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The Effectiveness of Quality Incentive Payments in General Practice (EQuIP-GP) study investigated whether targeted financial incentives promoting access to a preferred general practitioner, post-hospitalisation follow-up and longer consultations, increase patient-perceived relational continuity in primary care. Secondary outcomes included the use of medicines. To evaluate whether introducing a general practice-level service model incorporating enrolment and continuous and graded quality improvement incentives influenced the total prescriptions written and potentially inappropriate prescribing of medicines. A 12-month cluster-randomised controlled trial, whereby participating patients within intervention practices were offered enrolment with a preferred general practitioner, a minimum of three longer appointments, and review within seven days of hospital admission or emergency department attendance. Control practice patients received usual care. Differences between intervention and control groups pre-post trial for total prescriptions were analysed, as an indicator of polypharmacy, along with prescriptions for four groups of drugs known to have common quality of medicines issues: antibiotics, benzodiazepines, opioids and proton pump inhibitors (PPIs). A total of 774 patients, aged 18–65 years with a chronic illness or aged over 65 years, from 34 general practices in metropolitan, regional and rural Australia participated. The mean number of medicine prescriptions per month at baseline was 4.19 (SD 3.27) and 4.34 (SD 3.75) in the control and intervention arms, respectively, with no significant between-group differences in changes pre-post trial and also no significant between-group or within-group differences of prescription rates for antibiotics, benzodiazepines, opioids or PPIs. Total prescribing volume and the use of key medicines were not influenced by quality-linked financial incentives for offering longer consultations and early post-hospital review for enrolled patients. [ABSTRACT FROM AUTHOR]

• Online dietary advice for multiple sclerosis often agrees with dietary guidelines. • Some online sources recommend restrictive eating patterns. • Individual foods and/or supplements may also be recommended. • Web scraping techniques can be used to simulate online searches for dietary advice. People diagnosed with multiple sclerosis (MS) often seek to modify their diet guided by online advice, however this advice may not align with national dietary guidelines. The aim of this study was to simulate an online search for dietary advice conducted by a person with MS and evaluate the content. It was hypothesised that a variety of eating patterns are promoted for MS online and these dietary approaches can be contradictory. An online search was simulated using Google Trends-informed search terms and Google and Bing search engines. URLs were extracted using R. Nutrition data were extracted including recommendations for diets, foods, supplements, and health professional consultation. Statistical analyses were conducted using R. 73 URLs from 49 websites were extracted, with only 14 results common to both search engines. Dietary recommendations included overall eating patterns (58 webpages, 79%), individual foods (55 webpages, 75%), and supplements (33 webpages, 45%). The most promoted eating pattern for MS was a balanced diet (33 recommendations, 48%), more likely by nonprofit organisations and health information websites (14 and 17 recommendations, 100% and 89%); lifestyle program websites were more likely to recommend restrictive diets (19 recommendations, 100%) (p < 0.001). 52% pages advised consulting a health professional, most often a doctor or dietitian. A balanced diet is the most recommended eating pattern for MS online, though advice promoting restrictive diets persists. [ABSTRACT FROM AUTHOR]

Summary Background & aims Obesity, defined as a BMI ≥ 30 kg/m2, has demonstrated protective associations with mortality in some diseases. However, recent evidence demonstrates that poor nutritional status in critically ill obese patients confounds this relationship. The purpose of this paper is to evaluate if poor nutritional status, poor food intake and adverse health-related outcomes have a demonstrated association in non-critically ill obese acute care hospital patients. Methods This is a secondary analysis of the Australasian Nutrition Care Day Survey dataset (N = 3122), a prospective cohort study conducted in hospitals from Australia and New Zealand in 2010. At baseline, hospital dietitians recorded participants' BMI, evaluated nutritional status using Subjective Global Assessment (SGA), and recorded 24-h food intake (as 0%, 25%, 50%, 75%, and 100% of the offered food). Post-three months, participants' length of stay (LOS), readmissions, and in-hospital mortality data were collected. Bivariate and regression analyses were conducted to investigate if there were an association between BMI, nutritional status, poor food intake, and health-related outcomes. Results Of the 3122 participants, 2889 (93%) had eligible data. Obesity was prevalent in 26% of the cohort (n = 750; 75% females; 61 ± 15 years; 37 ± 7 kg/m2). Fourteen percent (n = 105) of the obese patients were malnourished. Over a quarter of the malnourished obese patients (N = 30/105, 28%) consumed ≤25% of the offered meals. Most malnourished obese patients (74/105, 70%) received standard diets without additional nutritional support. After controlling for confounders (age, disease type and severity), malnutrition and intake ≤25% of the offered meals independently trebled the odds of in-hospital mortality within 90 days of hospital admission in obese patients. Conclusion Although malnourished obese experienced significantly adverse health-related outcomes they were least likely to receive additional nutritional support. This study demonstrates that BMI alone cannot be used as a surrogate measure for nutritional status and warrants routine nutritional screening for all hospital patients, and subsequent nutritional assessment and support for malnourished patients. [ABSTRACT FROM AUTHOR]

Objectives: Adolescents spend large proportions of the school day sitting; potentially increasing their health risks. This study aimed to evaluate the feasibility, acceptability and potential efficacy of a school-based intervention to reduce adolescent sitting time during the school day.Design: Two-arm parallel-group randomised controlled trial.Methods: Adolescents (13-16 years) were recruited from four private high schools in New South Wales, Australia. Schools were pair-matched and randomised to treatment or control. Research assistants were blinded to intervention aims and treatment allocation. Intervention initiatives included classroom and outdoor environmental measures to break up and reduce the proportion of adolescent school time spent sitting. Teacher and students surveys assessed intervention feasibility, acceptability and potential efficacy. Proportional sitting time was the primary outcome, measured by activPAL monitors, worn for one week during the school day. Secondary outcomes included body mass index, body fatness, working memory and non-verbal reasoning. Data were analysed using a general linear model for continuous variables and adjusted for clustering.Results: While teachers and students supported the program, process evaluation results indicate aspects of the intervention were not implemented with fidelity. Eighty-eight adolescents (Mage=14.7±0.7, 50% male) participated in the trial. Eighty-six had valid data for all variables (43 controls, 43 intervention). There was no significant intervention effect on the primary outcome. There was a significant effect on working memory (adjusted difference ±SD=-0.42±1.37; p=0.048 (Cohen's d)=0.31).Conclusions: These findings contribute to limited research in this area, providing guidance for future interventions in the high school environment.Trial Registration: The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12614001001684). [ABSTRACT FROM AUTHOR]

