Improving nutritional intake in vulnerable groups

Supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults: a systematic review of nonrandomised studies

Kimber et al., JHND Early View

Background

Supportive interventions for enhancing dietary intake in malnourished or nutritionally at risk adults are frequently recommended. A recent systematic review of randomised controlled trials identified limited and poor quality evidence to support their use. Observational studies have been shown to compliment and extend their evidence. This review aimed to synthesise evidence from nonrandomised studies aiming to improve nutritional intake in nutritionally vulnerable individuals and to describe their effects on cost, nutritional, clinical and patient centred outcomes.

Methods

Systematic searches of 10 electronic databases were undertaken to May 2013. Reference lists of identified studies and systematic reviews were scrutinised and hand searching of relevant meeting abstracts was undertaken. Titles and abstracts were reviewed, data extracted by two research-ers working independently and summarised using a structured narrative format.

Results

Forty-one studies (n = 3751 participants) were identified for inclusion. Interventions identified included changes to the organisation of nutritional care (n = 15), changes to the feeding environment (n = 11), modification to meals (n = 6), supplementation of meals (n = 7) and recipients of home delivered meals (n = 2). Eighteen of 23 studies reported improvements in nutritional intake; however, effects on nutritional status, clinical outcomes and costs were reported in few studies and findings were inconsistent. Eighteen studies reported patient experience, highlighting benefits to nutritional status most commonly as judged by the carers but the methods used lacked rigour.

Conclusions

This systematic review describes a range of interventions that may be implemented in clinical practice. A limited range of outcomes are reported and it is difficult to draw any meaningful conclusions on the effect of the different methods.

Nutritional interventions for healthy ageing

Role of fatty acids and micronutrients in healthy ageing: a systematic review of randomised controlled trials set in the context of European dietary surveys of older adults

Ruxton et al., JHND Early View

Background

Ageing is a multifaceted and inevitable process involving a decline in health and well-being that could be ameliorated by dietary modification. We review and discuss the evidence for nutritional interventions that may support healthy ageing.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify randomised controlled trials investigating the role(s) of fatty acids and micronutrients in relation to markers of healthy ageing.

Results

European dietary surveys suggest that diets in elderly people are generally high in saturated fat, whereas intakes of vitamin D, magnesium, potassium, zinc and copper are below recommended levels. Thirty-four studies meeting the criteria were found, with 12 of these investigating the role of fatty acids and 22 considering intakes of micronutrients in relation to healthy ageing. Overall, these studies suggested that certain nutrients were consistent with healthy ageing; for example, omega-3 fatty acids were helpful for cognitive health, whereas combinations of calcium, vitamin D and K were linked with better bone health.

Conclusions

Vitamin, mineral and fatty acid intakes are in need of improvement to help elderly populations achieve optimal diet quality and support healthy ageing. This could involve the judicious use of supplements alongside dietary advice. Additional research is needed to determine optimal nutrient doses, combinations and forms in relation to desired health outcomes.

Compliance of the Scottish diet with Eatwell guidance

Using food intake records to estimate compliance with the Eatwell Plate dietary guidelines

Whybrow et al., JHND Early View

Background

The UK Eatwell Plate is consumer based advice recommending the proportions of five food groups for a balanced diet: starchy foods, fruit and vegetables, dairy foods, nondairy sources of protein and foods and drinks high in fat or sugar.

Many foods comprise ingredients from several food groups and consumers need to consider how these fit with the proportions of the Eatwell Plate. This involves disaggregating composite dishes into proportions of individual food components. The present study aimed to match the diets of adults in Scotland to the Eatwell Plate dietary recommendations and to describe the assumptions and methodological issues associated with estimating Eatwell Plate proportions from dietary records.

Methods

Foods from weighed intake records of 161 females and 151 males were assigned to a single Eatwell group based on the main ingredient for composite foods, and the overall Eatwell Plate proportions of each subject’s diet were calculated. Food group proportions were then recalculated after disaggregating composite foods.

Results

The fruit and vegetables and starchy food groups consumed were significantly lower than recommended in the Eatwell Plate, whereas the proportions of the protein and foods high in fat or sugar were significantly higher. Failing to disaggregate composite foods gave an inaccurate estimate of the food group composition of the diet.

Conclusions

Estimating Eatwell Plate proportions from dietary records is not straightforward, and is reliant on methodological assumptions. These need to be standardised and disseminated to ensure consistent analysis.

Serum PUFA but not SFA are associated with dietary intake in Swedish adults

Cross-sectional relationships between dietary fat intake and serum cholesterol fatty acids in a Swedish cohort of 60-year-old men and women

Laguzzi et al., JHND Early View

Background

The present study aimed to describe the relationship between self-reported dietary intake and serum cholesterol fatty acids (FAs) in a Swedish population of 60-year-old men and women.

Methods

Cross-sectional data collected in 1997–1998 from 4232 individuals residing in Stockholm County were used. Five diet scores were created to reflect the intake of saturated fats in general, as well as fats from dairy, fish, processed meat and vegetable oils and margarines. Gas chromatography was used to assess 13 FAs in serum cholesterol esters. The association between each diet score and specific FAs was assessed by percentile differences (PD) with 95% confidence intervals (CI) at the 10th, 25th, 50th, 75th and 90th percentile of each FA across levels of diet scores using quantile regression.

Results

Fish intake was associated with high proportions of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). For each point increase in fish score, the 50th PD in EPA and DHA was 32.78% (95% CI = 29.22% to 36.35%) and 10.63% (95% CI = 9.52% to 11.74%), respectively. Vegetable fat intake was associated with a high proportion of linoleic acid and total polyunsaturated fatty acids (PUFA) and a low proportion of total saturated fatty acids (SFA). The intake of saturated fats in general and dairy fat was slightly associated with specific SFA, although the intake of fat from meat was not.

