Body composition and its relationship to metabolic risk factors in Asian children

Obesity is a major public health problem in both developed and developing countries. The body mass index (BMI) is the most common index used to define obesity. The universal application of the same BMI classification across different ethnic groups is being challenged due to the inability of the index to differentiate fat mass (FM) and fat�]free mass (FFM) and the recognized ethnic differences in body composition. A better understanding of the body composition of Asian children from different backgrounds would help to better understand the obesity�]related health risks of people in this region. Moreover, the limitations of the BMI underscore the necessity to use where possible, more accurate measures of body fat assessment in research and clinical settings in addition to BMI, particularly in relation to the monitoring of prevention and treatment efforts. The aim of the first study was to determine the ethnic difference in the relationship between BMI and percent body fat (%BF) in pre�]pubertal Asian children from China, Lebanon, Malaysia, the Philippines, and Thailand. A total of 1039 children aged 8�]10 y were recruited using a non�]random purposive sampling approach aiming to encompass a wide BMI range from the five countries. Percent body fat (%BF) was determined using the deuterium dilution technique to quantify total body water (TBW) and subsequently derive proportions of FM and FFM. The study highlighted the sex and ethnic differences between BMI and %BF in Asian children from different countries. Girls had approximately 4.0% higher %BF compared with boys at a given BMI. Filipino boys tended to have a lower %BF than their Chinese, Lebanese, Malay and Thai counterparts at the same age and BMI level (corrected mean %BF was 25.7�}0.8%, 27.4�}0.4%, 27.1�}0.6%, 27.7�}0.5%, 28.1�}0.5% for Filipino, Chinese, Lebanese, Malay and Thai boys, respectively), although they differed significantly from Thai and Malay boys. Thai girls had approximately 2.0% higher %BF values than Chinese, Lebanese, Filipino and Malay counterparts (however no significant difference was seen among the four ethnic groups) at a given BMI (corrected mean %BF was 31.1�}0.5%, 28.6�}0.4%, 29.2�}0.6%, 29.5�}0.6%, 29.5�}0.5% for Thai, Chinese, Lebanese, Malay and Filipino girls, respectively). However, the ethnic difference in BMI�]%BF relationship varied by BMI. Compared with Caucasians, Asian children had a BMI 3�]6 units lower for a given %BF. More than one third of obese Asian children in the study were not identified using the WHO classification and more than half were not identified using the International Obesity Task Force (IOTF) classification. However, use of the Chinese classification increased the sensitivity by 19.7%, 18.1%, 2.3%, 2.3%, and 11.3% for Chinese, Lebanese, Malay, Filipino and Thai girls, respectively. A further aim of the first study was to determine the ethnic difference in body fat distribution in pre�]pubertal Asian children from China, Lebanon, Malaysia, and Thailand. The skin fold thicknesses, height, weight, waist circumference (WC) and total adiposity (as determined by deuterium dilution technique) of 922 children from the four countries was assessed. Chinese boys and girls had a similar trunk�]to�]extremity skin fold thickness ratio to Thai counterparts and both groups had higher ratios than the Malays and Lebanese at a given total FM. At a given BMI, both Chinese and Thai boys and girls had a higher WC than Malays and Lebanese (corrected mean WC was 68.1�}0.2 cm, 67.8�}0.3 cm, 65.8�}0.4 cm, 64.1�}0.3 cm for Chinese, Thai, Lebanese and Malay boys, respectively; 64.2�}0.2 cm, 65.0�}0.3 cm, 62.9�}0.4 cm, 60.6�}0.3 cm for Chinese, Thai, Lebanese and Malay girls, respectively). Chinese boys and girls had lower trunk fat adjusted subscapular/suprailiac skinfold ratio compared with Lebanese and Malay counterparts. The second study aimed to develop and cross�]validate bioelectrical impedance analysis (BIA) prediction equations of TBW and FFM for Asian pre�]pubertal children from China, Lebanon, Malaysia, the Philippines, and Thailand. Data on height, weight, age, gender, resistance and reactance measured by BIA were collected from 948 Asian children (492 boys and 456 girls) aged 8�]10 y from the five countries. The deuterium dilution technique was used as the criterion method for the estimation of TBW and FFM. The BIA equations were developed from the validation group (630 children randomly selected from the total sample) using stepwise multiple regression analysis and cross�]validated in a separate group (318 children) using the Bland�]Altman approach. Age, gender and ethnicity influenced the relationship between the resistance index (RI = height2/resistance), TBW and FFM. The BIA prediction equation for the estimation of TBW was: TBW (kg) = 0.231�~Height2 (cm)/resistance (ƒ¶) + 0.066�~Height (cm) + 0.188�~Weight (kg) + 0.128�~Age (yr) + 0.500�~Sex (male=1, female=0) . 