Search

Refereed/Peer-reviewed Workers employed in rotating shift schedules are at a higher metabolic risk compared with those in regular day and fixed shift schedules; however, the contribution of diet is unclear. This systematic review aimed to investigate how rotating shift work schedules affect dietary energy intake and dietary patterns compared with regular day and fixed shift schedules. In addition, intraperson energy intake and dietary pattern comparisons within rotating shift schedules were investigated. Database searches were conducted on MEDLINE, Cochrane, CINAHL, PSYCinfo, EMBASE, and Scopus, in addition to manual search of bibliographic references, to identify articles. Two separate meta-analyses compared dietary intake between day work and rotating shift work schedules and within the rotational shift work group (morning/day and night shifts). Differences in dietary patterns were synthesized narratively. Thirty-one studies (n = 18,196 participants) were included in the review, and meta-analyses were conducted with 24-hour mean energy intake data from 18 (n = 16,633 participants) and 7 (n = 327 participants) studies, respectively. The average 24-hour energy intake of rotating shift workers was significantly higher than that of workers in regular daytime schedules [weighted mean difference (WMD): 264 kJ; 95% confidence interval (CI): 70, 458 kJ; P < 0.008; I2 = 63%]. However, the mean difference in 24-hour energy intake between morning/day shifts compared with night shifts within rotational shift schedules was not statistically significant (WMD: 101 kJ; 95% CI: −651, 852 kJ; P = 0.79; I2 = 77%). Dietary patterns of rotating shift workers were different from those of day workers, showing irregular and more frequent meals, increased snacking/eating at night, consumption of fewer core foods, and more discretionary foods. This review highlights that dietary intake in rotational shift workers is potentially higher in calories and features different eating patterns as a consequence of rotating shift work schedules. This review was registered at PROSPERO as ID 182507.

Background: Duchenne muscular dystrophy (DMD) is a severe X-linked neuromuscular disorder. Young people with DMD have high rates of obesity. There is emerging evidence that a higher BMI may negatively affect clinical outcomes in DMD. This study aimed to explore the relationship between obesity and clinical outcomes in DMD. Methods: This was a retrospective clinical audit of young people (two–21 years) with DMD. Height and weight were collected to calculate BMI z-scores to classify obesity, overweight and no overweight or obesity (reference category). Cox proportional hazards models determined the impact of obesity at five to nine years on clinical milestones including time to: loss of ambulation, timed function test cut-offs, obstructive sleep apnoea (OSA) diagnosis and first fracture. Results: 158 young people with DMD were included; most (89.9%) were steroid-treated. Mean follow-up was 8.7 ± 4.7 years. Obesity prevalence increased from age five (16.7%) to 11 years (50.6%). Boys with obesity at nine years sustained a fracture earlier (hazard ratio, HR: 2.050; 95% CI: 1.038–4.046). Boys with obesity at six to nine years were diagnosed with OSA earlier (e.g., obesity nine years HR: 2.883; 95% CI: 1.481–5.612). Obesity at eight years was associated with a 10 m walk/run in 7–10 s occurring at an older age (HR: 0.428; 95% CI: 0.207–0.887), but did not impact other physical function milestones. Conclusions: Although 50% of boys with DMD developed early obesity, the impact of obesity on physical function remains unclear. Obesity puts boys with DMD at risk of OSA and fractures at a younger age. Early weight management interventions are therefore important.

This study aimed to describe the prevalence, severity and socio-demographic predictors of food insecurity in Australian households during the COVID-19 pandemic in 2020, from the perspective of women. A cross-sectional online survey of Australian (18–50 years) women was conducted. The survey collected demographic information and utilised the 18-item US Department of Agriculture Household Food Security Survey Module and the Kessler Psychological Distress Scale (K10). A multivariable regression was used to identify predictors of food security status. In this cohort (n = 1005), 19.6% were living in households experiencing food insecurity; with 11.8% experiencing low food-security and 7.8% very low food-security. A further 13.7% of households reported marginal food-security. Poor mental health status (K10 score ≥ 20) predicted household food insecurity at all levels. The presence of more than three children in the household was associated with low food-security (OR 6.24, 95% CI: 2.59–15.03). Those who were renting were 2.10 (95% CI: 1.09–4.05) times likely to experience very low food-security than those owning their own home. The COVID-19 pandemic may have contributed to an increased prevalence of household food insecurity. This study supports the need for a range of responses that address mental health, financial, employment and housing support to food security in Australia. Monash University National Heart Foundation Future Leader Fellowship National Health & Medical Research Council

