and private hospitals and to compare and contrast the findings to the previous survey. A total of 67 Food Service Managers (FSM) from NSW public and private hospitals (26% of total NSW hospitals) completed an online survey (based on the Mibey & Williams 2001 survey) regarding food service operations. Additional questions related to patient satisfaction, key performance indicators (KPIs) and menu selections were added. Results were then compared to previous survey findings. ‘Cook-fresh’ (51.2%) and an insulating cover and base (27.6%) were the most common food production and delivery systems. Patient satisfaction surveys were used in 85% of hospitals. There was a significant difference (p = 0.002) between the public and private hospital use of electronic and paper menus, and between FSM qualifications (p = 0.005) in 2001 and 2012, with 7.5% reporting no qualifications in 2012 compared to 25% in 2001. KPI usage had a 49% non-response, but named indicators included food and labour costs. The 2012 results suggest only minor changes since 2001, however this may also be attributed to the small survey sample. Consequently, further follow-up with larger NSW hospitals (>250 beds) is recommended.

Funding source: University of Wollongong

Contact author: Victoria Walker –

177 Secondbite's Food Angels Program – Transforming Australians from Food Insecurity to Food Independence

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1SecondBite, Kensington, VIC 3031, Australia

2Monash University, Notting Hill, VIC 3168, Australia

This case study presents SecondBite's Food Angels program as one which strives to develop ‘food independence’ amongst Australia's most vulnerable food insecure individuals. Food independence is a novel concept within the sector and refers to the confidence, motivation and skills required for an individual to source, prepare, enjoy and store the variety of healthy foods required for physical and mental well-being. Food Angels is much more than the eight-week educational program. It is designed to truly enable behaviour change, promote community inclusion and break the cycle of emergency food relief dependency. Food Angels is delivered via a host agency and is integrated into existing case-management services. The program involves the delivery of fresh nutritious food hampers together with nutrition, shopping and cooking skill development for families and individuals in crisis. To date, Food Angels has been piloted in 3 organisations across Victoria and Tasmania, with a total of 29 families and homeless youth. Preliminary process and formative evaluation data from participants and case workers, suggests that the program has successfully inspired post-program healthy cooking practices, created social connections and increased knowledge around healthy eating, food budgeting, label reading and food safety. Further evaluation is required to measure the programs' long-term impact, however, these initial results present evidence that SecondBite's Food Angels program has great potential to develop the food independence of people in need throughout metropolitan, rural and remote areas of Australia.

Contact author: Liza Wallis –

189 Graduate Destinations: Where Do Our Graduates Go and How Can We Improve their Journey?

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University of Wollongong, Wollongong, NSW 2522, Australia

New graduates need to be equipped with a broad range of knowledge and skills that enhance their opportunities for employment, enable them to practice safely and communicate well. This study aimed to determine the career and study paths that new graduates from the University of Wollongong (UOW) take once they have complete their qualifications in either nutrition, dietetics, exercise science or exercise rehabilitation and to establish how prepared that they and their employers felt they were for this. Three online surveys (December 2012 graduates, 2007–July 2012 graduates and employers) were conducted via Survey Monkey® in late 2012 that asked about work and study experiences post graduation, strengths and weaknesses of programs, ideas for further curriculum development and their experiences of employing UOW graduates. Twenty-three responses were received from the December graduating students, 96 from earlier graduates and 23 from employers. Perceived strengths of the programs included available support, the staff, small interactive sessions and the placement and practical experiences. Areas for review included the timing of some final year subjects, the lack of placement in earlier years and the lesser focus on private practice, as well as research careers when compared to other practice areas. The employer comments were positive regarding the programs and graduates. Common areas for further consideration included private practice, coaching and placement timeframes. Further study areas included PhD and Research Masters, as well as business studies and OHS. The graduate survey will be conducted annually with the findings enhancing curriculum development and the student learning experience.