0.316�~Ethnicity (Thai ethnicity=1, others=0) �] 4.574, and for the estimation of FFM: FFM (kg) = 0.299�~Height2 (cm)/resistance (ƒ¶) + 0.086�~Height (cm) + 0.245�~Weight (kg) + 0.260�~Age (yr) + 0.901�~Sex (male=1, female=0) �] 0.415�~Ethnicity (Thai ethnicity=1, others=0) �] 6.952. The R2 was 88.0% (root mean square error, RSME = 1.3 kg), 88.3% (RSME = 1.7 kg) for TBW and FFM equation, respectively. No significant difference between measured and predicted TBW and between measured and predicted FFM for the whole cross�]validation sample was found (bias = �]0.1�}1.4 kg, pure error = 1.4�}2.0 kg for TBW and bias = �]0.2�}1.9 kg, pure error = 1.8�}2.6 kg for FFM). However, the prediction equation for estimation of TBW/FFM tended to overestimate TBW/FFM at lower levels while underestimate at higher levels of TBW/FFM. Accuracy of the general equation for TBW and FFM compared favorably with both BMI�]specific and ethnic�]specific equations. There were significant differences between predicted TBW and FFM from external BIA equations derived from Caucasian populations and measured values in Asian children. There were three specific aims of the third study. The first was to explore the relationship between obesity and metabolic syndrome and abnormalities in Chinese children. A total of 608 boys and 800 girls aged 6�]12 y were recruited from four cities in China. Three definitions of pediatric metabolic syndrome and abnormalities were used, including the International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP) definition for adults modified by Cook et al. and de Ferranti et al. The prevalence of metabolic syndrome varied with different definitions, was highest using the de Ferranti definition (5.4%, 24.6% and 42.0%, respectively for normal�]weight, overweight and obese children), followed by the Cook definition (1.5%, 8.1%, and 25.1%, respectively), and the IDF definition (0.5%, 1.8% and 8.3%, respectively). Overweight and obese children had a higher risk of developing the metabolic syndrome compared to normal�]weight children (odds ratio varied with different definitions from 3.958 to 6.866 for overweight children, and 12.640�]26.007 for obese children). Overweight and obesity also increased the risk of developing metabolic abnormalities. Central obesity and high triglycerides (TG) were the most common while hyperglycemia was the least frequent in Chinese children regardless of different definitions. The second purpose was to determine the best obesity index for the prediction of cardiovascular (CV) risk factor clustering across a 2�]y follow�]up among BMI, %BF, WC and waist�]to�]height ratio (WHtR) in Chinese children. Height, weight, WC, %BF as determined by BIA, blood pressure, TG, high�]density lipoprotein cholesterol (HDL�]C), and fasting glucose were collected at baseline and 2 years later in 292 boys and 277 girls aged 8�]10 y. The results showed the percentage of children who remained overweight/obese defined on the basis of BMI, WC, WHtR and %BF was 89.7%, 93.5%, 84.5%, and 80.4%, respectively after 2 years. Obesity indices at baseline significantly correlated with TG, HDL�]C, and blood pressure at both baseline and 2 years later with a similar strength of correlations. BMI at baseline explained the greatest variance of later blood pressure. WC at baseline explained the greatest variance of later HDL�]C and glucose, while WHtR at baseline was the main predictor of later TG. Receiver�]operating characteristic (ROC) analysis explored the ability of the four indices to identify the later presence of CV risk. The overweight/obese children defined on the basis of BMI, WC, WHtR or %BF were more likely to develop CV risk 2 years later with relative risk (RR) scores of 3.670, 3.762, 2.767, and 2.804, respectively. The final purpose of the third study was to develop age�] and gender�]specific percentiles of WC and WHtR and cut�]off points of WC and WHtR for the prediction of CV risk in Chinese children. Smoothed percentile curves of WC and WHtR were produced in 2830 boys and 2699 girls aged 6�]12 y randomly selected from southern and northern China using the LMS method. The optimal age�] and gender�]specific thresholds of WC and WHtR for the prediction of cardiovascular risk factors clustering were derived in a sub�]sample (n=1845) by ROC analysis. Age�] and gender�]specific WC and WHtR percentiles were constructed. The WC thresholds were at the 90th and 84th percentiles for Chinese boys and girls, respectively, with sensitivity and specificity ranging from 67.2% to 83.3%. The WHtR thresholds were at the 91st and 94th percentiles for Chinese boys and girls, respectively, with sensitivity and specificity ranging from 78.6% to 88.9%. The cut�]offs of both WC and WHtR were age�] and gender�]dependent. In conclusion, the current thesis quantifies the ethnic differences in the BMI�]%BF relationship and body fat distribution between Asian children from different origins and confirms the necessity to consider ethnic differences in body composition when developing BMI and other obesity index criteria for obesity in Asian children. Moreover, ethnicity is also important in BIA prediction equations. In addition, WC and WHtR percentiles and thresholds for the prediction of CV risk in Chinese children differ from other populations. Although there was no advantage of WC or WHtR over BMI or %BF in the prediction of CV risk, obese children had a higher risk of developing the metabolic syndrome and abnormalities than normal�]weight children regardless of the obesity index used.