Objectives: This study reports the long-term effects of a professional learning program for classroom teachers on fundamental motor skill (FMS) proficiency of primary school students from ethnically diverse backgrounds.Design: A cluster non-randomized trial using a nested cross-sectional design.Methods: The study was conducted in 8 primary schools located in disadvantaged and culturally diverse areas in Sydney, Australia. The intervention used an action learning framework, with each school developing and implementing an action plan for enhancing the teaching of FMS in their school. School teams comprised 4-5 teachers and were supported by a member of the research team. The primary outcome was total proficiency score for 7 FMS (run, jump, catch, throw, kick, leap, side gallop). Outcome data were analyzed using mixed effects models.Results: Eight-hundred and sixty-two students (82% response rate) were assessed at baseline in 2006 and 830 (82%) at follow-up in 2010. Compared with students in the control schools, there was a significantly greater increase in total motor skill proficiency among children in the intervention schools at follow-up (adjusted difference=5.2 components, 95%CI [1.65, 8.75]; p=0.01) and in four of the seven motor skills.Conclusions: Training classroom teachers to develop and implement units of work based around individual FMS is a promising strategy for increasing FMS among ethnically diverse children over an extended period of time. [ABSTRACT FROM AUTHOR]

Objectives: To validate activPAL3™ (AP3) for classifying postural allocation, estimating time spent in postures and examining the number of breaks in sedentary behaviour (SB) in 5-12 year-olds.Design: Laboratory-based validation study.Methods: Fifty-seven children completed 15 sedentary, light- and moderate-to-vigorous intensity activities. Direct observation (DO) was used as the criterion measure. The accuracy of AP3 was examined using a confusion matrix, equivalence testing, Bland-Altman procedures and a paired t-test for 5-8y and 9-12y.Results: Sensitivity of AP3 was 86.8%, 82.5% and 85.3% for sitting/lying, standing, and stepping, respectively, in 5-8y and 95.3%, 81.5% and 85.1%, respectively, in 9-12y. Time estimates of AP3 were equivalent to DO for sitting/lying in 9-12y and stepping in all ages, but not for sitting/lying in 5-12y and standing in all ages. Underestimation of sitting/lying time was smaller in 9-12y (1.4%, limits of agreement [LoA]: -13.8 to 11.1%) compared to 5-8y (12.6%, LoA: -39.8 to 14.7%). Underestimation for stepping time was small (5-8y: 6.5%, LoA: -18.3 to 5.3%; 9-12y: 7.6%, LoA: -16.8 to 1.6%). Considerable overestimation was found for standing (5-8y: 36.8%, LoA: -16.3 to 89.8%; 9-12y: 19.3%, LoA: -1.6 to 36.9%). SB breaks were significantly overestimated (5-8y: 53.2%, 9-12y: 28.3%, p<0.001).Conclusions: AP3 showed acceptable accuracy for classifying postures, however estimates of time spent standing were consistently overestimated and individual error was considerable. Estimates of sitting/lying were more accurate for 9-12y. Stepping time was accurately estimated for all ages. SB breaks were significantly overestimated, although the absolute difference was larger in 5-8y. Surveillance applications of AP3 would be acceptable, however, individual level applications might be less accurate. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to validate SenseWear Mini software algorithm versions 2.2 (SW2.2) and 5.2 (SW5.2) for estimating energy expenditure (EE) in children.Design: Laboratory-based validation study.Methods: 57 children aged 5-12 y completed a protocol involving 15 semi-structured sedentary (SED), light-intensity (LPA), and moderate- to vigorous-intensity (MVPA) physical activities. EE was estimated using portable indirect calorimetry (IC). The accuracy of EE estimates (kcal·min-1) from SW2.2 and SW5.2 were examined at the group level and individual level using the mean absolute percentage error (MAPE), Bland-Altman plots and equivalence testing.Results: MAPE values were lower for SW5.2 (30.1±10.7%) than for SW2.2 (44.0±6.2%). Although mean differences for SW5.2 were smaller than for SW2.2 during SED (-0.23±0.22 vs. -0.61±0.20kcal·min-1), LPA (-0.69±0.76 vs. -1.07±0.46kcal·min-1) and MVPA (-2.22±1.15 vs. -2.57±1.15kcal·min-1), limits of agreement did not decrease for the updated algorithms. For all activities, SW2.2 and SW5.2 were not equivalent to IC (p>0.05). Errors increased with increasing intensity.Conclusion: The current SenseWear Mini algorithms SW5.2 underestimated EE. The overall improved accuracy for SW5.2 was not accompanied with improved accuracy at the individual level and EE estimates were not equivalent to IC. [ABSTRACT FROM AUTHOR]

