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Introduction: The life expectancy of older adults continues to increase; however, knowledge regarding their total energy requirements is lacking. This study aimed to compare the total energy expenditure (TEE) of older adults ≥80 years measured using doubly labelled water (DLW), with estimated TEE. The hypothesis was that the Mifflin, Ikeda, and Livingston equations will more closely estimate energy requirements than the commonly used Schofield equation. Methods: Resting metabolic rate (RMR) and TEE were measured using the reference methods of indirect calorimetry and DLW, respectively. Bland-Altman plots compared measured RMR and TEE with predicted RMR using equations (Mifflin, Ikeda, Livingston, Schofield) and predicted TEE (predicted RMR × physical activity level). Results: Twenty-one older adults (age range 80.7–90.1 years, BMI 26.1 ± 5.5 kg/m2) were included. The Schofield equation demonstrated the greatest bias from measured RMR, overestimating approximately up to double the mean difference (865 ± 662 kJ/day) compared with the three other equations. The Schofield equation exhibited the greatest bias (overestimation of 641 ± 1,066 kJ/day) compared with measured TEE. The other three equations underestimated TEE, with the least bias from Ikeda (37 ± 1,103 kJ/day), followed by Livingston (251 ± 1,108 kJ/day), and Mifflin (354 ± 1,140 kJ/day). Data are mean ± SD. Conclusions: In older adults ≥80 years, the Ikeda, Mifflin, and Livingston equations provide closer estimates of TEE than the widely used Schofield equation. The development of nutrition guidelines therefore should consider the utilization of equations which more accurately reflect age-specific requirements.

The global population is living longer; however, not everyone ages at the same rate with regard to their physical and cognitive abilities and their vulnerability to certain diseases and death. This review aimed to synthesize the contribution of biological age-predictive biomarkers to nutrition research and highlight the implications for future research and clinical practice. MEDLINE, CINAHL, and Cochrane CENTRAL were systematically searched on 30 September 2021 for randomized controlled trials and cross-sectional studies examining the association between nutrition and biological age in older adults reporting on genetic, clinical, or molecular biomarkers of biological aging. Cochrane's ROB 2 and ROBINS-I were used to assess the quality of included studies. Synthesis was undertaken narratively. Of 1245 records identified from the search, 13 studies from 8 countries and territories, involving 5043 participants, were included. Seven studies assessed associations between nutrient food intake and telomere attrition, reporting protective effects for branched-chain amino acids, calcium and vitamin D, and a diet of a lower inflammatory index; whereas they found shorter telomeres in people consuming more processed foods and arachidonic acid and other proinflammatory compounds. Five studies examined the associations between plasma nutrition biomarkers and cognitive function, and found a protective effect for HDL cholesterol, lycopene, carotenoids, ω-3 and ω-6 fatty acids, and vitamins B, C, D, and E; whereas trans fatty acids and fibrinogen correlated with a decline in cognitive function. One study used Horvath's clock and reported the epigenetic rejuvenation effect of a Mediterranean diet. In conclusion, biological aging was negatively associated with an anti-inflammatory diet. However, a few studies did not control for the confounding effect of other lifestyle factors. Future research should address this and also assess the synergistic effect of different nutrients, their combinations, and evaluate their dose-response relations. Nutrition practice can incorporate updated screening procedures for older people that include relevant biological aging nutrition markers, leading to anti-aging precision nutrition therapy. The methodology of this systematic review was registered in PROSPERO (CRD42021288122).

Meeting the nutritional needs and foodservice expectations of hospital inpatients is challenging. This study aimed to determine whether adults receiving specialist inpatient mental health services meet their energy and protein requirements and are satisfied with the foodservice.An observational study of adults admitted to three specialist inpatient mental health services within a large health service. Energy and protein intake were determined over 24 h via observation, and nutritional requirements were estimated using standard procedures. Validated questionnaires were used to assess satisfaction with the lunch meal, elements of the foodservice system, and overall foodservice satisfaction.Among 74 participants, the median (IQR) energy intake (6954 [5111-10 250]kJ/day) was less than estimated requirements (8607 [7319-9951]kJ/day), whilst protein intake (85 [62-120]g/day) exceeded requirements (59 [46-70]g/day). Food from external sources was consumed by 50% of participants. Satisfaction surveys found vegetables were rated more poorly than the meat or carbohydrate portion of the meal, food quality was rated lowest compared with meal service, staffing and physical environment. The majority of participants (89%) rated their last meal as average, with the remainder (11%) rating it as poor.There are opportunities to improve the meal and foodservice experience for this patient group to meet their nutritional requirements and expectations. Investment in quality food and menus that are appropriate for the demographics, exploration of the most appropriate foodservice system, and adequate dietetic resourcing are needed to improve nutrition care within specialist inpatient mental health services.

