Psychosocial predictors of adherence to a gluten-free diet

Prediction of adherence to a gluten-free diet using protection motivation theory among adults with coeliac disease

Dowd et al., JHND Early View

Background

Coeliac disease is a chronic autoimmune disease that requires strict adherence to a gluten-free diet. However, strict adherence to a gluten-free diet is difficult, with findings from a recent review suggesting that up to 42% of individuals with coeliac disease do not eat a strict gluten-free diet.

Methods

The present study aimed to examine psychosocial predictors of adherence (purposeful and accidental) to a gluten-free diet among adults with coeliac disease over a 1-month period. In this longitudinal study, 212 North American adults with coeliac disease completed online questionnaires at two time points, baseline and 1 month later.

Results

The results revealed that intentions partially mediated the effects of symptom severity, self-regulatory efficacy, planning and knowledge on purposeful gluten consumption. Intentions did not mediate the effects of severity, response cost, self-regulatory efficacy, planning and knowledge for accidental gluten consumption but, interestingly, self-regulatory efficacy directly predicted fewer accidental incidents of gluten-consumption.

Conclusions

These findings delineate the differential psychological processes in understanding accidental and purposeful gluten consumption among adults with coeliac disease and emphasise the importance of bolstering self-regulatory efficacy beliefs to prevent accidental and purposeful consumption of gluten.

Risk of undernutrition in the elderly

Dietary intake in the dependent elderly: evaluation of the risk of nutritional deficit

Fernández-Barrés et al., JHND Early View

Background

Malnutrition is a frequent problem in elderly dependent patients and their prognosis is adversely affected. Assessment of food consumption and adequacy of energy and nutrient intake of dependent elderly is needed to plan any selected actions for this population.

Methods

The study comprised a multicentre cross-sectional study of 190 users (≥65 years) of a home care programme provided by primary care centers in Tarragona (Spain), at nutritional risk (Mini Nutritional Assessment: 17–23.5 points). Food consumption was assessed using a semiquantitative validated food frequency questionnaire. Energy intake was compared with the Spanish dietary reference intake (DRI) and nutritional intakes with the DRI of the American Institute of Medicine.

Results

Mean (SD) age was 85.0 (7.2) years (67.5% female). The food items consumed were varied but lower than the recommended portions for cereals, fruits, vegetables and legumes. Energy intake was 7454.2 (1553.9 kJ day–1) [1781.6 (371.4) kcal day–1] (97.7% of recommended dietary allowance; RDA) and protein intake was 1.0 (0.4) g kg–1 of weight (121.4% of RDA). Proteins provided 13.3%, carbohydrates provided 39.9% and fats provided 45.8% of energy intake. The intakes of calcium, vitamin D, vitamin E and folates were less than two-thirds of the RDA and their probability of inadequate intake was >85%.

Conclusions

Dietary intakes of elderly dependent patients at nutritional risk were well balanced. In general, energy and protein intakes meet the recommendations. The diet was high in energy density, low in complex carbohydrates, high in simple carbohydrates and excessive in fats. The dependent elderly had inadequate intake of micronutrients often related to fragility, such as calcium, vitamin D, vitamin E and folates.

Factors influencing food choice in young adults

You are what you choose to eat: factors influencing young adults’ food selection behaviour

Hebden et al., JHND Early View

Background

Young or ‘emerging’ adulthood (ages 18–24 years) is a life-stage characterised by rapid weight gain, particularly among those born in recent decades, when environments have become saturated with cheap, highly palatable, processed foods. Although intervening in the immediate food environments of emerging adults is indicated, little is known about the factors influencing their food selection. The present study aimed to: (i) measure the relative importance of different influences on foods selected by emerging adults for consumption from a tertiary education setting and (ii) examine whether these influences differ according to gender, adiposity status, perceived stress and dieting or physical activity behaviours.

Methods

An online survey was administered with 112 emerging adults aged 19–24 years assessing demographics, perceived stress, dieting, physical activity and influences on food selection. Adiposity indicators (body mass index and waist circumference) were measured. Analyses compared the importance of influences on food selection by gender, adiposity, perceived stress, dieting and physical activity.

Results

Taste was the most important influence on food selection, followed by convenience (availability), cost, nutrition/health value, smell and stimulatory properties (alertness). Participants with an elevated waist circumference selected foods to help them cope with stress and control their weight. Those reporting a higher level of physical activity placed greater importance on nutritional/health value of foods but less importance on taste. Female dieters also placed less importance on taste and value for money.

Conclusions

Health promotion strategies addressing tertiary education food environments of emerging adults should ensure the ready availability of tasty and nutritious foods at a low cost.

Making the transition to complementary feeding- recommendations are not followed

Transition from milks to the introduction of solid foods across the first 2 years of life: findings from an Australian birth cohort study

Amezdroz et al., JHND Early View

Background

The current literature regarding the transition from milks to solid foods across the first 2 years of life is limited despite the important influence of early dietary intake on children’s growth and development. The present study describes dietary intake from birth to 2 years across four developmental relevant time-points within an Australian birth cohort.

Methods

Dietary data from 466 infants was collected at four time-points in the first 2 years of life via parent-reported questionnaire, including a 45-item food and beverage frequency questionnaire. Subsample analyses of children who were aged 1–3, 6–8, 12–14 and 18–20 months at the time of data collection were conducted.