Objectives: Educator-led programs for physical activity and motor skill development show potential but few have been implemented and evaluated using a randomized controlled design. Furthermore, few educator-led programs have evaluated both gross motor skills and physical activity. Therefore, the aim of this study was to evaluate a gross motor skill and physical activity program for preschool children which was facilitated solely by childcare educators.Design: A six-month 2-arm randomized controlled trial was implemented between April and September 2012 in four early childhood centers in Tasmania, Australia.Methods: Educators participated in ongoing professional development sessions and children participated in structured physical activity lessons and unstructured physical activity sessions.Results: In total, 150 children were recruited from four centers which were randomized to intervention or wait-list control group. Six early childhood educators from the intervention centers were trained to deliver the intervention. Gross motor skills were assessed using the Test of Gross Motor Development (2nd edition) and physical activity was measured objectively using GT3X+ Actigraph accelerometers. No statistically significant differences were identified. However, small to medium effect sizes, in favor of the intervention group, were evident for four of the five gross motor skills and the total gross motor skill score and small to medium effect sizes were reported for all physical activity outcomes.Conclusions: This study highlights the potential of educator-led physical activity interventions and supports the need for further translational trials within the early childhood sector. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effect of a school playground intervention on the physical activity levels of primary/elementary aged children.Design: Two-arm parallel group randomized controlled trial.Methods: In 2011, children aged 4-13 years from thirteen primary/elementary schools (in Illawarra, New South Wales, Australia) were invited to participate in the study. School recruitment was based on existing policies, equipment and willingness to participate. Participating schools were randomly allocated to the intervention or control using the 'hat and draw' method. The intervention was delivered over four months. Intervention schools introduced policy changes and portable equipment to break-time after baseline measures were collected. The primary outcome was the proportion of break-time spent in Moderate to Vigorous Physical Activity (MVPA) assessed by the System for Observing Playground Activity in Youth (SOPLAY). The analysis involved linear mixed models adjusting for the clustering effect of schools. The study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614001128684).Results: Four schools (two intervention and two control) met the inclusion criteria (1582 children: 790 males; 267 controls, total of 792 females; 248 controls). Students from the intervention schools had a greater increase at follow-up in the proportion of break-time in MVPA; (adjusted difference=12.5 percentage points, 95% CI [-13.0%, 38.0%]; P=0.17; r=0.6) compared to the controls. MVPA at recess significantly increased (adjusted difference=18.0 percentage points, 95% CI [6.9%, 29.1%]; P=0.02; effect size=0.7). There were no significant increases in MVPA when examining overall break times. Results were greater for girls compared to boys.Conclusions: Making environmental and policy changes are promising strategies for promoting health-enhancing physical activity during school break-time. [ABSTRACT FROM AUTHOR]

Summary Attrition causes analytical and efficacy issues in weight loss trials. Consistent predictors of attrition in weight loss trials have not been identified. Trial design could be improved if factors predicting attrition are accounted for. The aim of this study is to quantify the effect of easily measured pre study and early study variables to determine their relationship with attrition in dietary weight loss trials. Methods Data was pooled from four previous dietary weight loss trials. Mixed effects logistic regression, Receiver Operator Curves and decision trees (classification and regression trees) were used to determine which of the variables (percent weight loss at 1 month, age, gender and baseline BMI) predicted dropout and to determine cutoffs useful for future trial design. Results The sample included 289 subjects, 73% female, with a mean age of 46.68 ± 9.27 years and average dropout of 25%. Percent weight loss at 1 month was the strongest predictor of dropout, those with a weight loss ≤2% were 4.99 times (95% CI 2.71, 9.18) more likely to drop out than those with a weight loss >2% in the first month ( P < 0.001). When considering only data available at the beginning of a trial those ≤50 years old were 2.07 times (95% CI 1.2, 3.5) more likely to drop out than those >50 ( P = 0.006). Discussion Early weight loss and age were identified as significant variables for predicting attrition in weight loss trials. Trial designs maybe improved by incorporating these variables and developing interventions targeting these factors may improve participant retention. [ABSTRACT FROM AUTHOR]

Objectives: Examine the predictive validity of the activPAL™ metabolic equivalents equation, develop an activPAL™ threshold value to define moderate-to vigorous-intensity physical activities, and examine the classification accuracy of the developed moderate-to vigorous-intensity physical activities threshold value in 4- to 6-year-old children.Design: A sample of forty 4- to 6-year-old children from the Illawarra region in New South Wales, Australia were included in data analysis.Methods: Participants completed a ∼ 150-min room calorimeter protocol involving age-appropriate sedentary behaviors, light-intensity physical activities and moderate-to vigorous-intensity physical activities. activPAL™ accelerometer counts were collected over 15s epochs. Energy expenditure measured by room calorimetry and direct observation were used as the criterion measure. Predicted metabolic equivalents were calculated using the activPAL™ metabolic equivalents equation (activPAL™ software version 5.8.0). Predictive validity was evaluated using dependent-samples t-tests. Participants were randomly allocated into two groups to develop and cross-validate an intensity threshold for moderate-to vigorous-intensity physical activities. Receiver operating characteristic curve analysis was used to determine moderate-to vigorous-intensity physical activities threshold. The classification accuracy of the developed threshold was cross-validated using sensitivity, specificity, and area under the receiver operating characteristic-curve.Results: The activPAL™ metabolic equivalents equation significantly overestimated metabolic equivalents during sedentary behaviors and significantly underestimated metabolic equivalents for light-intensity physical activities, moderate-to vigorous-intensity physical activities and total metabolic equivalents compared to measured metabolic equivalents (all P<0.001). The developed threshold of ≥1418 counts per 15s resulted in good classification accuracy for moderate-to vigorous-intensity physical activities.Conclusion: The current activPAL™ metabolic equivalents equation requires further development before it can be used to accurately estimate metabolic equivalents in preschoolers. The developed threshold exhibited acceptable classification accuracy for moderate-to vigorous-intensity physical activities; however studies cross-validating this moderate-to vigorous-intensity physical activities threshold in free-living preschool-aged children are recommended. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the impact of a 12-month school-based multi-component program on adolescent girls’ physical activity and sedentary behaviors, and hypothesized mediators of physical activity behavior change. Design: Group randomized controlled trial with 12-month follow-up. Methods: The intervention, guided by Social Cognitive Theory, involved 357 adolescent girls (13.2±0.5 years) from 12 secondary schools (6 intervention schools, 6 control schools) in low-income communities in the Hunter and Central Coast regions of New South Wales, Australia. The intervention included enhanced school sport, lunchtime physical activity sessions, interactive seminars, student handbooks, nutrition workshops, pedometers, parent newsletters and text messages to encourage physical activity and healthy eating, and a decrease in sedentary behavior. Outcomes were assessed at baseline and 12-months and included: physical activity (accelerometers), sedentary behaviors (questionnaire and accelerometers), and social-cognitive mediators of physical activity (questionnaire). Results: There were significant between group differences in favor of the intervention group for self-reported recreational computer use (−26.0min; 95% CI, −46.9 to −5.1), and sedentary activities summed (−56.4min; 95% CI, −110.1 to −2.7), however objective sedentary behavior showed no differences. There were no group-by-time effects for any of the physical activity outcomes or hypothesized mediators. Conclusions: A school-based intervention tailored for adolescent girls from schools located in low-income communities significantly reduced time spent in sedentary activities. However, improvements in physical activity and hypothesized mediators of physical activity behavior were not observed. Future studies are encouraged to explore alternative mechanisms of behavior change derived from integrated and socio-ecological theories. [Copyright &y& Elsevier]