Funding source: A Faculty Scholar Grant from the University of Wollongong

Contact author: Karen Walton –

194 Evaluating the Nutritional Content of Flagstaff Fine Foods Against the Current Meals-On-Wheels Nutrition Guidelines and Recommended Dietary Intakes

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University of Wollongong, Wollongong, NSW 2522, Australia

Flagstaff Fine Foods (FFF) is a not for profit organisation that is a major supplier of meals to Meals-on-Wheels (MOW), a service designed to improve the health of vulnerable people in the community. The aim of this study was to evaluate the nutritional composition of the FFF meals against recommendations. A secondary aim was to highlight which meals would be suitable vehicles for food fortification. The project was initiated by FFF as they were keen to review their meals, especially their mini meals (200 g portions, designed to meet the needs of older people with poor appetites) and blended (pureed) meal ranges, with the view to further fortify to increase nutritional content as recommended. Nutrient analyses provided by FFF were collated and menu items grouped into hypothetical meal options, which included soup, main (standard, mini or blended) and dessert. Percentage contributions of each hypothetical meal were compared to the RDI (70+ yearrs) for energy and protein and to the existing MOW recommendations: 1/3 of the daily energy and 1/2 of the daily protein requirements. The average energy composition of the hypothetical meals was 33–41%, 26–32% and 29–36% for standard, mini and blended meals, respectively. Contributions of the hypothetical meal to protein requirements were 41–58%, 28–40% and 39–55% for standard, mini, blended meal, respectively. Not all meals options provided by FFF provided adequate energy and protein for older adults. Fortification of certain menu items is planned to improve the nutritional values of the meals provided, particularly the mini meals.

Funding source: A University of Wollongong Community Engagement Grant

Contact author: Karen Walton –

120 Evaluating Community Food Security Interventions Using most Significant Change Technique

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1Population Health, Department of Health and Human Services, Launceston, TAS 7250, Australia

2School of Health and Life Sciences, University of Tasmania, Launceston, TAS 7250, Australia

3Community Dietetic Placement, Griffith University, Nathan, QLD 4111, Australia

The determinants of community food security are broad and thus the programs designed to address them are required to be multi-facetted increasing the complexity of being able to measure the outputs and outcomes. The Most Significant Change Technique (MSC) is a community development narrative evaluation method designed to capture both the intended and unintended impact of a community intervention at the beginning, middle and end of the project period. Between 2010 and 2013, MSC was used to measure the results of a community driven food security intervention; a project designed to increase the accessibility and affordability of fresh produce whilst building community capacity, in a low socio-economic urban fringe community of Northern Tasmania. Input into the evaluation design and the systematic analysis of the narrative by project committee during the intervention has helped shaped the project trajectory and outputs whilst building community capacity. The resulting broad rich narrative is a powerful advocacy tool for further investment. The learning's from using this technique for the first time in a community food security intervention provide a platform from which to further develop the MSC for use in evaluating food security interventions.

Contact author: Alison Ward –

104 Can We Do Better? Observational Study of Nutritional Status and Elderly Hip Fracture Patients at John Hunter Hospital in 2011

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1John Hunter Hospital Nutrition and Dietetics Department, Newcastle, NSW, Australia

2John Hunter Hospital Trauma Department, Newcastle, NSW, Australia

Nutrition status is a major determinant of post-injury outcomes in hip fracture patients.

The aim was to describe the pre-injury nutritional status of elderly low energy hip fracture patients admitted to John Hunter Hospital and track changes in nutritional status during hospitalisation. A prospective observational study of patients aged over 65 years admitted to John Hunter Hospital with a low energy hip fracture. Nutritional assessment at admission and weekly, thereafter, until discharge or death using Patient-Generated Subjective Global Assessment (PG-SGA). Outcomes measures included: global nutritional score, hospital length of stay, body weight and discharge destination. One hundred and twenty-seven participants were recruited. The average length of stay was 20.0 + 12.6 days and the average age was 85.0 + 6.4 years. Twenty-four per cent of participants died and more than 60% were discharged to private or public rehabilitation. Nutritional status deteriorated significantly during admission with 45% of 125 patients well-nourished on admission whilst only 26% of 82 patients remained so at discharge. Although the majority of participants had poor nutritional status on admission less than 20% were seen by a dietitian.