Professional growth through working together : a study of reciprocal benefits for teacher and education advisor through classroom based professional development

Teacher professional development provided by education advisors as one-off, centrally offered sessions does not always result in change in teacher knowledge, beliefs, attitudes or practice in the classroom. As the mathematics education advisor in this study, I set out to investigate a particular method of professional development so as to influence change in a practising classroom teacher’s knowledge and practices. The particular method of professional development utilised in this study was based on several principles of effective teacher professional development and saw me working regularly in a classroom with the classroom teacher as well as providing ongoing support for her for a full school year. The intention was to document the effects of this particular method of professional development in terms of the classroom teacher’s and my professional growth to provide insights for others working as education advisors. The professional development for the classroom teacher consisted of two components. The first was the co-operative development and implementation of a mental computation instructional program for the Year 3 class. The second component was the provision of ongoing support for the classroom teacher by the education advisor. The design of the professional development and the mental computation instructional program were progressively refined throughout the year. The education advisor fulfilled multiple roles in the study as teacher in the classroom, teacher educator working with the classroom teacher and researcher. Examples of the professional growth of the classroom teacher and the education advisor which occurred as sequences of changes (growth networks, Hollingsworth, 1999) in the domains of the professional world of the classroom teacher and education advisor were drawn from the large body of data collected through regular face-to-face and email communications between the classroom teacher and the education advisor as well as from transcripts of a structured interview. The Interconnected Model of Professional Growth (Clarke & Hollingsworth, 2002; Hollingsworth, 1999) was used to summarise and represent each example of the classroom teacher’s professional growth. A modified version of this model was used to summarise and represent the professional growth of the education advisor. This study confirmed that the method of professional development utilised could lead to significant teacher professional growth related directly to her work in the classroom. Using the Interconnected Model of Professional Growth to summarise and represent the classroom teacher’s professional growth and the modified version for my professional growth assisted with the recognition of examples of how we both changed. This model has potential to be used more widely by education advisors when preparing, implementing, evaluating and following-up on planned teacher professional development activities. The mental computation instructional program developed and trialled in the study was shown to be a successful way of sequencing and managing the teaching of mental computation strategies and related number sense understandings to Year 3 students. This study was conducted in one classroom, with one teacher in one school. The strength of this study was the depth of teacher support provided made possible by the particular method of the professional development, and the depth of analysis of the process. In another school, or with another teacher, this might not have been as successful. While I set out to change my practice as an education advisor I did not expect the depth of learning I experienced in terms of my knowledge, beliefs, attitudes and practices as an educator of teachers. This study has changed the way in which I plan to work as an education advisor in the future.