Summary: Background & aims: The Australasian Nutrition Care Day Survey (ANCDS) ascertained if malnutrition and poor food intake are independent risk factors for health-related outcomes in Australian and New Zealand hospital patients. Methods: Phase 1 recorded nutritional status (Subjective Global Assessment) and 24-h food intake (0, 25, 50, 75, 100% intake). Outcomes data (Phase 2) were collected 90-days post-Phase 1 and included length of hospital stay (LOS), readmissions and in-hospital mortality. Results: Of 3122 participants (47% females, 65 ± 18 years) from 56 hospitals, 32% were malnourished and 23% consumed ≤ 25% of the offered food. Malnourished patients had greater median LOS (15 days vs. 10 days, p < 0.0001) and readmissions rates (36% vs. 30%, p = 0.001). Median LOS for patients consuming ≤ 25% of the food was higher than those consuming ≤ 50% (13 vs. 11 days, p < 0.0001). The odds of 90-day in-hospital mortality were twice greater for malnourished patients (CI: 1.09–3.34, p = 0.023) and those consuming ≤ 25% of the offered food (CI: 1.13–3.51, p = 0.017), respectively. Conclusion: The ANCDS establishes that malnutrition and poor food intake are independently associated with in-hospital mortality in the Australian and New Zealand acute care setting. [Copyright &y& Elsevier]

Objective: Missing data due to study dropout is common in weight loss trials and several statistical methods exist to account for it. The aim of this study was to identify methods in the literature and to compare the effects of methods of analysis using simulated data sets. Methods: Literature was obtained for a 1-y period to identify analytical methods used in reporting weight loss trials. A comparison of methods with large or small between-group weight loss, and missing data that was, or was not, missing randomly was conducted in simulated data sets based on previous research. Results: Twenty-seven studies, some with multiple analyses, were retrieved. Complete case analysis (n = 17), last observation carried forward (n = 6), baseline carried forward (n = 4), maximum likelihood (n = 6), and multiple imputation (n = 2) were the common methods of accounting for missing data. When comparing methods on simulated data, all demonstrated a significant effect when the between-group weight loss was large (P < 0.001, interaction term) regardless of whether the data was missing completely at random. When the weight loss interaction was small, the method used for analysis gave considerably different results with mixed models (P = 0.180) and multiple imputations (P = 0.125) closest to the full data model (P = 0.033). Conclusion: The simulation analysis showed that when data were not missing at random, treatment effects were small, and the amount of missing data was substantial, the analysis method had an effect on the significance of the outcome. Careful attention must be paid when analyzing or appraising studies with missing data and small effects to ensure appropriate conclusions are drawn. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Fish or fish oil consumption may increase levels of total and high molecular weight (HMW) adiponectin, a hormone associated with anti-inflammatory and insulin-sensitising effects, however it is not known if the effects of the food and supplement are the same. The aim of this study was to compare the effect of consuming fish and fish oil supplements on plasma total and HMW adiponectin concentrations in overweight human participants. Materials/Methods: 29 overweight and obese participants underwent a two week run-in period, followed by a four week isocaloric dietary intervention which provided 1.8g of long chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA) in the form of either fish or fish oil supplements. Primary outcomes were changes in plasma total and HMW adiponectin. Secondary outcomes were changes in anthropometric variables, plasma insulin and glucose levels, and dietary intakes. Results: Changes in plasma HMW adiponectin during the intervention period were significantly different between groups (p=0.009). Mean HMW adiponectin increased by 0.29μg/mL in the ‘fish’ group and decreased by 0.60μg/mL in the ‘supplement’ group. There were no significant changes in other anthropometric and biochemical variables. Dietary data suggested the ‘fish’ group significantly increased their fish (p=0.001) and dietary LC n-3 PUFA (p=0.001) consumption over the course of the study. Conclusions: Short-term consumption of fish and fish oil supplements did not have the same effects on HMW adiponectin levels. The impact of fish intake on HMW adiponectin levels may not be mediated by its LC n-3 PUFA content alone. [Copyright &y& Elsevier]

Summary: Background & aim: This paper describes nutrition care practices in acute care hospitals across Australia and New Zealand. Methods: A survey on nutrition care practices in Australian and New Zealand hospitals was completed by Directors of dietetics departments of 56 hospitals that participated in the Australasian Nutrition Care Day Survey 2010. Results: Overall 370 wards representing various specialities participated in the study. Nutrition risk screening was conducted in 64% (n = 234) of the wards. Seventy nine percent (n = 185) of these wards reported using the Malnutrition Screening Tool, 16% using the Malnutrition Universal Screening Tool (n = 37), and 5% using local tools (n = 12). Nutrition risk rescreening was conducted in 14% (n = 53) of the wards. More than half the wards referred patients at nutrition risk to dietitians and commenced a nutrition intervention protocol. Feeding assistance was provided in 89% of the wards. “Protected” meal times were implemented in 5% of the wards. Conclusion: A large number of acute care hospital wards in Australia and New Zealand do not comply with evidence-based practice guidelines for nutritional management of malnourished patients. This study also provides recommendations for practice. [Copyright &y& Elsevier]

