Nutritional assessment and dietary intervention, particularly enteral nutrition, are important in the management of Crohn's disease (CD). National audits have reported that dietetic resourcing in gastroenterology is inadequate. The present study aimed to identify current practice in the nutritional assessment and dietary management of enteral nutrition in CD, as well as investigate the factors that influenced it.

A nationwide questionnaire survey adopting complete population sampling of all 296 UK acute hospitals was undertaken aiming to determine dietetic resourcing for gastroenterology. In addition, the case-note review method was used to investigate approaches to nutritional assessment and dietary management of enteral nutrition as treatment for active CD.

Data were returned from 149 (56%) hospitals, providing assessment and management information on 190 patients. The median number of dietetic sessions dedicated to gastroenterology was 2 per week (interquartile range 4). Hospitals with five or more sessions per week dedicated to gastroenterology used a greater number of components in their nutritional assessment [mean (SD) 21.5 ( 5.0)] than those with fewer sessions [mean (SD) 19.6 (SD) 6.1, P = 0.05]. Enteral nutrition was perceived to be effective in 100 (55%) of 182 patients. The major reasons for limited success were poor compliance and inadequate volumes consumed, as well as insufficient treatment duration.

The components included in a nutritional assessment of CD patients are significantly lower in hospitals with fewer dietetic gastroenterology sessions. Focus on improving compliance and duration of enteral nutrition is urgently required to maximise the success of enteral nutrition in the treatment of CD.

Standards for anthropometrical assessment define that measurements must be carried out with the subject in the standing position, although this is not always possible. The effect of body position on girth measurement has not been evaluated, even though this issue is clinically relevant because it may bias nutritional assessment results. The present study aimed to evaluate the effect of body position and symmetry on girth measurement.

A cross-sectional study was conducted on 102 older adults aged ≥65 years from care homes and tertiary hospitals. Right and left arm, waist, hip mid-thigh and calf girths were obtained with the subject standing or in the supine position. Mini-Nutritional Assessment Short-Form (MNA-SF) score and reference data percentiles (NHANES IV) misclassification according to girths assessed in the supine position was evaluated.

A high intraclass correlation coefficient (ICC > 0.97) and quartiles agreement (k > 0.89) were found between girth measurements conducted on participants in the standing and supine positions. According to MNA-SF, 23.5% of the participants were undernourished and 51% were at risk of undernutrition. A high agreement between MNA-SF score using calf circumference measured on standing or supine position was found (k = 0.96). A relevant agreement for NHANES IV girth percentiles by sex and age was also found (ICC > 0.89).

Agreement between girth measurements on standing and supine positions among older adults is high and differences do not have any clinically relevant impact on MNA–SF classification and reference data percentiles.

Weight management interventions can be extended using mobile telephone technology to deliver support in real-time, real-world settings. The present study aimed to determine whether text messaging helped patients maintain or lose weight following a weight-loss programme.

In this controlled study, overweight and obese [body mass index (BMI) >30 kg m^–2 or >28 kg m^–2 with co-morbidities] adults who completed a weight-loss programme participated in an additional 12-week text message intervention [Lifestyle, Eating and Activity Programme (LEAP) Beep]. Patients were allocated goals for steps, fruit, vegetable and breakfast consumption. Patients regularly ‘texted’ their progress and received tailored practitioner feedback. Pre/post-intervention body weight, waist circumference (WC), BMI, quality of life (QOL), anxiety and depression measurements were compared retrospectively with a control group offered weight checks only.

Compared to control (n = 17), the intervention group's (n = 17) body weight, WC and BMI reduced significantly (−1.6 versus 0.7 kg, P = 0.006; −2.2 versus 1.5 cm, P = 0.0005; −0.6 versus 0.7 kg m^–2, P = 0.03, respectively). QOL and depression scores also improved (−6.8 versus 1 point, P = 0.134; −0.2 versus 0.2 points, P = 0.228). No difference was observed in anxiety scores between the groups. Intervention versus control group follow-up attendance improved significantly (4.4 versus 1.7 attendances, P = 0.0005).

LEAP Beep promoted losses in weight, WC and BMI, and improved QOL parameters and follow-up attendance. Text messaging is a cheap, portable, convenient and innovative medium facilitating goal setting, self-monitoring and information exchange. Further improvements to automation at the same time as maintaining individual support are necessary to ease practitioner burden. Text messaging offers cost-efficient dietetic input, opening up possibilities for practitioner-to-patient support and yields positive weight outcomes following initial weight loss.

To determine the association between fatty acid intake and the prevalence of risk factors for the metabolic syndrome.

In this population-based cross-sectional study, a sample of 2750 Tehranian subjects (44% men and 56% women) aged 20–74 years, who completed a validated food frequency questionnaire, was studied. The metabolic syndrome (MetS) was defined in accordance with the modified guidelines of the National Cholesterol Education Program Adults Treatment Panel III, and waist circumference was coded according to the newly-introduced cut-off points for Iranian adults (≥95 cm for both sexes). Metabolic risk factors across quartile categories of each type of dietary fat [total fat intake, total poly-unsaturated fatty acid (PUFA) intake, total MUFA intake, total saturated fatty acid (SFA) intake expressed as percentage of energy and quartiles of the ratio of polyunsaturated fat to saturated fat (P : S)] were compared.

The mean (SD) ages of participants were 40.8 (14.6) and 38.6 (12.9) years, respectively, for men and women. The mean contribution of fat to energy intake was approximately 26% in men and women. A positive trend over successive quartiles of SFA intake with low-density lipoprotein-cholesterol (LDL-C) and triglyceride, as well as P/S ratio intake with high-density lipoprotein-cholesterol (HDL-C), was found.

An inverse association between HDL-C with SFA and PUFA intake and a positive association with MUFA and the P/S ratio was found. A significant association of fatty acid consumption and risk of the MetS in this population was observed, except for total PUFA intake.

Special dietary fatty acids are associated with metabolic risk factors among the Iranian population. Because of the high prevalence of cardiovascular disease and MetS, national nutrition policies must be developed accordingly for the modification of dietary fatty acid intake with respect to causation and prevention.

Existing nutritional guidelines suggest that protein requirements of adults with stage five chronic kidney disease undergoing haemodialysis (HD) or peritoneal dialysis (PD) are increased as a result of protein losses during dialysis. The present review aimed to update previous guidance and develop evidence-based practice guidelines on the protein requirements of adults undergoing maintenance dialysis.

Following a PICO approach (Participants or Population, Intervention or Exposure, Comparison and Outcome), four research questions were formulated to investigate the total protein requirement and protein quality required by adults undergoing HD and PD. A comprehensive, systematic review was undertaken using the databases Medline, EMBASE and the Cochrane Library from 2005 to September 2009 for HD studies and from 1997 to September 2009 for PD studies.

The literature search yielded 2931 studies, which were assessed for inclusion. Following appraisal, 19 studies in HD and 18 studies in PD met the inclusion criteria and were systematically reviewed. Limited good quality evidence supports the recommendations that: (i) adults undergoing maintenance HD require a minimum protein intake of 1.1 g kg⁻¹ ideal body weight (IBW) per day; and (ii) adults undergoing maintenance PD require a minimum protein intake of 1.0–1.2 kg⁻¹ IBW per day, in conjunction with an adequate energy intake. There were no studies that addressed the quality of protein for either HD or PD.

Evidence suggests that nutritional status may be maintained with lower protein intakes than previously recommended. However, the evidence base is limited and further randomised controlled trials are required to establish the optimal protein intake for dialysis patients.

Food habits, nutrient needs and intakes differ between males and females, although few nutritional studies on patients with coeliac disease (CD) have reported results stratified by gender.

To compare energy and nutrient intakes among 13-year olds diagnosed with CD in early childhood with those of a non-coeliac (NC) age- and gender-matched control group, and also with estimated average requirements (EAR).

A case–control study was conducted in Sweden 2006–2007 within the coeliac screening study ETICS (Exploring The Iceberg of Coeliacs in Sweden). Dietary intake was assessed among 37 adolescents (23 girls) diagnosed with CD at median age 1.7 years (CD group) and 805 (430 girls) NC controls (NC group) using a food-frequency questionnaire covering 4 weeks. Reported energy intake was validated by comparison with the calculated physical activity level (PAL).

Regardless of CD status, most adolescents reported an intake above EAR for most nutrients. However, both groups had a low intake of vitamin C, with 13% in the CD-group and 25% in the NC-group below EAR, and 21% of boys in the CD-group below EAR for thiamine. The intake of fatty acids was unbalanced, with a high intake of saturated and a low intake of unsaturated fats. Girls and boys in the CD-group had an overall lower nutrient density in reported food intake compared to girls and boys in the NC-group.

Nutrient intake of adolescent girls and boys with CD was mostly comparable to intakes of NC controls. Dietitians should take the opportunity to reinforce a generally healthy diet when providing information about the gluten-free diet.

Rates of overweight and obesity are now considered to be epidemic. Few studies have examined the spatial distribution of overweight and obesity at the community level, an area of geography recommended for prevention and intervention. Therefore, the present study aimed to examine the spatial variation of overweight and obesity using community geographic boundaries.

A cross-sectional secondary spatial data analysis was conducted using three combined cycles of Canadian Community Health Survey data for the province of Nova Scotia with community level boundaries. Descriptive rates were calculated using standardised incidence ratio values and spatial analysis was carried out using Global and Local Moran's I and the GetisOrdGi* statistic for cluster identification.

Maps illustrating local cluster analysis showed a significant degree of similarity between neighbouring communities in urban areas more so than rural communities. Hot spot analysis maps showed communities clustering together in the urban centre tended to have lower incidence of overweight and obesity (‘cool spots’), whereas clustered communities in a more rural area had a higher incidence of overweight and obesity (‘hot spots).

The present study showed that there was geographical variation in overweight and obesity between urban and rural communities, and also there was a tendency for communities to cluster based on the incidence of overweight and obesity. This highlights the importance of understanding community level obesity rates and associated behavioural determinants, such as diet and physical activity, as well as the role that urbanisation or rurality may play in intervention initiatives for these behavioural determinants. Specifically, public health nutrition efforts for community level food environments in rural areas should ensure an individualised approach is used, whereas urban areas may be amenable to more general approaches aiming to support healthy weight status among the broader population.

The assessment of nutritional status among paediatric patients is important for the planning and execution of nutritional strategies that strive to optimise the quality of life and growth among sick children. The present study aimed to evaluate the nutritional status and dietary intake among children with acute leukaemia.

This cross-sectional study included 53 paediatric patients aged 3–12 years old, who were diagnosed with either acute lymphoblastic leukaemia or acute myelogenous leukaemia and were undergoing chemotherapy treatments (induction or consolidation phase). Patients were matched for sex, age (±6 months) and ethnicity with healthy children as controls. Weight, height, body mass index, waist circumference, mid-upper arm circumference, triceps skinfold thickness, mid-upper arm muscle area and fat area were determined. Dietary intake was assessed using 3-day food records.

Anthropometric variables were generally higher among patients compared to controls, although the differences were not statistically significant (P > 0.05). The prevalence of overnutrition among patients according to body mass index-for-age, waist circumference-for-age, mid-upper arm circumference-for-age and triceps skinfold-for-age were 24.5%, 29.1%, 17.0% and 30.2%, respectively. Mean energy [5732 ± 1958 kJ (1370 ± 468 kcal) versus 6945 ± 1970 kJ (1660 ± 471 kcal), P < 0.01], protein (50.0 ± 19.7 g versus 62.3 ± 22.3 g, P < 0.01) and fat (43.6 ± 18.9 g versus 58.3 ± 16.7, P < 0.001) intakes of patients were significantly lower than controls.

The prevalence of being overweight and obesity in children with acute leukaemia was higher despite lower energy intake compared to controls. Studies assessing physical activity, the complex interaction and the effects of treatment drugs are warranted to better manage malnutrition among paediatric patients.

In the context of a rapidly increasing prevalence of noncommunicable diseases, fruit and vegetables could play a key preventive role. To date, there is no rapid assessment tool available for measuring the fruit and vegetable intakes of North-African women. The present study aimed to investigate the reproducibility and relative validity of an eight-item quantitative food frequency questionnaire that measures the fruit and vegetable intakes (FV-FFQ) of Moroccan women.

During a 1-week period, 100 women, living in the city of Rabat, Morocco (aged 20–49 years) completed the short FV-FFQ twice: once at baseline (FV-FFQ1) and once at the end of the study (FV-FFQ2). In the mean time, participants completed three 24-h dietary recalls. All questionnaires were administered by interviewers. Reproducibility was assessed by computing Spearman's correlation coefficients, intraclass correlation (ICC) coefficients and kappa statistics. Relative validity was assessed by computing Wilcoxon signed-rank tests and Spearman's correlation coefficients, as well as by performing Bland–Altman plots.

In terms of reproducibility, Spearman's correlation coefficient was 0.56; ICC coefficient was 0.68; and weighted kappa was 0.35. In terms of relative validity, compared with the three 24-h recalls, the FV-FFQ slightly underestimated mean fruit and vegetable intakes (−10.9%; P = 0.006); Spearman's correlation coefficient was 0.69; at the individual level, intakes measured by the FV-FFQ were between 0.39 and 2.19 times those measured by the 24-h recalls.

The brief eight-item FV-FFQ is a reliable and relatively valid tool for measuring mean fruit and vegetable intakes at the population level, although this is not the case at the individual level.

We aimed to develop tools that could be reliably used to evaluate self-efficacy for consuming vegetables and low-sugar foods and beverages for African American and Latino children living in inner-city communities.

A total of 112 children, aged 8–11 years, identified by a parent as being either African-American or Latino, were recruited and administered questionnaires. Internal consistency, a measure of reliability, was assessed by calculating the Cronbach's alpha of test scores.

Cronbach's alpha exceeded the threshold of acceptability of 0.70 for the Authors' Vegetables Self-Efficacy Index, and all three Low-Sugar Self-Efficacy Indices, including the Reference Index, the Authors' Low-Sugar Food and Beverage Index, and the Low-Sugar Beverages Index.

We present internally consistent tools that could be reliably used to evaluate self-efficacy for consuming vegetables and low-sugar foods and beverages in 8–11-year-old African-American and Latino children from low socio-economic communities.

Homeless people in the UK and elsewhere have typically been found to consume a nutritionally inadequate diet. There is need for contemporary research to update our understanding within this field. The present study aimed to provide an insight into the nutrient intake and food choice of a sample of homeless adults.

In this mixed-methods study, 24 homeless individuals accessing two charitable meal services in Sheffield, UK, participated in up to four 24-h dietary recalls between April and August 2012. Twelve individuals took part in a semi-structured interview focusing on food choice.

Energy intake was significantly lower than the estimated average requirement. Median intakes of vitamin A, zinc, magnesium, potassium and selenium were significantly lower than reference nutrient intakes. Contributions of saturated fat and nonmilk extrinsic sugars to total energy intake were significantly higher, whereas dietary fibre was significantly lower, than population average intakes. Charitable meals made an important contribution to intakes of energy and most micronutrients. Thematic analysis of interview transcripts revealed three major themes: food aspirations; constraints over food choice; and food representing survival.

The present study reveals risk of dietary inadequacies amongst homeless people alongside a lack of control over food choices. Charitable meal services are suggested as a vehicle for improving the dietary intake and nutritional health of homeless people.

The present study aimed to assess the effects of Ramadan intermittent fasting on body weight and composition and the effects of age and sex.

Body weight, height, waist and hip circumferences were measured, body mass index (BMI) was calculated and fat mass, fat-free mass and percentage body fat were assessed by bioelectrical impedance on 240 adult subjects (male: 158) who fasted between sunrise and sunset for at least 20 days. Measurements were taken 1 week before and 1 week after Ramadan. Energy and macronutrient intakes were assessed using a 3-day food frequency questionnaire on a sub-sample of subjects before and during Ramadan.

Subjects were grouped according to age and sex: ≤35 years (n = 82, males: 31) and 36–70 years (n = 158, males: 127). There were significant reductions in weight and BMI (P < 0.001) in almost all subjects, with the biggest being in males ≤35 years [−2.2% (SE 2.2%), P < 0.001]. Waist and hip circumferences fell in most subjects, except females aged 36–70 years. Fat mass fell in most subjects, ranging from 2.3% to 4.3% from baseline, except in females aged 36–70 years who did not experience a significant change. Fat-free mass was significantly reduced in all subjects (P < 0.001), whereas percentage body fat was lower only in males by 2.5% (SE 3.2%) (P = 0.029) in those aged ≤35 years and by 1.1% (SE 1.5%) (P < 0.001) in those aged 36–70 years. Dietary intake was similar before and during Ramadan, except in males whose protein intake fell during Ramadan (P = 0.032).

Ramadan fasting leads to weight loss and fat-free mass reductions. Body composition changes vary depending on age and sex.

To assess the selenium status of a group of schoolchildren from the Region of Madrid, Spain.

Study subjects comprised 483 children (216 boys and 267 girls) aged between 8 and 13 years. Selenium intake was determined using a 3-day food record. The foods consumed were transformed into energy and nutrients, and the selenium intake was compared with that recommended. Serum selenium levels were also recorded.

Mean (SD) selenium intake [91.0 (25.2) μg day⁻¹] was above the recommended level in 99.4% of subjects; the main dietary sources were cereals, meats, fish and milk products. The serum selenium concentration [mean (SD) 71.1 (14.4) μg L⁻¹], however, was <60 μg L⁻¹ in 13.9% of subjects, and <45 μg L⁻¹ in 5.6%. The serum selenium concentration correlated with the selenium intake (r = 0.169; P < 0.05). Children with a serum selenium concentration of <75 μg L⁻¹ had significantly smaller selenium intakes than those with a serum concentration of ≥75 μg L⁻¹.