Developing tools to facilitate integrated reflection

Much has been said and documented about the key role that reflection can play in the ongoing development of e-portfolios, particularly e-portfolios utilised for teaching and learning. A review of e-portfolio platforms reveals that a designated space for documenting and collating personal reflections is a typical design feature of both open source and commercial off-the-shelf software. Further investigation of tools within e-portfolio systems for facilitating reflection reveals that, apart from enabling personal journalism through blogs or other writing, scaffolding tools that encourage the actual process of reflection are under-developed. Investigation of a number of prominent e-portfolio projects also reveals that reflection, while presented as critically important, is often viewed as an activity that takes place after a learning activity or experience and not intrinsic to it. This paper assumes an alternative, richer conception of reflection: a process integral to a wide range of activities associated with learning, such as inquiry, communication, editing, analysis and evaluation. Such a conception is consistent with the literature associated with ‘communities of practice’, which is replete with insight into ‘learning through doing’, and with a ‘whole minded’ approach to inquiry. Thus, graduates who are ‘reflective practitioners’ who integrate reflection into their learning will have more to offer a prospective employer than graduates who have adopted an episodic approach to reflection. So, what kinds of tools might facilitate integrated reflection? This paper outlines a number of possibilities for consideration and development. Such tools do not have to be embedded within e-portfolio systems, although there are benefits in doing so. In order to inform future design of e-portfolio systems this paper presents a faceted model of knowledge creation that depicts an ‘ecology of knowing’ in which interaction with, and the production of, learning content is deepened through the construction of well-formed questions of that content. In particular, questions that are initiated by ‘why’ are explored because they are distinguished from the other ‘journalist’ questions (who, what, when, where, and where) in that answers to them demand explanative, as opposed to descriptive, content. They require a rationale. Although why questions do not belong to any one genre and are not simple to classify — responses can contain motivational, conditional, causal, and/or existential content — they do make a difference in the acquisition of understanding. The development of scaffolding that builds on why-questioning to enrich learning is the motivation behind the research that has informed this paper.

Scaffolding for integrated reflection

This paper presents some theoretical perspectives that might inform the design and development of information and communications technology (ICT) tools to support integrated (in-session) reflection and deep learning during e-learning. The role of why questioning provides the focus of discussion and is informed by the literature on critical thinking, sense-making, and reflective practice, as well as recent developments in knowledge management, computational linguistics and automated question generation. It is argued that there exists enormous scope for the development of ICT scaffolding targeted at supporting reflective practice during e-learning. The first generations of e-Portfolio tools provide some evidence for the significance of the benefits of integrating reflection into the design of ICT systems; however, following the review of a number of such systems, as well as a range of ICT applications and services designed to support e-learning, it is argued that the scope of implementation is limited.

A modified dual-band microstrip monopole antenna

A modified microstrip-fed planar monopole antenna with open circuited coupled line is presented in this paper. The operational bandwidth of the proposed antenna covers the 2.4 GHz ISM band (2.42-2.48 GHz) and the 5 GHz WLAN band (5 GHz to 6 GHz). The radiating elements occupy a small area of 23×8 mm2. The Finite Difference Time Domain method is used to predict the input impedance of the antenna. The calculated return loss shows very good agreement with measured data. Reasonable antenna gain is observed across the operating band. The measured radiation patterns are similar to those of a simple monopole antenna.

Criminology and genetically modified food

Genetically modified or engineered foods are produced from rapidly expanding technologies that have sparked international debates and concerns about health and safety. These concerns focus on the potential dangers to human health, the risks of genetic pollution, and the demise of alternative farming techniques as well as biopiracy and economic exploitation by large private corporations. This article discusses the findings of the world's first Royal Commission on Genetic Modification conducted in New Zealand and reveals that there are potential social, ecological and economic risks created by genetically modified foods that require closer criminological scrutiny. As contemporary criminological discourses continue to push new boundaries in areas of crimes of the economy, environmental pollution, risk management, governance and globalization, the potential concerns posed by genetically modified foods creates fertile ground for criminological scholarship and activism.

Modified beam theories for bending properties of nanowires considering surface/intrinsic effects and axial extension effect

