Dietetics

The aim of this paper is to report on the differences in clinical and service engagement outcomes of patients attending the paediatric dietetic outpatient service at a major metropolitan hospital before the outbreak of the coronavirus (using face-to-face care) and during the pandemic (using telehealth). This paper also reports on learning lessons from the rapid implementation of telehealth in this service. This study collected pre- and post-coronavirus pandemic data from 44 paediatric patients. Data on outcomes pre- and post-implementation were analysed. There were no statistically significant differences between pre- and post-coronavirus data for growth (p = 0.92), adherence to dietetic recommendations (p = 0.08) or attendance rate (p = 1.00). This study also found a low uptake of virtual telehealth, technical issues and suboptimal anthropometric data collection associated with this modality of care. Telehealth was not associated with a change in clinical and service engagement outcomes. Thus, telehealth service delivery is not inferior to usual face–face dietetic care and has the potential to be a useful adjunct to usual nutrition care for paediatric health service users after the coronavirus pandemic. Full article

Type 2 diabetes mellitus is a major contributor to morbidity and mortality worldwide. This disease often leads to poor health outcomes, such as neuropathy and diabetic foot ulcers, and increased risk for comorbidities such as cardiovascular complications and renal disease. Lifestyle modifications including diet and physical activity interventions are often explored as prevention and management strategies for T2DM. It is well established that fruits are a rich source of fiber and a variety of phytochemicals, vitamins, minerals, and bioactive compounds that can help optimize human health. Unfortunately, many experts associate the consumption of fruit with a moderate to high glycemic index (GI), which leads to a spike in blood glucose and eventually elevated hemoglobin A1c (HbA1c). The purpose of this comprehensive review is to outline the current clinical literature on the relationship between fruit consumption and various indices of glucose metabolism. A variety of fruits have been clinically studied to determine this relationship, namely in the fresh form (e.g., berries, apples, watermelon, cherries, mangoes), dried fruits (raisins and dates), and juices (derived from cranberry, orange, grape, cherry, and pomegranate). Overall, intake of fruits and fruit-derived products is beneficial for healthy subjects and subjects with T2DM regarding their impact on glucose metabolism and other cardiometabolic markers (e.g., inflammatory responses, lipid profiles). Nonetheless, it is more advisable for diabetic patients to consume fresh or dried fruits rather than fruit-derived products. A special consideration needs to be attributed to both the amount of fruit intake with regards to their respective GI and glycemic load (GL), and when these fruits are consumed. Trials with more a comprehensive design and specific outcomes are required to reveal the mechanisms underlying the beneficial effects of fruit consumption on the T2DM population particularly. Full article

Cocoa beverage and dark chocolate are important dietary sources of polyphenol and have been hypothesised to improve the lipid profile. This systematic review and meta-analysis aimed to investigate the effect of cocoa beverage and dark chocolate intake on lipid profile in individuals living with normal and elevated LDL cholesterol. The question on whether cocoa beverage and chocolate differentially modify the lipid profile was also explored. A systematic literature search was conducted on PubMed and Cochrane Library on 26 February 2022 following the PRISMA guideline. Cocoa beverage and chocolate consumption had no significant effect on circulating concentrations of total cholesterol, LDL cholesterol, and triglycerides (p > 0.05, all), but favourably and significantly increased circulating concentration of HDL cholesterol by 0.05 (95% CI [0.02, 0.09]) mmol/L (p = 0.002). Changes in lipid profile were similar when comparing populations with normal vs. elevated LDL cholesterol (p > 0.05, all). When considering the food matrix, cocoa beverage intake significantly increased HDL cholesterol by 0.11 (95% CI [0.06, 0.17]) mmol/L (p < 0.001), but the improvement in HDL cholesterol was not significant when chocolate (p = 0.10) or a combination of cocoa beverage and chocolate (p = 0.19) (subgroup differences, p = 0.03) was administered. Cocoa consumption could be recommended as part of a healthy diet in the general population with normal and elevated LDL cholesterol. Full article

