Refeeding syndrome and student dietitians

Agreement between student dietitians’ identification of refeeding syndrome risk with refeeding guidelines, electrolytes and other dietitians: a pilot study

Matthews et al., JHND Early View

Background

Limited research exists concerning how consistently and accurately student and newly-graduated dietitians are identifying refeeding syndrome risk in hospitalised patients. The present study aimed to determine the consistency of students’ and newly-graduated dietitians’ classification of refeeding syndrome risk, as well as agreement with the application of comparison tools such as the National Institute for Health and Care Excellence guidelines, patients’ electrolytes and supplementation, and clinical dietitians previously surveyed.

Methods

Recently-graduated and final-year Griffith University dietetics students were invited to complete an online survey. The survey questioned demographics and asked respondents to classify the level of refeeding syndrome risk (i.e. none, some, high, unsure) in 13 case studies. Electrolytes and supplementation data were sourced from electronic patient records. Chi-squared tests, t-tests and linear regression analyses were conducted.

Results

Fifty-three eligible people responded [n = 53 of 112, mean (SD) age 26 (4) years, 89% female, 34% graduates]. Respondents’ answers were generally more consistent and more likely to agree with comparison tools when two tools showed the same level of refeeding syndrome risk (49–98%, β = 0.626–1.0994, P < 0.001) than when they differed (11–49%). Respondents’ level of agreement with refeeding identification guidelines, electrolyte levels, supplementation and dietitians previously surveyed did not differ by graduate status, degree level, clinical placement status or having read refeeding syndrome guidelines recently (P > 0.05).

Conclusions

Students’ and new graduates’ identification of refeeding syndrome risk improved when there was consistency between guidelines, electrolytes and dietitians’ responses. More research is needed to improve the evidence behind refeeding guidelines, with the aim of enhancing the accuracy and consistency of assessment.

Vitamin D and muscle strength

Vitamin D and muscle strength throughout the life course: a review of epidemiological and intervention studies

McCarthy and Kiely, JHND Early View

The putative role of vitamin D in muscle function and strength throughout the life course is of interest because muscle strength is required for engagement in physical activity at all ages. As vitamin D deficiency is widely reported in the population, especially in countries at high latitude, the potential importance of vitamin D in muscle function throughout life, and the potential impacts on growth and development, participation in physical activity, and effects on skeletal and cardio-metabolic health, comprise an important topic for discussion. This review provides an overview of muscle function and summarises the role of the vitamin D receptor and the proposed molecular mechanisms of action of vitamin D in muscle cells. In addition, the review provides a comprehensive assessment of the clinical evidence surrounding the association between vitamin D and muscle strength. Among adults, particularly older adults, cross-sectional and cohort studies reported a positive association between vitamin D status and muscle strength. These associations have been largely confirmed by intervention studies. Limited research has been carried out in adolescents and children; two cross-sectional studies in adolescents have suggested an association between serum 25-hydroxyvitamin D concentrations and muscle strength. However, the two intervention studies in adolescents have yielded conflicting results. Other than a single observational study, data in young children are very limited and further investigation in under 12-year-olds is warranted.

Obesity- it’s in your neighbourhood

The spatial clustering of obesity: does the built environment matter?

Huang et al., JHND Early View

Background

Obesity rates in the USA show distinct geographical patterns. The present study used spatial cluster detection methods and individual-level data to locate obesity clusters and to analyse them in relation to the neighbourhood built environment.

Methods

The 2008–2009 Seattle Obesity Study provided data on the self-reported height, weight, and sociodemographic characteristics of 1602 King County adults. Home addresses were geocoded. Clusters of high or low body mass index were identified using Anselin’s Local Moran’s I and a spatial scan statistic with regression models that searched for unmeasured neighbourhood-level factors from residuals, adjusting for measured individual-level covariates. Spatially continuous values of objectively measured features of the local neighbourhood built environment (SmartMaps) were constructed for seven variables obtained from tax rolls and commercial databases.

Results

Both the Local Moran’s I and a spatial scan statistic identified similar spatial concentrations of obesity. High and low obesity clusters were attenuated after adjusting for age, gender, race, education and income, and they disappeared once neighbourhood residential property values and residential density were included in the model.

Conclusions

Using individual-level data to detect obesity clusters with two cluster detection methods, the present study showed that the spatial concentration of obesity was wholly explained by neighbourhood composition and socioeconomic characteristics. These characteristics may serve to more precisely locate obesity prevention and intervention programme

Data from ALSPAC: vitamin D and calcium in pre-school children

Sources of vitamin D and calcium in the diets of preschool children in the UK and the theoretical effect of food fortification

Cribb et al., JHND Early View

Background

Dietary intakes of vitamin D are very low in the UK. Dietary calcium is also necessary to promote bone health. The fortification of foods with vitamin D could be a safe and effective way of increasing intake.

