Summer time

Apologies in advance to authors as we enter the summer period in the northern hemisphere. This time of year is especially difficult for us in trying to secure reviewers for manuscripts and to get those reviews back in a timely manner. This means that maintaining a fast turnaround becomes more challenging than usual.

And of course, the editors need a break too. Normal service will be restored as soon as possible.

Assessing body composition in post-menopausal women

Comparison of multi- and single-frequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for assessment of body composition in post-menopausal women: effects of body mass index and accelerometer-determined physical activity

Gaba et al., JHND Early View

Background
Bioelectric impedance analysis (BIA) is commonly used in research to assess body composition. However, studies that validate the accuracy of BIA exclusively in post-menopausal women are lacking. The main purpose of the present study was to evaluate the agreement of multi-frequency (MF)-BIA and single-frequency (SF)-BIA with dual-energy X-ray absorptiometry (DXA) in the estimation of fat mass (FM) and fat-free mass (FFM) among post-menopausal women with variation in body mass index (BMI) and physical activity (PA).

Methods
FM and FFM were estimated by BIA and DXA in 146 post-menopausal women with a mean (SD) age of 62.8 (5.2) years. PA was determined by an accelerometer.

Results
The mean (SD) difference between MF-BIA and DXA was −1.8 (1.8) kg (P = 0.08) and 1.3 (1.8) kg (P = 0.01) for FM and FFM, respectively. SF-BIA provided a significantly lower estimate of FM [−2.0 (2.2) kg; P = 0.04] and a higher estimate of FFM [1.8 (2.4) kg; P < 0.01] compared to DXA. MF-BIA provided significantly better estimates of FM and FFM with narrower limits of agreement than SF-BIA in obese and insufficiently active subjects. In other BMI and PA groups, both BIA devices showed a similar deviation from DXA.

Conclusions
BIA tends to underestimate FM and overestimate FFM relative to DXA. MF-BIA appears to be a more appropriate method for the assessment of body composition than SF-BIA in post-menopausal woman with BMI >30 kg/m2 and in those who are insufficiently active.

Take a sneaky peek

Take a sneaky peek

The Editorial for the next issue of JHND is already available online at this link. Do take a look.

We are really keen to attract papers from the top authors in our field and have done a lot of work to make the journal more appealing. As shown in the editorial, our response times are much better than in the past and in the drive for quality our acceptance rate has fallen. As the title says- we are tougher but more rewarding.

Unsatisfactory complementary feeding practices in Sri Lanka

Current infant feeding practices and impact on growth in babies during the second half of infancy

Bandara et al., JHND Early View

Background

Sri Lanka has made remarkable improvements in health, social and educational indices. However, child malnutrition exists as a significant health problem. Infant feeding indicators have not reached expected levels and improvements are partly constrained by a lack of data. The present study aimed to determine current infant feeding practices and their impact on growth among 6–12-month-old infants.

Methods

The study comprised a descriptive cross-sectional investigation conducted in randomly selected (= 7) Public Health Midwife areas in Galle, Sri Lanka. An interviewer-administered questionnaire was used to obtain data on sociodemographics and infant feeding. Mothers (= 515) attending well-baby clinics were recruited on voluntary and consecutive basis. Infants’ body weights and lengths were measured using standard procedures.

Results

Exclusive breastfeeding rate for first 6 months was 49.0%. In total, 42.6% infants (219 out of 515) were given rice as first weaning food, followed by salt (58.6%) and sugar (42.3%). Oil had been introduced to 84.9% of infants by the end of 12 months. Most infants (over 71%) were given dairy products, whereas 62.3% were being fed various liquid foods using bottles. The introduction of commercial infant cereals, chocolates, plain tea, ice cream and deep fried snacks was noted. Age-specific body weight and length were not achieved by 30.5% and 29.5% of infants, respectively. Weight for length was not achieved by 25.5% of the infants. Delayed achievements of motor milestones were observed. Mothers’ knowledge scores on basic nutrients were low.

Conclusions

Complementary feeding indices of the study group were not satisfactory. Maternal and child healthcare personnel need to identify causative factors for inappropriate feeding with a view to improve the complementary feeding patterns.

Sex and body fat

Sex and age-related differences in perceived, desired and measured percentage body fat among adults

Campisi et al., JHND Early View

Background

Body image distortion/discrepancy leads to psychological stress, disordered eating and mental and physical disease. To begin to assess body image distortion/discrepancy, we compared perceived, desired and measured percentage body fat in male versus female and college-aged versus non-college aged individuals. In addition, we assessed the acute stress response to body composition measurement.

Methods

Body fat percentage of 15 college aged (‘College Students’; CS) (mean = 19 years) and 16 non-college aged (‘Non-College Aged Students’; NCS) (mean = 39 years) males and females was assessed with the BodPod Body Composition Tracking System (Life Measurement Instruments, Concord, CA, USA). Participants indicated their perception of body fat and their desired body fat using a somatomorphic matrix. Salivary cortisol, heart rate and blood pressure were also measured. Data were analysed by analysis of variance and alpha was set at 0.05.