Purpose:This study aimed to determine the effects of an acute “train-low” nutritional protocol on markers of recovery optimization compared to standard recovery nutrition protocol.Methods:After completing a 2-hour high-intensity interval running protocol, 8 male endurance athletes consumed a standard dairy milk recovery beverage (CHO; 1.2 g/kg body mass [BM] of carbohydrate and 0.4 g/kg BM of protein) and a low-carbohydrate (L-CHO; isovolumetric with 0.35 g/kg BM of carbohydrate and 0.5 g/kg BM of protein) dairy milk beverage in a double-blind randomized crossover design. Venous blood and breath samples, nude BM, body water, and gastrointestinal symptom measurements were collected preexercise and during recovery. Muscle biopsy was performed at 0 hour and 2 hours of recovery. Participants returned to the laboratory the following morning to measure energy substrate oxidation and perform a 1-hour distance test.Results:The exercise protocol resulted in depletion of muscle glycogen stores (250 mmol/kg dry weight) and mild body-water losses (BM loss = 1.8%). Neither recovery beverage replenished muscle glycogen stores (279 mmol/kg dry weight) or prevented a decrease in bacterially stimulated neutrophil function (−21%). Both recovery beverages increased phosphorylation of mTORSer2448(main effect of time = P Ser9/total-GSK-3β occurred on CHO (P = .012). Blood glucose (P = .005) and insulin (P = .012) responses were significantly greater on CHO (618 mmol/L per 2 h and 3507 μIU/mL per 2 h, respectively) compared to L-CHO (559 mmol/L per 2 h and 1147 μIU/mL per 2 h, respectively). Rates of total fat oxidation were greater on CHO, but performance was not affected.Conclusion:A lower-carbohydrate recovery beverage consumed after exercise in a “train-low” nutritional protocol does not negatively impact recovery optimization outcomes.

Public institutions have the opportunity implement environmental sustainability policies through leveraging their buying potential. Implementation of sustainable initiatives into hospital foodservices is a priority given the role of hospitals within the food system. Compared to conventional agricultural methods, organic food production uses more sustainable practices and warrants consideration for utilisation in hospitals. This systematic review aimed to synthesise the published literature to identify benefits, limitations and implementation issues regarding the use of organic foods in hospital foodservice settings.The review protocol was prospectively published (PROSPERO registration CRD42022322245) and reported consistent with PRISMA guidelines. A systematic search of four databases was undertaken from January 2000 to March 2022. Reference lists of eligible papers were checked; key outcome data were extracted and synthesised. Study quality was assessed using the Quality Criteria Checklist for Primary Research or the Critical Appraisal Skills Programme checklist.After review of 4102 titles/abstracts and 113 full-text papers, the final library comprised 10 papers of moderate to high quality. Implementation of organic foods increased quality in addition to environmental sustainability improvements. The price premium, additional production requirements, change to kitchen routines and concerns with food quality and security of supply were reported as barriers. Government targets for increasing organic food, organisational support, and staff knowledge and training supported implementation.This review identified opportunities for implementation of organic foods into hospital foodservices, but there are numerous barriers to be overcome through strategies including organisational support and staff training. This article is protected by copyright. All rights reserved.

Background Programmatic assessment has been proposed as the way forward for competency-based assessment, yet there is a dearth of literature describing the implementation and evaluation of programmatic assessment approaches. Objective To evaluate the implementation of a programmatic assessment and explore its ability to support students and assessors. Design A qualitative evaluation of programmatic assessment was employed. Participants/setting Interviews with graduates (n = 8) and preceptors (n = 12) together with focus groups with faculty assessors (n = 9) from the one Australian university explored experiences of the programmatic approach, role of assessment in learning, and defensibility of assessment decisions in determining competence. Analysis performed Data were analyzed into key themes using framework analysis. Results The programmatic assessment increased confidence in defensibility of assessment decisions, reduced emotional burden of assessment, increased value of assessment, and identified and remediated at-risk students earlier when philosophical and practice shifts in approaches to assessment were embraced. Conclusions Programmatic assessment supports a holistic approach to competency development and assessment and has multiple benefits for learners and assessors.

Background To understand, monitor and compare the scope of food waste in hospital foodservices, it is essential to measure food waste using a standardised method. The aims of this systematic review were to: (i) describe and critique the methodological features of waste audits used in hospital foodservice settings that measure aggregate food and food-related waste and (ii) develop a consensus tool for conducting a food waste audit in a hospital foodservice setting. Methods Seven electronic databases were searched for peer reviewed literature, and 17 Google Advanced searches located grey literature that described food waste audit methods previously used or developed for hospital foodservices. Study selection and quality assessment occurred in duplicate. Data describing the audit method, its feasibility, and strengths and limitations were extracted and synthesised to develop a consensus tool. Results Eight peer reviewed and nine grey literature documents describing a variety of food waste audit methods were found. The most common practices were 2-week data collection (n = 5), foodservice staff collecting data (n = 6), measuring food waste only (n = 11), measuring food waste at main meals (n = 5) and using electronic scales to measure waste (n = 12). A consensus tool was developed that proposes a method for preparing, conducting and analysing data from a food waste audit. Conclusions This review used published evidence to develop the first ever food waste audit consensus tool for hospital foodservices to use and measure food and food-related waste. Future research is needed to apply and test this tool in practice.