Results

Infant formula remained consistently consumed by over 75% of children from the 6–8- to 18–20 months old age groups. Mean (SD) age of introduction to solid foods was 5.2 (1.3) months. Almost 20% and 10% of children were introduced before 16 and after 32 weeks, respectively. The highest consumption of core foods, recommended for a healthy diet, daily was seen in the 12–14 months old age group with lower proportions in the 18–20 months old age group coinciding with an increased proportion of children eating discretionary choice foods, not recommended for a healthy diet. Discretionary choice foods/beverages presented in children’s diets as early as in the 6–8 months old age group. By 18–20 months, at least 20% of children were consuming savoury biscuits, sweet biscuits, muesli bars and luncheon meats at least twice a week.

Conclusions

The present study identified a number of findings outside the recommendations of the Australian Dietary and Infant Feeding Guidelines. Further work is warranted to explore these outcomes.

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Factors influencing French dietary patterns

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Dietary patterns of French adults: associations with demographic, socio-economic and behavioural factors

Bertin et al., JHND Early View

Background

Although the French eating model may differ from those of other countries, no studies to date have investigated dietary patterns in a wide age range of adults and at the national level. We aimed to identify dietary patterns (DP) of French adults and assess their associations with demographic, socio-economic and behavioural factors.

Methods

The present study included 2624 adults (1087 men, 1537 women) aged 18–79 years from the cross-sectional national French INCA2 dietary survey. Dietary data were collected using a 7-day estimated food record. Clusters of DP were derived using principal component analysis and clustering, conjointly. Age-adjusted logistic regression analyses were used to investigate the association between DP and correlates.

Results

Five DP were identified, namely ‘traditional’, ‘prudent’, ‘diversified’, ‘processed’ and ‘sandwiches’. Men were more likely to follow a traditional diet and women the ‘prudent’ pattern. Members of the ‘processed’ and ‘sandwiches’ patterns were younger compared to non-members. Healthier dietary patterns were overall positively associated with a higher socio-economic position, healthier behaviours (in terms of sedentary behaviours and smoking status) and lower body mass index. Under-reporting of energy intake, restrictive diet to lose weight and dietary supplement consumption were also related to specific DP, although differentially in men and women. Associations with contextual factors (i.e. household composition, agglomeration size and region) were also observed.

Conclusions

The identification of adults’ dietary patterns and associated behaviours (all modifiable) is important for the conceptualisation of multi-behavioural programs. The additional information on social and environmental correlates is also essential for targeting the most vulnerable population groups in the context of such public health interventions.

Malnutrition in hospitals

Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition Task Force

Keller et al., JHND Early View

Background

Poor food intake is common in acute care patients and can exacerbate or develop into malnutrition, influencing both recovery and outcome. Yet, research on barriers and how they can be alleviated is lacking. The present study aimed to (i) describe the prevalence of food intake barriers in diverse hospitals and (ii) determine whether patient, care or hospital characteristics are associated with the experience of these barriers.

Methods

Patients (n = 890; 87%) completed a validated questionnaire on barriers to food intake, including perceptions of food quality, just before their discharge from a medical or surgical unit in each of 18 hospitals across Canada. Scores were created for barrier domains. Associations between these barriers and selected patient characteristics collected at admission or throughout the hospital stay and site characteristics were determined using bivariate analyses.

Results

Common barriers were being interrupted at meals (41.8%), not being given food when a meal was missed (69.2%), not wanting ordered food (58%), loss of appetite (63.9%) and feeling too sick (42.7%) or tired (41.1%) to eat. Younger patients were more likely (P < 0.0001) to report being disturbed at meals (44.6%) than older patients (33.9%) and missing a meal for tests (39.0% versus 31.0%, P < 0.05). Patients who were malnourished, women, those with more comorbidity, and those who ate <50% of the meal reported several barriers across domains.

Conclusions

The present study confirms that barriers to food intake are common in acute care hospitals. This analysis also identifies that specific patient subgroups are more likely to experience food intake barriers. Because self-reported low food intake in hospital was associated with several barriers, it is relevant to consider assessing, intervening and monitoring barriers to food intake during the hospital stay.

Living gluten free

Living gluten-free: adherence, knowledge, lifestyle adaptations and feelings towards a gluten-free diet

Silvester et al., JHND Early View

Background

A gluten-free diet (GFD) requires tremendous dedication, involving substantive changes to diet and lifestyle that may have a significant impact upon quality of life. The present study aimed io assess dietary adherence, knowledge of a GFD, and the emotional and lifestyle impact of a GFD.

Methods

Community dwelling adults following a GFD completed a questionnaire with items related to reasons for avoiding gluten, diagnostic testing, GFD adherence, knowledge and sources of information about a GFD, the Work and Social Adjustment Scale, and the effect of a GFD diet on lifestyle, feelings and behaviours.

Results

Strict GFD adherence among the 222 coeliac disease (CD) patients was 56%. Non-CD individuals (n = 38) were more likely to intentionally ingest gluten (odds ratio = 3.7; 95% confidence interval = 1.4–9.4). The adverse impact of a GFD was modest but most pronounced in the social domain. Eating shifted from the public to the domestic sphere and there were feelings of social isolation. Affective responses reflected resilience because acceptance and relief were experienced more commonly than anxiety or anger. Non-CD respondents were less knowledgeable and less likely to consult health professionals. They experienced less anger and depression and greater pleasure in eating than CD respondents.

Conclusions

The findings obtained in the present suggest there is good potential for positive adaptation to the demands of a GFD; nevertheless, there is a measurable degree of social impairment that merits further study. The GFD may be a viable treatment option for conditions other than CD; however, education strategies regarding the need for diagnostic testing to exclude CD are required.

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