Methods

Diets of preschool children, 755 at 18 months and 3.5 years, from the Avon Longitudinal Study of Parents and Children were assessed using dietary records completed by parents. Energy, vitamin D and calcium intakes were calculated. Multinomial logistic regression was used to estimate the odds ratio for being in the highest/lowest quartile of intake. Intakes were recalculated to test different fortification regimes.

Results

Vitamin D intakes were low; all children were below the UK and US dietary recommendations. Calcium intakes decreased between the two ages as a result of reduced milk consumption. Children in the lowest quartile for vitamin D intake at 18 months were twice as likely to remain in that quartile at 3.5 years (odds ratio = 2.35; 95% confidence interval = 1.56–3.55). The majority of foods provide no vitamin D with fat spreads and milk as the main sources. The contribution from breakfast cereals increased, from 6% to 12%, as a result of the increased consumption of fortified cereals. Dairy foods provided the highest contribution to calcium at 18 months but were less important at 3.5 years. Theoretical intakes from different fortification regimens suggest that milk fortified at 2 μg 100 g–1 vitamin D would provide most children with adequate but not excessive intakes.

Conclusions

Dietary vitamin D intakes were very low and calcium intakes were mostly adequate. Fortification of milk with vitamin D could be a good way to boost intakes.

Jumping from Harvard to Vancouver

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The Journal has made the decision to change the referencing style for all articles, with immediate effect. We are moving away from the existing Harvard style to the Vancouver style of referencing and full details are available in the author guidelines on our website. For a while things may look a bit clunky as new papers will be intermingled with papers that were accepted using the old referencing style and which are already published on Early View.

The new style will bring about a radical change in the appearance of our papers. The example below shows how Vancouver will make a difference.

Harvard version:

A small of study children demonstrated a relationship between maternal iron status and adiposity and offspring blood pressure (Godfrey et al., 1994). Blood pressure was also an outcome reported by Project Viva, a US prospective cohort study following the children of women whose nutritional status had been measured in detail in the period prior to and during pregnancy. Gillman and colleagues (2003) reported that maternal calcium supplementation during pregnancy reduced blood pressure in 6 month old infants. Project Viva also identified an association between higher maternal vitamin D intake and lower risk of childhood asthma among 3-year-olds (Camargo et al., 2007). The same cohort showed that babies born to women who gained excessive weight in pregnancy were more likely to be obese in childhood (Oken et al., 2009). Normia et al., (2013), reported that in a small cohort of mother-child (4 year old) pairs, higher maternal carbohydrate intake was associated with higher childhood systolic blood pressure and higher childhood systolic blood pressure was noted in offspring exposed to lowest or highest tertiles of maternal fat intake during pregnancy. A longer-term follow up of Scots in their forties for whom maternal food intake data was available also provided evidence that maternal intake could be a driver of intrauterine programming (Campbell et al., 1996). Adult blood pressure was associated with maternal intakes of animal protein and sugars, but the relationship was complex and non-linear.

Camargo, C.A., Rifas-Shiman, S.L., Litonjua, A.A., Rich-Edwards, J.W., Weiss, S.T., Gold, D.R., Kleinman, K.& Gillman, M.W. (2007). Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am. J. Clin. Nutr. 85, 788-795.

Campbell, D.M., Hall, M.H., Barker, D.J.P., Cross, J., Shiell, A.W. & Godfrey, K.M. (1996). Diet in pregnancy and the offspring’s blood pressure 40 years later. Br. J. Obs. Gynae. 103, 273-280.

Gillman, M.W., Rifas-Shiman, S., Rich-Edwards, J., Kleinman, K. & Lipshultz, S.E. (2003). Maternal calcium intake and offspring blood pressure. Circulation 107, E7016.

Godfrey, K.M., Redman, C.W., Barker, D.J. & Osmond, C. (1991). The effect of maternal anaemia and iron deficiency on the ratio of fetal weight to placental weight. Br. J. Obs. Gynae. 98, 886-891.

Normia, J. Laitinen, K., Isolauri, E., Poussa, T., Jaakkola, J & Ojala T. (2013) Impact of intrauterine and post-natal nutritional determinants on blood pressure at 4 years of age. J. Hum. Nutr. Diet. 10.1111/jhn.12115

Oken, E., Kleinman, K.P., Belfort, M.B., Hammitt, J.K. & Gillman, M.W. (2009). Associations of gestational weight gain with short- and longer-term maternal and child health outcomes. Am. J. Epidemiol. 170, 173-180.

Vancouver version:

A small of study children demonstrated a relationship between maternal iron status and adiposity and offspring blood pressure(1). Blood pressure was also an outcome reported by Project Viva, a US prospective cohort study following the children of women whose nutritional status had been measured in detail in the period prior to and during pregnancy. Gillman and colleagues (2) reported that maternal calcium supplementation during pregnancy reduced blood pressure in 6 month old infants. Project Viva also identified an association between higher maternal vitamin D intake and lower risk of childhood asthma among 3-year-olds(3). The same cohort showed that babies born to women who gained excessive weight in pregnancy were more likely to be obese in childhood(4). Normia et al., reported that in a small cohort of mother-child (4 year old) pairs, higher maternal carbohydrate intake was associated with higher childhood systolic blood pressure and higher childhood systolic blood pressure was noted in offspring exposed to lowest or highest tertiles of maternal fat intake during pregnancy(5). A longer-term follow up of Scots in their forties for whom maternal food intake data was available also provided evidence that maternal intake could be a driver of intrauterine programming(6). Adult blood pressure was associated with maternal intakes of animal protein and sugars, but the relationship was complex and non-linear.