OBJECTIVE Weight loss is a primary manifestation of dementia. This review aimed to systematically synthesise the literature on total energy expenditure (TEE) in people with dementia. METHODS The protocol, registered with PROSPERO, was reported against PRISMA guidelines. Eligible studies investigated TEE in people with dementia. Six electronic databases and a supplementary Internet search identified relevant publications. Results were synthesised narratively. RESULTS The final library considered the TEE of 358 participants. Two studies used the gold standard method of doubly labelled water (DLW); other studies used TEE measures validated against DLW. TEE varied considerably, from 6095 ± 1353 kJ to 9765 ± 2066 kJ. The TEE of community-dwelling people with dementia (range 8430 ± 2250 kJ-9765 ± 2066 kJ) was higher than in institutionalised groups (range 6095 ± 1353 kJ-7619 ± 1827 kJ). CONCLUSION New technologies will enable future research in this patient population to be less burdensome than those reliant on DLW measures. In planning future research, avoidance of selection bias and considering disease stage and movement are important considerations.

This review explored peer-reviewed and grey literature to describe the types and characteristics of food or food-related waste management strategies used in hospital food service settings; their financial, environmental and staffing outcomes; and the barriers and enablers associated with their implementation.Six electronic databases, 17 Google Advanced searches, and 19 targeted websites were searched for peer-reviewed and grey literature. Literature reporting the financial, environmental, or staffing outcomes of food or food-related waste management strategies that reused, recovered energy from, or recycled waste instead of sending it to landfill were eligible. Document screening and review were completed in duplicate, and included peer-reviewed literature were assessed for quality using the Mixed Methods Appraisal Tool. Data were synthesised narratively.Four peer-reviewed and 81 grey literature records reported 85 strategies. When grouped from most to least favourable according to the food recovery hierarchy they managed waste by: donating surplus food (n = 21); feeding animals (n = 2); industrial use (n = 11); composting (n = 34) and other (n = 17). These approaches had the capacity to reduce waste hauling fees (n = 14), reduce staff handling of waste (n = 3), and decrease the amount of waste sent to landfill (n = 85). Barriers included contamination of waste streams, while enablers included leadership and time-neutral changes.This review summarises the waste management strategies used by hospitals worldwide that divert food and food-related waste from landfill, their outcomes, and position in the food recovery hierarchy to enable hospital food services to implement appropriate practice and policy changes to decrease their environmental footprint.

Communal dining offers multiple benefits for hospital patients, yet dining rooms may be underutilized in practice. This study aimed to understand and explore staffs' perspectives and experiences of communal dining in subacute care, and the impacts on staff mealtime practice. Using qualitative, ethnographic methodology, 94 hours of fieldwork were conducted across two subacute care wards. Participants were staff involved in nutrition care or present on the ward at mealtimes. Ninety-one semistructured and ethnographic interviews were conducted with 59 staff, and 54 episodes of observation captured more than 190 staff. Interviews and field notes were thematically analyzed using an inductive approach. Three themes were identified: (i) benefits to patients; (ii) logistical and practical challenges; and (iii) supportive cultural factors. While staff recognized how communal dining benefited patients, logistical and practical challenges impacted their ability to facilitate it in practice. Healthcare organizations seeking to embed communal dining into the mealtime routine should recognize that clear delineation of staff roles and responsibilities, and cultural change involving normalization, setting expectations, and collective advocacy may be needed to optimize benefits for patients.

Foodservice is a key contributor to environmental impacts of the healthcare sector, in particular hospitals. Driving towards sustainable solutions in foodservices can bring financial and social benefits, whilst allowing hospitals to position themselves as leaders towards a sustainable food system and healthcare sector. Such a change depends on those working directly or indirectly with foodservices. Staff possess valuable knowledge, ideas, motivation and responsibility for improving the environmental sustainability of the foodservice system. The aim of this study was to explore the perspectives of staff working across the hospital food supply chain towards: (1) sustainable practices in hospital food provision; (2) existing barriers and enablers; and (3) recommendations for implementing sustainable foodservice practices in the future. Through qualitative inquiry, semi-structured interviews were conducted with individuals at operational and management levels responsible for policy, purchasing, production, onsite plating and delivery and waste disposal at three hospitals in Australia. Framework analysis was used to synthesise transcribed data into practices, barriers and enablers, and recommendations. Interviews (n=46 participants) identified current sustainable practices including those related to recyclable packaging, effective equipment and technology and efficient processes. Unsustainable practices included restrictions on sourcing food, packaging that cannot be separated or recycled, rigid foodservice models and menu, waste production and processes. Enablers to improve sustainability included the power of individuals to influence change, education on recycling, knowledge generation, audits and grants for innovative research, rebates and quality improvement processes. Barriers included competing priorities, poor communication, lack of training opportunities and knowledge, infection control restrictions, lack of policy, funding, and time between meal ordering and delivery. Participants proposed practice changes across the food supply chain and recommended generation and sharing of knowledge, leadership and policy support. Perspectives of individuals within foodservice reveal shared motivation and desire for sustainable foodservices, with support needed from leaders and policy. Future research should use a co-design approach involving staff to create and implement sustainable strategies within hospitals. To see widespread and timely change, action is needed towards effective and meaningful policy.