Abstract: Olive leaf supplement was characterised by HPLC and administered to healthy young adults over 28d (three tablets or equivalent liquid dose per day), or in a single bolus dose of three tablets (or liquid equivalent). Oleuropein was the major biophenol in the extracts. There are no data on the excretion of urinary end-products of the metabolism of the olive leaf biophenols. Following both chronic and acute ingestion neither oleuropein, nor its hydrolysis product, hydroxytyrosol, were detected in urine samples. However, glucuronic acid conjugates, derived from oleuropein aglycone were detected in all urine samples up to 6h following acute ingestion. The data suggest that oleuropein is bioavailable, which is a necessary pre-condition for bioactivity. [Copyright &y& Elsevier]

Abstract: Objective: We determined the effect of dietary supplementation with an olive leaf capsule or liquid extract on oxidative status of young and healthy male and female subjects. Methods: This was a single-center, randomized, single-blinded, prospective pilot comparison of the effect of dietary supplementation with olive leaf extracts. Healthy young adult male and female subjects (n = 45) were randomized into three groups and received daily doses of control, capsule, or liquid extract of olive leaf. Urinary F2α-isoprostane, 8-hydroxy-2′-deoxyguanosine, and Folin-Ciocalteu total reducing power were measured to assess the impact of supplementation. Results: Baseline values (mean ± standard deviation) of the biomarkers were 0.24 ± 0.13 μg, 9.16 ± 2.94 μg, and 424.9 ± 121.4 mg of gallic acid equivalents per gram of creatinine, respectively, for the control group. Using these markers, supplementation with liquid or capsule did not alter oxidative status compared with the control group. Possible reasons for the lack of an observed correlation are presented. Conclusion: Dietary supplementation with olive leaf extract did not alter the oxidative status of healthy young adults. [Copyright &y& Elsevier]

Abstract: There has been a significant increase in the volume of research relating to antioxidants and health. The very nature of this research is inter-disciplinary, yet the full potential of such an approach, whereby nutritionists (clinicians), chemists, pharmacists and others all bring their expertise to bear in a concerted way, is rarely achieved. This is perhaps due to a lack of understanding of the methodology and terminology of the various disciplines. In this review, the terminology and features of nutritional studies are examined with particular emphasis on the confounders that may often be ignored by laboratory-based researchers. Attention is drawn to the potential role that ethics approval processes may have in directing outcomes. [Copyright &y& Elsevier]

Presents information on a study which compared bioelectrical impedance and skinfold anthropometry with dual-energy x-ray absorptiometry in the measurement of body composition in people with HIV or AIDS. Methodology; Results and discussion; Applications of the study.

Abstract: Background & aims: Older malnourished patients experience increased length of hospital stay and greater morbidity compared to their well nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 12 months follow-up. Methods: Secondary data analysis of 2602 consecutive patient admissions to an acute tertiary hospital in New South Wales, Australia on or before 1st June 2009. Twelve-month data was analysed in a sub-sample of 774 patients. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records included hospital readmission rate, total length of stay (LOS), change in level of care at discharge, and in-hospital mortality. Results: A third (34%) of patients were malnourished and 55% at risk of malnutrition. Using a Cox proportional hazards regression model, controlling for underlying illness and age, patients at risk of malnutrition were 2.46 (95% CI: 1.36, 4.45; p = 0.003) times more likely to have a poor clinical outcome (mortality/discharge to higher level of care), while malnourished patients had a 3.57 (95% CI: 1.94, 6.59; p = 0.000) times higher risk. Conclusions: A poor nutritional status carries a substantially greater risk of death and/or loss of dependency in older adults. Interventions to improve the nutritional status of patients during their hospital stay, and following discharge back to the community, are needed to lower the risk of adverse outcomes. [Copyright &y& Elsevier]

Summary: Background and aims: Studies examining diet-induced thermogenesis and substrate oxidation in a whole room calorimeter (WRC) benefit from a state of energy balance in the measurement period. We found reports on four approaches to assessing energy needs in this context, and they vary considerably. This study assessed the utility of three simple alternatives for predicting energy requirements for calorimeter studies. Methods: Energy expenditure (EE) data on 37 males and 104 females was obtained from the baseline measurements of three weight-loss trials. The EE data was from 3-d RT3 accelerometer measurements in a free-living environment, and 24-h WRC measurements. A linear regression model was developed from Study 1 and Study 2 (N =97), using mean 3-d EE as the independent variable. Twenty-four hours WRC EE (N =29) was compared with three prediction methods: (a) Schofield equation, (b) regression model, and (c) free-living EE×85%. Results: Energy expenditure measured by accelerometers was 2454.1±491.9kcal/d in the free-living condition and 2022.7±295.8kcal/d during the 24-h calorimeter stay (83.8%±10.6% of free-living). Energy requirements in the whole room calorimeter was estimated as 0.405×mean [3-d RT3 energy expenditure]+1009.6kcal/d (N =97, R 2 =0.479, P <0.001). Predicted energy requirements were not significantly different from the WRC EE but the Schofield method produced the lowest mean bias and standard deviation. Conclusion: Schofield equations are an inexpensive and convenient alternative for predicting energy requirements in WRC studies. [Copyright &y& Elsevier]