Although selenium intake was generally above that recommended, the serum selenium concentration of the children could be improved. This could be achieved by increasing the relative consumption of cereals and other selenium rich foods such as fish.

Overweight and obesity are increasing concerns among Aboriginal women, and lifestyle behaviours (i.e. dietary patterns and physical activity) are considered to be contributing factors. The present study aimed to explore the social, cultural, behavioural and environmental factors influencing diet intake from a trans-generational perspective and to characterise the dietary practices among Woodland Cree women.

A mixed methods design using a concurrent triangulation approach explored the factors influencing diet intake and healthy eating among First Nations women on a reserve community in northern Saskatchewan, Canada. Dietary practices were assessed using 24-h recalls.

Dietary analysis revealed low intake of fruits and vegetables and milk and alternatives in the sample, with high intake of ‘other’ foods. Limited amounts of traditional food (TF) were reported. Taste primarily influenced food choice, with a preference for TF highlighted among older participants. Healthy eating was considered to be a health-promoting behaviour, yet a lack of availability, high costs and difficulties accessing various foods were the most noted barriers to healthy eating.

The dietary practices in this sample indicate the limited consumption and variety of TF and fruits and vegetables, and a high consumption of ‘other’ foods, which suggests inadequate intakes of various vitamins and nutrients. The findings from a trans-generational perspective highlight various barriers across the age groups that can substantially impact food choices, and reinforces the need for community and age-specific strategies to address issues of exposure, accessibility and affordability to nutritious foods that improve the diet and preserve cultural identity among residents living in reserve communities.

Self-Completed Recall and Analysis of Nutrition (scran24) is a prototype computerised 24-h recall system for use with 11–16 year olds. It is based on the Multiple Pass 24-h Recall method and includes prompts and checks throughout the system for forgotten food items.

The development of scran24 was informed by an extensive literature review, a series of focus groups and usability testing. The first stage of the recall is a quick list where the user is asked to input all the foods and drinks they remember consuming the previous day. The quick list is structured into meals and snacks. Once the quick list is complete, additional information is collected on each food to determine food type and to obtain an estimate of portion size using digital images of food. Foods are located within the system using a free text search, which is linked to the information entered into the quick list. A time is assigned to each eating occasion using drag and drop onto a timeline. The system prompts the user if no foods or drinks have been consumed within a 3-h time frame, or if fewer than three drinks have been consumed throughout the day. The food composition code and weight (g) of all items selected are automatically allocated and stored. Nutritional information can be generated automatically via the scran24 companion Access database.

scran24 was very well received by young people and was relatively quick to complete. The accuracy and precision was close to that of similar computer-based systems currently used in dietary studies.

With an established, yet avoidable, link between dietary intake and poor health, the nutritional habits of adolescents remains a public health concern. Previous studies report an inverse relationship between dietary intake and socio-economic status (SES), although few studies have considered the influence of the SES gradient. The present study compared the nutritional profiles of neighbouring schools with pupils from middle to high economic backgrounds.

One hundred and ninety pupils from a high SES school (HSESS) and 159 pupils from a middle SES school (MSESS) (aged 11–12 years) completed a 63-item validated food frequency questionnaire. Pupils rated their diet quality and this was compared with a composite Healthy Eating Index (HEI).

Children attending MSESS consumed significantly higher intakes of energy (P < 0.001), carbohydrate (P = 0.001), fat (P < 0.001) and protein (P = 0.001). As a percentage of energy contribution, pupils in both schools consumed excess saturated fat (HSESS, +5% boys, +4% girls; MSESS, +4% both boys and girls) and sugar (HSESS, +9% boys, +11% girls; MSESS, +10% boys, +11% girls). When HEI was compared with self-report diet quality, 96% HSESS pupils and 94% MSESS pupils over-rated the quality of their diet.

The present study identified that, although pupils from MSESS consume a significantly higher intake of energy and macronutrient compared to a nearby HSESS, the percentage of energy contribution of saturated fat and sugar is above government recommendations for pupils from both schools. Additionally, the majority of pupils from both schools substantially over-rated their diet quality compared to a HEI.

The British Dietetic Association and the International Confederation of Dietetic Associations are developing an international model for dietetics practice as an aid in providing evidence-based practice. In the USA, undergraduate programmes are mandated by the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) to incorporate the nutrition care process (NCP) into the curriculum so that students can use the process during their dietetic internship and later practice. The present study aimed to assess interns’ readiness in the NCP prior to beginning a dietetic internship.

Before starting the internship, the 40 interns in the 2009–2010 class of a university-based internship were sent an e-mail requesting they complete an online survey. Questions inquired about their NCP background with respect to: academic preparation, work or volunteer experiences, knowledge and confidence in ability to apply the NCP. Survey results were analysed with SPSS statistical software (SPSS Inc., Chicago, IL, USA).

The 39 interns completing the survey indicated they had prior exposure to the NCP. All but one reported that their academic coursework covered the NCP. Approximately half of the interns worked or volunteered in settings that used the NCP. Overall, students correctly answered most of the questions assessing their basic knowledge in the NCP. Thirty-seven of the 39 interns had some confidence or felt confident in their ability to apply the NCP during internship rotations.

This distance internship attracts students from all over the USA, and so the findings of the present study shed light on current undergraduate preparation in the NCP.

Epidemiological studies of red meat consumption often fail to distinguish between leaner and fattier or processed cuts of meat. Red meat has also been frequently linked with less healthy diet patterns. Data exploring the health effects of lean red meat in younger individuals are scarce, particularly in the context of a healthy diet. The present study examined the effects of lean red meat in combination with higher intakes of fruit/nonstarchy vegetables on lipid profiles in older adolescent girls.

Data from 1461 girls who were followed for 10 years, starting at 9–10 years of age, in the National Heart Lung and Blood Institute Growth and Health Study were used. Diet was assessed using multiple sets of 3-day records collected over eight examination cycles. Outcome measures included fasting levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C and triglycerides at age 18–20 years.

After adjusting for age, race, socioeconomic status, height, activity level, hours of television per day, and intakes of whole grains and dairy foods using multivariable modelling, girls consuming ≥6 oz lean red meat per week combined with two or more servings of fruit/nonstarchy vegetables per day had LDL-C levels approximately 6–7 mg dL⁻¹ lower (P < 0.05) than girls with lower intakes of lean red meat and fruit/nonstarchy vegetables. In addition, girls with higher intakes of both were 33% less likely (odds ratio = 0.67, 95% confidence interval = 0.48–0.94) to have an LDL-C ≥110 mg dL⁻¹ and 41% less likely (odds ratio = 0.59, 95% confidence interval = 0.42–0.83) to have an elevated LDL : HDL ratio (≥2.2) at the end of adolescence.

These analyses suggest that lean red meat may be included in a healthy adolescent diet without unfavourable effects on lipid values.

Patients with enteral feeding tubes are increasingly managed in their home environment and these patients require support from a range of healthcare professionals.

A cluster randomised trial of an educational intervention was undertaken among General Practitioners and nurses both in the community and in nursing home caring for patients recently discharged to primary care. This was a short, duration (<1 h), nutrition education programme delivered in the work place soon after the patient was discharged from hospital. The primary outcome was an improvement in knowledge immediately after the intervention and the secondary outcome was knowledge at 6 months.

Those in the intervention group had improved knowledge, which was significantly greater than those in the control group (P < 0.001), although this knowledge was not sustained at 6 months.

A short, work-based targeted nutrition education programme is effective for improving knowledge among general practitioners and nurses both in the community and in nursing homes.

The present study aimed to evaluate the impact of animal and vegetable protein supplementation on health-related quality of life (HRQL) in patients with hepatitis C virus (HCV) and to investigate clinical and nutritional variables related to quality of life in these patients.

One hundred and forty patients infected with HCV were randomly assigned to one of two groups: the Soy Group (SG; n = 72), where patients received a soy supplement diet and the Casein Group (CG; n = 68), where patients received casein as a supplement. Anthropometric, biochemical and clinical assessments were performed in all patients, and the Short-Form Health Survey was applied at baseline and 12 weeks after study initiation.

Before supplementation, poor HRQL scores were associated with female sex (P = 0.004) and advanced fibrosis (F3/F4; P = 0.04). Reduced HRQL scores were correlated with age (r = −0.263; P = 0.002), serum albumin levels (r = 0.245; P = 0.004), lean mass (r = 0.301; P < 0.0001) and body fat percentage (r = −0.262; P = 0.002). After 12 weeks of intervention, patients in both supplementation groups showed significantly increased HRQL scores, with no difference being observed between the SG and the CG.

Nutritional therapy with either soybean or casein supplementation improved quality of life in patients infected with HCV. Quality of life was influenced by anthropometric, biochemical, clinical and sociodemographic factors in patients with HCV before nutritional supplementation.

Food is one of the most commonly reported triggers of irritable bowel syndrome (IBS) symptoms. However, the role of diet in the aetiology and management of IBS has not been clearly established. The present study aimed to examine the dietary practices of Irish patients with IBS and to determine whether these practices increased their vulnerability to nutritional inadequacies.

A questionnaire was completed by 135 IBS patients on their perceptions of the role of diet in their symptoms and whether they restrict their diet according to the symptoms experienced. A similar questionnaire was used to investigate the perceptions of 111 healthy subjects to the gastrointestinal symptoms experienced on the consumption of food.

Food was considered to cause or worsen their gastrointestinal symptoms in 89.6% of IBS patients compared to 55% of healthy subjects (P < 0.001). Cereal-based foods, predominantly bread or its components, were the most frequently cited (53.3%), and spicy foods (39.3%), vegetables and fatty foods (35.6% for both) also featured prominently. A significantly greater number of patients with IBS reported changing their diet to minimise symptoms compared to healthy controls (91.9% versus 45.5%, P < 0.001). In relation to whole food groups, milk products (9.6%), fruit (7.4%) and vegetables (5.2%) were those most commonly restricted, with only a small number of IBS patients seeking professional healthcare advice.

The majority of IBS patients consider their symptoms to be related to food, and change their diet by limiting the foods that they perceive as problematic, with some restricting whole food groups. Few patients sought professional healthcare advice when implementing dietary change, possibly exposing a considerable number to an increased risk of nutritional deficiency.

Based on the Social Marketing approach and Diffusion of Innovations Theory that indicates the importance of opinion leaders with respect to the spreading of new ideas, concepts or practices within a community, the present study aimed to examine positions and perceptions of Israeli leading dietitians and health officials regarding nutrition labelling and the Choices logo, before it was launched in Israel in February 2011, as well as how they would communicate it to the public as agents of influence.

The study involved in-depth face-to-face and telephone interviews with 15 senior dietitians and Health Ministry officials using semi-structured protocols including questions about nutrition labelling and the Choices logo.

The respondents considered that the nutrition facts panels usually found on the backs of packages are too complicated for the average consumer. Simiularly, fronts of packages are cluttered with advertisements and health claims, causing confusion. The study participants would like to see an integrative label on the front of the package to facilitate consumers' decisions. However, the Choices logo raises ethical and social questions about the conflict between corporate interests and public health: (i) the label's relativity versus objectivity; (ii) the consumer's responsibility to create a balanced diet; (iii) the label's credibility; and (iv) bias against companies, products and audiences.

The results of the present study highlight the importance of a need for an integrated programme of nutrition promotion, including the use of social marketing based on a cooperative effort between the food industry, regulators and professionals, to recommend changes and adjustments in nutritional front of package labelling with the aim of promoting healthier nutrition consumption.

The present study aimed to assess the association of obesity and malnutrition with the mortality of hospitalised patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and the risk of readmission in <30 days.

A retrospective chart review of consecutive patients admitted with COPD as the primary reason for discharge in Spain between 1 January 2006 and 31 December 2007 was performed. Patients with a diagnosis of obesity or malnutrition in the hospital discharge clinical report were identified. The in-hospital mortality and re-admittance 30 days after discharge indices of obese and malnourished patients were compared against the subpopulation without these diagnoses.

Of the 313 233 COPD admittances analysed, there were 22 582 (7.2%) diagnoses of obesity and 6354 (2.0%) diagnoses of malnutrition. In-hospital global mortality and the re-admittance risk were 12.0% and 16.7%, respectively. Obese patients showed a lower in-hospital mortality risk [odds ratio (OR) = 0.52; 95% confidence interval (CI) = 0.49–0.55] and early re-admittance risk (OR = 0.87; 95% CI = 0.85–0.92) compared to non-obese patients. Malnourished patients had a much higher risk of death when in hospital (OR = 1.73; 95% CI = 1.62–1.85) or of being re-admitted within 30 days after discharge (OR = 1.29; 95% CI = 1.22–1.38), even after adjusting for possible confounding factors.

Obesity in patients hospitalised for COPD substantially reduces in-hospital mortality risk and the possibility of early re-admittance. Malnutrition is associated with an important increase in in-hospital mortality and risk of re-admittance in the 30 days following discharge.

Accurate estimates of energy expenditure are required in clinical nutrition in order to determine the requirements of individuals and to inform feeding regimes. Calorimetry can provide accurate measurements but is often impractical in clinical or community settings; prediction equations are widely used to estimate resting energy expenditure (REE) but have limited accuracy. A portable, self-calibrating, handheld calorimeter (HHC) may offer an alternative way of determining REE. The aim of the study was to evaluate whether estimates of REE derived using an HHC are closer to accurate measurements than values calculated using selected prediction equations.

REE was measured in 36 healthy adults aged 21–58 years using a flow-through indirect calorimeter (FIC) and HHC. Estimated REE was calculated using three predictive equations (Harris & Benedict; Schofield; Henry). Differences in REE between the ‘gold standard’ values derived using the FIC and those derived using the HHC and equations were examined using paired t-tests and Bland Altman plots.

Mean REE_HHC was significantly lower than mean REE_FIC [4556 ± 1042 kJ (1089 ± 249 kcal) versus 6230 ± 895 kJ (1489 ± 214 kcal), P = 0.000] and also significantly lower than mean values calculated using all three equations. The mean difference between REE_HHC and REE_FIC [1674 ± 908 kJ (400 ± 217 kcal)] was significantly greater (P = 0.000) than the mean differences between the values calculated using the three prediction equations [272 ± 490 kJ (65 ± 117 kcal) (Harris-Benedict), 264 ± 510 kJ (63 ± 122 kcal) (Schofield), 84 ± 502 kJ (20 ± 120 kcal) (Henry)].

The HHC provides estimates of REE in healthy people that are less accurate than those calculated using the prediction equations and so does not provide a useful alternative.

Clinical practice has suggested that, in severely obese patients seeking bariatric surgery, clinical conditions, behavioural characteristics and psychological status might all differ from those of their counterparts starting conventional conservative therapy.

Two groups of obese patients with closely similar body mass values were considered. The first group included individuals voluntarily and spontaneously seeking biliopancreatic diversion and the second group comprised patients at the beginning of a weight loss programme. After anthropometric and metabolic evaluation, the patients underwent an alimentary interview; eating behaviour and psychological status were assessed by Three Factor Eating Questionnaire and by Toronto Alexithymia Scale (TAS).

Among bariatric candidates, a greater number of individuals with type 2 diabetes and dyslipidaemia and high tendency to disinhibition and susceptibility to hunger scores was observed, whereas the other aspects of eating pattern were essentially similar. In the two groups, no difference in TAS score and or number of patients with alexithymic traits was observed. Finally, a logistic regression model showed that only age and metabolic derangement predicted the bariatric option, whereas eating behaviour or psychological status did not influence individual therapeutic choice.

Independently of the degree of obesity, bariatric surgery was requested by the more metabolically deranged patients, whereas, in the surgical candidates, the eating pattern and psychological conditions were very similar to those of obese persons at the beginning of a conservative weight loss programme. These results suggest a highly realistic and practical attitude in severely obese patients towards obesity and bariatric surgery.

The wide spread use of long-term enteral nutrition and the substantive costs dictate a need to study the outcome, as well as the clinical and epidemiological characteristics, of these patients. The present study aimed to analyse the incidence and characteristics of a cohort of patients on home enteral nutrition (HEN) over 12 years.

A prospective observational study was performed between January 1999 and December 2010. All adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up.

The incidence of HEN ranged between 9.52 per 100 000 inhabitants in 2001 to 30.0 per 100 000 inhabitants in 2009. HEN was administered orally in 472 patients (68.28%) (group 1), and through a nasogastric tube in 168 patients (24.30%), a percutaneous enteral gastrostomy tube in 47 patients (6.80%) and a jejunostomy in four patients (0.60%) (group 2; 219 patients). During the course of HEN, 31 patients had diarrhoea (4.5%), 17 patients had constipation and 12 patients had nausea. The mean (SD) duration of HEN was 159.9 (97) days. In multivariable analysis, an independent factor associated with death was age (hazard ratio = 1.03; 95% confidence interval - 1.01–1.05), adjusted by sex, route and diagnosis.

HEN has a high incidence in our area and it is a valid and safe technique for nutrition support.

Increasing fruit and vegetable consumption is a goal for the UK. Therefore, the effectiveness of a fruit and vegetable voucher scheme coupled with key ‘five-a-day’ consumption messages as a brief intervention in primary care consultations was assessed in the present study.

One thousand one hundred and eighty-eight vouchers as a prescription for fruits and vegetables were routinely distributed to patients attending a primary healthcare centre in a deprived area, and 124 volunteer patients routinely attending the centre were included. Telephone-based questionnaires were used to examine changes in consumption over the short and medium term. Other key aspects assessed in the evaluation related to fruit and vegetable purchasing behaviour, knowledge relating to what constitutes a portion size, the relationship between food and health, and barriers to consumption.