Background Ageing populations show a propensity for reduced food intake, which impacts nutritional adequacy. Nutrition guidelines for residential care homes (RCHs) are currently based on serve size of core food groups and do not consider nutrient density. The present study aimed to investigate the weight of foods served/consumed compared to recommended serve sizes and to compare energy and protein intake with individual requirements. Methods This was an observational study of older adults living in four RCHs. Dietary intake was estimated through the difference between weighed reference meals and a single, double-weighed 24-h food plate waste collected from each participant. FoodWorks9® (Xyris® Software, Brisbane, Australia) was used to calculate energy, protein and serves of core food groups from food intake and the menu provided to recommended serve sizes. Individual intake was compared with nutrition guidelines and estimated energy and protein requirements. Results Across 420 participants, 9.8% completed a main meal (lunch or dinner). The servings provided [248 g; interquartile range (IQR) = 206-290 g] were less than the recommended servings for a main meal (306 g = protein/starch/two vegetables), with 157 g (IQR = 109-221 g) consumed. The menu provided for minimum serves of all core food groups except for dairy. Median energy intake (n = 389) (5272 kJ day-1 , IQR = 4229-6720 kJ) and protein intake (47.3 g day-1 , IQR = 35.9-60.8 g) were less than estimated requirements (8181 kJ day-1 , IQR = 7300-9338 kJ day-1 ; 76.7 g day-1 , IQR = 66.7-90.8 g). Conclusions Nutritional needs were not met in this cohort. The findings of the present study highlight the need for smaller, nutrient-dense meals and revised menu standards to ensure nutritional adequacy in this vulnerable population.

BACKGROUND The image of dietitians presented on the Internet shapes public perception of the profession, which in turn may influence engagement with professionals. The aim was to describe the portrayal of the dietetic profession on the Internet and how this aligns with international professional demographics. METHODS In this cross-sectional observational study, images appearing in two Google image searches using the word 'dietitian' were analysed for content by two independent researchers. A coding framework was used to identify personal characteristics of professionals and others presented in the image, as well as the work setting. These were compared to demographic data of members of professional associations in Australia, the United Kingdom (UK) and the United States of America (USA). RESULTS The dietitian portrayed in the images (n = 339) was most often female (88%), Caucasian (72%), aged between 26-39 years (63%), pictured alone (78%), pictured with food (78%) and in a setting that could not be determined (76%). The age and gender profile presented matches the characteristics of the international workforce; however, there was an absence of images illustrating dietitians in authentic work roles. CONCLUSIONS The images resulting from an online search for 'dietitian' do not fully illustrate the profession. There are opportunities to create and share authentic images online that show the breadth of work roles and diversity of professionals' age, gender, cultural background and size.

Malnutrition in hospitalized patients remains a significant problem. Protected Mealtimes is a complex, inter-professional ward-based intervention that was first introduced in the United Kingdom to address this issue. Now implemented internationally, the approach still remains in key policy documents including the National Health Service Essence of Care. This review aims to synthesize the nutrition, satisfaction and quality of life patient/resident outcomes that arise from the implementation of Protected Mealtimes in hospitals and residential aged care facilities and to consider fidelity issues that have been reported in previous research. A defined search strategy was implemented in seven databases to identify full text papers of original research that evaluated Protected Mealtimes implementation. After screening, data were extracted from eight studies (7 quantitative and 1 qualitative study) that were conducted in hospitals. There was no research identified from the aged care sector. There were few positive outcomes that resulted from Protected Mealtimes implementation, many fidelity issues with the intervention were reported. It is apparent that Protected Mealtimes provide few, if any, benefits for hospitalized patients. It is a complex, multi-pronged initiative that has limited fidelity and limited outcomes. As such, we recommend that disinvestment by policy makers for hospitals should be considered, with the implementation of other evidence based mealtime initiatives. We provide no recommendation for disinvestment in the aged care sector, since the approach has not been evaluated against any of the eligible outcomes of this review.

Background Hospitals have a responsibility to support human health, and given the link between human and environmental health, hospitals should consider their environmental impacts. Hospital foodservices can negatively affect the environment at every stage of the food supply chain (production/procurement, distribution, preparation, consumption, and waste management/disposal). Objective To systematically identify and synthesize the following across the hospital patient food/nutrition supply chain: environmental and associated economic impacts of foodservice; outcomes of strategies that aim to improve the environmental sustainability of foodservice; and perspectives of patients, staff, and stakeholders on environmental impacts of foodservice and strategies that aim to improve the environmental sustainability of foodservice. Methods Eight electronic databases (ie, Cumulative Index to Nursing and Allied Health Literature Plus, Embase via Ovid, Global Health, National Health Service Economic Evaluation Database, Ovid Medline, ProQuest Environmental Science Collection, Scopus, and Web of Science) were searched from database inception to November 2018 for original research conducted across any stage of the hospital food supply chain (from production/procurement to waste management/disposal) that provides food/nutrition to patients, with no restrictions on language or study design. Titles/abstracts then full texts were screened independently by two authors. The Mixed Methods Appraisal Tool was used for quality appraisal for included studies. Data were synthesized narratively. Results From 29,655 records identified, 80 studies met eligibility criteria. Results were categorized into production/procurement (n=12), distribution (n=0), preparation (n=6), consumption (n=49), waste management/disposal (n=8), and multiple food supply chain aspects (n=5). The environmental impact most widely explored was food waste, with many studies reporting on food waste quantities, and associated economic losses. Strategies focused on reducing food waste by increasing patients’ intake through various foodservice models. Perspectives identified a shared vision for sustainable foodservices, although there are many practical barriers to achieving this. Conclusion The literature provides examples across the hospital food supply chain that demonstrate how environmental sustainability can be prioritized and evaluated and the opportunities for credentialed nutrition and dietetics practitioners to contribute. Future studies are warranted, particularly those measuring environmental impacts and testing the effects of sustainable strategies in the distribution, preparation, and waste management stages.