Objective: The aim of this study was to examine food patterns of Australian children ages 9 to 13 y in relation to ω-3 long-chain polyunsaturated fatty acid (ω-3 LCPUFA) intake. Methods: Secondary analysis was conducted on nationally representative food data of 1110 Australian children ages 9 to 13 y (525 boys and 585 girls) that was obtained using two 24-h recalls. Principle component factor analysis was used to identify food patterns. Discriminant function analysis was used to identify the relationship between the food patterns and total ω-3 LCPUFA intake. Results: Four major food patterns emerged for each sex. For boys these were labeled: "snack foods," "soft drinks," "vegetables," and "pork and meat chops, steak, and mince." For girls they were labeled: "vegetables," "take-away," "tea, coffee, iced coffee drinks" and "canned meals and soup." Fish consumption bought from take-away outlets was more frequently consumed in the "soft drink" (r = 0.577) and take-away (r = 0.485) food pattern in boys and girls, respectively. In contrast, fish prepared at home was more often consumed in "vegetables" in both boys (r = 0.018) and girls (r = 0.106), as well as in the "pork and meat chops, steak and mince" food pattern in boys (r = 0.060). There was a trend that in boys, the "vegetables" group discriminated children who consumed ω-3 LCPUFA levels similar to adequate intakes (AI) (P = 0.067), whereas in girls, the take-away food pattern discriminated for being a fish consumer (P = 0.060). Conclusions: Dietary patterns associated with a high consumption of vegetables and "take-aways" food that include meat and fish are likely to positively influence dietary ω-3 LCPUFA intake in Australian children. [ABSTRACT FROM AUTHOR]

Abstract: Peptide Y-Y (PYY) is an anorexigenic hormone implicated in appetite control, and β-glucan is a fiber known to affect appetite. We hypothesized that plasma PYY levels would increase in overweight human adults consuming increasing doses of β-glucan. The objective was to test whether the effect could be seen with β-glucan delivered through extruded cereals containing a high β-glucan oat bran with demonstrated high molecular weight and solubility. Fourteen subjects consumed a control meal and 3 cereals of varying β-glucan concentration (between 2.2 and 5.5 g), and blood samples were collected over 4 hours. Analysis of raw PYY data showed a trend toward significant increases over 4 hours. An increasing dose of β-glucan resulted in higher levels of plasma PYY, with significant differences between groups from 2 to 4 hours post test-meal. Data for the area under the curve analysis also approached significance, with post hoc analysis showing a difference (P = .039) between the control and the highest dose of β-glucan (5.5 g). The PYY levels at 4 hours were significantly different between the control and high-dose meal test (P = .036). There was a significant dose response, with a positive correlation between the grams of β-glucan and PYY area under the curve (r 2 = 0.994, P = .003). The optimal dose of β-glucan appears to lie between 4 and 6 g, with the effects on PYY mediated by viscosity and concentration. Meal-test studies examining a range of hormones should measure hormones over a minimum of 4 hours and record meal intake for even longer time frames. [Copyright &y& Elsevier]

Abstract: This study with Australian consumers investigated how appealing different health claims combined with particular food carriers were to Australian consumers, and compared the results of a similar study with Dutch consumers. 149 shoppers considered up to 30 different food concepts, rating how ‘attractive’, ‘believable’, and ‘new and different’ they found each concept and their ‘intention to try’. Each variable was significantly related to intention to try (p <0.001) and together explained 56% of the intention score. Claims and carriers independently had a significant effect on ratings of attractiveness and intention to try but, unlike the Dutch study, the carrier was a more important predictor of intention to purchase than the claim. Implications for regulation of health claims for food are discussed. [Copyright &y& Elsevier]

Objective: To test repeatability and relative validity of a computerized and interviewer administered assessment. Methods: Using a context-based case-control trial, 41 adults with type 2 diabetes mellitus were randomized into four groups to complete dietary assessments (computerized or interviewer administered) at 0, 2 and 8 weeks and food records at 0 and 2 weeks. Repeatability of reported energy, total fat, saturated, polyunsaturated and monounsaturated fatty acids between the computerized and interviewer administered methods were assessed using repeated measures ANOVA. Paired t-tests and Pearson''s correlations determined relative validity of the assessments. Results: Thirty-one patients completed all visits. Statistically significant differences were found between computerized and interviewer administered data for total fat (p =0.048) and saturated fatty acids (p =0.019) between 0 and 2 weeks. Computerized assessments correlated better with food records (r =0.16–0.52) compared with interviewer administered assessments (r =−0.02 to 0.51). Conclusion: Computerized assessments saw a learning effect with repeated use indicating that users were becoming more familiar with the website with repeated use. Relative validity suggests that the website may capture more foods though this requires further investigation. Practice implications: By allowing patients to self-report their intakes on a computer, dietitians will have the ability to spend increased time with their patients counseling them toward change. [Copyright &y& Elsevier]

Hypertension is a preventable risk factor for cardiovascular disease, the leading cause of death globally. When hypertension is present with tobacco smoking, poor nutrition, physical inactivity or excessive alcohol consumption, risk of cardiovascular disease is increased. Given the prolonged engagement and ongoing relationship with patients, general practice nurses are ideally situated to actively engage with patients about optimal blood pressure control and lifestyle risk reduction. This study will test the effectiveness of a nurse-led intervention to reduce blood pressure in adults with hypertension and high cardiovascular risk. A multi-site, cluster randomised control trial where the general practice is the unit of randomisation. General Practices (n = 20) will be block randomised to the intervention or usual care group. Adults with hypertension and high cardiovascular risk will be identified through an audit of electronic medical records and invited to attend an assessment visit. Eligible consenting patients will be recruited to the study. The intervention involves three face-to-face consultations and two telephone consultations with the nurse to assess lifestyle risk and develop an action plan. An appointment with the general practitioner will optimise pharmacotherapy. The primary outcome is blood pressure, with secondary outcomes of lifestyle risk factors; smoking, nutrition, alcohol and physical activity body mass index and medication adherence. Patients will have outcome measures evaluated at 6 and 12 months. ImPress is innovative in its proactive approach of identifying those at greatest risk of cardiovascular disease in combination with the emerging role of the general practice nurse to target care towards improved blood pressure control. If successful, findings from this trial could enhance the nursing role, improve health outcomes, inform health policy and provide an evidence base from which to transform blood pressure management in general practice. This trial has been registered with the Australian and New Zealand Clinical Trials Registry as ACTRN12618000169246. [ABSTRACT FROM AUTHOR]