Conclusions

In the present study population, using a rather simple dietary assessment method, the intake of fish and vegetable fats was clearly associated with serum PUFA, whereas foods rich in saturated fats in general showed a weak relationship with serum SFA. Our results may contribute to increased knowledge about underlying biology in diet–cardiovascular disease associatio

Portion size and gestational weight gain in pregnant women

The association between portion size, nutrient intake and gestational weight gain: a secondary analysis in the WATCH study 2006/7

Blumfield et al., JHND Early View

Background

Excessive gestational weight gain (GWG) is associated with adverse maternal–child health outcomes. Managing energy intake and GWG versus optimising nutrient intake can be challenging. The present study aimed to examine the relationships between dietary portion size, GWG and nutrient intakes during pregnancy. It is hypothesised that, after adjustment for potential confounders, portion size would be positively associated with both GWG and nutrient intakes during pregnancy.

Methods

Prospective data were obtained for 179 Australian women from the Women and Their Children’s Health Study. A validated food frequency questionnaire was used at 18–24 and 36–40 weeks of gestation to quantify diet and portion size during the previous 3 months of pregnancy. Nutrient intakes were compared with Australian Nutrient Reference Values (NRVs). GWG was measured up to 36 weeks and compared with the Institute of Medicine weight gain recommendations (WtAdh).

Results

In multivariate regression models, portion size factor (PSF) was positively associated with GWG in women with high socio-economic status (SES; β = 0.20, = 0.04) and those with an overweight/obese pre-pregnancy body mass index (BMI) (β = 0.28, = 0.04). PSF uniquely accounted for 8.2% and 3.7% of the variability in GWG for women with high SES and overweight/obese pre-pregnancy BMIs, respectively. Nutrient intakes and PSF were similar regardless of WtAdh. Women achieved NRVs for calcium and zinc in all PSF categories. Most of the women with large PSF still failed to achieve the NRVs for folate (95.7%), iron (89.6%) and fibre (85.5%).

Conclusions

All women require advice on quality food choices during pregnancy to optimise health outcomes. Targeting portion size alone is insufficient to manage GWG but may prove to be a valuable tool in pregnant women of high SES and/or those who are overweight/obese pre-pregnancy.

Pinch grip as an alternative to hand grip strength in haemodialysis patients

Pinch grip strength as an alternative assessment to hand grip strength for assessing muscle strength in patients with chronic kidney disease treated by haemodialysis: a prospective audit

El-Katab et al., JHND Early View

Background

Muscle weakness and wasting are prevalent in haemodialysis (HD) patients, and substantially increase mortality. Convenient, readily applicable screening tests for routine clinical practice are required. Hand grip strength (HGS) has been validated in HD patients but cannot be readily measured during a HD session. On the other hand, pinch strength (PS) can be measured during a HD session, and we aimed to compare the two methods of assessing muscle strength.

Methods

We measured pinch strength (PS) and hand grip strength (HGS) in 209 adult HD patients. The mean of three measurements was taken.

Results

The mean (SD) HGS was 15.3 (7.1) kg, compared to a PS of 2.9 (1.5) kg (P < 0.0001). HGS was weaker in the arteriovenous fistula (AVF) arm than the non-AVF arm [14.01 (6.9) versus 16.4 (7.1) kg (P < 0.001)], as was PS [AVF arm 2.63 (1.30) versus 3.08 (1.65) kg (P < 0.001)]. We found a strong correlation between HGS and PS (r = 0.82, P < 0.001. Comparing HGS and PS, we found a mean difference of 12.08 kg (Bland–Altman analysis), although the absolute difference was smaller with lower HGS.

Conclusions

We found PS to be highly correlated with HGS, and was more convenient for patients because PS could be readily performed during the HD session. PS may provide an easier screening tool for muscle strength than HGS for dialysis patients, although further validation studies are required.

A food frequency questionnaire for estimation of vitamin D intake in adults

Validation of a food frequency questionnaire to determine vitamin D intakes using the method of triads

Weir et al., JHND Early View

Background

Dietary sources of vitamin D (both natural and fortified) are increasingly contributing to consumers’ vitamin D intake and status. Therefore, the present study aimed to validate a vitamin D food frequency questionnaire (FFQ) for the assessment of habitual vitamin D intake.

Methods

A total of 49 apparently healthy consenting adults (aged 18–64 years) from the local community were sampled at the end of winter. Dietary intakes were recorded using a 4-day weighed food record (4d-WFR) and a 17-item FFQ based on foods known to contribute to dietary vitamin D intake. Fasting vitamin D status was quantified by serum 25-hydroxyvitamin D [25(OH)D] using liquid chromatography tandem mass spectrometry. The method of triads was applied using these three measurements to determine the overall validity of the FFQ.

Results

Vitamin D intakes from 4d-WFR ranged between 0.42 and 31.65 μg day−1, whereas intakes determined from the FFQ ranged from 1.03 to 36.08 μg day−1. Serum 25(OH)D concentrations ranged between 12.89 and 279.00 nmol L−1. The mean (SD) difference between the FFQ and 4d-WFR was +1.62 ( 3.86). There were strong correlations between the vitamin D intake estimated by the FFQ and that from the 4d-WFR (= 0.562) and also with serum 25(OH)D concentrations (= 0.567). Vitamin D intake estimated from the 4d-WFR was also strongly correlated with serum 25(OH)D concentrations (= 0.411). The overall validity coefficient calculated using the method of triads was high (0.881).

Conclusions

The vitamin D FFQ has been validated for use in future studies aiming to assess habitual vitamin D intake.