Aim: To evaluate the nutritional adequacy of the hospital haemodialysis menu, quantify the dietary intake of hospitalised haemodialysis patients and explore patient perceptions of the menu. Methods: The menu analysis compared the default menu to reference standards using a one sample t-test via SPSS. Eight hospitalised haemodialysis patients were purposively interviewed using semi-structured interviews. Thematic analysis was used to identify the dominant themes. The participant’s actual dietary intake was calculated and compared to individual nutrients using evidence-based guidelines. Results: Compared to the reference standards, the default inpatient haemodialysis menu did not provide adequate energy (p < 0.001, mean = 8767 kJ/day ± 362), sodium (p < 0.001, mean = 72 mmol/day ± 9), potassium (p < 0.001, mean = 64 mmol/day ± 4), vitamin C (p ≤ 0.001, mean = 33 mg/day ± 10) and fibre (p < 0.001, mean = 26 g/day ± 3). Inadequate intake of energy and protein occurred in half of the participants. Passive acceptance of the menu, environmental and cultural considerations contributed to missed food opportunities impacting the patient experience and limited intake. Conclusions: The profile of the current default inpatient haemodialysis menu impacts the dietary intake and the experience of haemodialysis inpatients. It is recommended that the default menu is optimised in line with evidence-based guidelines for inpatients. Full article

This study shows the effect of omega-3 unsaturated fatty acids via perilla oil intake on gut microbiota and constipation. Eight sedentary females participated in a nonrandomized placebo-controlled pilot study consisting of eight-week perilla oil (OIL) and placebo (PLA) intervention phases. There was a 10-month washout period between phases. All participants received 9 g of perilla oil-containing jelly in the OIL phase, and a placebo jelly in the PLA phase. Gut microbiota, α-diversity, and constipation scores were measured pre- and post-intervention in both phases. The α-diversity, an important indicator of gut microbiota diversity, was significantly increased post-intervention (4.5 ± 0.1) compared to pre-intervention (3.8 ± 0.3) in the OIL only (p = 0.021). Notably, the level of α-diversity was maintained even after the washout period of 10 months. Butyrate-producing bacteria, Lachnospiraceae (%), did not change in the OIL but were significantly reduced post-intervention (15.1 ± 4.8) compared to pre-intervention (20.1 ± 7.0) in the PLA (p = 0.040). In addition, the constipation scores were significantly or tended to be reduced during the OIL phase only (p < 0.05, p < 0.1). In conclusion, an eight-week perilla oil supplementation may enhance and establish the diversity of gut microbiota, which may relieve constipation. Full article

The beneficial effects of a Mediterranean diet are due to the numerous active compounds in the food and, particularly, the high concentration of compounds with synergistically acting antioxidant properties. Resveratrol, a stilbenoid nonflavonoid phenol, is an antioxidant that is naturally produced by numerous plants as a defensive agent in response to attacks from pathogens, such as bacteria and fungi. Resveratrol has several effects on human health, including on the lipid profile, where it primarily downregulates the enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase, reducing the synthesis of cholesterol. Resveratrol also increases the expression of LDL receptors in the liver, contributing to the reduction in the LDL-cholesterol levels. This short narrative review, based on relevant articles written in English from a PubMed search, using the keywords “resveratrol”, “atherosclerosis”, “cardiovascular disease”, and “Mediterranean Diet“, focuses on the possible effects of this molecule on cardiovascular disease, lipid metabolism, and atherosclerosis. Full article

Being overweight or obese is a public health problem. This work evaluated a food and nutrition education (FNE) intervention to reduce overweight status among schoolchildren in four schools in the West Panama Province. This was a quasi-experimental before-and-after study that implemented a 34-week FNE intervention through workshops with didactic material to 403 children between 8 and 13 years old. A knowledge and attitude survey was used as an evaluation tool before and after the FNE intervention. The prevalence of excess weight (40%) did not reduce after the intervention. The zBMI at the beginning was 0.57 (1.29) for girls and 0.70 (1.36) for boys, and at the final evaluation was 0.57 (1.28) for girls and 0.67 (1.33) for boys. No significant differences were observed between the point of evaluation and sex. No differences were reported in the median level of attitude, although higher levels of knowledge were reported in students of both sexes. The FNE in schoolchildren can be effective in acquiring knowledge and maintaining a positive attitude towards food, but more research is needed to address nutritional status. Although the intervention had no impact on nutritional status, the FNE facilitated the adoption of skills and competencies in schoolchildren. The success of the implementation of the study highlighted the feasibility of replicating the FNE interventions on a larger scale to contribute positively to the multi-level and sectoral public policy Study Without Hunger in Panama. Full article