Background: Contemporary energy expenditure data are crucial to inform and guide nutrition policy in older adults to optimize nutrition and health.Objective: The aim was to determine the optimal method of estimating total energy expenditure (TEE) in adults (aged >= 65 y) through 1) establishing which published predictive equations have the closest agreement between measured resting metabolic rate (RMR) and predicted RMR and 2) utilizing the RMR equations with the best agreement to predict TEE against the reference method of doubly labeled water (DLW).Methods: A database consisting of international participant-level TEE data from DLW studies was developed to enable comparison with energy requirements estimated by 17 commonly used predictive equations. This database included 31 studies comprising 988 participant-level RMR data and 1488 participant-level TEE data. Mean physical activity level (PAL) was determined for men (PAL = 1.69, n = 320) and women (PAL = 1.66, n = 668). Bland-Altman plots assessed agreement of measured RMR and TEE with predicted RMR and TEE in adults aged >= 65 y, and subgroups of 65-79 y and >= 80 y. Linear regression assessed proportional bias.Results: The Ikeda, Livingston, and Mifflin equations most closely agreed with measured RMR and TEE in all adults aged >= 65 y and in the 65-79 y and >= 80 y subgroups. In adults aged >= 65 y, the Ikeda and Livingston equations overestimated TEE by a mean +/- SD of 175 +/- 1362 kJ/d and 86 +/- 1344 kJ/d, respectively. The Mifflin equation underestimated TEE by a mean +/- SD of 24 +/- 1401 kJ/d. Proportional bias was present as energy expenditure increased.Conclusions: The Ikeda, Livingston, or Mifflin equations are recommended for estimating energy requirements of older adults. Future research should focus on developing predictive equations to meet the requirements of the older population with consideration given to body composition and functional measures.

Aims To identify and describe weight management interventions that include a dietary component for young people with chronic healthcare needs and overweight or obesity and their effect on body mass index (BMI) or weight. Methods Six databases were searched in 2017 and 2020 for experimental studies in English: Ovid MEDLINE, Ovid Embase, Ovid AMED, EBSCO CINAHL, Scopus and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Two independent reviewers conducted data extraction and quality assessment using the Cochrane Risk of Bias tool. Eligible studies included young people with chronic healthcare needs ≤18 years with overweight or obesity with an intervention that included a dietary component. Eligible outcomes were BMI or weight. Data were synthesised narratively. Results The search identified 15 293 references, 12 studies were included (randomised controlled trials n = 5, before-after comparisons n = 7). Participant diagnoses were neurodevelopmental disabilities (n = 5) and mental illness (n = 1); survivors of cancers or tumours (n = 4); congenital heart disease (n = 1) and; migraine (n = 1). No studies addressed weight management in physical disabilities. Eight studies demonstrated a significant reduction in BMI or weight. Of these, most interventions used dietary counselling or an energy deficit, were family-focused, multicomponent and delivered by a multidisciplinary team including dietitians. A high risk of bias was detected across studies. Conclusions There is limited high-quality evidence about effective dietary solutions for the management of overweight and obesity for young people with chronic healthcare needs. While more research is required, dietary management appears to be important to manage weight in these populations.

The story of the past 15 years in U.S. education has been one of fundamental reform and transformation. These changes are felt most acutely in the daily lives of teachers and principals and often have lasting effects on the context of the school community. This case study explores the challenges facing a principal when attempting reform and improvement efforts set in a larger backdrop of social and economic change. This case involves issues related to understanding school context and improving communication skills for new principals and can be used for principal preparation and educational leadership courses.