Several studies of the surface effect on bending properties of a nanowire (NW) have been conducted. However, these analyses are mainly based on theoretical predictions, and there is seldom integration study in combination between theoretical predictions and simulation results. Thus, based on the molecular dynamics (MD) simulation and different modified beam theories, a comprehensive theoretical and numerical study for bending properties of nanowires considering surface/intrinsic stress effects and axial extension effect is conducted in this work. The discussion begins from the Euler-Bernoulli beam theory and Timoshenko beam theory augmented with surface effect. It is found that when the NW possesses a relatively small cross-sectional size, these two theories cannot accurately interpret the true surface effect. The incorporation of axial extension effect into Euler-Bernoulli beam theory provides a nonlinear solution that agrees with the nonlinear-elastic experimental and MD results. However, it is still found inaccurate when the NW cross-sectional size is relatively small. Such inaccuracy is also observed for the Euler-Bernoulli beam theory augmented with both contributions from surface effect and axial extension effect. A comprehensive model for completely considering influences from surface stress, intrinsic stress, and axial extension is then proposed, which leads to good agreement with MD simulation results. It is thus concluded that, for NWs with a relatively small cross-sectional size, a simple consideration of surface stress effect is inappropriate, and a comprehensive consideration of the intrinsic stress effect is required.

Computationally efficient methods for solving time-variable-order time-space fractional reaction-diffusion equation

Fractional differential equations are becoming more widely accepted as a powerful tool in modelling anomalous diffusion, which is exhibited by various materials and processes. Recently, researchers have suggested that rather than using constant order fractional operators, some processes are more accurately modelled using fractional orders that vary with time and/or space. In this paper we develop computationally efficient techniques for solving time-variable-order time-space fractional reaction-diffusion equations (tsfrde) using the finite difference scheme. We adopt the Coimbra variable order time fractional operator and variable order fractional Laplacian operator in space where both orders are functions of time. Because the fractional operator is nonlocal, it is challenging to efficiently deal with its long range dependence when using classical numerical techniques to solve such equations. The novelty of our method is that the numerical solution of the time-variable-order tsfrde is written in terms of a matrix function vector product at each time step. This product is approximated efficiently by the Lanczos method, which is a powerful iterative technique for approximating the action of a matrix function by projecting onto a Krylov subspace. Furthermore an adaptive preconditioner is constructed that dramatically reduces the size of the required Krylov subspaces and hence the overall computational cost. Numerical examples, including the variable-order fractional Fisher equation, are presented to demonstrate the accuracy and efficiency of the approach.

A further exploration of sensation seeking propensity, reward sensitivity, depression, anxiety, and the risky behaviour of young novice drivers in a structural equation model

Young novice drivers constitute a major public health concern due to the number of crashes in which they are involved, and the resultant injuries and fatalities. Previous research suggests psychological traits (reward sensitivity, sensation seeking propensity), and psychological states (anxiety, depression) influence their risky behaviour. The relationships between gender, anxiety, depression, reward sensitivity, sensation seeking propensity and risky driving are explored. Participants (390 intermediate drivers, 17-25 years) completed two online surveys at a six month interval. Surveys comprised sociodemographics, Brief Sensation Seeking Scale, Kessler’s Psychological Distress Scale, an abridged Sensitivity to Reward Questionnaire, and risky driving behaviour was measured by the Behaviour of Young Novice Drivers Scale. Structural equation modelling revealed anxiety, reward sensitivity and sensation seeking propensity predicted risky driving. Gender was a moderator, with only reward sensitivity predicting risky driving for males. Future interventions which consider the role of rewards, sensation seeking, and mental health may contribute to improved road safety for younger and older road users alike.

Introductory Indigenous Studies in Education : Reflection and the Importance of Knowing

Although the demand for pre-service teachers to be better informed about Indigenous issues in Australia has been broadly articulated, it is reasonably new for universities to make Indigenous studies a compulsory area of study, or to define what is meant by 'Indigenous education'. This book was motivated by the growing necessity for an approach to Indigenous education that would include more than just a summarising of Indigenous history and traditional culture. It is useful for anyone with an interest in challenging their ideas about culture, identity and history in Australia.

The microRNA expression signature on modified titanium implant surfaces influences genetic mechanisms leading to osteogenic differentiation

