Usability of electronic food systems in hospital

Technology to engage hospitalised patients in their nutrition care: a qualitative study of usability and patient perceptions of an electronic foodservice system

Roberts et al., Early View unknown

Background

Active patient involvement in nutrition care may improve dietary intakes in hospital. Our team is developing an innovative programme allowing patients to self-assess and self-monitor their nutrition at the bedside. The present study aimed to assess usability and patient perceptions of an electronic foodservice system (EFS) for participating in nutrition care.

Methods

This qualitative study was conducted in an Australian tertiary hospital. Participants were sampled purposively and included patients who were able to provide informed consent and communicate in English. Patient interviews were conducted at the bedside and consisted of: (i) usability testing of the EFS using ‘Think Aloud’ technique and (ii) questioning using a semi-structured interview guide to understand perceptions of the EFS. Interview data were analysed using inductive content analysis.

Results

Thirty-two patients were interviewed. Their perceptions of using the EFS to participate in nutrition care were expressed in five categories: (i) Familiarity with technology can affect confidence and ability but is not essential to use EFS; (ii) User interface design significantly impacts EFS usability; (iii) Identifying benefits to technology increases its acceptance; (iv) Technology enables participation, which occurs to varying extents; and (v) Degree of participation depends on perceived importance of nutrition.

Conclusions

Patients found the EFS acceptable and acknowledged benefits to its use. Several factors appeared to influence usability, acceptability and willingness to engage with the system, such as user interface design and perceived ease of use, benefits and importance. The present study provides important insights into designing technology-based interventions for engaging inpatients in their nutrition care.

A pilot RCT of a pregnancy intervention to prevent allergy in infants.

A pilot randomised controlled trial investigating a Mediterranean diet intervention in pregnant women for the primary prevention of allergic diseases in infants

Sewell et al., JHND Early View unknown-2

Background

Observational studies suggest a potentially protective role of the Mediterranean diet (MD) in allergic diseases, including asthma. Large scale randomised controlled trials (RCTs) are needed to test the hypothesised allergy-prevention benefits of a MD during pregnancy. The present two-arm pilot RCT in pregnant women at high-risk of having a child who would develop allergic disease investigated maternal recruitment, retention and acceptability of an MD dietary intervention in the UK. The trial also assessed the effect of the intervention on MD adherence scores at 12 and at 24 weeks post-randomisation.

Methods

Thirty women were recruited at around 12 weeks of gestation. Retention was high (28 out of 30; 93%). The intervention was acceptable to participants. Mean (SD) adherence to the MD at baseline was 12.4 (2.9) in the intervention arm (n = 14) and 13.0 (1.9) in the control arm (n = 16), where 24 represents maximal adherence. There was a favourable short-term change in MD score: the adjusted mean difference (intervention – control) in the change in MD score from baseline to 12 weeks post-randomisation was 2.4 (95% confidence interval = 0.6–4.2, P = 0.012).

Conclusions

The trial provides important insights into recruitment, retention and sustaining the dietary intervention, which will be used in the design of a large RCT.

Impact of lifestyle change on the cardio- metabolic risk factors of relatives of diabetic subjects

Lifestyle change reduces cardiometabolic risk factors and glucagon-like peptide-1 levels in obese first-degree relatives of people with diabetes

Bowes et al., JHND Early View unknown-2

 

Background

Preventing type 2 diabetes in a real-world setting remains challenging. The present study aimed to assess the effectiveness of a lifestyle-based programme for individuals at high risk of developing type 2 diabetes as assessed by achieved weight loss, cardiovascular risk factors and glucagon-like peptide-1 (GLP-1).

Methods

Sixty-six obese individuals with history of diabetes in first-degree relatives participated in an 8-month lifestyle programme consisting of 12 × 1.25 h group education sessions led by dietitian and a weekly exercise programme. Before and after comparisons were made of fasting blood glucose, insulin, HbA1c, lipids, GLP-1 and quality of life (QoL).

Results

Fifty-four participants of whom the majority were women [47 females; mean (SD) body mass index 35.3 (2.8) kg m−2; age = 52 (10) years] completed the 8-month programme. Mean (SD) weight loss was 10.1 (6.0) kg (P < 0.001). Out of 54 participants, 36 lost more than 7% of their body weight and 47 lost more than 5%, with significant improvements in cardiovascular risk factors, glycaemia and QoL scores. The fall was observed in basal (P < 0.05 versus baseline) but not stimulated GLP-1 levels. In the subgroup of participants losing >10 kg, a correlation was found between weight change and change in both basal (r = 0.61, P < 0.05) and stimulated (r = 0.49, P < 0.05) GLP-1.

Conclusions

An evidence-based lifestyle programme achieved sustained weight loss in obese first-degree relatives of individuals with type 2 diabetes associated with improvements in cardiometabolic risk factors and QoL without the ‘voltage drop’ of less benefit commonly seen when moving from the clinical trial experience into the real world.

Mediterranean diet screening tool for the USA

Evaluation of a dietary screener: the Mediterranean Eating Pattern for Americans tool

Cerwinske et al., JHND Early View unknown-1

Background

Evidence exists for an association between accordance with a Mediterranean diet pattern and slower rates of cognitive decline. However, an ‘Americanised’ version of the Mediterranean diet screener is needed to assess accordance in the USA. Thus, the Mediterranean Eating Pattern for Americans (MEPA) tool was developed to assess accordance with a Mediterranean-like food pattern when time is limited. The present study aimed to determine whether the MEPA screener captured the key elements of the Mediterranean diet compared to the more comprehensive food frequency questionnaire (FFQ).