Contact author: Cheryl Watterson –

147 Feasibility of a Telephone-Based Weight Loss Program Delivered in a Hospital Outpatient Setting

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1Cancer Prevention Research Centre, The University of Queensland, Brisbane, QLD 4006, Australia

2Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia

3The Mater Medical Research Institute, Brisbane, QLD 4101, Australia

Engaging patients with a face-to-face, group-based healthy eating and lifestyle program (HELP) is a clinical challenge for tertiary hospital outpatient clinics. This study evaluated the feasibility and effectiveness of a telephone-delivered program (iHELP) as an alternative option. Patients who declined the 2-month HELP program (consists of 8 weekly sessions) were offered the iHELP alternative (16 phone calls over 6 months targeting physical activity, healthy eating and weight loss). Weight (kg), physical activity (accelerometry min/day) and self-reported serves of fruit and vegetables were measured at baseline, 2 months, and 6 months. Changes within the iHELP group were analysed by paired t-tests. Relative differences in weight change between HELP and iHELP at 2 months were compared by linear regression models, adjusting for baseline values. Thirty-six patients (10% of referrals) commenced the HELP group (56% female, 58 ± 14 years, 19% employed), with 53% completion at 2 months. Sixty-one patients (24% of eligible) commenced iHELP (46% female; 49 ± 12 years, 66% employed), with 64% retention at 2 months and 48% completion at 6 months. Preliminary 6-month results from iHELP completers show significant weight loss (−4.8 ± 5.1%, p < 0.05) and improvements in vegetable serves but not physical activity. Relative to HELP, iHELP was associated with greater weight loss (mean [95%CI]: −1.8 [−3.5, −0.1]; p = 0.037) at 2 months. Telephone-delivered weight management services can be more effective than usual care, and reach a greater number and broader demographic of patients referred within an acute care hospital setting. Exploring alternative and broader-reaching service delivery models is important for the significant proportion of patients who remain unengaged with these services.

Funding source: Queensland Health – Health Practitioner Grant.

Contact author: Megan Whelan –

103 Trial for Reducing Weight Retention in New Mums (TRIM): A Pilot Randomised Controlled Trial Investigating the Effectiveness of an Innovative, Low Intensity, Postpartum Weight Management Program

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1Department of Nutrition and Dietetics, Mater Mothers' Hospital, QLD, Australia

2Mater Medical Research Institute, QLD, Australia

3Department of Obstetric Medicine, Mater Mothers' Hospital, QLD, Australia

4School of Medicine, University of Queensland, QLD, Australia

Excessive gestational weight gain and failure to return to pregnancy weight by six months postpartum are associated with long-term obesity. Many women struggle to regulate gestational weight gain, particularly if overweight or obese. Limited literature exists on the most effective approach for weight management postpartum. Our research evaluated a postpartum weight management program that combined behaviour change principles, a low-intensity format, with nutrition information for women with a BMI >25 kg/m2.

Program effectiveness was evaluated using a stratified RCT. At 36 weeks gestation, control women (n = 35) received a nutrition resource and intervention women (n = 36) received a nutrition assessment and goal-setting session regarding nutrition post-pregnancy, plus a six month correspondence intervention. Weight, diet quality, physical activity levels, breastfeeding rates, and fasting glucose and insulin were assessed at 6 weeks and 6 months postpartum. Two-thirds of the intervention and half the control women completed the study. No significant differences were observed between any outcomes, potentially due to small sample size. Median weight change was −1.1 kg (6 weeks to 6 months), and 1.0 kg (pre-pregnancy to 6 months). Intervention women breastfed for half a month longer than control women (180 days versus 164 days, p = 0.09). An average of 2.3/6 activity sheets/participant were returned.