Results

Mean (SD) percentage body fat of males [15.2% (6.1%] was significantly lower than that of females [28.4% (6.4%)] (P < 0.0001). Both CS and NCS females perceived their body fat to be lower (5%) than measured body fat and desired their body fat to be lower (12%) than measured (P < 0.05). CS and NCS male participants demonstrated the opposite result; both CS and NCS male populations perceived their body fat to be higher (5%) than measured body fat and desired their body fat to be higher (4%) than measured (P < 0.05). No differences between any groups were observed in heart rate, blood pressure or cortisol response to body fat measurement.

Conclusions

Sex-related but not age-related differences in perceived, desired and measured percentage body fat were observed.

Inadequate nutrition care in patients at risk of pressure ulcers

Nutrition care-related practices and factors affecting nutritional intakes in hospital patients at risk of pressure ulcers

Roberts et al., JHND Early View

Background

Malnutrition is common in hospitals and is a risk factor for pressure ulcers. Nutrition care practices relating to the identification and treatment of malnutrition have not been assessed in patients at risk of pressure ulcers. The present study describes nutrition care practices and factors affecting nutritional intakes in this patient group.

Methods

The study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients at risk of pressure ulcers as a result of restricted mobility were observed for 24 h to determine their daily oral intake and practices such as nutrition screening, documentation and intervention. Independent samples t-tests and chi-squared tests were used to analyse dietary intake and nutrition care-related data. Predictors of receiving a dietitian referral were identified using logistic regression analyses.

Results

Two hundred and forty-one patients participated in the present study. The observed nutritional screening rate was 59% (142 patients). Weight and height were documented in 71% and 34% of cases. Sixty-nine patients (29%) received a dietitian referral. Predictors of receiving a dietitian referral included lower body mass index and longer length of stay. On average, patients consumed 73% and 72% of the energy and protein provided, respectively. Between 22% and 38% of patients consumed <50% of food provided at main meals.

Conclusions

Nutrition care practices including malnutrition risk screening and documentation of nutritional parameters appear to be inadequate in patients at risk of pressure ulcers. A significant proportion of these patients eat inadequately at main meals, further increasing their risk of malnutrition and pressure ulcers.

Inborn errors of protein metabolism and CVD risk

Cardiovascular disease biomarkers in patients with inborn errors of protein metabolism: a pilot study

Karam et al., JHND Early View

Background

Limited data exist so far on cardiovascular disease biomarkers in patients maintained on a protein-restricted diet for inborn errors of protein metabolism. The present study aimed to analyse plasma cholesterol, lipoproteins, triglycerides and total homocysteine in patients with various inborn errors of protein metabolism in comparison with healthy controls.

Methods

A cross-sectional study of cardiovascular disease biomarkers was conducted in a cohort of patients with inborn errors of protein metabolism: nine phenylketonuria, nine urea cycle defect, six branched chain organic acidaemia and two tyrosinaemia type I patients compared to 30 healthy controls. All patients were on a strict natural protein diet for a mean (SD) period of 5.37 (2.30) years (range 2–9 years). Dietary assessment, plasma cholesterol, triglycerides, lipoproteins and total homocysteine levels were obtained.

Results

There were no significant differences in blood lipid studies and total homocysteine levels between patients and controls.

Conclusions

The results obtained in this pilot study suggest that cardiovascular disease biomarkers are not increased in patients with inborn errors of protein metabolism. This may be explained by the possible protective effect of a mono- and polyunsaturated fat rich Mediterranean diet. Additional studies with a larger number of patients are needed to confirm this finding.

Top of the pops

Here at JHND HQ I am waiting for the release of the new journal impact factors for last year. To be honest I am expecting a slight dip in JHNDs fortunes but am not desperately worried as we have a longer-term plan for improving our reputational indices. In the meantime here are our top cited papers for each of the last 4 years.

 

Number 1 for 2011 was:

Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome By Staudacher and colleagues. 

Background:  Emerging evidence indicates that the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may result in symptoms in some patients with irritable bowel syndrome (IBS). The present study aimed to determine whether a low FODMAP diet is effective for symptom control in patients with IBS and to compare its effects with those of standard dietary advice based on the UK National Institute for Health and Clinical Excellence (NICE) guidelines.

Methods:  Consecutive patients with IBS who attended a follow-up dietetic outpatient visit for dietary management of their symptoms were included. Questionnaires were completed for patients who received standard (n = 39) or low FODMAP dietary advice (n = 43). Data were recorded on symptom change and comparisons were made between groups.

Results:  In total, more patients in the low FODMAP group reported satisfaction with their symptom response (76%) compared to the standard group (54%, P = 0.038). Composite symptom score data showed better overall symptom response in the low FODMAP group (86%) compared to the standard group (49%, P < 0.001). Significantly more patients in the low FODMAP group compared to the standard group reported improvements in bloating (low FODMAP 82% versus standard 49%, P = 0.002), abdominal pain (low FODMAP 85% versus standard 61%, P = 0.023) and flatulence (low FODMAP 87% versus standard 50%, P = 0.001).