Topographically and chemically modified titanium implants are recognized to have improved osteogenic properties; however, the molecular regulation of this process remains unknown. This study aimed to determine the microRNA profile and the potential regulation of osteogenic differentiation following early exposure of osteoprogenitor cells to sand-blasted, large-grit acid-etched (SLA) and hydrophilic SLA (modSLA) surfaces. Firstly, the osteogenic characteristics of the primary osteoprogenitor cells were confirmed using ALP activity and Alizarin Red S staining. The effect of smooth (SMO), SLA and modSLA surfaces on the TGF-β/BMP (BMP2, BMP6, ACVR1) and non-canonical WNT/Ca2+ (WNT5A, FZD6) pathways, as well as the integrins ITGB1 and ITGA2, was determined. It was revealed that the modified titanium surfaces could induce the activation of TGF-β/BMP and non-canonical WNT/Ca2+ signaling genes. The expression pattern of microRNAs (miRNAs) related to cell differentiation was evaluated. Statistical analysis of the differentially regulated miRNAs indicated that 35 and 32 miRNAs were down-regulated on the modSLA and SLA surfaces respectively, when compared with the smooth surface (SMO). Thirty-one miRNAs that were down-regulated were common to both modSLA and SLA. There were 10 miRNAs up-regulated on modSLA and nine on SLA surfaces, amongst which eight were the same as observed on modSLA. TargetScan predictions for the down-regulated miRNAs revealed genes of the TGF-β/BMP and non-canonical Ca2+ pathways as targets. This study demonstrated that modified titanium implant surfaces induce differential regulation of miRNAs, which potentially regulate the TGF-β/BMP and WNT/Ca2+ pathways during osteogenic differentiation on modified titanium implant surfaces.

Non-invasive method for detecting changes in soil moisture using wireless sensor networks

There are several popular soil moisture measurement methods today such as time domain reflectometry, electromagnetic (EM) wave, electrical and acoustic methods. Significant studies have been dedicated in developing method of measurements using those concepts, especially to achieve the characteristics of noninvasiveness. EM wave method provides an advantage because it is non-invasive to the soil and does not need to utilise probes to penetrate or bury in the soil. But some EM methods are also too complex, expensive, and not portable for the application of Wireless Sensor Networks; for example satellites or UAV (Unmanned Aerial Vehicle) based sensors. This research proposes a method in detecting changes in soil moisture using soil-reflected electromagnetic (SREM) wave from Wireless Sensor Networks (WSNs). Studies have shown that different levels of soil moisture will affects soil’s dielectric properties, such as relative permittivity and conductivity, and in turns change its reflection coefficients. The SREM wave method uses a transmitter adjacent to a WSNs node with purpose exclusively to transmit wireless signals that will be reflected by the soil. The strength from the reflected signal that is determined by the soil’s reflection coefficients is used to differentiate the level of soil moisture. The novel nature of this method comes from using WSNs communication signals to perform soil moisture estimation without the need of external sensors or invasive equipment. This innovative method is non-invasive, low cost and simple to set up. There are three locations at Brisbane, Australia chosen as the experiment’s location. The soil type in these locations contains 10–20% clay according to the Australian Soil Resource Information System. Six approximate levels of soil moisture (8, 10, 13, 15, 18 and 20%) are measured at each location; with each measurement consisting of 200 data. In total 3600 measurements are completed in this research, which is sufficient to achieve the research objective, assessing and proving the concept of SREM wave method. These results are compared with reference data from similar soil type to prove the concept. A fourth degree polynomial analysis is used to generate an equation to estimate soil moisture from received signal strength as recorded by using the SREM wave method.

Modified texture menu analysis

Lower energy and protein intakes are well documented in patients on texture modified diets. In acute hospital settings, the provision of appropriate texture modified foods to meet industry standards is essential for patient safety and nutrition outcomes. The texture modified menu at an acute private hospital was evaluated in accordance with their own nutritional standards (NS) and Australian National Standards (Dietitians Association of Australia and Speech Pathology Australia, 2007). The NS documents portion sizes and nutritional requirements for each menu. Texture B and C menus were analysed qualitatively and quantitatively over 9 days of a 6 day cyclic menu for breakfast (n=4), lunch (n=34) and dinner (n=34). Results indicated a lack of portion control, as specified by the NS, across all meals including breakfast (65–140%), soup (55–115%), meat (45–165%), vegetables (55–185%) and desserts (30–300%). Dilution factors and portion sizes influenced the protein and energy availability of Texture B & C menus. While the Texture B menu provided more energy, neither menu met the NS. Limited dessert options on the Texture C menu restricted the ability of this menu to meet protein NS. A lack of portion control and menu items incorrectly modified can compromise protein and energy intakes. Strategies to correct serving sizes and provision of alternate protein sources were recommended. Suggestions included cost-effectively increasing the variety of foods to assist protein and energy intake and the procurement of standardised equipment and visual aids to assist food preparation and presentation in accordance with texture modified guidelines and the NS.