Recent evidence suggests a link between Inflammatory Bowel Disease (IBD) and eating disorders, an emerging complex bidirectional association. Indeed, the overlap of symptoms and signs can lead to delayed diagnosis and misdiagnosis of both conditions, but also the fear of food-induced symptoms, commonly observed in patients with IBD, determines dietary restrictions which in predisposed individuals may induce an overt eating disorder. ARFID (Avoidant Restrictive Food Intake Disorder) and anorexia nervosa are the eating disorders more frequently reported, while disordered eating and orthorexia nervosa are emerging conditions. Disease worsening due to refusal of therapies in patients with anorexia is also a matter of concern and an increased awareness of the possible association of these conditions by gastroenterologists and dietitians is strongly warranted in order for patients to receive the appropriate counseling. Full article

Sleep quality (duration, efficiency, and latency) is directly associated with human health. An interventional study reported that the time of dinner influenced sleep latency, suggesting that it may also be associated with other sleep quality indices under free-living conditions. Therefore, we cross-sectionally examined the association between the time from dinner to bedtime (TDB) and sleep quality indices under free-living conditions in the young Japanese population. Based on the TDB, 264 participants were separated into three quantiles (T1, ≤3.79 h; T2, 3.80–4.94 h; T3, ≥4.95 h from dinner to bedtime). The T1 (mean ± standard error; 26.4 ± 2.2 min, p = 0.081) and T2 groups (30.8 ± 2.2 min, p = 0.001) showed longer sleep latency compared to the T3 group (19.6 ± 2.2 min), after adjusting for confounding factors. Sleep efficiency in the T1 group (77.5 ± 1.6%) tended to be greater than in the T3 group (72.1 ± 1.6%, p = 0.061), whereas sleep efficiency in the T2 group was not significantly different (77.0 ± 1.6%) from that in the T1 group. Therefore, shortened TDB was associated with prolonged sleep latency in free-living conditions. Meal timing, especially dinner, should be considered along with other sleep hygiene measures to improve human health. Full article

Cancer survivors consider nutrition to be highly important and are motivated to seek information about lifestyle changes, including nutrition, to improve their long-term health. Despite this, suboptimal dietary intake is still reported. Understanding cancer-specific barriers and facilitators to healthy eating among this population could help develop targeted interventions for this group. This study explored the barriers and facilitators to following a healthy diet among cancer survivors using the Theoretical Domains Framework (TDF) and COM-B model. Semi-structured focus groups with 20 cancer survivors were conducted between February and August 2021, which were transcribed verbatim. Seven key TDF domains accounted for 87% of all coded responses. These were (a) environmental context and resources; (b) knowledge; (c) behavioural regulation; (d) social/professional role and identity; (e) belief about consequences; (f) social influences; and (g) skills. Key barriers were lack of knowledge, non-specific or irrelevant information, environmental aspects, and family. Facilitators were awareness of the importance of nutrition, the health benefits of a plant-based diet, confidence in cooking skills, organisation, balance, family, time, and viewing themselves as someone who eats healthily and access to fresh produce. Enablement was the most prominently linked intervention function. This work can inform future interventions in this area and ensure they are end-user-centred. Full article

Background: Climate change is a serious threat to human wellbeing and development. Global reduction of meat intake is key to addressing climate change and other modern sustainability challenges. Plant-based and mycoprotein-based meat substitutes are predicted to play a key role in the reduction of meat intake; however, their impact on human health is unclear. The main objective of this meta-analysis was to assess the short-term effects of meat substitutes on important cardiometabolic biomarkers (total cholesterol, TC; LDL-cholesterol, LDL-C; HDL-cholesterol, HDL-C; triglycerides, TG; systolic blood pressure, SBP; diastolic blood pressure, DBP; fasting blood glucose, FBG; weight) in controlled clinical trials. Methods: Embase and MEDLINE were searched to identify controlled clinical trials with meat substitute interventions and cardiometabolic biomarker outcomes. Standardised mean differences in TC, LDL-C, HDL-C, TG, FBG, SBP, DBP, and weight and 95% confidence intervals were pooled using a random effects model. Risk of bias, heterogeneity, sensitivity, and publication bias were assessed. Of the 934 records identified, 12 studies met the inclusion criteria. In the pooled analyses, the consumption of meat substitutes was associated with significantly lower TC (−0.50 mmol/L [95% CIs −0.70, −0.29]), LDL-C (−0.39 mmol/L [−0.57, −0.21]), and TG (−0.15 mmol/L [−0.29, −0.01]), non-significantly lower FBG (−0.08 [−0.23, 0.08]), SBP (−0.32 [−1.79, 1.41]), and weight (−0.12 [−1.52, 1.27]), and non-significantly higher HDL-C (0.01 [−0.02, 0.05]) and DBP (0.49 [−0.30, 1.28]). There was evidence of publication bias, and some heterogeneity was detected. The certainty of evidence was moderate for the TC and HDL-C results, low for the LDL-C, TG, SBP, DBP, and weight results, and very low for the FBG results. Conclusions: Replacement of some or all meat with plant-based or mycoprotein-based substitutes may lower TC, LDL-C, and TG. Full article