Despite low intervention engagement and difficulties in recruitment, the high retention rate suggests this remains an area of interest to women. Future strategies must recognise unique postnatal needs to facilitate women's engagement, be individually tailored, and include features that support behaviour change to decrease women's risk of chronic health issues.

Funding source: funding grant from the Golden Casket Foundation, Mater Health Services

Contact author: Shelley Wilkinson –

207 Can a Relatively Low Intensity, Motivational Interviewing Based Intervention Prevent Weight Gain in Mid-Age Women? Outcomes of the 40-Something Rct

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1University of Canberra, Bruce, ACT 2617, Australia

2Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia

The life stage of menopause has been identified as a high risk time for weight gain yet there are few obesity prevention interventions for this target group. The 40-Something Study was designed to test whether a 12-month intervention by primary healthcare practitioners using motivational interviewing (MI) can prevent weight gain at this life stage. An RCT design (ACTRN12611000064909) was used to compare a structured intervention (SI) (four Dietitian consultations and one Exercise Physiologist consultation) to a self-directed intervention (SDI) (provision of written information). Anthropometric, biochemical and health behaviour data were collected at baseline on 54 non-obese (BMI 18.5–29.9 kg/m2)), premenopausal women 44–50 years who were then randomly allocated to the SI (n = 28) or SDI (n = 26) group. Forty women (22 SD and 18 SDI) completed all intervention components and were reassessed at 12 months. The primary outcome of weight at 12 months was assessed using analysis of covariance with baseline weight as the covariate, and intervention group as the fixed factor. The SI group significantly decreased weight (from 68.7 (8.9) kg to 63.2 (7.7) kg, p < 0.001), compared with the SDI group who had a non significant change (from 68.6 (6.7) kg to 66.6 (5.6) kg. The model was significant for intervention group (p = 0.017). The RCT demonstrated the efficacy of this low intensity intervention utilising MI in achieving weight gain prevention. The next stage will be to assess whether the improvements are maintained over a further 12 month period.

Funding source: received from the University of Newcastle. C Collins is supported by an NHMRC Career Development Fellowship.

Contact author: Lauren Williams –

138 Development of a Field Method for the Identification of Sarcopenia in Older Adults

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Flinders University, Adelaide, SA 5001, Australia

Increasing numbers of older adults may lead to increased prevalence of sarcopenia with associated increases in health care costs and dependency, however diagnosis is challenging. This study aimed to develop, and validate, a field method to identify sarcopenia in older adults, based on recently published diagnostic criteria. A secondary analysis was conducted on data from the Australian Longitudinal Study of Ageing. The reference algorithm indicates sarcopenia when gait speed ≤0.8 m/s plus low muscle mass (skeletal muscle index (SMI) from dual-energy x-ray absorptiometry: ♂ < 7.26 kg/m2; ♀ < 5.5 kg/m2) or gait speed >0.8 m/s plus low grip strength (♂ <30 kg; ♀ <20 kg) plus low muscle mass. In the field method SMI was replaced by mid upper-arm circumference (MUAC) (<25th percentile: ♂ <26.9 cm; ♀ <26.5 cm). Relative validity of the bedside method was assessed from sensitivity and specificity, and positive and negative predictive values, when compared with the reference technique. Complete case analysis was conducted on 98 participants (38 M; 60 F) with mean (SD) age 87 (3.2) years. The bedside method had sensitivity of 73%, specificity 71%, positive predictive value 48% and negative predictive value 88%.The literature indicates that nutrition screening tools with sensitivity and specificity ≥70% are acceptable for clinical use. This field method demonstrated validity consistent with the evidence. This is the first study to report on the validity of a field method for the identification of sarcopenia in the oldest-old, using data from a large well-conducted prospective cohort study. Recommendations for future research include establishment of the reliability and predictive validity of this field method.

Contact author: Alison Yaxley –