Although 76.2% of participants used the prescription vouchers when purchasing fruits and vegetables, a significant change in the consumption or purchasing behaviour was not observed (P > 0.05). Participants' level of knowledge relating to the number of portions recommended and the portion size of different fruits and vegetables showed a moderate increase from baseline over the short and medium term. The primary barriers to fruit and vegetable consumption were reported as ‘the quality of fresh fruits and vegetables’ and ‘the money available to spend on food’.

The use of ‘the fruit and vegetable on prescription’ scheme was an effective method of engaging participants in improving awareness of key diet-related health messages. However, further intervention is required to produce a significant impact on the actual behaviour change.

Evidences have suggested that larger utensils may provoke ‘size-contrast illusions’, influencing the perceived volume and food consumption.

To analyse the influence of plate size on the visual estimate of food portion size.

Two 400 g portions of pasta with tomato sauce were presented on two plates of different diameters (24.0 and 9.0 cm). Each participant visually estimated on an individual basis the quantities of the pasta portions (g) present on each plate. In addition, each subject classified the size of the portions on each plate as ‘small’, ‘medium’ and ‘large’. The mean estimates of the amount of pasta on each plate were compared by the nonparametric Mann–Whitney. The differences in the frequencies of portion classifications between plates were evaluated by the chi-squared test.

Forty-eight students (average 25.8 ± 8.9 years) participated in the study. There was no difference in the median amount of pasta estimated for the large and small plates (150 g; range 50–500 and 115 g; range 40–500 g, respectively). The classification of the portion size as ‘large’ was reported by a significantly greater number of persons when they evaluated the amount of pasta arranged on the large plate compared to the small plate (47.9 versus 22.9%, respectively; P = 0.018).

The size of the plate did not influence the estimate of food portions, even though it did influence the classification of portion size.

To investigate changes in intakes of ‘negative’ and ‘positive’ foods, fruit, vegetables, and salad in serial cohorts of 9–10-year-old children from 2000–2001 to 2010–2011.

For this serial, cross-sectional study, children in school year 5 (9–10 years of age) completed the SportsLinx Lifestyles Survey [n = 30 239 (15 336 boys and 14 903 girls)]. Changes in positive and negative food scores, and the proportion of boys and girls reportedly consuming fruit, vegetables and salad on the previous day to surveying, were investigated annually from 2000 to 2011.

The consumption of negative foods declined and positive foods increased significantly compared to baseline. Positive changes in fruit, vegetables and salad consumption were observed over time, with the most recent cohort more likely to consume fruit, vegetables and salad compared to the 2000–2001 baseline. Girls displayed more favourable positive and negative food scores and were more likely to consume fruit, salad and vegetables across several study years compared to boys.

The consumption of negative and positive foods, fruit, vegetables, and salad has improved over the last 10 years. In addition, girls appear to have better positive and negative food scores, and were more likely to consume fruit, vegetables and salad, across a number of study years or cohorts compared to boys. These encouraging findings suggest that children's food intake has improved since 2000. Furthermore, the data indicate that boys and girls may require separate or different healthy eating messages to further improve food intake.

Intestinal absorption capacity is considered to be the best method for assessing overall digestive intestinal function. Earlier reference values for intestinal function in healthy Dutch adults were based on a study that was conducted in an inpatient metabolic unit setting in a relatively small series. The present study aimed to readdress and describe the intestinal absorption capacity of healthy adults, who were consuming their usual (Western European) food and beverage diet, in a standard ambulatory setting.

Twenty-three healthy subjects (aged 22–60 years) were included in the analyses. Nutritional intake (energy and macronutrients) was determined with a 4-day nutritional diary. Subsequently, mean faecal losses of energy (by bomb calorimetry), fat, protein and carbohydrate were determined following a 3-day faecal collection. Finally, intestinal absorption capacity was calculated from the differences between intake and losses.

Mean (SD) daily faeces production was 141 (49) g (29% dry weight), containing 891 (276) kJ [10.7 (1.3) kJ g⁻¹ wet faeces; 22.6 (2.5) kJ g⁻¹ dry faeces], 5.2 (2.2) g fat, 10.0 (3.8) g protein and 29.7 (11.7) g carbohydrates. Mean (SD) intestinal absorption capacity of healthy subjects was 89.4% (3.8%) for energy, 92.5% (3.7%) for fat, 86.9% (6.4%) for protein and 87.3% (6.6%) for carbohydrates.

The present study provides normative values for both stool nutrient composition and intestinal energy and macronutrient absorption in healthy adults on a regular Dutch diet in an ambulatory setting. Intestinal energy absorption was found to be approximately 90%.

Coeliac disease is an autoimmune disorder that is considered to affect approximately one in 100 people. In the UK, gluten-free (GF) foods can be prescribed by general practitioners (GPs) to treat this condition and there are national guidelines on the quantities of GF food an individual should receive on prescription. Information on actual prescribing behaviour by GPs, and how this compares with guideline recommendations, is scarce. The present study aimed to describe GPs prescribing practice of GF foods, within one locality in the UK, comparing this with national guidelines.

A retrospective evaluation of GP electronic medical records for all patients with a gluten-sensitive enteropathy diagnosis and/or those prescribed GF food between April 2010 and March 2011 was carried out in 16 GP practices in the west of Scotland, serving a total of 85 667 patients.

Of 175 (0.18% of the total practice population) patients, 152 were identified with coeliac disease, eight with dermatitis herpetiformis and six with both conditions. A further nine patients received GF foods on prescriptions with no recorded diagnosis. There was a positive association between adherence to the prescribing guidelines and female sex (P < 0.0001) and (for those with a recorded diagnosis) increasing age (P = 0.001). There was no significant association between either socio-economic deprivation or co-morbidities and adherence to the prescribing guidelines.

There was significant under prescribing of GF foods in those identified. Further research is required to establish whether these results are representative of wider practice in the UK.

The high amounts of phytic acid present in diets from developing countries are considered as important inhibitors of zinc (Zn) absorption. The present study aimed to assess the fractional absorption of Zn from a meal containing common Brazilian foods using the stable isotope technique.

Twelve men, aged 19–42 years, were fed a healthy experimental diet comprising lettuce, tomato, French fries, steak with onions, rice, beans, papaya, orange, pineapple, and passion fruit juice. Each subject received one intravenous dose of enriched ⁷⁰Zn, and the lunch was extrinsically labelled with enriched ⁶⁷Zn. Urinary ⁶⁷Zn and ⁷⁰Zn enrichments were assessed by inductively coupled plasma mass spectrometry.

The labelled meal phytate : Zn molar ratio was very divergent with respect to chemically determined and calculated data. Subjects presented a normal Zn nutritional status before and after the study. The mean Zn absorption from the labelled meal was 30% (range 11–47%).

According to the World Health Organization parameters, the results denote a moderate/high Zn bioavailability in the evaluated meal, with a variability in the absorption percentage that is similar to other studies. The data show that a typical Brazilian meal, with an adequate energy amount and a balanced macronutrient distribution, presents a Zn bioavailability in accordance with the worldwide recommended standard.

Central obesity has a higher risk of the metabolic syndrome (MetS) and cardiovascular diseases. It is estimated by measuring waist circumference (WC) and waist-to-hip ratio (WHR), which are operator-dependent. The present study aimed to validate a body composition monitor (BCM) as a tool for estimating visceral adipose tissue (VAT), as well as to assess its capacity to predict the MetS and its correlation with anthropometric parameters.

We measured WC, WHR and body mass index (BMI) in 60 recruited subjects. BCM estimated VAT (1–30 points). Body composition and resting energy expenditure (REE) were compared with bioelectrical impedance analysis (BIA) and indirect calorimetry, respectively. VAT was estimated by BCM (range 1–30 points), We evaluated the capability of VAT, WC, BMI and WHR to predict the MetS by ATP-III criteria.

The mean (SD) age of subjects was 36.8 (12.9) years, 80% were female, and 47% had the MetS. Body composition and REE estimated by BCM had a significant correlation with BIA (r = 0.85–0.91, P< 0.001) and REE (r = 0.86, P < 0.001), respectively, even after adjusting by sex. VAT estimation by BCM was positively correlated with WC (r = 0.75, P< 0.001) and WHR (r = 0.61, P < 0.001). The area under the receiver operator characteristic curves to predict the MetS was 0.93 for VAT, 0.81 for WC, 0.76 for WHR and 0.74 for BMI. VAT ≥10 points had a sensitivity of 100% and a specificity of 82% for predicting the MetS.

VAT estimation by BCM efficiently predicts the MetS and correlates with anthropometric parameters of central obesity. Its routine use could facilitate cardiovascular risk estimation and follow-up in overweight and obese patients in ambulatory practice.

High-fibre and low-carbohydrate diets may enhance satiety and promote weight loss. We compared a diet rich in beans aiming to increase dietary fibre and promote weight loss with a low-carbohydrate diet in a randomised controlled trial to assess effect and tolerability of the high-fibre bean-rich diet.

One hundred and seventy-three women and men, with a mean body mass index of approximately 36 kg m⁻² (one-fifth with diabetes type 2) were randomised to a high-fibre bean-rich diet that achieved mean (SD) fibre intakes of 35.5 (18.6) g day⁻¹ for women and 42.5 (30.3) g day⁻¹ for men, or a low-carbohydrate diet. Both diets were induced gradually over 4 weeks and included a 3-day feeding phase. Among 123 (71.1%) completers at 16 weeks, mean (SD) weight loss was 4.1 (4.0) kg in the high-fibre versus 5.2 (4.5) kg in the low-carbohydrate group [difference, 1.1 kg, 95% confidence interval (CI) = −2.6 to −0.5; P = 0.2], with results similar to the intent-to-treat population. Low-density lipoprotein (LDL)-cholesterol levels decreased with the high-fibre diet (difference in LDL-cholesterol versus low-carbohydrate diet, 0.2 mmol L⁻¹, 95% CI = 0.01–0.44 mmol L⁻¹; P = 0.045), as did total cholesterol (P = 0.038), whereas changes in other lipids and glucose did not differ. After 52 weeks, the low-carbohydrate (n = 24) group tended to retain weight loss better than the high-fibre group (P = 0.06), although total cholesterol remained lower with the bean-rich diet (P = 0.049).

A high-fibre bean-rich diet was as effective as a low-carbohydrate diet for weight loss, although only the bean-rich diet lowered atherogenic lipids.

Obesity is associated with risks for mother and infant, and the mothers' dietary habits influence breast milk composition. Polyamines are secreted in breast milk and are essential for the regulation of intestinal and immune function in newborns and infants. The present study aimed to investigate the level of polyamines in human milk obtained from obese and normal weight mothers at different times of lactation.

Breast milk from 50 mothers was obtained at day 3, and at 1 and 2 months after delivery. The mothers had normal body weight [body mass index (BMI) < 25 kg m^–2] or were obese (BMI > 30 kg/m²). A subgroup of obese mothers participated in a weight reduction programme during pregnancy. Polyamines were analysed using high-performance liquid chromatography.

The total polyamine content was significantly lower at all times in breast milk from obese mothers compared to milk from controls. Spermine levels did not differ between groups at any time in contrast to the levels of putrescine and spermidine. Putrescine concentrations were highest on day 3 and spermidine and spermine were highest at 1 month of lactation. The obese mothers, who received dietary advice during pregnancy based on the Nordic Nutrition Recommendations, had higher concentrations of putrescine and spermidine in their milk than the obese mothers without any intervention.

Polyamine concentrations were lower in breast milk from obese mothers compared to mothers with a normal weight. General dietary intervention in obese mothers increased the polyamine levels, suggesting that the low levels in obesity were at least partly associated with food habits. However, the consistency of spermine suggests a special metabolic function of this polyamine.

The primary objective of the present study was to assess changes in the nutritional status and quality of life in acute leukaemia patients, aged ≥15 years, who had undergone induction chemotherapy.

A preliminary and post-induction chemotherapy assessment of patients' nutritional status, quality of life, sociodemographic status and medical characteristics was conducted using the Patient Generated Subjective Global Assessment (PG-SGA) and the European Organization for Research and Treatment of Cancer quality of life (QOL-C30, version 3) questionnaires. The PG-SGA is a clinical nutrition assessment tool used to evaluate oncology patients. Patients with newly-diagnosed acute laeukaemia, aged ≥15 years, at three hospitals in Tehran (from May 2009 to March 2010), were recruited for the present study.

Sixty-three acute leukaemia patients [65% men and 35% women with a mean (SD) age of 33 (15.4) years] participated in the present study. A total of 19.4% were found to be malnourished prior to chemotherapy. After chemotherapy, 76.1% of patients were considered moderately malnourished, whereas 6.3% were severely malnourished. After induction chemotherapy, both the nutritional status and quality of life deteriorated in the majority of patients, as demonstrated by a paired t-test.

A deteriorated nutritional status and quality of life was the result of the side effects posed by induction chemotherapy in the patients investigated in the present study. These findings highlight the need for an appropriate nutritional support programme to improve the nutritional status and quality of life in patients with leukaemia undergoing chemotherapy.

There is lack of data in Greece on the trends in energy and nutrient intake. The present study aimed to examine differences in these parameters among first-grade children of Crete, Greece, between 1992/93 and 2006/07.

Children (aged 5.7–7.6 years) from two-representative cross-sectional samples participated during 1992/93 (n = 245) and 2006/07 (n = 257). Nutrient and food intakes were assessed using estimated 3-day-food records. Nutrient intakes were estimated as amounts per 4185 kJ (1000 kcal) of energy intake (EI), whereas macronutrients were estimated as percentage of total EI.

Between 1992/93 and 2006/07, respectively, significant increases (P < 0.05) were observed in the intake of energy (boys: 7996 versus 8646 kJ; girls: 7265 versus 7963 kJ), calcium (boys: 488 versus 587 mg; girls: 464 versus 594 mg), iron (boys: 5.8 versus 7.3 mg; girls: 5.7 versus 7.4 mg) and vitamins B₂ (boys: 1.01 versus 1.17 mg; girls: 1.0 versus 1.16 mg) and B₆ (boys: 0.80 versus 0.87 mg; girls: 0.75 versus 0.95 mg), for boys and girls, respectively. Among boys, the intake of protein (13.6 versus 14.6% of EI) and total trans fatty acids (TTFA) (0.84 versus 0.99 g) was also significantly lower in 1992/93 (P < 0.016). Between 1992/93 and 2006/07, total fat (boys: 42.9% versus 42.8%, girls: 42% versus 43.1%) and saturated fat (boys: 15.5% versus 15.4%, girls: 15% versus 15.3%) exceeded the 30–35% and <10% dietary recommendations, respectively, A significantly higher proportion of children in 2006/07, compared to 1992/93, had a higher intake of total energy (>120% of the recommended energy allowance).

The intake of several macronutrients (protein, TTFA, total and saturated fat) in this sample of children did not meet the recommended intakes in either time period.

The present study aimed to assess the dietary fat intake and blood fatty acid status of healthy Norwegian men and women living in Bergen whose habitual diet is known to be high in long-chain omega-3 fat.

Healthy men (n = 41) and women (n = 40) aged 20–50 years who were regular blood donors completed 7-day food diaries and their nutrient intake was analysed by Norwegian food database software, kbs, version 4.9 (kostberegningssystem; University of Oslo, Oslo, Norway). Blood samples were obtained before blood donation and assessed for the fatty acid composition of plasma triglycerides and cholesterol esters, phosphatidylcholine, and red cell phosphatidylcholine and phosphatidylethanolamine.

There was no difference in dietary fat intake between men and women. Total and saturated fat intakes exceeded the upper limits of the recommendations of the National Nutrition Council of Norway. Although polyunsaturated fat intake was close to the lower limit of the recommended level, the intake varied greatly among individuals, partly as a result of the use of supplementary fish oil. Moreover, the proportional fatty acid composition of plasma and red cell lipids was similar between men and women. Enrichment of docosahexaenoic acid in red cell phosphatidylethanolamine was found in fish oil users.

The results of the present study provide a snapshot of the current nutritional status of healthy Norwegian adults. Moreover, the detailed blood fatty acid composition of men and women whose habitual diet constitutes high long-chain polyunsaturated omega-3 fat as well as saturated fat could be used as reference value for population studies.

Young adulthood is a stressful transition period that may increase the risk for disturbed eating, especially for college students. The present study aimed to explore disturbed eating behaviours and a broad array of associated psychographic characteristics in a large, diverse sample of college students.

College students (n = 2604; 58% white; 63% female) enrolled at three large, public US universities in 2009 and 2010 were recruited to take an online survey. The survey included reliable and valid disturbed eating behaviour and associated psychographic characteristic measures.

Many participants engaged in disturbed eating practices. For example, one-quarter of women and one-fifth of men engaged in dietary restraint. One in seven reported regularly binge eating. One-third used inappropriate compensatory behaviours (self-induced vomiting, medicine misuse and excessive exercise) as a means for controlling weight and/or shape, with the rate of these behaviours reaching clinically significant levels for 4%, 3% and 5% of participants, respectively. Examination of psychographic characteristics revealed that one-fifth had moderate levels of depression and anxiety severity and almost half engaged in at least one obsessive–compulsive disorder type behaviour. Females felt under more pressure to attain the media physical appearance standard than males.

The findings of the present study suggest that nutrition education interventions for college students may be needed to address disturbed eating behaviours and to provide guidance on how to seek professional help. The findings also suggest that it may be prudent for healthcare professionals to routinely screen college students for disturbed eating behaviours and offer interventions early when treatment is likely to be most effective.

Malnutrition is prevalent in acute hospitals and malnourished patients have an increased risk of morbidity and mortality. Studies of malnutrition and quality of life (QoL) are generally limited by both the nutritional and QoL assessment methods employed. The present study aimed to evaluate the relationship between malnutrition, as assessed using a range of nutritional assessment methods, and QoL, as measured by EuroQol-5D-3L and Short-Form (SF)-36 questionnaires.

