Universal free school meal uptake in an urban community

Factors associated with universal infant free school meal take up and refusal in a multicultural urban community

Goodchild et al., JHND Early View

Background

Universal infant free school meals (UIFSM) were introduced in September 2014 and are available to all key stage 1 (4–7 years) children attending state-maintained infant and primary schools in England. The present study aimed to investigate the school-based factors, child and family socio-demographic characteristics, and parental beliefs associated with UIFSM take up in an urban community.

Methods

A cross-sectional questionnaire survey was completed in October to November 2015, amongst parents whose children attended eligible schools in Leicester, England. A questionnaire about school meals was also completed by each school.

Results

Parents reported their child did not take (non-UIFSM, n = 159) or took (UIFSM, n = 517) a UIFSM on most days. The non-UIFSM group were more likely to be White-British, have a higher socio-economic status, have English as a first language, and involve their child in the decision over whether or not to take UIFSM, compared to the UIFSM group. Cluster analysis revealed that non-UIFSM parents were either concerned over quality of meals and what/how much their child ate, concerned only by what/how much their child ate or whether their child did not like the food provided. Two subsets of parents in the UIFSM group were either very positive about UIFSM or appeared to take meals because they were free. Schools used a variety of measures to increase and maintain UIFSM take up.

Conclusions

Parents like to have control over what their child eats at school and children need to enjoy their school meals. Using a range of interventions to target subsets of parents may help local authorities, schools and caterers to increase UIFSM take up.

Patient-centred care to improve dietetic practice

Patient-centred care to improve dietetic practice: an integrative review

Sladdin et al., JHND Early View

Background

Patient-centred care (PCC) is associated with significant improvements in patients’ health outcomes and healthcare systems. There is an opportunity to better understand PCC in dietetics. Thus, the present integrative review aims to critically synthesise literature relating to PCC in dietetics.

Methods

A systematic literature search was conducted between February and March 2016. Studies were included if they (i) involved dietitians and/or patients who had participated in an individual dietetic consultation; (ii) related to one or more components of PCC; and (iii) were empirical full-text studies in English, involving adult participants, published between 1997 and 2016. Following title and abstract screening, full texts were retrieved and independently assessed for inclusion by two of the investigators. Two independent investigators conducted data extraction and quality assessment using the Mixed Methods Appraisal Tool. Study findings were analysed thematically using meta-synthesis. Twenty-seven studies met the inclusion criteria.

Results

Six themes were discovered inductively: (i) establishing a positive dietitian–patient relationship; (ii) displaying humanistic behaviours; (iii) using effective communication skills; (iv) individualising and adapting care; (v) redistributing power to the patient; and (vi) lacking time for PCC practices. The first three themes were closely related. Studies used a broad range of methodological designs. Limitations of the studies included a lack of reflexivity and a lack of representativeness of the study population.

Conclusions

It is apparent that dietitians require good communication skills and humanistic qualities to build positive relationships with patients. Patients strongly desire individualised nutrition care and greater involvement in care. Ensuring dietitians are able to incorporate patient-centred practises during care requires further research.

Supplementing young children with vitamin A.

Socio-economic determinants of vitamin A intake in children under 5 years of age: evidence from Pakistan

Changezi and Lindberg JHND Early View

Background

Vitamin A deficiency, which is a leading health issue worldwide, is estimated to affect approximately 190 million children globally. The most affected areas are Africa and parts of Southeast Asia.

Methods

The present study examined the use of vitamin A supplementation and the association between socio-demographic factors and vitamin A supplementation in children aged less than 5 years from a cross-sectional demographic survey of Pakistan. Odds ratios were used to express the association between the independent and dependent variables.

Results

For 10 906 children, the coverage of vitamin A supplementation was 68.5%, with regional variations of between 8% and 79%. A multiple logistic regression analysis was used on a nationally representative sample of mothers aged 15–49 years. The adjusted results showed that socio-demographic factors such as a maternal age greater than 24 years, living in rural areas and regional variations were positively associated with vitamin A supplementation.

Conclusions

From the results of the present study, we conclude that socio-demographic factors were influential on vitamin A supplementation in children aged less than 5 years. Therefore, national and community-level efforts to support younger mothers in urban areas in the regions with the lowest coverage are needed to increase the acceptance of vitamin A supplementation, aiming to improve the nutritional status of children and decrease inequity in health.

 

A novel classification of processed foods

A novel processed food classification system applied to Australian food composition databases

O’Halloran et al., JHND Early View

Background

The extent of food processing can affect the nutritional quality of foodstuffs. Categorising foods by the level of processing emphasises the differences in nutritional quality between foods within the same food group and is likely useful for determining dietary processed food consumption. The present study aimed to categorise foods within Australian food composition databases according to the level of food processing using a processed food classification system, as well as assess the variation in the levels of processing within food groups.

Methods

A processed foods classification system was applied to food and beverage items contained within Australian Food and Nutrient (AUSNUT) 2007 (n = 3874) and AUSNUT 2011–13 (n = 5740). The proportion of Minimally Processed (MP), Processed Culinary Ingredients (PCI) Processed (P) and Ultra Processed (ULP) by AUSNUT food group and the overall proportion of the four processed food categories across AUSNUT 2007 and AUSNUT 2011–13 were calculated.

Results

Across the food composition databases, the overall proportions of foods classified as MP, PCI, P and ULP were 27%, 3%, 26% and 44% for AUSNUT 2007 and 38%, 2%, 24% and 36% for AUSNUT 2011–13. Although there was wide variation in the classifications of food processing within the food groups, approximately one-third of foodstuffs were classified as ULP food items across both the 2007 and 2011–13 AUSNUT databases.