Background Dietary pattern analysis provides important evidence revealing diet–disease relationships. It may be especially useful in areas less well researched, such as diet and hypertension in clinical populations. Objective The aim of this study was to identify the association between dietary patterns and blood pressure (BP) in a sample of overweight adults volunteering for a clinical trial for weight loss. Design This cross-sectional analysis used baseline data from the HealthTrack study, a 12-month randomized controlled trial. Dietary intake was evaluated with 4-day food records. Participants/setting Participants were 328 adults recruited from the Illawarra region of New South Wales, Australia, between May 2014 and April 2015. Main outcome measures Resting BP and 24-hour urine sodium and potassium were measured. Statistical analysis Dietary patterns were derived by principal component analysis from 21 food groups. Multiple regression analysis was performed to assess the association between the extracted dietary patterns and BP. Results The participants’ mean age was 43.6±8.0 years, mean body mass index was 32.4±4.2, and mean systolic BP/diastolic BP was 124.9±14.5/73.3±9.9 mm Hg. Six major dietary patterns were identified: “nuts, seeds, fruit, and fish,” “milk and meat,” “breads, cereals, and snacks,” “cereal-based products, fats, and oils,” “alcohol, eggs, and legumes,” and “savoury sauces, condiments, and meat.” The “nuts, seeds, fruit, and fish” dietary pattern was significantly and inversely associated with systolic BP ( F [7,320]=15.248; P <0.0005; adjusted R 2 =0.234 and diastolic BP ( F [7,320]=17.351; P <0.0005; adjusted R 2 =0.259) and sodium-to-potassium ratio ( F [7,320]=6.210; P <0.0005; adjusted R 2 =0.100). Conclusions A dietary pattern rich in nuts, seeds, fruit, and fish was inversely associated with blood pressure in this clinical sample. The findings suggest that current dietary guidelines are relevant to an overweight clinical population and support the value of dietary pattern analysis when exploring the diet–disease relationship. [ABSTRACT FROM AUTHOR]

Background Integrating professional expertise in diet, exercise and behavioural support may provide more effective preventive health services but this needs testing. We describe the design and baseline results of a trial in the Illawarra region of New South Wales, Australia. Methods The HealthTrack study is a 12 month randomised controlled trial testing effects of a novel interdisciplinary lifestyle intervention versus usual care. The study recruited overweight and obese adults 25–54 years resident in the Illawarra. Primary outcomes were weight, and secondary outcomes were disease risk factors (lipids, glucose, blood pressure), and behaviour (diet, activity, and psychological factors). Protocols, recruitment and baseline characteristics are reported. Results Between May 2014 and April 2015, 377 participants were recruited and randomised. The median age (IQR) of the mostly female sample (74%) was 45 (37–51) years. The sample comprised obese (BMI 32 (29–35) kg/m 2 ) well educated (79% post school qualifications) non-smokers (96%). A high proportion reported suffering from anxiety (26.8%) and depression (33.7%). Metabolic syndrome was identified in 34.9% of the sample. Conclusions The HealthTrack study sample was recruited to test the effectiveness of an interdisciplinary approach to preventive healthcare in self-identified overweight adults in the Illawarra region. The profile of participants gives some indication of those likely to use services similar to the trial design. [ABSTRACT FROM AUTHOR]

Objective: In countries with traditionally low fish consumption such as Australia, foods enriched with ω-3 long-chain polyunsaturated fatty acids (ω-3 LCPUFA) may play a role in meeting ω-3 LCPUFA intakes for optimal health. The aim of this study was to assess the effect of replacing bread, egg, milk, and yogurt with ω-3 LCPUFA enrichment of these foods on total ω-3 LCPUFA intake in Australian children's diets. Methods: Dietary modeling was undertaken using survey data from a nationally representative sample of 4487 children (2249 boys, 2238 girls) ages 2 to 16 y in whom the Multiple Source Method was used to estimate usual ω-3 LPUFA intakes distributions from two 24-h dietary recalls, corrected for within-person variation; 15 models were constructed. Results: The adjusted mean ± SD and median and interquartile range (IQR) of usual dietary intakes of ω-3 LCPUFA gradually increased from 2.5 ± 0.8 to 7.1 ± 4.9 mg/d and 2.3 (1.9-2.9) to 5.4 (3.6-9.2), respectively, after the modeling (P = 0.001 for each model). Median (IQR) intake of total ω-3 LCPUFAs in non-fish eaters and fish eaters was 1.4 (0.8-2.3) and 2.3 (1.0-6.1) mg/d, respectively, which increased threefold to 4.3 (2.6-7.8) and 7.5 (3.9-13) mg/d, respectively, after replacement of all four ω-3 enriched foods. Conclusion: Replacement of four core foods with ω-3 enriched alternatives resulted in improved simulated ω-3 LCPUFA intakes in Australian children but not to optimal levels of intake. Increased fish consumption is still the most effective strategy for increasing ω-3 LCPUFA intake. [ABSTRACT FROM AUTHOR]