The study comprised a prospective cross-sectional study of malnutrition and QoL in 149 inpatients aged 65–99 years. Exclusion criteria were: terminal illness, active malignancy, lack of capacity to consent and severe communication difficulties. Spearman's rank correlation coefficient was used to test the association between QoL indices and nutritional markers. QoL scores for those scoring above and below thresholds for nutritional risk were compared. Regression models were created to identify nutritional indices contributing to the variability of QoL.

There were significant associations between QoL scores and the Mini Nutritional Assessment (MNA)-SF. Clear differences were evident between malnourished and well-nourished patients (on the MNA-SF), those with low and normal arm muscle circumference and those with good and poor physical function. Regression analysis showed that nutritional scores and functional status made independent contributions to the prediction of QoL. The effect on food intake, mobility and psychological stress/acute disease also had a significant influence.

Malnutrition risk is linked to a poorer QoL in older people on admission to hospital. Functional status and eating-related factors are major influencers on QoL in this group. These findings reinforce the role of nutrition as a priority with respect to achieving improvements in QoL.

Almost 60% of elderly care in-patients are at risk of malnutrition. Malnourished patients have poorer clinical outcomes and this is a key factor with respect to prolonging the length of stay. Since 2003, the Malnutrition Universal Screening Tool (MUST) has been advocated as a method for identifying these at-risk patients. Screening should take place on admission; however, the Trust has set a stretch target of aiming to document the score accurately within 6 h of admission.

Three ‘care of the elderly’ wards participated in the project. Each month, the timeliness (within 6 h of admission) and accuracy (compared to a dietician assessment) of the MUST scores on the wards were reviewed. Plan–Do–Study–Act cycles were used to rapidly test changes in the ward areas. Tests included a study day, one-to-one ward-based nutrition training, a focus on the use of alternative anthropometric measurements, the development of a training pack and the identification of the challenges for undertaking accurate and timely assessments.

Baseline data identified that a MUST was documented in <60% of patients within 6 h of admission and that only 70% were accurate. After implementation of the change package, all the wards achieved an improvement and documented MUST within 6 h of admission; one ward achieved 90% accuracy in the scores.

Ward teams receiving training and monthly feedback of their results creates ownership, momentum and maintains enthusiasm for striving to reach stretch targets. The team continues to work on improving accurate nutritional screening across the Trust by using quality improvement methodologies.

To date, there are no food frequency questionnaires that have been validated to assess nutrient intakes in pregnant women in Ireland. The present study aimed to assess the relative validity of a self-administered food frequency questionnaire during pregnancy.

The food frequency questionnaire was administered once during pregnancy between 12 and 34 weeks. Participants also completed a 3-day food diary during each trimester of pregnancy (reference method) and intakes from both the food frequency questionnaire and the mean of the 3-day food diaries were compared in a sample of 130 participants from the control arm of an intervention study.

Energy-adjusted Pearson's correlation coefficients ranged from 0.24 (riboflavin) to 0.59 (magnesium) and were all statistically significant (P < 0.05). The food frequency questionnaire tended to report higher energy and nutrient intakes compared to the food diaries. On average, 74% of participants were classified into the same ± 1 quartile and 7% into opposing quartiles by the two methods.

Overall, our food frequency questionnaire showed good relative validity. We conclude that a single administration of a food frequency questionnaire is a valid tool for ranking women in accordance with their nutrient intakes during pregnancy.

Stress and negative emotions have been shown to be critical factors in inducing overeating as a form of maladaptive coping in obese people.

The present study aimed to evaluate the efficacy of an 8-week stress management programme that includes progressive muscle relaxation (PMR) and diaphragmatic breathing on weight loss and eating behaviour in a sample of overweight and obese women who started a weight-loss programme. A total of 34 women with a mean (SD) body mass index of 38.17 (7.19) kg m⁻² and mean (SD) age 47.35 (11.64) years were recruited from the outpatients Obesity Clinic of a public hospital in Athens. Participants were randomly assigned into a Stress Management (SM) and a control group. Anthropometric measurements were taken before and after the intervention, and the participants completed the following questionnaires: Dutch Eating Behaviour Questionnaire (DEBQ), Eating Attitudes Test (Eat-26), Health Locus of Control (HLC) and Perceived Stress Scale (PSS) before and after the intervention.

The findings indicated a significant improvement in weight loss in the SM group [4.44 (0.83) kg] after intervention compared to the control group [1.38 (0.78) kg] (P < 0.05). A higher restrained eating behaviour was observed in the SM group after intervention compared to the control group, although there was no significant difference in perceived stress levels.

The intervention group showed greater weight reduction, possibly because of the stress management programme, and a greater dietary restraint was demonstrated by them compared to the control group. It is likely that stress management could facilitate weight loss in obese women; however, more studies are needed to confirm this hypothesis.

Nutrition supplements enriched with immune function enhancing nutrients have been developed to aid wound-healing, although evidence regarding their effectiveness is limited and systematic reviews have lead to inconsistent recommendations. The present pragmatic, randomised, prospective open trial evaluated a wound-specific oral nutrition supplement enriched with arginine, vitamin C and zinc compared to a standard supplement with respect to outcomes in patients with chronic wounds in an acute care setting.

Twenty-four patients [11 males and 13 females; mean (SD) age: 67.8 (22.3) years] with chronic wounds (14 diabetic or venous ulcers; 10 pressure ulcers or chronic surgical wounds) were randomised to receive either a wound-specific supplement (n = 12) or standard supplement (n = 12) for 4 weeks, with ongoing best wound and nutrition care for an additional 4 weeks. At baseline, and at 4 and 8 weeks, the rate of wound-healing, nutritional status, protein and energy intake, quality of life and product satisfaction were measured. Linear mixed effects modelling with random intercepts and slopes were fitted to determine whether the wound-specific nutritional supplement had any effect.

There was a significant improvement in wound-healing in patients receiving the standard nutrition supplement compared to a wound-specific supplement (P = 0.044), although there was no effect on nutritional status, dietary intake, quality of life and patient satisfaction.

The results of the present study indicate that a standard oral nutrition supplement may be more effective at wound-healing than a specialised wound supplement in this clinical setting.

The present study examined temporality in the representation of food in two popular British women's magazines between 1950 and 1998.

A quantitative content analysis of (i) prevalence of cooking, slimming, nutrition advice in articles; (ii) prevalence of food advertising by food type; and (iii) likelihood of various nutrition and consumer messages in advertising was performed on a sample comprising 200 magazines, with 3045 advertisements and 88 articles.

The prevalence of food advertisements decreased (P < 0.001), whereas food articles increased, across decades (P < 0.001). Cooking tips dominated 1950s food writing (100%), contrasting with miniscule coverage in the 1990s (5%). Slimming advice was not represented in 1950s articles and was most common in 1970s articles (55% of articles). Food advertising for all food types decreased in the 1990s decade. There were greater bread and cereals (P < 0.001), protein foods (P = 0.001) and dairy (P < 0.001) advertising in later decades; advertising for sugar- and fat-rich foods (P < 0.001), condiments and baking ingredients (P < 0.001) and beverages (P < 0.001) was greater in earlier decades. Odds of advertising claims for energy, easy digestion, nourishment, general health, economy, good for family (all P < 0.01), pleased others (P = 0.017) and convenience (P = 0.031) were greater in the 1950s and decreased thereafter. Claims around taste and quality were highest in the 1960s (all P < 0.01). Mineral, additive-free, and protein claims were most likely to be invoked in 1970s advertising (all P < 0.01). Low-fat, low-calorie and fibre claims peaked in the 1980s (all P < 0.01), whereas the odds of specific fat claims was greatest in the 1990s (P = 0.015).

Representation of food resonated with prevailing food culture but was not always congruent with nutrition policy.

The present study examined dietary messages conveyed in articles and advertising in two popular British women's magazines, Woman and Home and Woman's Own, between 1940 and 1954.

A qualitative analysis of written content was performed, focusing on regularities evident in content, and addressing the construction of the role of women in relation to food provision, as well as assertions for nutritional health. The setting comprised a desk-based study. The study sample encompassed 37 magazines, and yielded a corpus of 569 articles concerned with food or dietary supplements, of which 80.1% were advertisements.

Ministry of Food dietary advice featured prominently up to 1945 and advocated food consumption according to a simple nutrient classification. Advertising and article content also used this classification; advocating consumption of food and supplements on the grounds of energy, growth and protection of health was customary. Providing food to meet nutritional needs was depicted as fundamental to women's war effort and their role as dutiful housewives. Advertising in 1950s magazines also focused on nutritional claims, with a particular emphasis on energy provision.

These claims reflected the prevailing food policy and scientific understanding of nutritional health. This analysis of food messages in women's magazines provides lessons for contemporary nutrition policy.

Three international surveys were developed aiming to identify the current nutrition educational tools used in the management of phenylketonuria (PKU) and the perceived effectiveness of these tools by clinicians, parents and patients.

The first two surveys were distributed through the Metabolic Dietitians ListServe (pno-metabl@listserv.cc.emory.edu), and the third survey was distributed by international clinics and the National PKU Alliance website (www.npkua.org). A total of 888 responses (S1, n = 88; S2, n = 81; S3, n = 719) were collected from all three surveys. The surveys represent participants from 17 countries, in Europe; North America (USA and Canada); Mexico; Argentina; Turkey; Australia; and Africa (Tunisia).

A consistent decline in ‘parents as role models’ as an educational tool was observed starting at age 10 years. Patients responded they feel their families are the most effective form of education, whereas handouts were selected as the least effective educational tool by patients. Parents responded they feel the most effective educational tool is one-on-one counselling. Patients and parents show a desirable trend in wanting to attend group clinic, even in centres where this type of educational tool is not offered.

There was a discrepancy between clinicians and patient views regarding the perceived effectiveness of the nutrition education tools. Future research is needed surrounding the impact nutrition education may have on improved dietary compliance in patients with PKU.

Although many health disparities arise as a result of socioeconomic inequalities, less is known about the diet quality of women after menopause. The present study aimed to determine the factors affecting food habits and body mass index (BMI) among premenopausal and post-menopausal Mauritian working women.

The study was conducted as a cross-sectional survey in different workplaces located in the nine districts of Mauritius. Mauritian women (n = 400; 215 premenopausal, 185 post-menopausal) were recruited using stratified random sampling. Participants completed a self-reported questionnaire comprising a food frequency questionnaire previously constructed and used to address dietary guidelines that assess the intake of vegetables, fruits, dairy products, cereals, high- and low-fat protein sources, fats and sweetened beverages, as well as questions aiming to elicit socioeconomic profile, menopausal status, physical activity level and demographic data. Height, weight, waist and hip circumferences were measured. An independent sample t-test, chi-squared test and one-way analysis of variance were used for the statistical analyses.

The mean dietary guideline score was significantly higher for post-menopausal than premenopausal women, (P = 0.017). Each socioeconomic status (SES) category of post-menopausal women also demonstrated a higher dietary guideline score than that of premenopausal women (P > 0.05). A high BMI was significantly associated with a low SES of participants (P = 0.042) and post-menopausal stage (P = 0.001).

Low SES and post-menopausal stage are risk factors for obesity among female workers in Mauritius. Although post-menopausal women ate a better diet, their mean BMI was higher than that of premenopausal women.

Unrealistic weight loss expectations (WLEs) and greater body dissatisfaction may be associated with the poor long-term outcomes of dietary and lifestyle weight loss treatments. We evaluated the association between body size, WLEs and body dissatisfaction in young women attempting to lose weight.

Forty-four young healthy women [age range 18–35 years, body mass index (BMI) range 23–40 kg/m²] were recruited. Women were classified as obese (BMI ≥ 30.0 kg/m²) and non-obese (BMI <30.0 kg/m²). The Body Dissatisfaction scale of the Eating Disorder Inventory-2 and the Body Image Assessment for Obesity silhouette charts were used to assess body dissatisfaction. WLEs were categorised according to personal (ideal, happiness, satisfaction, weight history), lifestyle (fitness) and social (career, family acceptance, peer acceptance, mass media, social pressure) factors. Individual WLEs were compared with recommended clinical targets (5%, 10% and 20%) for weight loss.

Body dissatisfaction was lower in non-obese subjects and was directly associated with BMI (P < 0.05). WLEs were directly associated with BMI and the obese group reported greater expectations. Five non-obese subjects (23%) desired to lose more than 20% of their body weight, whereas the proportion was significantly higher in the obese group (17 subjects; 74%). Subjects derived the greatest WLEs from mass media, whereas they perceived that family and friends were supportive of a lesser degree of weight loss.

We observed a mismatch between clinical and personal expectations, and social pressure and interpersonal relationships appear to have a prominent role with respect to influencing the association.

Currently, there is limited evidence about effective strategies to manage childhood obesity and the metabolic syndrome in school settings. The present study aims to analyse changes in the prevalence of being overweight/obese and having the metabolic syndrome in relation to a 10-month lifestyle intervention based on individualised face-to-face sessions and parental education in school settings.

The study sample comprised a cross-sectional sample of 96 overweight/obese Mexican children aged 6–12 years from eight schools. Clinical, anthropometric measurements and 24-h recalls were obtained during each of 13 visits. Laboratory measurements were determined at the beginning and end. The energy-reduced diet was based on dietary recommended intakes. Individualised structured daily meals and a physical activity plan, tailored-made for each child, were provided every 3 weeks at the schools. Parental attendance was required. Student′s t-test, McNemar and Shapiro-Wilk tests and simple linear regression were used for the statistical analysis.

The prevalence of metabolic syndrome fell significantly from 44% to 16% (P < 0.01), high blood pressure fell from 19% to 0%, hypertrigliceridaemia fell from 64% to 35%, high-density lipoprotein-cholesterol ≤ 40 fell from 60% to 41%, hyperglycaemia fell from 1% to 0%, and waist circumference ≥90th percentile fell from 72% to 57%. There was a 2.84 [95% confidence interval (CI) = −4.10 to −1.58; P < 0.01] significant decrease in body mass index percentile and in body-fat percentage (95% CI = −3.31 to −1.55; P < 0.01). Of the overweight children, 32% achieved normal-weight, whereas 24% of the obese ones converted to overweight and 1% reached normal-weight. Physical activity increased 16 min day^–1 (P = 0.02) and 2 days week^–1.

A school-setting lifestyle intervention led to a decreased prevalence of being overweight/obese and to a striking reduction in the prevalence of the metabolic syndrome in a sample of Mexican children.

A substantial proportion of individuals who live in community settings in the UK experience malnutrition. Routine screening for malnutrition by healthcare practitioners has been recommended in many regions. The present study aimed to understand community nurses' perceptions of barriers and facilitators to undertaking nutritional screening.

A qualitative study was undertaken with a purposive sample of community nurses working in one UK healthcare organisation. Semi-structured interviews were used to elicit perceptions of barriers and facilitators. Interviews were digitally recorded, anonymised and transcribed. Initial codes were assigned for salient constructs identified in the transcripts, refined by grouping, and a thematic list was developed.

Twenty district nurses and community matrons were interviewed at which time saturation of the data was achieved. Six themes emerged: supportive organisational culture, time and resource to screen and intervene, ease and acceptability of the screening tool, professional judgement as good as screening, the need for training and sharing good practice, and enhancing communication between care settings.

The findings of the present study suggest that screening is more likely to be completed where an organisation is perceived to have a clear expectation that it is undertaken and also demonstrates this through training and availability of resources. The need for a process or tool that nurses find easy to use and relevant to their practice area was highlighted. Further research should examine the effect of the use of a nutritional screening tool by community nurses on nutritional care planning and intervention.

Vitamin D plays an essential role in bone mineralisation and its deficiency is associated with several chronic diseases. Some studies have reported a deficient status of vitamin D in Spanish and European population. The present study aimed to assess vitamin D intake, dietary sources of this nutrient and its adequacy with respect to the dietary reference intakes (DRI) in a representative sample of Spanish adults.

Four hundred and eighteen adults (aged 18–60 years) from 15 Spanish provinces were studied. They constituted a representative sample of the Spanish adult population. Energy and nutrient intake were determined using a 24-h dietary recall questionnaire for two consecutive days. Vitamin D intake was compared with the DRI for this vitamin.

Mean (SD) vitamin D intake was 3.5 (4.0) μg day^–1 (69.5% of the DRI). Of the participants studied, 81.6% had vitamin D intakes below the DRI and 68.7% had intakes below 67% of the DRI. Of the vitamin D, 91.4% came from food sources and 8.6% came from dietary supplements. The main food sources of vitamin D were fish, eggs, dairy products, cereals, oils and meat. In addition, those subjects who met the DRI for vitamin D had a higher consumption of fish, vegetables and fruits and a lower consumption of meats than those subjects who did not meet the DRI.

Vitamin D intake was inadequate in the sample of the adult Spanish population. Therefore, an increase in the consumption of oily fish, as well as fortified dairy products and cereals, might help to improve vitamin D intake.

Phytochemicals are natural non-nutritive bioactive compounds found in fruits, vegetables, whole grains, nuts and legumes, as well as other plant foods. In the present study, we assessed the dietary phytochemical index (PI) in relation to cardiometabolic risk factors among Iranian adults.

This cross-sectional study was conducted within the framework of third phase of Tehran Lipid and Glucose Study 2006–2008. For the present study, 2567 subjects aged 19–70 years (1129 men and 1438 women) were selected randomly. Dietary data were collected using a validated semi-quantitative food frequency questionnaire with 168 food items. The PI was calculated based on daily energy derived from phytochemical-rich foods. The odds ratios of abdominal obesity, impaired fasting glucose, hypertriglyceridaemia, low high-density lipoprotein-cholesterol and hypertension were assessed across PI quartile categories.