Food insecurity in Australia is increasing. Organisations within the charitable food sector aim to manage, and in some cases are implementing strategies to prevent, food insecurity, such as food literacy programmes. This pilot study describes the challenges and opportunities for evaluating the impact of a food literacy programme, FoodMate by SecondBite™, which aims to reduce food insecurity amongst ‘at risk’ young people. Three community agencies working with ‘at risk’ young people delivered an 8-week food literacy programme in Melbourne, Australia. A pre-test/post-test design was used and outcome measures included: (i) food intake, (ii) diet quality, (iii) cooking confidence and (iv) food independence. These were assessed via questionnaires and 24-hour recalls at three time points: pre-programme (T1), post-programme (T2) and at 4 to 6-week follow-up (T3). Twenty-one young people aged 16–25 years participated in this pilot study. The response rate for the questionnaire and 24-hour recalls declined across the study: T1 (n = 21), T2 (n = 11) and T3 (n = 9). Some positive effects were associated with the programme but attrition rates were high and the majority of participants did not complete all measures. Although results were inconclusive, this study describes some common challenges of conducting a food literacy intervention with vulnerable young people and highlights the benefit of nutrition researchers and practitioners working together to conduct evaluation of such programmes.

There are many health and economic consequences for patients with osteopenia, the precursor to osteoporosis. A range of treatments may provide positive outcomes for otherwise healthy adults, including dietary and exercise approaches, either alone or in combination. The primary aim of this systematic review was to evaluate the effect of dietary approaches (including diet alone, diet with dietary supplements, both with or without physical activity intervention) on bone mineral density (BMD) to treat adults aged ≥18 years who were classified as having osteopenia. Six databases (Ovid MEDLINE including Ovid Medline in process, Cochrane Library, EMBASE, CINAHL Plus, Web of Science and Scopus) were searched systematically to identify randomised controlled trials of dietary approaches to treat osteopenic adults published from 1994 to November 2014. Study eligibility was determined, and included studies were assessed for risk of bias. Outcome data, particularly the primary outcomes of BMD T- and Z-scores or other measures of bone density, were combined narratively. The searches yielded 3511 papers, with three studies fulfilling the inclusion criteria. These studies included 254 participants, all free-living post-menopausal females with confirmed osteopenia. Vitamin D interventions were tested in all included studies, with none showing significant differences between intervention and placebo groups on BMD. This review has identified a lack of evidence to guide clinical practice in this area. Opportunities exist for future research to determine the effect of non-pharmacological approaches to osteopenia treatment in healthy populations, especially research that considers younger-aged and male populations, physical activity, habitual dietary intake and key bone health nutrients.

Background Simulated patients (SPs) are often used in dietetics for the teaching and assessment of communication skills. The present study aimed to determine the impact of a SP encounter on communication skills in undergraduate preclinical dietetic students in the context of the resources required for delivering this educational strategy. Methods This observational study collected assessment data from four cohorts of third-year dietetic students to examine the effect of participation in SP-embedded Objective Structured Clinical Exams. Students completed two SP interviews, 2 weeks apart, and communication skills were measured on both occasions. A subgroup of students received a video of their SP encounter. Differences between the two SP interview scores were compared to assess the impact of the SP encounter on communication skills. The required staff and resources were described. Results Data were collected involving 215 students. Out of 30 marks, there was a modest mean (SD) improvement in communication skills from the first to the second SP interview of 2.5 (4.2) (P < 0.01). There was an association between student ability and improvement in communication skills, with failing students demonstrating the greatest improvement between SP encounters. There were no observed benefits for the subset of students who received videos. Conclusions Providing repeat SP interview opportunities results in only modest improvement in communication skills for most students. The use of SPs needs to be considered in context of the substantial costs and resources involved and tailored to student ability.

In a clinical setting, collecting information on dietary intake and physical activity is an essential component of nutrition assessment. Parent- or self-reported measures may be an acceptable method to ascertain important information on dietary habits and physical activity levels (PALs). This article aims to investigate whether parents can accurately report physical activity and dietary energy intake (EI) in ambulatory boys with Duchenne muscular dystrophy (DMD).Four-day parent-reported physical activity diaries were used for estimated PALs. Estimated EI was measured (by parents) concurrently using a 3-day food and drink diary. Total energy expenditure (TEE) was measured using doubly labeled water over 10 days. Resting energy expenditure (REE) was measured using indirect calorimetry. Measured PALs were derived from TEE/REE.Dietary intake and energy expenditure assessments were completed for 14 boys with a mean age of 8.44 ± 1.90 years. No statistical difference was detected between mean parental estimated EI (1645 kcal/d) and TEE (1785 kcal/d). PALs were measured and estimated in 6 of the boys. Again, there was no statistically significant difference between measured (1.37) and parental estimated (1.45) PALs. Bland-Altman analysis demonstrated that the bias between the measurement instruments was consistent across a range of EI and PAL values.Parent-reported dietary intake and physical activity diaries could provide a simple and cost-effective assessment of EI and habitual physical activity in groups of boys with DMD.