Background: Obesity prevention among youth of low SES is a public health priority given the higher prevalence of youth obesity in this population subgroup. Purpose: To evaluate the 24-month impact of a school-based obesity prevention program among adolescent girls living in low-income communities. Design: The study was a school-based group RCT, the Nutrition and Enjoyable Activity for Teen Girls (NEAT Girls) intervention. Setting/participants: The study involved 12 secondary schools located in low-income communities in New South Wales, Australia. Participants were 357 adolescent girls (aged 13.2±0.5 years). Intervention: The 12-month multicomponent intervention was guided by social cognitive theory and involved strategies to promote physical activity, reduce sedentary behaviors, and improve dietary outcomes. Main outcome measures: The primary outcome was BMI, and secondary outcomes were BMI z-score; percentage body fat (bioelectrical impedance analysis); physical activity (accelerometers); dietary intake; and recreational screen-time (self-report). Data were collected in 2010–2012 and analyzed in 2012. Results: After 24 months, there were no intervention effects on BMI (adjusted mean difference −0.33, 95% CI= −0.97, 0.28, p=0.353) and BMI z-score (−0.12, 95% CI= −0.27, 0.04, p=0.178). However, there was a group-by-time interaction for percentage body fat (−1.96%, 95% CI= −3.02, −0.89, p=0.006). Intervention effects for physical activity, screen time, and dietary intake were not significant. Conclusions: The NEAT Girls intervention did not result in effects on the primary outcome. Further study of youth who are “at risk” of obesity should focus on strategies to improve retention and adherence in prevention programs. Trial registration: This study is registered at Australian New Zealand Clinical Trials ACTRN1261000033004. [ABSTRACT FROM AUTHOR]

Abstract: Replacing full-fat dairy products with reduced-fat varieties is a dietetic strategy for reducing energy intake while maintaining nutritional adequacy. This study aimed to explore the dietary outcomes of this recommendation in the context of weight loss. This study involved a secondary analysis of diet-history data for 86 adults (23 males and 63 females; body mass index=31.1±3.4) who had completed 3 months of a weight-loss trial in 2009, including advice to consume reduced-fat dairy products. Dairy food intake was categorized using the Australian 1995 National Nutrition Survey food hierarchy. Paired t tests and Wilcoxon signed rank tests determined dairy product consumption change after dietetic intervention. Total fat and energy per day from dairy products decreased significantly, from 14.1±1.2 g to 5.8±0.6 g and 283±20 kcal to 223±14 kcal, respectively, and total carbohydrate from dairy products increased significantly (P=0.04). Only 19.7% of participants met their dietary target of two to three servings of dairy foods per day at 3 months. When analyzed by sex, males decreased their intake of dairy products significantly, from 377.63±62.3 g/day to 357.3±46.7 g/day. Despite consuming less fat from dairy products, females did not significantly reduce energy intake from these foods (P=0.05). This study indicated that men and women responded differently to advice to change from regular to reduced-fat dairy products. Of more concern, however, is that in a weight-loss context, both men and women might choose to consume fewer servings of this food category with significant nutritional implications. Overall, this research highlights the need to consider the impact of sex and the background diet when recommending reduced-fat dairy products in the weight-loss context. [Copyright &y& Elsevier]

Abstract: Bioelectrical impedance equations are frequently used by food and nutrition professionals to estimate percent fat mass in overweight and obese children. However, it is not known whether they are accurate for such children, as they have been primarily developed for children of varying body weights. The aim of this cross-sectional study was to evaluate the predictive validity of four previously published prediction equations developed for the pediatric population, among a sample of overweight and obese children. Thirty overweight or obese children (mean age=7.57±1.28 years) underwent measurement of fat mass, percent fat mass, and fat-free mass using dual-energy x-ray absorptiometry (DEXA) and bioelectrical impedance analysis (BIA). Impedance values from the BIA were entered into the four prediction equations and Pearson correlations used to determine the significance of associations between each of the BIA prediction equations and DEXA for percent fat mass, fat mass, and fat-free mass. For percent fat mass, paired t tests were used to assess differences between the methods and the technique of Bland and Altman was used to determine bias and error. Results showed that the mean percent fat mass as determined by DEXA for this age group was 40.79%. In comparison with other BIA prediction equations, the Schaefer equation had the closest mean value of 41.98%, and was the only equation not to significantly differ from the DEXA (P=0.121). This study suggests that the Schaefer equation is the only accurate BIA prediction equation for assessing percent fat mass in this sample of overweight and obese children from primarily white backgrounds. [Copyright &y& Elsevier]

Abstract: Objective: A cardioprotective dietary fat profile is recommended for the treatment of type 2 diabetes. The clinical feasibility of advice strategies targeting specific fatty acid intakes and the extent to which they can be achieved by free-living populations needs to be tested. Walnuts, with high n-3 polyunsaturated fatty acid (PUFA) content, may help optimize fatty acid intakes, but regular consumption might increase total fat and energy intakes. This study examined whether advice that refers to a total dietary pattern inclusive of walnuts would result in low-fat energy-controlled diets with optimal dietary fat proportions for patients with type 2 diabetes mellitus. Research design and methods: A parallel-design, controlled trial was completed by 55 free-living men and women with established type 2 diabetes mellitus. Participants were randomly assigned to one of three groups: low-fat (general advice), modified low-fat (total diet advice using exchange lists to differentiate PUFA-rich foods), walnut-specific (modified low fat including 30 g walnuts/day). Dietary intakes and clinical outcomes were measured at baseline, and at 3 and 6 months. Dietary goals were: less than 10% of energy from saturated fat, 7% to 10% of energy from PUFA, adequate n-3 PUFA (≥2.22 g α-linolenic acid, ≥0.65 g eicosapentaenoic acid [EPA]+docosahexaenoic acid [DHA]) and n-6 to n-3 ratio less than 10. The proportion of subjects achieving dietary goals and major food sources of fat were determined. Results: At baseline, dietary intakes were not significantly different between groups. No group and few individuals (10%) were consuming adequate PUFA, with meat the main source of dietary fat (22% total dietary fat). At 3 and 6 months, energy and macronutrient intakes were similar among groups. The walnut group, however, was the only group to achieve all fatty acid intake targets (P<.01), and had the greatest proportion of subjects achieving targets (P<.05). Walnuts were the main source of dietary fat (31%) and n-3 PUFA (50%), while 350 g oily fish/day provided a further 17% n-3 PUFA consumed by this group. Conclusions: Specific advice for the regular inclusion of walnuts in the context of the total diet helps achieve optimal fat intake proportions without adverse effects on total fat or energy intakes in patients with type 2 diabetes mellitus. [Copyright &y& Elsevier]