The mean (SD) age of participants was 39.4 (13.2) years. Participants in the upper quartile of PI were older, and had a lower weight and waist circumference. The mean (SD) of the PI was 17.3 (5.6), 25.5 (6.4), 32.7 (8.3) and 42.8 (10.5) in the first, second, third and fourth quartiles, respectively. Compared with those in the lower quartile of PI, participants in the upper quartiles had a 66% lower risk of abdominal obesity [95% confidence interval (CI) = 0.23–0.51] and a 36% lower risk of hypertriglyceridaemia (95% CI, 0.47–0.86), after adjustment for potential confounders.

Higher intakes of phytochemical-rich foods are associated with a lower risk of abdominal obesity and hypertriglyceridaemia as the main cardiometabolic risk factors.

A healthcare professional's aptitude to develop research skills and actively engage in research is necessary to optimise healthcare efficacy. The present study investigated the factors that contribute to research capacity within the Australian dietetic workforce.

Queensland-based dietitians scored their department and individual skill or success in research on a 10-point scale using an anonymous online survey that incorporated the validated Research Capacity in Context tool. Descriptive statistics were assessed against geographical setting, dietetic experience and the proportion of role (Full Time Equivalent; FTE) designated to research. Research activities were defined by the number of items currently involved in or completed in the past 6 months (n = 11). Factors associated with research activities were assessed by multivariable linear regression.

Dietitians (n = 130) identified having a moderate skill or success in 14 research items [mean (SD) 5.1 (1.7)] and perceived that their departments provided a moderate level of research support in 19 research items [mean (SD) 6.1 (2.5)]. Geographical setting, the proportion of role designated to research (FTE) and participation in research activities were associated with individual and department ratings of research skill or success. Research involvement was predicted by the proportion of role (FTE) designated to research (β = 0.34, t = 4.16, P < 0.001) and years of experience in dietetics (β = 0.32, t = 2.67, P < 0.009).

A dietitian's capacity for research is related to professional experience and the designation of research in the role description. The findings of the present study will provide a baseline of research capacity and expertise among dietitians, and also inform the strategic development of building research capacity.

Food models were constructed for nine commonly consumed food items using a range of low cost materials. These were tested among a random sample of 80 school children (aged 10–16 years). A total of 719 estimations were made.

A high percentage (68%) of correct estimations and high correlation (r > 0.95, P < 0.001) for estimated versus actual weight were observed. Bland–Altman analysis indicated 91% of estimations within the limits of agreement. Accuracy and precision was high for both amorphous and non-amorphous foods.

Portion size estimation using realistic food models is found to be accurate and precise and is suitable for use in children.

Orofacial granulomatosis (OFG) is a rare disease of unknown cause. A cinnamon- and benzoate-free diet is successful in up to 72% of patients. Phenolic acids are among the chemical constituents restricted in this diet, which avoids some but not all of these structurally similar compounds. The present study aimed to: (i) develop a novel diet low in phenolic acids; (ii) implement this in a small clinical trial; and (iii) assess its nutritional adequacy.

A literature review identified 10 papers quantifying phenolic acids from which 91 10-mg phenolic acid exchanges were devised. A phenolic acid exclusion diet with precautionary micronutrient supplementation was designed and implemented in 10 patients. Phenolic acids were excluded for 6 weeks and were reintroduced at a rate of one exchange every second day for 6 weeks. Wilcoxon matched pairs tests analysed disease outcomes measured by an oral disease severity scoring tool at weeks 0, 6 and 12. Nutritional adequacy was assessed, excluding micronutrient supplementation, at weeks 0 and 6, and compared intakes with dietary reference values.

The diet was nutritionally inadequate for a range of micronutrients. Seven of 10 patients responded. Mean [standard deviation (SD)] severity scores improved from week 0–6 [20.8 (9.39) and 10.1 (5.72); P = 0.009] and were maintained in five patients who completed the reintroduction [6.6 (3.13) and 7.2 (5.54); P = 0.713].

A low phenolic acid diet with micronutrient supplementation holds promise of a novel dietary treatment for OFG. Further work is required in larger studies to determine long-term outcomes.

Previous studies highlight a possible association between alcohol-drinking patterns and dietary inadequacies, which may have negative implications, particularly for women of child-bearing age. The present study aimed to compare dietary adequacy among alcohol drinkers versus nondrinkers in Inuvialuit women of child-bearing age.

A cross-sectional survey of 92 randomly selected women of childbearing age (19–44 years) was conducted in three communities in the Northwest Territories of Arctic Canada, using a validated quantitative food frequency questionnaire. Data were analysed to compare mean daily energy and nutrient intakes, dietary adequacy and nutrient densities (per 4184 kJ) between alcohol drinkers and nondrinkers, as well as heavy drinkers and nonheavy drinkers, using the nonparametric Wilcoxen rank sum test.

The response rate was between 65% and 85% depending on the community sampled. Of the study participants, 54% (n = 49) were drinkers and 46% (n = 42) were nondrinkers. Of the drinkers, 45% (n = 22) were heavy drinkers. Mean energy intakes were high among all women, although they were significantly higher among drinkers [17 179 kJ (4106 kcal)] compared to nondrinkers [13 317 kJ (3183 kcal)]. There were no significant differences in nutrient intake between the two groups; however, drinkers had a lower nutrient density for most nutrients. Heavy drinkers had a significantly lower nutrient density for all nutrients, except protein, iron, and vitamins B₆, C and D, compared to nonheavy drinkers.

The findings of the present study provide evidence of inadequate dietary intake among Inuvialuit of child-bearing age, regardless of alcohol-drinking behaviour.

The present study explored the association between dairy food consumption and the risk of the metabolic syndrome in Korean adults using the most recent nationally representative data.

The study sample comprised 4862 Korean adults (≥19 years) who participated in the fifth Korean National Health and Nutrition Examination Surveys. Dairy food consumption was assessed using a food frequency questionnaire. The metabolic syndrome was defined according to the joint interim statement of the International Diabetes Federation and the American Heart Association/National Heart, Lung and Blood Institute.

We found that the prevalence of the metabolic syndrome was significantly lower in subjects with higher milk or yogurt consumption (P < 0.0001). Adjusted odds ratios (ORs) for abdominal obesity and high fasting glucose were significantly lower among subjects in the highest (≥ once per day) than in the lowest (none or rarely) category of milk consumption after adjusting for potential risk factors [OR = 0.68, 95% confidence interval (CI) = 0.50–0.93, P for trend = 0.0314; OR = 0.82, 95% CI = 0.65–1.03, P for trend = 0.0233]. The adjusted ORs for lower high-density lipoprotein cholesterol was 28% lower among subjects in the highest compared to subjects in the lowest category of yogurt consumption (OR = 0.72, 95% CI = 0.52–1.00, P for trend = 0.0197). Furthermore, higher consumption of milk or yogurt was found to be significantly associated with a lower risk of the metabolic syndrome (OR = 0.71, 95% CI = 0.55–0.93, P for trend = 0.0066; OR = 0.71, 95% CI = 0.48–1.05, P for trend = 0.0067).

High intakes of dairy foods may be associated with a lower risk of the metabolic syndrome.

Ulcerative colitis (UC) is often associated with nutritional deficiency, which appears to contribute to the progression of UC severity. The present study aimed to evaluate nutritional status and dietary intake in UC remission patients.

The present study comprised a cross-sectional study in which variables such as extent of disease (distal colitis, left-sided colitis, pancolitis), remission period, sex and age were recorded. Extent of disease was assessed by the results of a colonoscopy and dietary intake was evaluated by using 3-day, 24-h recalls. A Kruskall–Wallis test was used to compare the intake of macro- and micronutrients among the three study groups. The analysis was complemented by the Mann–Whitney test. A logistic regression analysis was performed to identify predictive factors of extent of disease (pancolitis versus left-sided colitis versus distal colitis).

The median (range) age of the 59 patients was 49.0 (37.0–63.0) years and 53.3% were female. Twenty-six (44.1%) patients had distal colitis, 11 (18.6%) patients had left-sided colitis and 22 (37.3%) patients had pancolitis. A high probability of an inadequate intake of fibre (100%), fat soluble vitamins (>40% for vitamin A and >95% for vitamin E), vitamin C (>34%), calcium (>90%) and magnesium (>50%) was identified in the study group. Vitamin D intake (odds ratio = 0.60; 95% confidence interval = 0.39–0.94; P < 0.05) was significantly associated with increased intestinal damage.

A large number of individuals showed an inadequate intake of nutrients. In addition, the consumption of vitamin D was significantly associated with extent of disease.

There is an increasing number of adults with phenylketonuria (PKU) on a low phenylalanine diet. In the general population, an increasing body mass index (BMI) in the UK is a major problem with associated co-morbidities. The present study aimed to identify whether patients with diet-treated PKU have obesity rates comparable to those in the general population.

Two hundred and thirty-six PKU subjects (49% male, 51% female), aged >16 years, who were diagnosed by newborn screening and were receiving a low phenylalanine diet, were identified from seven metabolic centres in the UK. Retrospective data were collated on age, sex, BMI and mean phenylalanine concentration over the previous 12 months.

Mean (SD) phenylalanine concentration for all 236 subjects was 789 (311) μm; mean (SD) BMI was 26 (5.4) kg m⁻² [males 25 (4.3) kg m⁻², females 27 (6.2) kg m⁻²]; mean (SD) age was 26 (7) years; and 55% had a BMI > 25 kg m⁻². The percentage of subjects with a BMI >25 kg m⁻² and >30 kg m⁻², as well as increasing obesity with age, was similar to the UK population. A correlation was observed between increasing BMI and a higher phenylalanine concentration (r = 0.243, P = 0.001).

The number of overweight and obese patients with diet-treated PKU in the UK is a concern. This could lead to other obesity-related complications increasing the complexity of diet and the cost of their care. There is a need to educate patients with respect to adopting a healthy, low phenylalanine diet and lifestyle to prevent further rises in BMI.

Front-of-pack (FOP) nutrition labelling has been proposed as a tool for helping consumers make healthy choices. Before determining its effects on consumer behaviour, factors involved in its use must be elucidated, i.e. understanding and acceptability on the part of the consumer. Among five FOP labels, we sought to determine which formats were most easily understood and accepted by a large sample of adults.

Among 39 370 adults who participated in the French Nutrinet-Santé cohort study, understanding and indicators of acceptability (attitude, liking, visual attractiveness and perceived cognitive workload) were measured for five FOP labels: The currently used ‘multiple traffic lights’ (MTL) and ‘simple traffic lights’ (STL), and the ‘colour range’ logo (CR), the ‘green tick’ and the PNNS logo. We investigated the contribution of the different elements to consumer perception of FOP labels using multiple correspondence analyses.

Over half of the sample population showed a high level of understanding and perceived no discomfort in terms of the different logos. Label formats were positioned along an acceptability gradient ranging from acceptance to rejection, consisting of ‘liking’, ‘attractiveness’ and indicators of perceived cognitive workload. MTL was significantly more often liked and was viewed as reliable and informative. MTL, STL and the green tick performed better than the CR and PNNS logos in terms of ease of identification and comprehension. CR was clearly the least appreciated and it had the most complex format.

Consumers prefer FOP labels which give complete, reliable and simplified information on the nutrient quality of foods.

The prevalence of obesity in adults with intellectual disabilities (ID) is rising, although the evidence base for its treatment in this population group is minimal. Weight management interventions that are accessible to adults with ID will reduce the inequalities that they frequently experience in health services. This short report compared the effectiveness of weight management in those with and without ID who completed nine sessions of a multi-component weight management programme.

TAKE 5 is a 16-week multi-component weight management intervention for adults with ID and obesity [body mass index (BMI) ≥30 kg m^–2]. This intervention is an adaption of the weight management programme provided by the Glasgow & Clyde Weight Management Service (GCWMS) for adults without ID and obesity (National Health Service based). Fifty-two participants of the TAKE 5 programme were individually matched by baseline characteristics (sex, age and BMI) with two participants without ID of the GCWMS programme. Comparisons in terms of weight and BMI change and rate of weight loss were made for those who attended all nine sessions.

There were no significant differences between the groups in the amount of weight loss (median: −3.6 versus −3.8 kg, respectively, P = 0.4), change in BMI (median: −1.5 versus −1.4 kg m^–2, P = 0.9), success of achieving 5% weight loss (41.3% versus 36.8%, P = 0.9) and rate of weight loss across the 16-week intervention.

A multi-component weight loss intervention can be equally effective for adults with and without ID and obesity.

Polyphenols are bioactive compounds widely found in fruit, vegetables and beverages of plant origin. Epidemiological studies have suggested an association between polyphenol intake and health; antioxidant, anti-inflammatory, anti-carcinogenic and other bioactivities may contribute to these beneficially protective effects. To date, most epidemiological studies describing polyphenol intake have been limited by the information available in nutrient databases. The present study aimed to determine the total and individual polyphenol intake among institutionalised elderly people living in Asturias (North of Spain) and to identify the major dietary sources of polyphenol classes and subclasses.

The study sample comprised 304 subjects with a mean age of 73.2 years for men and 76.8 years for women. Dietary intake was assessed by means of a food frequency questionnaire. Phenol content was estimated from the Phenol-Explorer database, as developed at the French National Institute for Agricultural Research. The contribution of each food to the total and subgroup intake of polyphenols was calculated as a percentage.

Except for flavonones, total polyphenol intake, groups and subgroups, was higher in men than women. The main polyphenol groups contributing to total polyphenol intake were flavonoids (62%) and phenolic acids (35.5%). We identified red wine, coffee, apples, oranges and green beans as the major food sources providing total polyphenol intake. Flavonoid and lignan intake was lower for those aged >80 years. Smoking habit, red wine consumption, physical activity and a Mediterranean diet score were associated with a greater polyphenol intake.

The present study provides information on polyphenol intake in an elderly Mediterranean population with a level of detail that has not been achieved previously. The identification of age and lifestyle factors associated with the intake of polyphenols may be useful in future studies regarding polyphenols.

The use of specific behavioural strategies such as portion control or meal planning is important for weight management, although studies of determinants of strategy use are limited. The present study explored the concept of hope and its association with the use of behavioural strategies.

Data were obtained from a larger cross-sectional survey conducted in 2009 among 178 patients of a city-county sponsored primary care clinic in the Midwest region of the USA. Hope was measured with subscales representing ‘agency’ (determination in meeting goals) and ‘pathways’ (perception of ways to meet goals) and a total score. Diet and physical activity-related strategies were captured with five and two scales, respectively.

Analyses showed a significant (P < 0.05) association between both the total hope score and the agency subscale and all behavioural strategy measures. The pathways subscale was significantly associated with physical activity-related strategies, and a subset of diet-related strategies.

The hope measures should be explored further in the context of a weight loss intervention to determine their predictive association with the use of specific behavioural strategies.

Water balance is achieved when water intake from solid and fluid foods and drinking water meets water losses, mainly in sweat, urine and faeces. Seasonality, particularly in Mediterranean countries that have a hot summer, may affect water loss and consequently water balance. Water balance has not been estimated before on a population level and the effect of seasonality has not been evaluated. The present study aimed to compare water balance, intake and loss in summer and winter in a sample of the general population in Greece.

The Water Balance Questionnaire (WBQ) was used to evaluate water balance, estimating water intake and loss in summer (n = 480) and in winter (n = 412) on a stratified sample of the general population in Athens, Greece.

In winter, mean (SD) water balance was −63 (1478) mL/day⁻¹, mean (SD)water intake was 2892 (987) mL/day⁻¹ and mean (quartile range) water loss was 2637 (1810–3922) mL/day⁻¹. In summer, mean (SD) water balance was −58 (2150) mL/day⁻¹, mean (SD) water intake was 3875 (1373) mL/day⁻¹ and mean (quartile range) water loss was 3635 (2365–5258) mL/day⁻¹. Water balance did not differ between summer and winter (P = 0.96); however, the data distribution was different; in summer, approximately 8% more participants were falling in the low and high water balance categories. Differences in water intake from different sources were identified (P < 0.05).

Water balance in summer and winter was not different. However, water intake and loss were approximately 40% higher in summer than in winter. More people were falling in the low and high water balance categories in summer when comparing the distribution on water balance in winter.

The usual daily weight fluctuations of well-hydrated older hospitalised people have not been documented internationally. To date, dehydration assessments based on a short-term body weight change defined as >2% have been drawn from healthy population data. The present pilot study aimed to describe usual body weight fluctuation at the same time of day over a 3-day time frame in well-hydrated older hospitalised adults.

An observational study of non-acute inpatients (n = 10) admitted to a Geriatric and Rehabilitation Unit, aged ≥60 years, assessed as well-hydrated, mobile, non-amputee and without conditions that influenced fluid status, was conducted. Participants were weighed hourly over a 9-h period for 3 days. Food and fluid intake, clothing items added or removed, and urine and faecal output were recorded.

Weight fluctuation for each participant [mean (SD) 80.2 (4.2) years; male 60.0%, n = 10] over 3 days ranged from 1.1% to 3.6%. Over 3 days, 40.0% (4/10) of participants had weight fluctuations of >2% and 20% (2/10) had weight fluctuations of >3%. Time of weigh-in accounted for 99.8% of the variation in weight fluctuation (P < 0.05), with the lowest fluctuations observed when weights were compared at the same time each day (≤0.4 kg).

Weights recorded at the same time daily had the greatest accuracy. Given that the range 1.1–3.6% was within normal weight fluctuations for well-hydrated older hospitalised participants, the weight change indicative of dehydration remains to be established in this setting but appears greater than conventionally used figures.

In flexible insulin therapy, determination of the prandial insulin dose only takes into account the carbohydrate content of the evening meal, and not the protein content. Protein can, however, contribute to gluconeogenesis. We compared the glycaemic effect of a standard evening meal with that of a test evening meal enriched in protein.