1. Godfrey KM, Redman CW, Barker DJ et al., (1991) The effect of maternal anaemia and iron deficiency on the ratio of fetal weight to placental weight. BJOG 98, 886-891.

2.Gillman MW, Rifas-Shiman S, Rich-Edwards J, et al., (2003) Maternal calcium intake and offspring blood pressure. Circulation 107, E7016.

3. Camargo CA, Rifas-Shiman SL, Litonjua AA, et al., (2007). Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr. 85, 788-795.

4. Oken E, Kleinman KP, Belfort B, et al., (2009) Associations of gestational weight gain with short- and longer-term maternal and child health outcomes. Am J Epidemiol 170, 173-180.

5. Normia J, Laitinen K, Isolauri E, et al.,  (2013) Impact of intrauterine and post-natal nutritional determinants on blood pressure at 4 years of age. J Hum Nutr Diet 10.1111/jhn.12115

6. Campbell DM, Hall MH, Barker DJP, et al., (1996) Diet in pregnancy and the offspring’s blood pressure 40 years later. BJOG 103, 273-280.

Protein wasting in haemodialysis

Predictors of protein-energy wasting in haemodialysis patients: a cross-sectional study

Ruperto et al., JHND Early View

Background

Protein-energy wasting (PEW) is a highly prevalent condition in haemodialysis patients (HD). The potential usefulness of nutritional-inflammatory markers in the diagnosis of PEW in chronic kidney disease has not been established completely. We hypothesised that a combination of serum albumin, percentage of mid-arm muscle circumference and standard body weight comprises a better discriminator than either single marker of nutritional status in HD patients.

Methods

A cross-sectional study was performed in 80 HD patients. Patients were categorised in two groups: well-nourished and PEW. Logistic regression analysis was applied to corroborate the reliability of the three markers of PEW with all the nutritional-inflammatory markers analysed.

Results

PEW was identified in 52.5% of HD patients. Compared with the well-nourished patients, PEW patients had lower body mass index, serum pre-albumin and body cell mass (all < 0.001) and higher C-reactive protein (s-CRP) (< 0.01). Logistic regression analyses showed that the combination of the three criteria were significantly related with s-CRP >1 mg dL−1, phase angle <4°, and serum pre-albumin <30 mg dL−1 (all < 0.05). Other indicators, such as lymphocytes <20% and Charlson comorbidity index, were significantly involved (both < 0.01). A receiver operating characteristic curve (area under the curve) of 0.86 (< 0.001) was found.

Conclusions

The combined utilisation of serum albumin, percentage of mid-arm muscle circumference and standard body weight as PEW markers appears to be useful for nutritional-inflammatory status assessment and adds predictive value to the traditional indicators. Larger studies are needed to achieve the reliability of these predictor combinations and their cut-off values in HD patients and other populations.

JHND is a truly international journal

Over the last year JHND has established itself as an international journal. We have an editorial board that covers the UK, Europe, USA, Canada and Australia and receive submissions from all over the world. When you publish with us, your article reaches libraries all over the world and in the online format papers accessed in all world regions. Over the last year JHND articles have been downloaded more than 30000 times.

 

Readership JHNDOnline traffic

We are constantly striving to make the experience of JHND a positive one. We offer rapid editorial turnaround times (current time to first decision is just over 30 days; time to acceptance is 55 days). Papers accepted for publication appear on our Early View site within 6 weeks of acceptance and we offer Open Access publication. Our drive for quality means that only the top 20% of submissions are published.

 

 

Facilitators and barriers to weight loss and weight loss maintenance

Facilitators and barriers to weight loss and weight loss maintenance: a qualitative exploration

Metzgar et al., JHND Early View

Background

The present study aimed to explore facilitators and barriers to weight loss (WL) and weight loss maintenance (WLM) in women who participated in a primary, 18-week comparative trial that promoted WL with an energy-restricted diet.

Methods

Twenty-three women participated in seven focus groups conducted by a moderator and co-facilitator using open-ended questions and probes. Focus groups were held in a private room and audio tape-recorded. Tapes were transcribed verbatim and thematic analysis was used to evaluate transcripts for common themes.

Results

Accountability to others, social support, planning ahead, awareness and mindfulness of food choices, basic nutrition education, portion control, exercise, and self-motivation were perceived as key facilitators for WL and WLM by women. Identified barriers included life transitions, health status changes, internal factors, environmental pressures, lack of accountability and an absence of social support.

Conclusions

Future interventions should address these salient facilitators and barriers to promote sustainable changes in women across their WL and WLM journeys.