To determine the prevalence of metabolic syndrome in patients attending outpatient community rehabilitation in Melbourne, Australia and to compare health literacy, physical activity, and dietary intake of people with and without metabolic syndrome.A cross-sectional, multi-centre, observational study of adults (One hundred and twenty three participants (64%) had metabolic syndrome. Of these, only three (2%) knew they had it. People with metabolic syndrome scored lower on health literacy (S-TOFHLA MD -2.10, 95% confidence interval (CI) -3.98 to -0.22) and took 1311 (95%CI 375 to 2246) fewer daily steps than those without metabolic syndrome. There were no differences in dietary intake.Metabolic syndrome is a prevalent and under-recognised condition in community rehabilitation. Community healthcare professionals and health services may need to consider a broader approach to management including lifestyle assessment and intervention of patients with various conditions. Implications for rehabilitationAlmost two-thirds of adults in community rehabilitation had underlying, undetected metabolic syndrome.Adults with metabolic syndrome completed less objectively measured physical activity and had lower health literacy levels than those without metabolic syndrome.A broader approach to management may need to be considered in community rehabilitation where patients presenting for rehabilitation of various conditions would likely benefit from lifestyle assessment and intervention.

Importance: Readmission to the hospital can lead to poorer patient outcomes and increased health care costs. The effect of occupational therapy interventions for adult hospitalized patients on readmission rates has not been previously evaluated. Objective: To systematically examine the published literature to determine the effects of occupational therapy interventions for adult hospitalized patients on readmission rates. Data Sources: Systematic search of five electronic databases was performed from database inception until May 2020, supplemented by citation and reference list searches. Study Selection and Data Collection: This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively; methodological quality of the included studies was assessed using the Downs and Black checklist. Meta-analyses were conducted with clinically homogeneous data; the overall body of evidence was graded for quality. Findings: Meta-analysis of 7 studies with 16,718 participants provided low-quality evidence that 1-mo readmission rates were reduced when adult patients hospitalized for general medical and surgical care received additional occupational therapy interventions compared with standard care. Subgroup analysis of 4 studies provided moderate-quality evidence that interventions focusing on the transition from hospital to the community were effective in reducing 1-mo readmissions to hospitals compared with standard care. Conclusions and Relevance: Occupational therapy interventions can be effective in reducing readmissions among some adult hospitalized patient populations, including those admitted for surgery or management of acute medical conditions, with stronger evidence to support transitional care interventions. What This Article Adds: Occupational therapy interventions can be effective in reducing readmissions among adult hospitalized patients. There is a continued need for occupational therapy practitioners to understand their value and contribution to reducing avoidable readmissions to hospitals.

Background: Poor food intake is an independent risk factor for malnutrition in oncology patients, and achieving adequate nutrition is essential for optimal clinical and health outcomes. This study investigated interrelationships between nutritional intake and clinical outcomes in hospitalised adult oncology patients. Methods: Estimated nutrition intake data were obtained from patients admitted to a 117-bed tertiary cancer centre during May–July 2022. Clinical healthcare data, including length of stay (LOS) and 30-day hospital readmissions, were obtained from patient medical records. Statistical analysis, including multivariable regression analysis, assessed whether poor nutritional intake was predictive of LOS and readmissions. Results: No relationships between nutritional intake and clinical outcomes were evident. Patients at risk of malnutrition had lower mean daily energy (−898.9 kJ, p = 0.001) and protein (−10.34 g, p = 0.015) intakes. Increased malnutrition risk at admission prolonged LOS (1.33 days, p = 0.008). Hospital readmission rates were 20.2%, and associated with age (r = −0.133, p = 0.015), presence of metastases (r = 0.125, p = 0.02) and longer LOS (1.34 days, r = 0.145, p = 0.02). Sarcoma (43.5%), gynaecological (36.8%) and lung (40.0%) cancers had the highest readmission rates. Conclusions: Despite research showing the benefits of nutritional intake during hospitalisation, evidence continues to emerge on the relationship between nutritional intake and LOS and readmissions that may be confounded by malnutrition risk and cancer diagnosis.

Background: Poor food intake is an independent risk factor for malnutrition in oncology patients, and achieving adequate nutrition is essential for optimal clinical and health outcomes. This review investigated the interrelationships between dietary intakes, hospital readmissions and length of stay in hospitalised adult oncology patients. Methodology: Three databases, MEDLINE, Web of Science and PubMed were searched for relevant publications from January 2000 to the end of August 2022. Results: Eleven studies investigating the effects of dietary intakes on length of stay (LOS) and hospital readmissions in cohorts of hospitalised patients that included oncology patients were identified. Heterogenous study design, nutritional interventions and study populations limited comparisons; however, a meta-analysis of two randomised controlled trials comparing dietary interventions in mixed patient cohorts including oncology patients showed no effect on LOS: mean difference −0.08 (95% confidence interval −0.64–0.49) days (p = 0.79). Conclusions: Despite research showing the benefits of nutritional intake during hospitalisation, evidence is emerging that the relationship between intakes, LOS and hospital readmissions may be confounded by nutritional status and cancer diagnosis.