The present study was conducted in 28 C-peptide negative patients with type 1 diabetes. Two evening meals that were similar in content, except that one was enriched by the addition of 300 g of 0%-fat fromage frais, were taken on two consecutive days. Insulin doses were maintained exactly the same before both evening meals. Patients were monitored with a continuous glucose-monitoring device.

Patients ate similar quantities at both evening meals, except for protein (21.5 g more at the test evening meal). The preprandial insulin dose was 0.96 (0.4) U per 10 g carbohydrates. After correction for differences of interstitial glucose at the start of the evening meals, both interstitial and capillary glucose levels were similar after both evening meals, except for the late-post-prandial interstitial glucose level.

We found no effect of dietary protein on post-prandial-, overnight- or late-night glucose levels in patients with type 1 diabetes. This confirms that dietary proteins need not be included in the calculation of prandial insulin dose.

Coeliac disease can be controlled only through adherence to a gluten-free diet. This diet is highly restrictive and can be challenging to maintain. It has been linked with elevated levels of psychological distress, including depression, anxiety and social phobia.

Narratives on living with coeliac disease were written by 130 adult members of Coeliac UK (mean age 52.7 years; mean time since diagnosis 10.2 years; 67% sample female; 28% male). Qualitative analysis using grounded theory methods identified five key categories: living with widespread ignorance; social invisibility; creating a coeliac community; a changed identity; grief – and accepting the trade-off.

A psychosocial model of living with coeliac disease was constructed from the findings, the central category of which was the changed identity of those diagnosed with the condition. Grief was experienced in relation to a loss of the former diet, changed personal and social identities, loss of social confidence and loss of social activities. Grief was generally mitigated over time as adjustments were made to changes in identity and lifestyle. Creating (or becoming part of) a coeliac community was a strategy enabling those with coeliac disease to re-establish their identities and increase social recognition and acceptance of the condition.

Gluten-free living entails a substantial restriction of food choice. The losses and changes entailed impact on the personal and social identities of those living with coeliac disease, and on the behaviour of others towards them. Psychosocial interventions focussed on facilitating coping and adjustment may benefit those experiencing difficulties.

To date, there are no dietary intervention studies available jointly examining the changes produced in cardiometabolic risk indices and diet quality assessed with the Healthy Eating Index 2005 (HEI-2005). The present study aimed to evaluate the effect of a 3-month multicomponent lifestyle intervention on several cardiometabolic risk indices, physical activity levels and diet quality.

A total sample of 108 hypercholesterolaemic adults (40–60 years old) were randomised to two intervention groups provided with and instructed to consume daily: (i) plain milk (n = 37) or (ii) enriched milk (n = 40) respectively; both groups were attending a 3-month dietary counselling programme. For the needs of the present study both intervention groups were analysed together IG: n = 77) and were compared against a control group following usual diet (CG: n = 31).

Regarding diet quality HEI scores for ‘milk’ (P = 0.021), ‘dark green/orange vegetables and legumes’ (P = 0.050) and ‘total HEI score’ (P = 0.045) were improved in the IG compared to the CG. The IG also improved ‘whole grains’ and ‘calories from solid fats, alcoholic beverages and added sugars’ scores compared to their baseline values. Both groups improved the ‘total vegetable’ HEI score. Regarding physical activity levels and cardiometabolic risk indices, the IG significantly increased the daily number of steps (P = 0.005) and decreased body weight (P = 0.021), body mass index (P = 0.019) and waist circumference (P = 0.027) to a higher extent compared to the changes observed in the CG. Moreover, the IG significantly decreased systolic (P = 0.001) and diastolic blood pressure (P = 0.050) compared to baseline values.

The present study revealed that this 3-month lifestyle and nutrition counselling intervention programme appears to have favourable effects on diet quality, physical activity levels, anthropometric and certain cardiometabolic risk indices.

Inadequate nutrient intake and physical inactivity may have adverse health consequences. The present study aimed to describe young female students' dietary intake, food choices and physical activity (PA) patterns, and also to determine the influence of dietary avoidance of meat and poultry on nutrient intake.

A cross-sectional study of female university students was conducted. Questionnaires were used to measure dietary intakes, food habits and PA. Anthropometric measurements of participants included height, weight and calculated body mass index (BMI).

There were 308 participants with a mean (SD) age of 22.9 (3.9) years and a BMI of 21.5 (2.8) kg m^–2; 78% were in the BMI range 18.5–24.9 kg m^–2. Of those who responded to the PA questionnaire (n = 218), 53% reported activity ≥150 min per week, with walking being the largest contributor. Completed food frequency questionnaires were returned by 256 participants. National recommendations for servings of cereals, vegetables, meat, fish and energy-dense ‘extra foods’ were not met by the majority of participants. Avoidance of animal foods was reported in 23% of women, and resulted in lower intakes of omega-3 fatty acids, vitamin B₁₂, selenium and zinc (P < 0.05) compared to non-avoidance. Iron intake from animal sources decreased significantly (P < 0.05) with the increase in meat and poultry avoidance.

Female students had a healthy weight and reported adequate physical activity. However, in comparison to meat and poultry consumers, the avoidance of these foods was associated with a lower intake of some micronutrients. A sustained low intake of micronutrients may lead to adverse health effects in the longer-term, such as compromised immune function and iron deficiency anaemia.

Research has suggested that patients and treatment providers hold different beliefs and models of obesity. This could impact upon the consistency and quality of interventions for weight management. The present study investigated the attitudes and beliefs of health professionals, commercial weight management advisors (expert patients) and overweight and obese dieters, towards obesity.

Data were collected using a self-administered questionnaire from 287 health professionals, 85 expert patients and 116 dieters. Respondents gave their views on obesity causation and consequences, and the most efficacious means to manage obesity. Demographic data and self-reported height and weight were also collected. Factor analysis, analysis of variance and t-tests were used to analyse the data.

Health professionals, expert patients and dieters held similar models of obesity, identifying the same causes (lifestyle causes), consequences (medical consequences) and treatments (current recommended options) of obesity/overweight.

The findings of the present study indicate a broader similarity between beliefs and attitudes of those involved in obesity treatment and those that they aim to treat than was previously assumed. The concordance of beliefs between patients and treatment providers is an encouraging finding and may have important implications for public health strategies in this area.

Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioural disorder of childhood, affecting 3–5% of school-age children. The present study investigated whether the supplementation of soy-derived phosphatidylserine (PS), a naturally occurring phospholipid, improves ADHD symptoms in children.

Thirty six children, aged 4–14 years, who had not previously received any drug treatment related to ADHD, received placebo (n = 17) or 200 mg day^–1 PS (n = 19) for 2 months in a randomised, double-blind manner. Main outcome measures included: (i) ADHD symptoms based on DSM-IV-TR; (ii) short-term auditory memory and working memory using the Digit Span Test of the Wechsler Intelligence Scale for Children; and (iii) mental performance to visual stimuli (GO/NO GO task).

PS supplementation resulted in significant improvements in: (i) ADHD (P < 0.01), AD (P < 0.01) and HD (P < 0.01); (ii) short-term auditory memory (P < 0.05); and (iii) inattention (differentiation and reverse differentiation, P < 0.05) and inattention and impulsivity (P < 0.05). No significant differences were observed in other measurements and in the placebo group. PS was well-tolerated and showed no adverse effects.

PS significantly improved ADHD symptoms and short-term auditory memory in children. PS supplementation might be a safe and natural nutritional strategy for improving mental performance in young children suffering from ADHD.

The present comparative cross-cultural study aimed to explore the relationship between eating behaviour and sociocultural influences with respect to appearance and body image in female university students from two cultural contexts, namely Cyprus and Lebanon.

The Dutch Eating Behavior questionnaire (DEBQ) and the Perceived Sociocultural Influences on Body Image and Body Change Questionnaire were used to assess sociocultural influences and body image, respectively, in 200 students from each country.

The results indicated that the Lebanese students were more likely to engage in emotional and external eating and their body image was impacted to a larger extent by sociocultural agents, including media influences, compared to the Cypriot students. Also, a positive relationship was found between emotional and external eating in both cultures. Finally, sociocultural influences correlated positively with external eating only in the Cypriot sample.

Culture-specific factors, such as the societal values and norms, as well as the Westernisation history of each country, are discussed as underpinnings for the differences found. These findings are significant for understanding the rise of eating pathology in these two cultures and provide evidence for a need to consider cultural environment when designing public health policies addressing the negative aspects of nutrition transition.

Innovative dietary intake measurement tools, such as web-based food records, are becoming increasingly available for self-monitoring. However, the accuracy of this method has not been well studied. This pilot study aimed to evaluate the accuracy of energy intake (EI) estimated by a web-based food record, by comparison with total energy expenditure (TEE) measured by doubly-labelled water (DLW) in overweight and obese women.

Total energy expenditure (TEE) was assessed in weight stable (±1 kg) women (n = 9), with a mean (SD) age of 34.5 (11.3) years and body mass index of 29.2 (1.4) kg m^–2 over 10 days using the DLW technique. All food and beverages were self-reported for 9-days using a web-based food record and mean daily EI calculated. Food record accuracy was assessed by calculating the absolute (EI − TEE) and percentage (EI/TEE × 100) differences between EI and TEE. Women were identified as under-reporters of EI based on the 95% confidence limits of the expected EI : TEE of 1.

The mean (SD) self-reported EI was 8351 (1225) kJ day⁻¹ [1996 (293) kcal day⁻¹] and TEE was 10 648 (1774) kJ day⁻¹ [2545 (424) kcal day⁻¹]. The mean (SD) absolute difference in self-reported EI and TEE was −2301 (1535) kJ day⁻¹ [−550 (367) kcal day⁻¹], representing a mean reporting accuracy of 79.6% (14.1%), with four participants under-reporting EI.

This pilot study highlights the opportunity for the use of the Internet as a novel medium for recording and assessing dietary intake. Although further research is needed in more diverse population groups, the accuracy of web-based food records for assessing EI appears to be consistent with other published dietary intake methods.

Inuit in Nunavut, Canada, are currently undergoing a nutritional transition that may contribute to an increased prevalence of chronic disease. Information is lacking about the extent to which contemporary Inuit diets are meeting current dietary recommendations.

A culturally appropriate quantitative food frequency questionnaire (QFFQ) developed and validated for Inuit in Nunavut, Canada, was used to assess food and nutrient intake in a cross-sectional sample of adults.

Participants included 175 women and 36 men with mean (SD) ages of 42.4 (13.2) and 42.1 (15.0) years, respectively. The response rate for those who completed the study was 79% with 208 QFFQs included for analysis. Reported mean daily energy intakes were: men 15 171 kJ (3626 kcal); women 11 593 kJ (2771 kcal). Dietary inadequacy was expressed as the percentage of participants reporting intakes below the sex- and age-specific estimated average requirements (EARs). For nutrients without EARs, adequate intakes were used. Energy and sodium intakes exceeded the recommendations. Less than 10% of participants met recommendations for dietary fibre intake. Vitamin E intakes were below EARs for ≥97% of participants, whereas >20% reported inadequate vitamin A, folate and magnesium intakes. Among women, >50% reported inadequate calcium and vitamin D intakes. Non-nutrient-dense foods contributed 30% of energy, 73% of sugars and 22% of fat. Traditional foods contributed 56% of protein and 49% of iron.

The present study demonstrates a relatively high prevalence of inadequate nutrient intakes among Inuit. The results may be used to monitor the nutrition transition among Inuit, evaluate nutritional interventions, and inform public health policy decision-making.

The present study aimed to assess the association of total and regional body fat percentage (FP) and lean mass (LM) with vitamin D deficiency {serum 25-hydroxyvitamin D [25(OH)D] <20 ng mL⁻¹} using the data of the Fourth Korea National Health And Nutrition Examination Survey (KNHANES IV).

Subjects were participants of the KNHANES IV conducted in 2009 and were aged ≥19 years. In 6791 participants, serum 25(OH)D, body composition [body mass index, waist circumference, and total and regional (trunk and legs) FP and LM by dual energy X-ray absorptiometry] were measured. Confounders (age, residential place, housing status, occupation, smoking, alcohol use, physical activity, medical history and calcium intake per day) were assessed.

After adjusting for confounders, vitamin D deficiency was significantly associated with FP with the odds ratios (ORs) from 1.09 to 1.20, and LM with the ORs from 0.81 to 0.87 in men. In men, serum 25(OH)D remained inversely associated with FP tertiles after adjustment for LM, and positively with LM tertiles after adjustment for FP. When FM tertiles and LM tertiles were combined in men, the OR for vitamin D deficiency was 2.2 (P < 0.05) in the combined subgroup of highest total FM tertile and lowest total LM tertile compared to the subgroup of lowest total FM tertile and highest total LM tertile. However, these associations were nonsignificant or inconsistent in women.

The associations of vitamin D deficiency with body fat and lean mass were significant in Korean men but were inconsistent in Korean women.

Although there is increasing evidence of barriers to nutritional health among elderly assisted-living residents, there has not been the same emphasis when examining the ways in which these individuals experience their mealtimes, as well as the factors that they perceive as contributing to their overall sense of health and well-being. Mealtimes may be disregarded as being particularly unimportant or hurried and overlooked, especially for those residents who may be lonely and have feelings of isolation, ultimately leading to a reduced food intake and poor nutrition.

A convenience sample of 38 men and women, aged ≥65 years, were selected from four assisted-living facilities in and around Montclair, NJ, USA, to participate in focus group discussions. Data were analysed using content analysis procedures.

Participants described their experiences of mealtimes, and the factors contributing to an overall sense of well-being during these occasions. The ability to make healthy food choices, socialise, interact with staff, friends and family members, and enjoy a tasty meal in a warm and inviting dining environment, may provide a dignity that is unmatched by other services.

The findings of the present study highlight the importance of maintaining the health of elderly assisted-living residents through strategies that enhance their mealtime experiences. Listening to the food voice of elderly through research such as that carried out in the present study will help policy makers develop a plan that will effectively deal with systemic barriers prevalent in these facilities, and incorporate strategies to motivate and encourage their residents to increase their food intake and improve their health and well-being.

Bread has been identified as a major contributor to the excessive salt (sodium chloride) intake of consumers in many countries, some of which have very high incidences of hypertension and related cardiovascular complications, such as stroke. This has prompted a global rise in interest in the salt content of breads produced and consumed in many other countries.

The sodium contents of retail samples of 100 brands of Nigerian white bread were determined by photometry with a view to estimating the relative contribution of bread to the recommended daily sodium intake of both normotensive and hypertensive adults in the country.

The salt content of the bread samples varied extensively, ranging from 0.51 g per 100 g (0.51%) to 1.8 g per 100 g (1.8%). The average salt content was 1.36 g per 100 g. Based on an estimated consumption of six slices of bread (about 180 g) per meal of bread, this equates to a daily intake of between 0.99 g and 3.33 g of salt from bread alone. This represents between 19.8% and 66.6% of the recommended daily allowance of 5 g for normotensive adults, and between 24.75% and 83.25% of the recommended daily allowance of 4 g for hypertensive adults.

The consumption of some brands of bread by normotensive and hypertensive adults puts them at great risk of exceeding their recommended daily allowance for salt. Thus, there is an urgent need to regulate the amount of salt added to bread. In the interim, compelling bakers to declare the salt content of their products on the packaging could help consumers, especially hypertensive adults, avoid brands with a high salt content.

Patients undergoing radiotherapy or chemoradiotherapy treatment for head and neck cancer have an increased risk of malnutrition, and may require enteral feeding via nasogastric or gastrostomy tube. The aim of this audit was to examine current enteral feeding practice, mortality, morbidity and 6-month outcome data of head and neck cancer patients receiving radical (chemo)radiotherapy at a regional cancer centre and to compare the results with a regional head and neck cancer gastrostomy audit.

A 2-year audit was conducted (2006–2008). Inclusion criteria were all adult patients diagnosed with squamous cell carcinoma of the head and neck, receiving radical radiotherapy or chemoradiotherapy treatment. The first-year data were collected retrospectively, and the second-year data were collected prospectively. Data were collected on all patients requiring enteral feeding with 6-month outcome data relating to route of nutrition.

Approximately 14% (n = 32/223) of patients were admitted for nasogastric feeding as a result of inadequate oral alimentation. On admission, 94% were at risk of refeeding syndrome, taking a mean (SD) of 11 (4.9) days to reach full nutritional requirements. Mean (SD) length of hospital stay was 13 (5.1) days. No major complications from nasogastric tube insertion were found. The mean (SD) length of nasogastric feeding was 72 (20.1) days with 89.6% managing full nutritional requirements orally at 6 months.

Patients requiring enteral feeding during treatment were fed via a nasogastric tube, rather than via a prophylactic gastrostomy tube. Compared with the regional gastrostomy audit results, our patients had a lower clinical risk/complication rate, with a greater proportion tolerating full oral intake at 6 months. Therefore, nasogastric feeding, rather than prophylactic gastrostomy tube feeding, could be a more appropriate method of enteral feeding in this patient group.

Individuals with coeliac disease (CD) and those with noncoeliac gluten sensitivity (GS) have reported difficulty following a gluten-free diet (GFD); however, few studies have explored the link between the food label, gluten-free (GF) claims and the difficulty associated with following a GFD.

The present study surveyed adults with CD (n = 1,583) and adults with GS (n = 797) about their reported difficulty following a GFD, including assessing the role of food labels and GF claims, as well as other factors known to contribute to this difficulty. A two-sample t-test and chi-squared tests for equality of means or proportions were used for the descriptive data and ordinal logistic regression (OLR) was used to model associations.

On average, individuals with GS reported slightly more difficulty following the GFD than did participants with CD. According to the OLR results, reading the food label often was significantly associated with less reported difficulty following a GFD, whereas consuming packaged processed foods and looking for GF claims more often were significantly associated with more reported difficulty for both respondent groups.