Anxiety disorder is characterized by excessive fear or avoidance of perceived threats that can be persistent and debilitating. Diet is a modifiable risk factor that may contribute to the pathogenesis or treatment of anxiety, depending on diet quality. Although the biological mechanisms by which food, specific nutrients, and nutraceuticals impact mental health are not completely understood, implicated pathways include inflammation, oxidative stress, brain plasticity effects, mitochondrial dysfunction, and neurotransmitter metabolism. Essential dietary trace minerals such as zinc, copper, iron, and selenium are critical components for numerous biological proteins and may have a role in these proposed mechanisms related to brain health and anxiety. This narrative review examines the influence of essential trace elements zinc, copper, iron, and selenium on anxiety symptoms based on the latest peer-reviewed scientific evidence. Current research indicates that deficiencies in zinc, iron, and selenium are associated with anxiety, while copper overload may impact anxiety to a greater degree than copper deficiency. Further investigation is needed to understand the specific neurobiological mechanisms involved. Overall, the collective findings demonstrate the importance of optimizing trace mineral homeostasis for the mitigation of anxiety disorders and preservation of mental health. Full article

Supervised practice is a prerequisite to becoming a registered dietitian. Research suggests that environmental and social factors may affect dietary choices. This focus group research aimed to gather opinions from dietetic interns to understand what factors related to supervised practice, if any, affected their dietary habits. Qualitative data were collected via seven recorded virtual focus groups in which trained moderators facilitated a discussion using a series of controlled questions. Participants, dietetic interns (n = 42) who were currently completing or had completed their supervised practice within the previous six months, attended one of seven virtual focus groups. Each focus group had five to eight participants. Transcripts were separately coded by two trained researchers using a grounded theory approach to identify themes and subthemes. Researchers discussed any disagreements in coding and established a consensus. Elements related to the dietetic internship were observed to influence participants’ dietary choices. Main themes included time, finances, food access and availability, physical and mental effects, non-supervised practice factors, and social factors. Dietetic programs and preceptors should explore ways to raise interns’ awareness and minimize the potential negative impacts of these factors on interns’ dietary habits to improve their overall internship experience. Full article

The aim of this survey was to identify, (1) use of Dietitians Australia best practice guidelines, (2) contemporary practices/knowledge, and (3) professional development needs of Australian dietitians in relation to management of clients with overweight or obesity. A cross-sectional online survey consisting of 67 multiple choice and Likert scale questions on the three survey aims was administered. Data were collected between 2020–2021 and reported descriptively as frequency (%). Of 178 survey attempts, 80 respondents completed all questions (45%). Most respondents spent >50% of their time working with individuals with overweight/obesity, usually in private practice (47%). Two thirds of respondents had accessed best practice guidelines, but only 12% had completely read best practice guidelines. General healthy eating was the most frequent dietary approach used (77%). Seventy-five percent (n = 56) of dietitians reported that dietary interventions were selected based on client preference. Almost half of dietitians rated their knowledge and level of skill in management of obesity as good. Approximately 60% (n = 41) dietitians reported their skill gap was related to providing behavioural therapy/counselling. Results of the current survey indicate that use of best practice guidelines is low. However, dietitians surveyed reported that they had a good understanding of obesity management and choose a client centred approach to management, which is in line with current recommendations. Professional development activities, particularly regarding behavioural counselling are of particular interest to dietitians working with individuals with obesity. Full article