Low skeletal muscle mass is known to be associated with poor morbidity and mortality outcomes in cancer, but evidence of its impact on health-related quality of life (HRQOL) is less established. This systematic review and meta-analysis was performed to investigate the relationship between skeletal muscle mass and HRQOL in adults with cancer. Five databases (Ovid MEDLINE, Embase via Ovid, CINAHL plus, Scopus, and PsycInfo) were systematically searched from 1 January 2007 until 2 September 2020. Studies reporting on the association between measures of skeletal muscle (mass and/or radiodensity) derived from analysis of computed tomography imaging, and a validated measure of HRQOL in adults with cancer, were considered for inclusion. Studies classifying skeletal muscle mass as a categorical variable (low or normal) were combined in a meta-analysis to investigate cross-sectional association with HRQOL. Studies reporting skeletal muscle as a continuous variable were qualitatively synthesized. A total of 14 studies involving 2776 participants were eligible for inclusion. Skeletal muscle mass classified as low or normal was used to dichotomize participants in 10 studies (n = 1375). Five different cut points were used for classification across the 10 studies, with low muscle mass attributed to 58% of participants. Low muscle mass was associated with poorer global HRQOL scores [n = 985 from seven studies, standardized mean difference -0.27, 95% confidence interval (CI) -0.40 to -0.14, P 0.0001], and poorer physical functioning domain HRQOL scores (n = 507 from five studies, standardized mean difference -0.40, 95% CI -0.74 to -0.05, P = 0.02), but not social, role, emotional, or cognitive functioning domain scores (all P 0.05). Five studies examined the cross-sectional relationship between HRQOL and skeletal muscle mass as a continuous variable and found little evidence of an association unless non-linear analysis was used. Two studies investigated the relationship between longitudinal changes in both skeletal muscle and HRQOL, reporting that an association exists across several HRQOL domains. Low muscle mass may be associated with lower global and physical functioning HRQOL scores in adults with cancer. The interpretation of this relationship is limited by the varied classification of low muscle mass between studies. There is a need for prospective, longitudinal studies examining the interplay between skeletal muscle mass and HRQOL over time, and data should be made accessible to enable reanalysis according to different cut points. Further research is needed to elucidate the causal pathways between these outcomes.

This study aimed to investigate and compare the cost, affordability, and accessibility of three elimination diet approaches for the treatment of patients with eosinophilic esophagitis: the two-, four- and six-food elimination diets and with comparison to a standard diet.An evidence-based modelling process was undertaken for costing and accessibility, including the development of three hypothetical reference families; four food baskets were modified from an established benchmark for each diet. Baskets were costed across eastern Melbourne, Australia. Affordability was modelled using two incomes: the equivalised disposable household income and welfare payments for reference families. Affordability was defined as30% of the median weekly household income and food stress defined as25% of a median weekly household income.All elimination diets were significantly more expensive than a standard diet and may be unaffordable for those receiving welfare. Prices significantly increased as the number of food allergens eliminated increased. Most items for a two-food elimination diet were available at major supermarkets; however, items for nutritionally complete four- and six-food elimination diets required a visit to a second store.A step-up approach, commencing with a two-food elimination diet, instead of starting with a six-food elimination diet, may alleviate affordability barriers for most family types, which may enhance compliance. Clinicians should consider family type, financial situation, as well as accessibility of allergen-free foods in the patient's residential area when deciding on the most appropriate dietary or therapeutic treatment approach for eosinophilic oesophagitis.

Aim There is no standardised interventional approach to preventing or treating sarcopenia in older adults in hospital. The aim of this review was to systematically identify and synthesise the effects of nutritional interventions on markers of sarcopenia in hospitalised patients aged 65 years and older. Methods Four databases were searched using terms for intervention, population and setting. Eligibility screening of title and abstract and then full‐text papers was competed in duplicate, independently. The final included papers were assessed for quality, and outcome data extracted independently and in duplicate. Outcome data were synthesised by meta‐analysis, where possible, or narratively. Results Seven hundred and thirty‐two articles were screened for eligibility yielding six studies for inclusion. All studies provided oral nutritional support that aimed to increase protein intake ranging from an additional 10 to 40 g/d, each with a unique formulation of amino acids and/or micronutrients; three studies combined nutritional intervention with an enhanced physical activity program. Five studies measured hand grip strength, the mean difference was 1.97 kg (95% CI 0.55‐3.39, P = .006) greater in the intervention group (n = 166) compared with control group (n = 165). Assessment of muscle mass and activities of daily living were heterogeneous and the changes inconsistent between studies. Conclusions Few studies inform nutritional management of inpatients with sarcopenia or at risk of sarcopenia. High quality, large intervention trials are needed urgently to identify the optimal nutrition and physical activity intervention combinations to manage sarcopenia in older hospitalised adults. These studies need to include outcome measures of physical function and muscle quality.