Individuals with GS may rely more heavily on the GF claim for information about a product's gluten content. Individuals with CD, on the other hand, may be more experienced food label readers and may rely more on the ingredient list for finding GF foods. More studies are needed aiming to understand the role of the food label in facilitating consumers' ability to follow a GFD.

The present study aimed to examine the agreement between measurements of standing height and self-reported height, height measured with a sliding caliper, and height estimated from either demispan or knee height in elderly patients.

Fifty-five patients (mean age 79 years) at a Swedish hospital were included in this observational study. The participants' heights were evaluated as the standing height, self-reported height, height measured in a recumbent position with a sliding caliper, and height estimated from the demispan or knee height.

The measurements made with a sliding caliper in the recumbent position agreed most closely with the standing height. Ninety-five percent of the individuals' differences from standing height were within an interval of +1.1 to −4.8 cm (limits of agreement). Self-reported height and height estimated from knee height differed relatively strongly from standing height. The limits of agreement were +5.2 to −9.8 cm and +9.4 to −6.2 cm, respectively. The widest distribution of differences was found in the height estimated from the demispan, with limits of agreements from +11.2 to −9.3 cm.

When measuring the height of patients who find it difficult to stand upright, a sliding caliper should be the method of choice, and the second choice should be self-reported height or the height estimated from knee height. Estimating height from the demispan should be the method of last resort.

Untreated glycogen storage disease (GSD)-1a patients experience hypoglycaemia and growth retardation. The present study examined the effects of dietary interventions on the maintenance of normoglycaemia.

Clinical trials were identified from EMBASE (January 1980 to November 2011), MEDLINE (January 1948 to November 2011) and the Cochrane Central Register of Controlled Trials (2011, Issue 4). The intermittent administration of uncooked cornstarch was compared with: (i) continuous nocturnal feeding of dextrose; (ii) modified uncooked cornstarch; and (iii) dextrose and an uncooked cornstarch–dextrose mixture. One author extracted the data, and assessed the trial eligibility and risk of bias. Quality assessment and data extraction were conducted and checked independently.

Of 41 articles retrieved, five controlled trials (49 participants) were identified with follow-up at 2 days to 14 years. Results from three nonrandomised controlled trials comparing uncooked cornstarch with continuous nocturnal feeding of dextrose were pooled in a meta-analysis based on a fixed-effect model. Twenty-six participants (three trials) receiving uncooked cornstarch showed a significant increase in blood glucose concentration: mean difference (MD) 0.62 mmol L⁻¹ [95% confidence interval (CI) = 0.23–1.00] (P = 0.002), 21 (two trials) increased serum insulin: MD 62.37 pmol L⁻¹ (95% CI = 32.19–92.55) (P < 0.0001) and 22 (three trials) increased plasma total cholesterol: MD 0.68 mmol L⁻¹ (95% CI = 0.17– 1.20) (P = 0.01) compared to continuous nocturnal feeding of dextrose. Twenty-eight subjects (three trials) showed decreased plasma lactate after nocturnal feeding: MD –0.42 mmol L⁻¹ (95% CI = −0.58 to −0.25) (P < 0.00001).

Short- to long-term overnight intermittent administration of uncooked cornstarch prevents nocturnal hypoglycaemia in GSD-1a children more effectively than continuous nocturnal feeding of dextrose.

Some small cohort studies have noted that obesity co-exists with lower serum iron levels. The present study aimed to examine the association between being overweight and iron deficiency (ID) in a large cohort of Greek children and adolescents.

A representative sample of 2492 primary schoolchildren aged 9–13 years old was examined. Anthropometric, biochemical, clinical, dietary intake and physical activity data were collected.

The prevalence of ID and iron deficiency anaemia (IDA) was higher in obese boys and girls compared to their normal-weight peers (P < 0.05). Serum ferritin was higher in obese compared to normal-weight boys (P = 0.024) and higher in obese compared to normal-weight and overweight girls (P = 0.001). By contrast, a negative association was found between transferrin saturation and adiposity in both boys and girls (P = 0.001 and P = 0.005). Furthermore, obese girls had significantly higher fibre intake than normal-weight girls (P = 0.048) and also overweight and obese boys and girls recorded significantly fewer pedometer steps than their normal-weight peers (P < 0.001). Finally, obesity more than doubled the likelihood of ID in both boys (odds ratio = 2.83; 95% confidence inteval = 1.65–4.85) and girls (odds ratio = 2.03; 95% confidence interval = 1.08–3.81) after controlling for certain lifestyle and clinical indices as potential confounders.

The present study shows that obese children and adolescents were at greater risk for ID and IDA than their normal-weight peers. Low grade inflammation induced by excessive adiposity may be a reason for the observed low iron levels. This is also strengthened by the elevated serum ferritin levels, comprising an acute phase protein that is plausibly increased in inflammation.

Celiac disease (CD) is a chronic gluten-sensitive enteropathy. Life-long gluten-free diet (GFD) is the only therapeutic option; however, it may contribute to the consumption of an unbalanced diet. The present study aimed to evaluate the dietary intake of CD affected children on a GFD and compare it with non-celiac children and with Italian nutritional intakes recommendations, as well as evaluate the contribution of commercially available gluten-free products (GFPs).

Eighteen celiac children, median age 7.6 years, median GFD duration 4.2 years, and 18 non-celiac controls, were enrolled in a cross-sectional age-matched study. Dietary intakes of both groups were collected using a food frequency questionnaire and a 24-hour dietary recall. Nutritional intakes were compared between the group and controls and with Italian dietary reference values. The contribution of GFPs to energy and macronutrient intakes was evaluated.

Median energy intake was significantly higher in CD patients than in controls (8961.8 and 5761.0 kJ day⁻¹; P < 0.001). CD subjects showed higher carbohydrate intakes and lower fat intakes compared to controls. Protein-derived energy did not differ. By contrast to control subjects, energy derived from carbohydrate intakes in CD children met the Italian recommendations. Both children groups showed higher protein and fat intakes than recommended in Italy. GFPs consumption accounted for 36.3% of daily total energy intake.

Intakes of simple sugars, fats and protein exceeded the National recommendations for health. Children with CD had significantly higher energy intakes than controls, although body mass index was comparable across the groups. Lack of nutritional information for GFPs prevented complete dietary analysis of subfractions of fat and micronutrient intakes. This aspect need to be addressed if studies in this field are to be meaningful in the future.

In a recent study, we showed that nonfood incentives combined with taste exposure increase children's acceptance of vegetables. However, the impact of children's previous experience of receiving food rewards is unknown. The present study investigated whether the experience of food rewards affects responses to an exposure-plus-reward intervention.

One hundred and thirty-seven parents of 4–6-year-old children taking part in an exposure-based intervention study completed an instrumental feeding (IF) questionnaire aiming to assess their use of food rewards. Based on these scores, children were categorised as frequently or rarely instrumentally-fed. Intervention groups were given 12 daily tastes of a target vegetable combined with no reward, a tangible reward, (sticker) or a verbal reward (praise). A no-treatment control group received no tastings. Liking and intake of a target vegetable were measured at baseline and post-intervention.

Irrespective of experience of IF, children in all intervention groups increased liking compared to controls (all P < 0.001) and both reward groups increased intake compared to controls (both P < 0.05). However, in the nonrewarded exposure group, only children with a limited experience with food rewards increased consumption (P < 0.05).

Experience of IF may limit the benefits of ‘mere exposure’. However, exposure with nonfood rewards can increase the acceptance of vegetables, regardless of previous experience.

Effective nutrition health interventions are theory-based, as well as being drawn from practice and research, aiming to successfully accomplish dietary behavioural changes. However, the integration of theory, research and practice to develop community dietary educational programmes is a challenge that many interventionists feel ill equipped to achieve.

In the present study, a community-based education programme was designed for Bangladeshi patients with chronic kidney disease and hypertension. The goal of this programme was to reduce dietary salt intake in this population group, with a view to reducing their blood pressure and slowing kidney disease progression.

The present study sets out the first four steps of a six-step model for creating a behaviour change programme.

These four steps were concerned with the translation of theory and evidence into intervention objectives, and illustrate how a practical, community-based intervention was developed from behavioural theory, relevant research, knowledge of practice and the target patient group. Steps 5 and 6, which are concerned with implementation and evaluation, will be reported separately.

To examine whether the nutritional status of aged undernourished residents in care could be improved through dietary modification to increase energy intake but not portion size.

A 12-week cluster randomised controlled trial was carried out in 21 residential care homes. Participants comprised undernourished residents with a body mass index (BMI) <18.5 kg m^–2. All menus were analysed to evaluate nutrient provision. Energy and macronutrient intakes of undernourished residents were estimated using 3-day weighed food intake diaries. Those resident in homes randomised to intervention had their usual meals enriched with energy-dense foods to a maximum of +1673 kJ day⁻¹.

Of 445 residents screened, 41 (9%) had a BMI <18.5 kg m^–2 and entered the study. Despite adequate food provision, energy and macronutrient intakes were below UK dietary reference values. Mean (SEM) energy intake increased [+556 (372) kJ, P = 0.154] in residents allocated to intervention but fell in those residents in ‘control homes’ receiving usual care [−151 (351) kJ, P = 0.676]. Weight change [+1.3 (0.53) kg, P = 0.03] was seen in intervention residents but not in controls [−0.2 (1.5) kg, P = 0.536]. Between-group differences for changes in weight and energy intake were not significant (P = 0.08 and 0.20, respectively). Six residents allocated to the intervention increased their BMI >18.5 kg m^–2 (P = 0.018).

Achieving weight gain in frail older people is difficult. These results suggest that enriching food could help address undernutrition and slow chronic weight loss. Interventions of a longer duration are needed to confirm or exclude the value of food enrichment.

Relatively little is known about the dietary intake and nutritional status of community-based individuals with eating disorders. This research aimed to: (i) describe the dietary intake of population-based adolescents with an eating disorder and (ii) examine associations between eating disorder symptoms, fatty acid intake and depressive symptoms in adolescents with and without an eating disorder.

Data were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a population-based cohort study that has followed participants from birth to young adulthood. This research utilised self-report data from the 17-year Raine Study assessment. Participants comprised 429 female adolescents who completed comprehensive questionnaire measures on dietary intake, eating disorder symptoms and depressive symptoms.

Adolescents with an eating disorder (n = 66) reported a significantly lower intake of total fat, saturated fat, omega-6 fatty acid, starch, vitamin A and vitamin E compared to adolescents without an eating disorder (n = 363). Adolescents with an eating disorder and pronounced depressive symptoms (n = 23) also reported a significantly lower intake of polyunsaturated fat and omega-3 and omega-6 fatty acid than adolescents with an eating disorder but no marked depression (n = 43). In the eating disorder sample but not the control sample, omega-3 and omega-6 fatty acid correlated significantly and negatively with eating disorder symptoms and with depressive symptoms.

Support is provided for a relationship between low omega-3 and omega-6 fatty acid intake and depressive symptoms in adolescents with eating disorders. Research is needed to examine the feasibility and effectiveness of fatty acid supplementation in this high-risk group.

The assessment of the factors that influence children's diets is important for supporting the development of public health policies for the prevention of diet-related diseases. The present study aimed to evaluate the diet quality of preschoolers by using the Healthy Eating Index (HEI) and to identify maternal and family characteristics associated with this score and its components.

The present study comprised a cohort study conducted with 345 low socioeconomic status children from São Leopoldo in southern Brazil aged 6 months and 3–4 years old. Dietary data were collected through 24-h recalls and diet quality was evaluated according to the HEI.

The mean (SD) total HEI score was 65.7 (11.2). Only 9.6% (n = 33) of the children had a good diet. No significant association was detected between the overall diet quality of children and the characteristics. The prevalence of children who achieved the 75th percentile of the scores for grains [prevalence ratio (PR) = 0.65; 95% confidence interval (CI) = 0.43–0.98] and total fat (PR = 0.80; 95% CI = 0.69–0.93) was lower among children whose families had higher incomes, whereas the prevalence for grains was lower in those whose fathers were employed (PR = 0.53; 95% CI = 0.34–0.81). The prevalence for diet variety (PR = 1.44; 95% CI = 1.01–2.05) and milk (P = 1.18; 95% CI = 1.04–1.35) was higher and for total fat (PR = 0.83; 95% CI = 0.70–0.98) and saturated fat (PR = 0.76; 95% CI = 0.59–0.98) was lower among children whose mothers had higher levels of education.

The total HEI score in these children indicates that compliance with dietary guidelines is generally poor. Although the overall diet quality did not show variation across maternal and family characteristics, some components of the diet were affected by these features.

Life-long gluten-free diet (GFD) is the only recognised treatment for coeliac disease (CD). The present study aimed to determine the nutritional adequacy of the ‘no detectable gluten’ diet.

Seven-day prospective food intake was assessed in 55 patients who were adherent to a GFD for more than 2 years and in 50 newly-diagnosed age- and sex-matched patients (18–71 years, 24% male) studied prospectively over 12 months on GFD. Historical precoeliac intake was also assessed in the latter group. Intake was compared with Australian Nutritional Recommendations and the Australian population data.

Nutritional intake was similar between groups. Of macronutrients, only starch intake fell over 12 months (26% to 23%, P = 0.04). Fibre intake was inadequate for all except in diet-experienced men. More than one in 10 of both newly-diagnosed and experienced women had inadequate thiamin, folate, vitamin A, magnesium, calcium and iron intakes. More than one in 10 newly-diagnosed men had inadequate thiamin, folate, magnesium, calcium and zinc intakes. Inadequate intake did not relate to nutrient density of the GFD. Inadequacies of folate, calcium, iron and zinc occurred more frequently than in the Australian population. The frequency of inadequacies was similar pre- and post-diagnosis, except for thiamin and vitamin A, where inadequacies were more common after GFD implementation.

Dietary intake patterns at 12 months on a GFD are similar to longer-term intake. Dietary inadequacies are common and may relate to habitual poor food choices in addition to inherent deficiencies in the GFD. Dietary education should also address the achievement of adequate micronutrient intake. Fortification of GF foods also need to be considered.

Coeliac disease (CD) is an under-diagnosed and often misunderstood disease, yet is one of the most common food intolerance disorders. The only treatment available to prevent the health impacts of CD is a lifelong, strict gluten-free diet (GFD). There are few studies that explore the experiences of diagnosis and the everyday experiences of living with this chronic condition.

Utilising a qualitative study design, and purposive sampling, the present study describes the experiences of 10 women with coeliac disease in Victoria, Australia. Individual interviews were conducted with women aged between 31 and 60 years who had been diagnosed with CD for at least 2 years.

A thematic analysis of the interview transcripts highlighted a number of issues for those living with the disease. Reactions to diagnosis, transition to a GFD and the changes needed to live with CD are discussed.

A range of recommendations including the need to increase CD awareness and education and further research on the impacts of living with the disease are made.

Both malnutrition and obesity are related to worsened post-operative outcomes after colorectal surgery. Obese cancer patients may be malnourished as a result of short-term weight loss. The present study aimed to evaluate preoperative nutritional status, body composition and dietary intake related to post-operative complications (POC) and post-operative hospital days (POHD) in elective colorectal cancer (CRC) patients.

Anthropometry, body composition measured by bioelectric spectroscopy and dietary habits assessed by a validated food-frequency questionnaire were examined in 100 newly-diagnosed CRC patients. Data from 30-day POC and POHD were collected from medical records. Nonparametric and chi-squared tests and logistic regression were used to analyse associations between body and dietary variables and post-operative outcome.

Twenty-nine patients had at least one POC. The median POHD was six. Body size and composition measures and short-term weight loss were no different between patients with and without POC, or between patients with POHD <7 and ≥7. Dietary variables were otherwise no different between patients with and without POC, although the median intake of marine n-3 polyunsaturated fatty acids (PUFA, the sum of eicosapentaenoic and docosahexaenoic acids) was significantly lower in patients with versus without POC (0.7 versus 1.2 g day⁻¹, P = 0.04).

We found that preoperative body size, body composition and short-term weight loss were not related to 30-day post-operative outcomes in CRC patients. A high content of marine n-3 PUFA in preoperative habitual diets may protect against POC after CRC surgery.

Trainee dietitians, nutritionists, nurses and doctors will direct the future of obesity treatment and prevention. To do so effectively, they must be willing and able to engage empathically with overweight and obese people. The present study aimed to assess weight bias among UK trainee healthcare professionals and to investigate the factors predicting weight bias, both static and potentially modifiable.

A self-completed questionnaire collected data on demographics, weight and height, the Fat Phobia Scale (F-scale), and the Beliefs about Obese People (BOAP) scale from 1130 students.

Overall, participants demonstrated significant levels of fat phobia [F-scale score mean (SD) = 3.8 (0.5)]. Only 1.4% of participants could be said to have expressed ‘positive or neutral attitudes’ (i.e. achieved a F-scale score ≤ 2.5). Hierarchical multiple regression revealed that lower fat phobia (as measured by the F-scale) was uniquely predicted by a higher self-reported body mass index, being on the Nursing BSc course and a stronger perception that obesity is not under a person's control (as measured by the BOAP scale).

There are unacceptable levels of weight bias among UK students training to become nurses, doctors, nutritionists and dietitians. The results of the present study suggest that a promising approach for future interventions would be the provision of balanced education about the controllability of obesity, focusing upon genetic and environmental factors, as well as diet and exercise.

The Food Intake Recording Software System, version 4 (firsst4), is a web-based 24-h dietary recall (24 hdr) self-administered by children based on the Automated Self-Administered 24-h recall (ASA24) (a self-administered 24 hdr for adults). The food choices in firsst4 are abbreviated to include only those reported by children in US national surveys; and detailed food probe questions are simplified to exclude those that children could not be expected to answer (e.g. questions regarding food preparation and added fats). ASA24 and firsst4 incorporate 10 000+ food images, with up to eight images per food, to assist in portion size estimation. We review the formative research conducted during the development of firsst4. When completed, firsst4 will be hosted and maintained for investigator use on the National Cancer Institute’s ASA24 website.