Methods

The study comprised a cross-sectional study in which 70 women completed both the VioScreen™ FFQ (Viocare, Princeton, NJ, USA) electronically and the 16-item MEPA screener, either electronically or by telephone, aiming to evaluate the inter-method reliability of the proposed screener. The convenience sample included patients (n = 49) and healthcare providers (n = 21) recruited from a tertiary care medical centre.

Results

The overall score from the MEPA screener correlated with corresponding overall MEPA FFQ score (ρ = 0.365, P = 0.002). Agreement between screener items and FFQ items was moderate-to-good for berries (κ = 0.47, P < 0.001), nuts (κ = 0.42, P < 0.001), fish (κ = 0.62, P < 0.001) and alcohol (κ = 0.64, P < 0.001), whereas those for olive oil (κ = 0.33, P = 0.001) and green leafy vegetables (κ = 0.36, P = 0.0021) were fair. Usual intakes of potassium, magnesium, vitamin C, saturated fat, selected carotenoids, folate and fibre derived from the FFQ varied with MEPA screener scores in the anticipated directions.

Conclusions

The MEPA screener captures several components of the Mediterranean style pattern, although further testing of the MEPA screener is indicated.

 

Predicting success in a weight loss trial

Using data mining to predict success in a weight loss trial

Batterham et al., JHND Early View unknown

Background

Traditional methods for predicting weight loss success use regression approaches, which make the assumption that the relationships between the independent and dependent (or logit of the dependent) variable are linear. The aim of the present study was to investigate the relationship between common demographic and early weight loss variables to predict weight loss success at 12 months without making this assumption.

Methods

Data mining methods (decision trees, generalised additive models and multivariate adaptive regression splines), in addition to logistic regression, were employed to predict: (i) weight loss success (defined as ≥5%) at the end of a 12-month dietary intervention using demographic variables [body mass index (BMI), sex and age]; percentage weight loss at 1 month; and (iii) the difference between actual and predicted weight loss using an energy balance model. The methods were compared by assessing model parsimony and the area under the curve (AUC).

Results

The decision tree provided the most clinically useful model and had a good accuracy (AUC 0.720 95% confidence interval = 0.600–0.840). Percentage weight loss at 1 month (≥0.75%) was the strongest predictor for successful weight loss. Within those individuals losing ≥0.75%, individuals with a BMI (≥27 kg m–2) were more likely to be successful than those with a BMI between 25 and 27 kg m–2.

Conclusions

Data mining methods can provide a more accurate way of assessing relationships when conventional assumptions are not met. In the present study, a decision tree provided the most parsimonious model. Given that early weight loss cannot be predicted before randomisation, incorporating this information into a post randomisation trial design may give better weight loss results.

Resolution of hypercatabolism allows for intensive rehabilitation in the convalescent period following stroke

Nitrogen balance in patients with hemiparetic stroke during the subacute rehabilitation phase

Wada et al., JHND Early View

Background

In highly invasive diseases, metabolism commonly changes. Hypercatabolism is frequent in acute stroke, and nitrogen balance tends to be negative. However, there has been no study describing nitrogen balance in subacute and chronic stroke patients. The present study aimed to examine nitrogen balance in the subacute and chronic phases and to identify the factors related to it.

Methods

Nitrogen balance was calculated from the collected urine of 56 patients with subacute stroke [mean (SD) 53.8 (18.4) days post-stroke] who were admitted for rehabilitation for their first-ever ischaemic or nonsurgical haemorrhagic stroke. In the first experiment, their nitrogen balance was measured during the rehabilitation phase, and factors (type, severity of hemiparesis, activities of daily living, dysphagia and malnutrition status) related to it were evaluated. The second experiment was performed to describe the time course of nitrogen balance in 31 consecutive patients, with assessments made at admission and at discharge.

Results

Nitrogen balance was positive in all patients in the subacute phase. A significant difference was seen in nitrogen balance between high and low fat-free mass in male patients. In the chronic phase, nitrogen balance was positive in 96% of the patients. There was no significant difference in nitrogen balance between discharge and admission.

Conclusions

In the subacute and chronic phases of stroke, it was confirmed that hypercatabolism had resolved and that intensive rehabilitation is possible in the convalescent period of stroke.

 

Temporal trends in dietary intake among US adults with type 2 diabetes

Trends in dietary intake among adults with type 2 diabetes: NHANES 1988–2012

Casagrande and Cowie, JHND Early View

Background

Dietary recommendations for adults with diabetes are to follow a healthy diet in appropriate portion sizes. We determined recent trends in energy and nutrient intakes among a nationally representative sample of US adults with and without type 2 diabetes.

Methods

Participants were adults aged ≥20 years from the cross-sectional National Health and Nutrition Examination Surveys, 1988–2012 (N = 49 770). Diabetes was determined by self-report of a physician’s diagnosis (n = 4885). Intake of energy and nutrients were determined from a 24-h recall by participants of all food consumed. Linear regression was used to test for trends in mean intake over time for all participants and by demographic characteristics.

Results

Among adults with diabetes, overall total energy intake increased between 1988–1994 and 2011–2012 (1689 kcal versus 1895 kcal; Ptrend < 0.001) with evidence of a plateau between 2003–2006 and 2011–2012. In 2007–2012, energy intake was greater for younger than older adults, for men than women, and for non-Hispanic whites versus non-Hispanic blacks. There was no change in the percentage of calories from carbohydrate, total fat or protein. Percentage of calories from saturated fat was similar across study periods but remained above recommendations (11.2% in 2011–2012). Fibre intake significantly decreased and remained below recommendations (Ptrend = 0.002). Sodium, cholesterol and calcium intakes increased. There was no change in energy intake among adults without diabetes and dietary trends were similar to those with diabetes.

Conclusions

Future data are needed to confirm a plateau in energy intake among adults with diabetes, although the opportunity exists to increase fibre and reduce saturated fat.