Technological advances, such as the GloboDiet software, have enabled the development of instruments to standardize dietary data collection through the 24-h dietary recall (24HR). Thus, the aim of this study was to evaluate the feasibility of using the Brazilian version of the GloboDiet software. The 24HR method guided by the GloboDiet software was applied by face-to-face (n = 2093) interviews and a second measurement by telephone (n = 1084) interviews with participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The adherence rate was calculated using data from control worksheets filled out by interviewers, whereas the Chi-square test was used to assess differences between sociodemographic groups and the participants’ final adherence status. For the interview’s duration, the data were presented as the median and the interquartile range—IQR (Q1–Q3 (25–75%)). Non-parametric tests were used to assess differences among individuals in terms of the total duration and stages of the interview. Adherence rates were 82.8% face-to-face and 68.4% telephone interviews. The total duration of the face-to-face and telephone interviews was 30.7 (IQR, 23.3–40.7) and 35.3 (IQR, 25.3–49.7) minutes (p < 0.001). These results evidence that the GloboDiet software is viable for the routine of an epidemiological study. Full article

Background: Diabulimia is associated with “resistance to treatment”, impaired glycemic control, and increased risk of diabetic complications. The aim of this study was to explore the possible lifestyle and diet factors associated with diabulimia using the “Diabetes Eating Problem Survey-Revised” (DEPS-R), a questionnaire assessing the risk of diabulimia in patients with T1DM. Methods: 100 outpatients with a diagnosis of T1DM for over a year, from two hospitals in Athens, Greece were asked to complete a questionnaire about their medical history and lifestyle behaviors along with the Eating Attitudes Test (EAT-26), the Beck Depression Scale (BDI-II) and the DEPS-R. Results: Multivariate linear regression analysis showed statistically significant associations between DEPS-R score and HbA1c% levels (b = 4.447, 95% CI 3.220–5.675), sex (male) (b = −4.413, 95% CI −8.778–−0.047, weight perception higher than normal (b = 9.896, 95% CI 5.266–14.526), time spent walking minutes per week (b= −0.019, 95% CI −0.031–−0.006), having received diabetes nutritional education (b = −5.128, 95%CI −10.141–−0.115), eating breakfast (b = −6.441, 95% CI −11.047–−1.835) and having a first relative diagnosed with an eating disorder (b = 6.164, 95%CI 0.030–12.298). The presence of these factors could help highlight the profile of potential individuals at risk of diabulimia and enhance preventive interventions. Full article

Purpose: A diet rich in fruits and vegetables is vital for prolonged health and wellness. Yet, the consumption of fruits and vegetables remains low in some regions. Methodology: This exploratory quantitative study utilized a web-based survey instrument to probe the likelihood of consumption by Canadian consumers. Canadians who have lived in the country for 12 months or more and were 18 years of age or older were surveyed. Care was given to get a representative sample from all Canadian regions. Findings: Barriers to produce consumption include cost (39.5%), lack of knowledge and preparation skills (38.5%), and confusion surrounding health benefits (6.3%). There is further confusion surrounding the nutrition of frozen vs. fresh vegetables. Finally, respondents were concerned about pesticide residue on imported produce (63.4%). Originality: Although evidence that fruits and vegetables can mitigate disease and that promotion of fruit and vegetable consumption has been a key policy area for the Canadian government, consumers still fail to integrate sufficient fruits and vegetables into their diets. To our knowledge, this is the only study probing consumers on their fresh produce intake in the Canadian context. Public awareness and education about the regular consumption of fruits and vegetables and their nutritional value and health-promoting benefits can increase consumption in many Canadian regions and demographics. Full article

In India, indigenous communities are nutritionally vulnerable, with indigenous women suffering the greater burden. Studies and surveys have reported poor nutritional outcomes among indigenous women in India, yet systematic documentation of community-specific nutrition data is lacking. We conducted a narrative review of 42 studies to summarise the nutritional profile of indigenous women of India, with details on their food and nutrient intakes, dietary diversity, traditional food consumption and anthropometric status. Percentage deficits were observed in intake of pulses, green leafy vegetables, fruits, vegetables, flesh foods and dairy products when compared with recommended dietary intakes for moderately active Indian women. Indices of diet quality in indigenous women were documented in limited studies, which revealed poor dietary diversity as well as low consumption of diverse traditional foods. A high risk of nutritional inadequacy was reported in all communities, especially for iron, calcium, and vitamin A. Prevalence of chronic energy deficiency was high in most communities, with dual burden of malnutrition in indigenous women of north-eastern region. Findings from this review can thus help guide future research and provide valuable insights for policymakers and program implementers on potential interventions for addressing specific nutritional issues among indigenous women of India. Full article