BACKGROUND: Change promotes quality in healthcare, yet adopting change can be challenging. Understanding how change in nutrition care is adopted may support better design and implementation of interventions that aim to address inadequate food intake in hospital. The present study followed the process of change in a healthcare organisation, exploring staff attitudes, beliefs and experiences of the implementation of a mealtime intervention. METHODS: In total, 103 h of fieldwork were conducted in this longitudinal ethnographic study over a 4-month period. Over 170 staff participated, with data captured using observation, interviews and focus groups. Data were analysed using an inductive, thematic approach, informed by implementation theory. RESULTS: Attitudes and experiences of change in nutrition care are described by three themes: (i) staff recognised the inevitability of change; (ii) staff cooperated with the intervention, recognising potential value in the intervention to support patient care, where increased awareness of their mealtime behaviours supported adopting practice changes; and (iii) some staff were able to reflect on their practice after implementing the intervention, whereas others could not. A model illustrating the interconnectedness of factors influencing implementation emerged from the research, guiding future nutrition care intervention design and supporting change. CONCLUSIONS: The requirement to address the underlying perceptions of staff about the need to change should not be underestimated. Increased efforts to market the change message to specific staff groups and physical behavioural reinforcement strategies are needed. Nutrition care in the future should focus on helping staff feel positive about making practice changes.

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.

Malnutrition and unintentional weight loss are known to occur in residential aged care facilities (RACFs). The use of oral nutritional supplements (ONS) and high-energy high-protein (HEHP) diets are two foodservice strategies that may be implemented in efforts to reduce unintentional weight loss in RACFs. This observational study aimed to determine whether incorporation of a structured high-energy high-protein diet (sHEHP) into the standard menu could reduce unintentional weight loss in RACF residents. RACFs in this study were facilities that provide long-term care to older adult residents. Weight change, body mass index and subjective global assessment scores of participants were measured at baseline and at six months across five RACFs receiving usual care with ONS or a sHEHP diet. Groups were different at baseline, with a high prevalence of severe malnutrition observed in the ONS group. Over the six-month period, there was a small but statistically significant difference in weight change within the groups: -1.64 ± 3.62 kg, ONS group; 0.56 ± 2.76 kg, sHEHP group

INTRODUCTION A range of activities are conducted in health care settings aiming to improve health care processes and outcomes. In many settings, these activities are classified into two broad domains of "quality improvement" and "health services research" each with its own methods, continuing education, support structures, and governance systems. We aimed to explore differences and similarities in the purpose, methods, and outcomes of approved allied health projects conducted under each of these domains at a large metropolitan health network. METHOD Using observational methods, we evaluated allied health quality improvement and research projects approved through the relevant governance systems in a single health network during a 12-month reporting period. Project leaders were surveyed, and project documentation was evaluated using the SQUIRE tool. RESULTS Allied health professionals were motivated to undertake both quality improvement (n = 13) and research projects (n = 15) to improve health care. Research projects were more likely to be disseminated externally, but quality improvement projects were more frequently reported to result in internal practice change. Methods were well documented for research projects, but this information was frequently lacking for quality improvement projects. Research projects were also more likely to be supported by external funding than quality improvement projects. IMPLICATIONS Allied health clinicians conducting improvement activities using research and quality improvement projects share common goals. There are likely to be opportunities to enhance value and implementation of findings into practice by bridging the divide between health service research and quality improvement activities in health networks.

IntroductionCommunity-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation.Methods and analysisAn assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with conversational English. Key exclusion criteria are severe depression or anxiety, impaired intellectual functioning and being medically unstable to walk. Participants allocated to the experimental group will receive 10 (8 weekly and 2 booster) telephone-based sessions of motivational interviewing to increase walking over 16 weeks. Participants allocated to the control group will receive an equivalent dose of telephone-based dietary advice. The primary outcome is daily time spent walking over 7 days assessed at weeks 0, 9, 26 and 52. Secondary outcomes include measures of psychological-related function, mobility-related function, community participation, health-related quality of life and falls. Health service utilisation and associated costs will be assessed. Process evaluation will assess the fidelity of the motivational interviewing intervention and explore contextual factors through semistructured interviews.Ethics and disseminationEthical approval obtained from Eastern Health (E19-002), Peninsula Health (50261/EH-2019), Alfred Health (617/20) and La Trobe University (E19/002/50261). The findings will be disseminated in peer-reviewed journals, conference presentations and public seminars.Trial registration numberACTRN12619000936123.