Conclusions:  A low FODMAP diet appears to be more effective than standard dietary advice for symptom control in IBS.

 

The most cited paper for 2012 was: 

Dietary counselling with or without oral nutritional supplements in the management of malnourished patients: a systematic review and meta-analysis of randomised controlled trials by Baldwin and Weekes. 

Dietary counselling and oral nutritional supplements (ONS) are recommended for managing malnutrition. A recent systematic review demonstrated (in separate analyses) that dietary counselling and dietary counselling with ONS improved energy intake, weight and some indices of body composition, although there was considerable heterogeneity. The present analysis aimed to examine the effects on mortality and nutritional indices of dietary counselling given with or without ONS and to explore the heterogeneity in the meta-analyses aiming to characterise the groups most likely to benefit from these interventions. A systematic review and meta-analysis was performed using Cochrane methodology. Twenty-six studies were included in the analysis: 12 comparing dietary counselling with usual care and 14 comparing dietary counselling and ONS if required with usual care (2123 participants). Quality of studies varied. Dietary counselling given with or without ONS had no effect on mortality [relative risk (fixed) = 1.12; 95% confidence interval = 0.86–1.46] but was associated with significant but heterogeneous benefits to weight [mean difference (random) = 1.7 kg; 95% confidence interval = 0.86–2.55], energy intake and some aspects of body composition. Subgroup analyses taking into account clinical background, age, nutritional status, type and length of intervention failed to reveal any differences in mortality, weight change and energy intake between groups. There were insufficient data on functional outcomes to explore these findings. Dietary counselling given with or without ONS is effective at increasing nutritional intake and weight but adequately-powered studies in similar patient populations and standardised for factors that might account for variations in response are required.

 

Number 1 for 2013 was: 

Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease by Shepherd and Gibson. 

Background

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.

Methods

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.

Results

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.

Conclusions

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.

 

And the top cited paper  from 2014 is:

Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries by Kautto et al.

Background

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.

Objectives

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).

Methods

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).

Results

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.

Conclusions

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.

RCP guidelines for prevention of stroke

Royal College of Physicians Intercollegiate Stroke Working Party evidence-based guidelines for the secondary prevention of stroke through nutritional or dietary modification

Hookway et al., JHND Early View

Background

Each year, 15 million people worldwide and 110 000 people in England have a stroke. Having a stroke increases the risk of having another. There are a number of additional known risk factors that can be modified by diet. The present study aimed to systematically review key nutrients and diets and their role in secondary prevention, as well as provide evidence-based guidelines for use in clinical practice. The work was conducted as part of the process to develop the 4th edition of the Royal College of Physicians’ (RCP) National Clinical Guideline (NCG) for Stroke.

Methods

Questions were generated by the research team, in consultation with the Virtual Stroke Group, an online professional interest group, and the RCP Intercollegiate Stroke Working Party Guideline Development Group. Nine questions covering several individual nutrients and diet combinations were defined and searches conducted up until 31 October 2011 using five electronic databases (Embase, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and Web of Science). All included studies were assessed for quality and risk of bias using van Tulder criteria for randomised controlled trials (RCTs) and Quality of Reporting of Meta-analyses (QUORUM) criteria for systematic reviews.

Results

Of 4287 abstracts were identified, 79 papers were reviewed and 29 systematic reviews and RCTs were included to provide evidence for the secondary prevention components of the guidelines. For each question, evidence statements, recommendations and practical considerations were developed.

Conclusions

This systematic review process has resulted in the development of evidence-based guidelines for use in clinical practice and has identified areas for further research.

Variation in beverage consumption across age groups

Fluid intake from beverages across age groups: a systematic review

Ozen et al., 2014 JHND Early View

Background

Fluid intake, especially water, is essential for human life and also necessary for physical and mental function. The present study aimed to assess beverage consumption across age groups.

Methods

A systematic review was conducted. Original research in English language publications and available studies (or abstracts in English) from 2000 to 2013 was searched for by using the medical subheading (MeSH) terms: (‘beverage’ OR ‘fluid’ [Major]) AND (‘consumption’ [Mesh] OR ‘drinking’ [Mesh] OR ‘intake’ [Mesh]) AND (‘child’ [Mesh] OR ‘adolescent’ [Mesh] OR ‘adult’ [Mesh]). Article selection was restricted to those papers covering healthy populations of all age groups in a nationwide sample, or from a representative sample of the population of a city or cities, which examined the trends or patterns of beverage intake and the determinants of beverage intake. Sixty-five studies were identified with respect to beverage consumption across age groups. The papers were screened by thoroughly reading titles or abstracts. Full-text articles were assessed by three investigators.

Results

Total beverage intake varied between 0.6 and 3.5 L day−1 among all age groups (males more than females). Plain water contributed up to 58%, 75% and 80% of the total beverage intake in children, adolescents and adults, respectively. Milk consumption was higher among children; consumption of soft drinks was higher among adolescents; and the consumption of tea, coffee and alcoholic beverages was higher among adults.

Conclusions

Plain water is the main water source for all age groups and the consumption of other beverages varies according to age.