Effectively assessing children’s dietary intake is essential for understanding the complex relationships among dietary behaviours and obesity. Dietary assessment accuracy decreases when children are unable or unmotivated to complete accurate self-reports. Technology-based assessment instruments for children’s self-report of diet can be enhanced in light of developments in media psychology and communication science. To motivate children to complete a dietary assessment, researchers could use animated, customisable agents; embed the assessment process into a video game; or add narratives to encourage self-reporting behaviour. To improve accuracy, the intake environment could be recreated virtually; training sessions could be interspersed to improve portion estimation; and implicit attitudinal measures could be incorporated as a control or to increase validity. Research is needed to evaluate possible methods of enhancing children’s self-reporting motivation and accuracy. The main challenge remains how to engage children without biasing their reporting.

Background:  The present study describes the development and formative evaluation of the Web-based Dietary Assessment Software for Children (WebDASC). WebDASC is part of the OPUS project (‘Optimal well-being, development and health for Danish children through a healthy New Nordic Diet’) and was intended to measure dietary change resulting from a school-based intervention.

Methods:  WebDASC was developed as a self-administered tool that could be used by 8–11-year-old children with or without parent’s aid. The development of WebDASC followed a prototyping approach: focus groups, informal interviews, literature review, and usability tests preceded its release. Special consideration was given to age-appropriate design issues.

Results:  In WebDASC an animated armadillo guides respondents through six daily eating occasions and helps them report foods and beverages previously consumed. A database of 1300 food items is available either through category browse or free text search, aided by a spell check application. A type-in format is available for foods not otherwise found through category browse or text search. Amount consumed is estimated by selecting the closest portion size among four different digital images. WebDASC includes internal checks for frequently forgotten foods, and the following features to create motivation: a food-meter displaying cumulative weight of foods reported, a most popular food ranking, and a computer game with a high score list.

Conclusions:  WebDASC was developed as an intuitive, cost-effective, and engaging method to collect detailed dietary data from 8- to 11-year-old children. Preliminary testing demonstrated that it was well accepted among children.

Dietary researchers need new software to improve nutrition data collection and analysis, although the creation of information technology is difficult. Software development projects may be unsuccessful as a result of an inadequate understanding of needs, management problems, technology barriers or legal hurdles. Cost over-runs and schedule delays are common. Barriers facing scientific researchers developing software include workflow, cost, schedule and team issues. Different methods of software development and the role that intellectual property rights play are discussed. A dietary researcher must carefully consider multiple issues to maximise the likelihood of success when creating new software.

Recent reports have suggested that registered nurses may not screen patients admitted to their care for malnutrition. The objective of this integrative review was to locate and review published research investigating barriers and facilitators to nutritional screening by nurses.

A systematic search for relevant English language publications was conducted through CINAHL®, Web of Science, MEDLINE® and EMBASE and an Internet search engine (completed November 2011). Reference lists of relevant publications were also searched. Search terms included nursing, dietetics, nutrition disorders and screening, as well as associated MeSH® terms and Subject Headings. Six hundred and sixteen publications were identified and 605 were excluded. Publications reporting research concerning barriers and facilitators to nutritional screening by nurses were selected using exclusion and inclusion criteria. These were reviewed and the key findings described, categorised, combined, reviewed and refined to create themes.

Eleven publications were reviewed. Publications primarily reported hospital-based studies undertaken in three continents and considered barriers rather than facilitators. Five themes emerged: organisational culture, competing priorities, the value of clinical judgement, training and education, and discrepancy between attitudes and practice.

Studies primarily involved acute care and indicated that routine screening for malnutrition will not take place unless it is considered an integral part of nursing assessment that is required by policy and resourced appropriately. Qualitative studies investigating barriers and facilitators to screening for malnutrition in community settings are needed and research is required to test interventions designed to modify or remove barriers and facilitate screening.

Accurate nutrient composition data for composite dishes unique to a population is essential for the development of a nutrient database and the calculation of dietary intake. The present study aimed to provide the nutritional composition of composite dishes frequently consumed in rural KwaZulu-Natal, South Africa.

Commonly consumed composite dishes were identified using 24-h recalls collected from 79 randomly selected community members. Multiple recipes were collected for each reported dish. The mean nutritional composition of each dish was calculated per 100 g using the nutribase clinical nutrition manager (Cybersoft Inc., Phoenix, AZ, USA).

A total of 79 recipes were collected for 16 commonly consumed dishes (seven meat-based, five starch-based and four legume/vegetable-based). ‘Fried chicken’ contained the most energy [1469 kJ (351 kcal)], protein (29.7 g), fat (23.7 g), cholesterol (123 mg) and niacin (8.4 mg). ‘Fried beef’ contained the most potassium (495 mg) and zinc (6.4 mg), whereas ‘fish stew’ had the most vitamin D (4.2 μg) and calcium (215 mg). ‘Fried cabbage’ and ‘fried spinach’ contained the largest percent energies from fat, at 79% and 76%, respectively. A traditional sweet bread, ‘jeqe’, made with fortified flour contributed significantly to iron (4.6 mg), niacin (4.5 μg) and folate (129 μg). The sodium content of dishes ranged from 88 to 679 mg per 100 g.

The nutritional composition data for commonly consumed dishes in rural KwaZulu-Natal is presented. Although the dishes are good sources of protein, vitamins and minerals, they also contain substantial amounts of fat. This culturally appropriate information will enable the calculation of dietary intake and can be used to encourage the consumption of recipes rich in key nutrients.

The present study aimed to calibrate a food frequency questionnaire (FFQ) using one 24-h recall (R24) associated with foodstuff replicas.

Calibration was performed by linear regression. Of a probability sample of 150 individuals (>18 years) of the town of Bambui, 98 completed the study.

The mean age of the participants was 43.8 years and 63.3% were women. The calibration of the FFQ included sex for the estimation of iron, protein and zinc; and an interaction between sex and R24 was significant for vitamin A and cholesterol models. Age contributed to the vitamin C, polyunsaturated fatty acids, proteins and zinc models, and an interaction between age and R24 was significant for protein and zinc.

Calibration coefficients and many interactions in linear regression models revealed important differences between dietary methods, indicating the complexity encountered when combining two methodologies for estimating food intake.

The present study aimed to conduct a preliminary investigation of the validity and reliability of a short dietary questionnaire designed to assess dietary intake of saturated fat and free sugars.

Forty students at Macquarie University, aged 17–46 years, completed the Dietary Fat and free Sugar – Short Questionnaire (DFS), a full-length food frequency questionnaire (C-FFQ) and a 4-day diet diary (DD). After a mean (SD) follow-up time of 158 (10) days, 29 participants completed a second administration of the DFS.

Correlation coefficients comparing DFS scores with the percentage energy from saturated fat and free sugar assessed by the C-FFQ and DD ranged from 0.35 to 0.71. The intraclass correlation (0.83) was high, indicating good reliability.

These results suggest that the DFS is a valid and reliable measure of saturated fat and free sugar intake. Because it is quick to administer and score, in the public domain, and easy to interpret, it maybe useful as a screener, simple self-check tool or for large-scale epidemiological studies.

School lunches potentially provide an important source of nutrients for children, although studies have shown that their food choices are not always associated with health benefits. The present study aimed to evaluate the effects of a kitchen-based intervention on intake from school lunches undertaken in 2005.

The three-phase study comprised a pre-intervention observation, the intervention itself and a post-intervention observation. Children aged 12–16 years attending a large, inner-city, secondary school in London were invited to participate. The intervention consisted of small, practical changes to the school menu with the purpose of reducing total and saturated fat and increasing fruit and vegetable consumption. Intake was evaluated using a weighed technique.

One hundred and eighty and 198 children participated in the pre- and post-intervention phases, respectively. After the intervention, a significant reduction was observed in mean (SD) intake of total fat [44% (8%) versus 40% (9%) total energy, P < 0.01] and of saturated fat [13% (6%) versus 10% (6%), P < 0.01]. The children also ate significantly more fruit and vegetables [12.0 (10.4) g versus 30.0 (30.5) g total weight, P < 0.001]. However, after the intervention, the mean intakes of total and saturated fat, fruit and vegetables were still significantly below the Caroline Walker Trust guidelines for school lunches.

The present study shows that total and saturated fat and fruit and vegetable intake from school lunches can be significantly improved by a short, kitchen-based intervention. Although the benefits were limited, the results support further work in this area.

There is strong evidence of a upward secular trend in skinfold thickness (SFT) and the prevalence of obesity has increased substantially over recent decades in developed countries. However, no studies on this trend have been reported in Shandong Province, China. The present study aimed to assess the decennial change in SFT and body composition among children and adolescents in Shandong Province during the past 15 years (1995–2010).

Data were obtained from two national surveys on student's constitution and health carried out by the government in 1995 and 2010 in Shandong Province, China. A total of 14 780 (7198 in 1995 and 7582 in 2010) students aged 7–18 years participated in the present study. Weight and SFT of all subjects were measured. Percentage body fat (%FM) was estimated by SFT, and fat mass (FM) and fat-free mass (FFM) were calculated from: FM (kg) = %FM × weight (kg)/100; FFM (kg) = weight (kg)−FM(kg). The range of differences of weight, SFT, FM and FFM over the different age groups between the 1995 and 2010 samples were calculated.

In the past 15 years, mean values of SFT have increased. The mean (range) increments of SFT were 6.28 (2.91–11.22) mm for boys and 3.29 (2.22–4.29) mm for girls, demonstrating a mean increase of 32% for boys and 14% for girls. The mean (range) increments of weight, FM and FFM were 7.26 (4.41–10.82) kg, 3.70 (1.47–6.58) kg and 3.56 (1.24–5.27) kg, at rates of 18%, 47% and 10% for boys, respectively, and 4.14 (2.78–5.64) kg, 1.68 (1.02–2.27) kg and 2.46 (1.52–3.49) kg, at rates of 11%, 20% and 8% for girls, respectively.

The mean values of SFT, FM and FFM have increased over time. Rates of increase were greater for FM than FFM.

There is a lack of data in Greece on trends in food intake according to weight status and physical activity (PA), despite the high prevalence of obesity. The present study aimed to examine differences in these parameters among first-grade children from Crete, Greece, over a 15-year period.

Children (aged 5.9–7.6 years) from two representative cross-sectional studies participated during 1992/93 (n = 245) and 2006/07 (n = 257). Estimated 3-day food records were used to assess food consumption and energy-density (ED) [kJ g⁻¹ (kcal g⁻¹)]. Moderate-to-vigorous-PA (MVPA) and cardiorespiratory-fitness were assessed by questionnaires and the 20-m shuttle-run test (20mSRT), respectively.

In 2006/07, compared to 1992/93, both sexes had a significantly higher intake of dairy products and snacks (P < 0.001), a lower intake of cereals (P < 0.001) and higher cardiorespiratory fitness levels (P < 0.001). Among girls, fruit/vegetable consumption was higher (P < 0.05), although legume intake was lower (P < 0.005). Among overweight/obese (OW/OB) children, ED significantly decreased (P < 0.05) and the mean consumption of fruits/vegetables was higher (P < 0.001). The percentage of OW/OB boys was significantly higher (P < 0.001); however, MVPA was significant higher in this group compared to 1992/93 (P < 0.001). During the two time-periods, active children in 2006/07 appeared to have a lower ED than active ones in 1992/93 (P < 0.001).

Several differences in food intake were observed among first-grade children of Crete between 1992/93 and 2006/07, as characterised by significant increases in the consumption of dairy products and snacks and a decrease in the intake of cereals, among both sexes. Future school-based interventions in this population should emphasise the need to increase fruit/vegetable, unrefined cereal and legume consumption.

Undernutrition and insufficient energy and protein intake is a common problem in hospitalised patients. The aim of this pilot study was to investigate whether a novel hospital menu would be an effective strategy for increasing nutritional intake in patients at nutritional risk.

A historically controlled intervention pilot study was conducted. Forty patients at nutritional risk were offered a novel hospital menu as a supplement to the ordinary hospital menu. The menu consisted of 36 naturally energy-enriched small dishes served on demand 24 h a day. Energy and protein intake were calculated as the mean over a period of 3 days.

No significant difference in energy and protein intake was observed between the groups; however, a significant (P = 0.001) time gradient in total energy intake was observed in the intervention group. Moreover, a significant (P = 0.03) time gradient in energy intake received from the novel menu was observed. The dishes from the novel menu were mainly ordered from 11.00 h to 14.00 h and from 17.00 h to 18.00 h.

No overall significant differences in energy and protein intake between the groups were found. However, the present pilot study revealed a significant time gradient in total energy intake (P = 0.001) and in energy intake from the novel menu (P = 0.03). This indicates the need to include a run-in period when investigating novel hospital menus as a support for patients at nutritional risk. Additionally, food service, available 24 h a day, appears to be unnecessary.

Energy balance (EB) is important when assessing nutritional status. EB has never been assessed in haemodialysis (HD) and peritoneal dialysis (PD) patients. The present study aimed to assess weekly EB in these patients.

This clinical cross-sectional study was conducted for 7 days in eight HD and eight PD patients. Nutritional status was assessed by anthropometry, bioelectrical impedance analysis and biochemical markers. Energy intake (EI per day) and total energy expenditure (TEE per day) were determined by a 7-day weighed food diary and a portable armband device, respectively.

No significant differences in age, body mass index, fat free mass (FFM), parathyroid hormone were found between the two groups. EB was calculated by subtracting TEE per day from EI per day. EB was negative in HD {−1347 (1276) kJ day⁻¹ [−322 (305) kcal day⁻¹]}, as well as in PD patients {−427 (5338) kJ day⁻¹ [−102 (395) kcal day⁻¹]}. TEE per day was positively correlated with EI per day, prealbumin, FFM. EI per day was positively correlated with prealbumin. C-reactive protein was negatively correlated with TEE and FFM (P < 0.05). EB showed a positive correlation with EI per day (P = 0.012) and a negative trend with TEE.

HD and PD patients have a negative EB and are at risk of malnutrition. Inflammatory status determines a lower EI per day and a reduction in TEE per day. The most important parameter in determining EB in HD and PD patients is EI per day. This topic deserves further investigation to better understand the mechanisms of impaired EB with respect to preserving patients' nutritional status.

Enteral nutrition formulas enriched with eicosapentaenoic acid (EPA) and gamma-linolenic acid (GLA) may modulate inflammatory processes and improve outcomes in mechanically-ventilated patients with respiratory failure. The present study aimed to determine whether there were differences in nutritional indices (protein intake, energy intake, fat intake) and outcomes [days on mechanical ventilation, days in the intensive care unit (ICU)] between mechanically-ventilated subjects who received a standard pulmonary enteral formula compared to those who received an EPA/GLA enriched pulmonary enteral formula.

Data on 50 adult subjects who were admitted to an ICU in a community hospital who required both mechanical ventilation and enteral nutrition support were collected (n = 19 in the standard enteral formula group; n = 31 in the EPA/GLA-enriched enteral formula group). The present study involved both retrospective and prospective data.

Subjects who were provided the EPA/GLA enriched enteral formula received significantly more enteral formula volume (P = 0.011), total fat (P < 0.0005) and total energy (P = 0.017) than subjects who were provided the standard enteral formula. When controlling for the effects of enteral formula volume, total fat intake and total energy intake as confounding variables, there were no significant differences between the enteral formula groups in ICU days (P = 0.440) or hours spent on mechanical ventilation (P = 0.410).

The use of a specialised pulmonary enteral formulation did not result in any statistically significant effects on ICU days and hours on mechanical ventilation. Subjects who were on the specialised formula did receive more enteral formula volume and more total energy intake, which may be clinically important. Further clinical studies are needed to address the impact that a specialised pulmonary enteral formula has on ICU stay and ventilator hours.

Acquisition of anthropometric measurements and assessment of growth in paediatric inpatients remains poor. The introduction of malnutrition screening tools that incorporate weight and height/length measurements might improve their acquisition and utilisation in other aspects of patient care.

Documentation of weight and/length measurements and their plotting on growth charts was evaluated using a case notes review in paediatric inpatients who were admitted before (n = 146), during (n = 154) and after the pilot (n = 151) and official (n = 128) clinical use of a screening tool.

Documentation of weight was high in all periods (> 97% of patients). Height/length measurement documentation was negligible (4% of patients) but improved after the introduction of the screening tool (> 62%; P < 0.0001), except in infants, who were not part of the screening programme.

Introduction of a screening tool improved the acquisition of anthropometric measurements by nursing staff, although its utilisation by medical staff remained poor.

Role flexibility is considered central to a health policy agenda stressing workforce redesign measures and professional role boundary change. Extensions in health professionals' role boundaries may involve the incorporation of new or ‘vacant’ roles, as well as the competitive acquisition of others. In the present study, the experiences of dietitians with extended roles in home enteral tube feeding (HETF) were explored and considered within the context of workforce role transition.

Six semi-structured interviews conducted with dietitians specialising in HETF were undertaken and the emergent role development for dietitians in HETF was explored.

Dietetic HETF roles emerged as a form of diversification, occupying a task ‘vacancy’, commonly on an opportunistic basis. Role overlap in these community based tasks was negotiated with community nurses, privately funded industry nurses and other medical staff. Notably, role conflict was encountered only with nutrition nurse specialists.

To date, a lack of role exclusivity in a small and confined speciality field with multiple potential competitors has resulted in surprisingly little role conflict. Financial constraints within the National Health Service are considered likely to favour a privately funded service model of delivery, and this may have implications for dietitians specialising in this field. Dietitians also perceived an increase in professional status as a result of extended roles.