Background Competency in the practice of public health is essential for dietitians, yet little is known about credible and dependable assessment in this field. The present study aimed to investigate the role of individual and group assessment tasks as elements of a public health nutrition competency-based assessment system. Methods Assessment performance data from 158 dietetics students (three group tasks and one individual task) who had completed a practical placement learning experience in a public health nutrition setting were examined using nonparametric techniques. All 158 students were deemed individually ‘competent’ on completion of the placement. Results The median mark was significantly lower for the individual compared to the group task, with a greater range of marks achieved in the individual assessment. There was a weak relationship between individual and group marks for the whole cohort (n = 158) (Spearman's rho correlation coefficient = 0.193, P = 0.015). Bland–Altman analysis showed that the mean (SD) agreement between the two assessment tasks was −5.9 (17.7) marks. Systematic bias between the two tasks was also demonstrated, indicating that students with the lowest average mark of the two assessments scored lower on the individual assessment task compared to their group task and those who had a higher average mark scored higher on the individual group assessment compared to their group task. Conclusions Student performance in public health differs between individual and group assessment. Individual assessment appears to differentiate between students, yet group work is essential for the development of teamwork skills. Both should be considered in the judgement of public health nutrition competency.

Nutritional issues that are associated with Duchenne muscular dystrophy (DMD) remain poorly understood. The aim of this analysis was to describe and explore longitudinal observations of body mass index (BMI) in a cohort of children with DMD. Anthropometric and clinical characteristics were collected retrospectively and longitudinally for boys with DMD seen in two large neuromuscular clinics. BMI Z-scores were determined using the Centers for Disease Control and Prevention reference values for children (2000). Medical records (n=193) were examined from which 75% were included for analysis. The mean age of the cohort at the time of data collection was 11.9 years, with 72% of patients currently or previously using steroids. The highest prevalence of obesity based on the BMI Z-score was 50% at the age of 10 years. Longitudinally, BMI Z-scores from the age of 2 to 12 years plot approximately one s.d. above the mean, after which there is a marked and progressive decline. BMI gainers were identified for whom BMI Z-score increased by 1.65 units compared with the 0.09 units in non-gainers. BMI gainers were younger when they had their first BMI measurement (5.9 vs 7.2 years), and this measure was significantly lower compared with the non-gainers (BMI Z-score: 0.04 vs 1.17). In this cohort, BMI was associated with age, ambulatory status and lung function. This study demonstrates that boys with DMD using steroid therapy experience shifts in BMI. A declining BMI appears to be associated with increasing age. Interpretation of growth patterns is limited here by a lack of normative growth references in DMD.

Duchenne muscular dystrophy (DMD) is a recessive X linked genetic disorder characterised by progressive muscle weakness and reduced muscle tone. Affecting only boys, it limits life expectancy to approximately 20 years. A literature review was conducted using MEDLINE and the Cochrane Library, employing the term 'Duchenne muscular dystrophy'. A total of 1491 articles in English were recovered. These papers were searched thematically under the headings: body composition (n = 10), energy expenditure (n = 10), nutrition (n = 6), corticosteroid therapy (n = 55) and gene therapy (n = 199). Key dietetic practice points were identified relevant to nutritional management. Papers supporting these key themes were assigned a level of evidence and grade of recommendation. There is limited high-quality evidence to guide the nutritional management of boys with DMD. Currently, the majority of evidence is based on expert opinion and clinical expertise. Delayed growth, short stature, muscle wasting and increased fat mass are characteristics of DMD and impact on nutritional status and energy requirements. The early introduction of steroids has altered the natural history of the disease, but can exacerbate weight gain in a population already susceptible to obesity. Prior to commencing steroids, anticipatory guidance for weight management should be provided. Malnutrition is a feature of end stage disease requiring a multidisciplinary approach, such as texture modification and supplemental feeding. Micronutrient requirements are yet to be determined but, as a result of corticosteroid treatment, vitamin D and calcium should be supplemented. Some evidence exists supporting supplementation with creatine monohydrate to improve muscle strength. More research is needed to provide a higher quality of evidence for dietitians working within this area.