Conclusions

This Australian processed food classification system will allow researchers to easily quantify the contribution of processed foods within the Australian food supply to assist in assessing the nutritional quality of the dietary intake of population groups.

 

The use of smartphone health apps and other mobile health technologies in dietetic practice

The use of smartphone health apps and other mobile health (mHealth) technologies in dietetic practice: a three country study

Chen et al., JHND Early View

Background

Smartphone health applications (apps) and other mobile health (mHealth) technologies may assist dietitians in improving the efficiency of patient care. The present study investigated the use of health apps and text messaging in dietetic practice and formulated intervention recommendations for supporting app uptake by dietitians based on the behavioural ‘COM-B’ system, where interactions between capability, opportunity and motivation influence behaviour.

Methods

A 52-item online survey tool, taking 20 min to complete, was developed and piloted, with questions exploring the use of health apps and text messaging in dietetic practice, types of apps dietitians recommended and that patients used, and barriers and enablers to app use in dietetic practice. The Australian, New Zealand and British dietetic associations distributed the survey to their members.

Results

A 5% response rate was achieved internationally, with 570 completed responses included for further analysis. Health apps, namely nutrition apps, were used by 62% of dietitians in their practice, primarily as an information resource (74%) and for patient self-monitoring (60%). The top two nutrition apps recommended were MyFitnessPal® (62%) and the Monash University Low FODMAP Diet® (44%). Text messaging was used by 51% of respondents, mainly for appointment-related purposes (84%).

Conclusions

Although the reported use of smartphone health apps in dietetic practice is high, health apps and other mHealth technologies are not currently being used for behaviour change, nor are they an integral part of the nutrition care process. Dietetic associations should provide training, education and advocacy to enable the profession to more effectively engage with and implement apps into their practice.

Nutrition interventions in chronic fatigue syndrome

Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review

Campagnolo et al., JHND Early View

Background

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is characterised by unexplained fatigue for at least 6 months accompanied by a diverse but consistent set of symptoms. Diet modification and nutritional supplements could be used to improve patient outcomes, such fatigue and quality of life. We reviewed and discussed the evidence for nutritional interventions that may assist in alleviating symptoms of CFS/ME.

Methods

Medline, Cinahl and Scopus were systematically searched from 1994 to May 2016. All studies on nutrition intervention were included where CFS/ME patients modified their diet or supplemented their habitual diet on patient-centred outcomes (fatigue, quality of life, physical activity and/or psychological wellbeing).

Results

Seventeen studies were included that meet the inclusion criteria. Of these, 14 different interventions were investigated on study outcomes. Many studies did not show therapeutic benefit on CFS/ME. Improvements in fatigue were observed for nicotinamide adenine dinucleotide hydride (NADH), probiotics, high cocoa polyphenol rich chocolate, and a combination of NADH and coenzyme Q10.

Conclusions

This review identified insufficient evidence for the use of nutritional supplements and elimination or modified diets to relieve CFS/ME symptoms. Studies were limited by the number of studies investigating the interventions, small sample sizes, study duration, variety of instruments used, and studies not reporting dietary intake method. Further research is warranted in homogeneous CFS/ME populations.

 

Glycomacropeptide may impact on control of phenylalanine intake in PKU

Glycomacropeptide in children with phenylketonuria: does its phenylalanine content affect blood phenylalanine control?

Daly et al., JHND Early View

Background

In phenylketonuria (PKU), there are no data available for children with respect to evaluating casein glycomacropeptide (CGMP) as an alternative to phenylalanine-free protein substitutes [Phe-free L-amino acid (AA)]. CGMP contains a residual amount of phenylalanine, which may alter blood phenylalanine control.

Methods

In a prospective 6-month pilot study, we investigated the effect on blood phenylalanine control of CGMP-amino acid (CGMP-AA) protein substitute in 22 PKU subjects (13 boys, nine girls), median age (range) 11 years (6–16 years). Twelve received CGMP-AA and nine received Phe-free L-AA, (1 CGMP-AA withdrawal). Subjects partially or wholly replaced Phe-free L-AA with CGMP-AA. If plasma phenylalanine exceeded the target range, the CGMP-AA dose was reduced and replaced with Phe-free L-amino acids. The control group remained on Phe-free L-AAs. Phenylalanine, tyrosine and Phe : Tyr ratio concentrations were compared with the results for the previous year.

Results

In the CGMP-AA group, there was a significant increase in blood phenylalanine concentrations (pre-study, 275 μmol L−1; CGMP-AA, 317 μmol L−1; P = 0.02), a decrease in tyrosine concentrations (pre-study, 50 μmol L−1; CGMP-AA, 40 μmol L−1; P = 0.03) and an increase in Phe : Tyr ratios (pre-study, Phe : Tyr 1 : 5.5; CGMP-AA, Phe : Tyr 1 : 8; P = 0.02).

Conclusions

In the control group, there was a nonsignificant fall in phenylalanine concentrations (pre-study, 325 μmol L−1; study, 280 μmol L−1; P = 0.9) and no significant changes for tyrosine or Phe : Tyr ratios (P = 0.9). Children taking the CGMP-AA found it more acceptable to L-AA. Blood phenylalanine control declined with CGMP-AA but, by titrating the dose of CGMP-AA, blood phenylalanine control remained within target range. The additional intake of phenylalanine may have contributed to the change in blood phenylalanine concentration. CGMP-AA use requires careful monitoring in children.