Background Ageing is associated with a decline in skeletal muscle mass and function (strength and power), known as sarcopenia. Inadequate dietary protein and inactivity have been shown to accelerate sarcopenia outcomes, occurring at different rates in males and females. Regardless, active older adults who often exceed the exercise guidelines still show signs of sarcopenia. This study aimed to explore the link between age, physical activity, protein intake, and biological sex with skeletal muscle mass, strength, power, and physical capacity/performance in active older adults. Fifty-four active older adults were recruited from this trial and grouped according to age (middle aged: 50–59 years, and older age: ≥ 60 years), exercise volume (low: ≥ 90–149 min/week, moderate: ≥ 150–299 min/week, and high: ≥ 300 min/week), protein intake (low: < 0.8 g/kg body mass (BM), moderate: ≥ 0.8–1.19g /kg BM, and high: ≥ 1.2 g/kg BM), and biological sex (males and females). Skeletal muscle and fat mass (dual X-ray absorptiometry), strength (1-repetition maximum using leg press, chest press, lateral pull down, and hand grip), power (counter movement jump), and general fitness (cardiorespiratory capacity and gait speed) were assessed. Data were grouped based on variables, and a general linear model (ANCOVA) or an independent t test was used to determine between group differences. Results Fifty three of the total participants’ data were analysed. The middle-aged group had 18%, 11%, and 10% higher leg press, chest press, and lateral pull down, respectively, compared to the older-aged group (p < .05). There were no significant differences between different levels of training volume and any of the outcomes. Higher protein intakes were associated with significantly less body fat mass (p = .005) and a trend towards a higher leg press (p = .053) and higher relative power (W/kg) (p = .056) compared with the moderate and low protein intake groups. Significant differences based on biological sex were observed for all outcomes except for gait speed (p = .611) and cardiorespiratory fitness (p = .147). Conclusions Contributions of age, physical activity, daily protein intake, and biological sex can explain the individual variation in outcomes related to changes in body composition, strength, power, and/or cardiorespiratory fitness in a cohort of active older adults. The preprint version of this work is available on Research Square: https://www.researchsquare.com/article/rs-51873/v1. Trial Registration This trial is registered in the ANZCTR.org.au, no. ACTRN12618001088235 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375286).

This study aimed to determine the effects of flavored dairy milk based recovery beverages of different nutrition compositions on markers of gastrointestinal and immune status, and subsequent recovery optimisation markers. After completing 2 h high intensity interval running, participants (n = 9) consumed a whole food dairy milk recovery beverage (CM, 1.2 g/kg body mass (BM) carbohydrate and 0.4 g/kg BM protein) or a dairy milk based supplement beverage (MBSB, 2.2 g/kg BM carbohydrate and 0.8 g/kg BM protein) in a randomized crossover design. Venous blood samples, body mass, body water, and breath samples were collected, and gastrointestinal symptoms (GIS) were measured, pre- and post-exercise, and during recovery. Muscle biopsies were performed at 0 and 2 h of recovery. The following morning, participants returned to the laboratory to assess performance outcomes. In the recovery period, carbohydrate malabsorption (breath H2 peak: 49 vs. 24 ppm) occurred on MBSB compared to CM, with a trend toward greater gut discomfort. No difference in gastrointestinal integrity (i.e., I-FABP and sCD14) or immune response (i.e., circulating leukocyte trafficking, bacterially-stimulated neutrophil degranulation, and systemic inflammatory profile) markers were observed between CM and MBSB. Neither trial achieved a positive rate of muscle glycogen resynthesis [−25.8 (35.5) mmol/kg dw/h]. Both trials increased phosphorylation of intramuscular signaling proteins. Greater fluid retention (total body water: 86.9 vs. 81.9%) occurred on MBSB compared to CM. Performance outcomes did not differ between trials. The greater nutrient composition of MBSB induced greater gastrointestinal functional disturbance, did not prevent the post-exercise reduction in neutrophil function, and did not support greater overall acute recovery.

Background Autologous stem cell transplant is a common procedure for people with haematological malignancies. While effective at improving survival, autologous stem cell transplant recipients may have a lengthy hospital admission and experience debilitating side-effects such as fatigue, pain and deconditioning that may prolong recovery. Prehabilitation comprising exercise and nutrition intervention before stem cell transplant aims to optimise physical capacity before the procedure to enhance functional recovery after transplant. However, few studies have evaluated prehabilitation in this setting. We aim to explore preliminary efficacy of improving physical capacity of prehabilitation for people undergoing autologous stem cell transplant. Methods The PIRATE study is a single-blinded, parallel two-armed pilot randomised trial of multidisciplinary prehabilitation delivered prior to autologous stem cell transplantation. Twenty-two patients with haematological malignancy waitlisted for transplant will be recruited from a tertiary haematology unit. The intervention will include up to 8 weeks of twice-weekly, supervised tailored exercise and fortnightly nutrition education delivered via phone, in the lead up to autologous stem cell transplant. Blinded assessments will be completed at week 13, approximately 4 weeks after transplant and health service measures collected at week 25 approximately 12 weeks after transplant. The primary outcome is to assess changes in physical capacity using the 6-minute walk test. Secondary measures are time to engraftment, C-reactive protein, physical activity (accelerometer), grip strength, health-related quality of life (EORTC QLQ-C30 and HDC29 supplement), self-efficacy and recording of adverse events. Health service data including hospital length of stay, hospital readmissions, emergency department presentations and urgent symptom clinic presentation at will also be recorded. Discussion This trial will inform design of a future definitive randomised controlled trial and implementation of prehabilitation for people receiving autologous stem cell transplant by providing data on efficacy and safety. Trial registration The PIRATE Trial has been approved by the Eastern Health Human Research Ethics Committee (E20/003/61055) and is funded by the Eastern Health Foundation. This trial is registered with the Australian New Zealand Clinical Trials Registry ACTRN12620000496910. Registered April 20, 2020.