Provision of meals on wheels to the elderly : case studies in the era of local government reform

Australia’s ageing population is on the increase. It is predicted that by 2021 one quarter of Victoria’s elderly population will be aged 60 and over. Not only are people living longer, but they also wish to remain living in the community. The Home and Community Care (HACC) Program was established in 1985 to facilitate and assist the elderly and disabled to remain in their home. In Victoria around 51% of HACC funds are managed by local governments, a level of government that has recently undergone major reforms, which ultimately impacted on the manner in which services were provided. The HACC program funds Meals on Wheels, a service that provides meals for those elderly who no longer can prepare their own meals. The aim of this study was to assess the Meals on Wheels service provided by two Melbourne councils with different service philosophies. The study has four main components: (1) Menu analysis by food and variety; (2) Analysis of actual meals; (3) Clients assessment of Food Services; and (4) Client assessment of the organoleptic qualities of Meals on Wheels. Two Melbourne councils were chosen for their different approaches to service delivery. The City of South tendered out both meal production and delivery, while the City of North maintained its MOW service in-house. The case study method of research allowed for each council’s service to be assessed objectively and without comparison. Several methodologies were used for collecting data in this study. Menu analysis was carried out by comparing the MOW menus with the HACC menu planning guidelines together with general menu planning principles. Analysis of actual meals was in two stages. The weights of the meals were recorded and compared with the HACC recommended food serving portions and meal combinations over a five-day period were analysed for their nutrient contents. Face to face interviews were conducted with clients for their assessment of MOW and the assessment of the organoleptic qualities of the meals was carried out over a five-day period. The results concluded that both councils menus were based on sound menu planning principles, but did not conform with Home and Community Care menu planning guidelines fully and did not include a serve of bread, fruit and milk. The weight analysis of the meal combinations revealed some discrepancies between actual meals and Home and Community Care guidelines by not meeting the recommended serving sizes. Meal combinations generally met Home and Community Care standard for kilojoule and protein, but other nutrients, such as thiamin, riboflavin, magnesium, calcium and zinc were generally below the recommended levels for Meals On Wheels. The majority of study group lived alone and received four to five meals per week. Delivery times of meals, selective menus and food quality were issues raised by clients. Whilst the quality and variety of vegetables was raised by clients they generally rated the organoleptic qualities of the meals as satisfactory. This study examined the four components of the service. A simple method of evaluation the service was developed, which highlight discrepancies with HACC standards and encouraged the councils to set a customer satisfaction standard. A number of recommendations are made to ensure that meals are aesthetically pleasing, including a list of different methods for preparing vegetables. The provision of additional foods, such as a “snack pack” is recommended to improve the supply of essential nutrients that were below the Home and Community Care standards. Meals on Wheels is a vital support service for the elderly living in the community and as such should aim to provide a high quality service that meets the needs of its clients.

High colonization by native arbuscular mycorrhizal fungi (AMF) of rubber trees in small-holder plantations on low fertility soils in North East Thailand

Rubber tree is a very important crop in Thailand, representing an essential source of income for farmers. In the past two decades, rubber tree plantations have been greatly expanding in unfavorable areas, where climate conditions are difficult and soil fertility is very poor. To optimize latex yields, mineral fertilizers have been widely used. A better understanding of the roles of the biological compartment in soil fertility is essential to determine alternative management practices to sustain soil fertility and optimize latex yields. Arbuscular mycorrhizal fungi (AMF) are widely recognized as beneficial for plants, mainly through their role in improving plant nutrient uptake. The objective of this study was to assess the AMF populations in rubber tree plantations and the impact of both soil characteristics and plantation age on these communities. Our results showed that all rubber trees were highly colonized, regardless of the soil structure and nutrient contents. AMF colonization was not affected by the age of the trees, suggesting that maintaining the symbiosis is likely to be beneficial at all stages. A better understanding and management of the microbial communities would contribute to maintaining or restoring soil fertility, leading to a better tree growth and optimized latex yield.

Knowledge about folate and the contribution of nutrient supplements to the intake of folic acid and vitamin B12 in Australian adults in 1995 and 1996

The present paper reports knowledge about folate and the contribution of supplements to the intake of folic acid and vitamin B12 in Australian adults during 1995 and 1996. Data were obtained from two population survey monitor surveys conducted in a sample of 5422 adults in 1995-96. The surveys were designed to complement food intake data from the 1995 National Nutrition Survey and to provide an estimate of total folate intake prior to the implementation of voluntary fortification of foods with folic acid. The proportion with knowledge about folate increased with education level and socioeconomic status and was greater in women than men. It was also greater in those who were married, and in those residing in Western Australia and the Australian Capital Territory than in other states and territories. Five per cent of men and 10% of women had taken a supplement containing folio acid on the previous day. The equivalent figures for vitamin B12 were 7.5% for men and 12.5% for women. On average, intake of folic acid from supplements was 11 micro g per day for men and 28 micro g per day for women and intake of vitamin B12 was 2.6 micro g per day for men and 4.5 micro g per day for women. For individuals who consumed a supplement containing folic acid on the day before the survey the median folic acid contribution was 200 micro g. In 1995 and 1996 only one in two adult Australians had heard of folate and only one in ten women of child-bearing age had taken a supplement containing folic acid.

A practical approach to monitoring nutrient supplement intake of Australian adults

The adoption, in mid-1995, of the revised food Standard A9, which permits the more liberal addition of nutrients to a range of food products, highlighted the need to obtain information on nutrient intake from supplements to complement the i 995 National Nutrition Survey data on nutrient intake from food. This paper describes the method used to obtain quantitative information on nutrient supplement intake and reports on the prevalence of supplement use in different subgroups of the Australian population. Information on supplement intake was obtained in two Australian Bureau of Statistics Population Survey Monitor surveys in August 1995 and February 1996 using the Therapeutic Goods Administration (TGA) registration numbers to identify individual products. Approximately 18% of men and 29% of women aged 18 years and over reported consuming a nutrient supplement on the day before the survey and these proportions increased to 25% and 35% respectively for consumption during the two weeks before the survey. The prevalence of supplement intake increased with age, education level, socioeconomic status, employment status and with fruit and vegetable intake. The substantial proportion of Australian adults who consume nutrient supplements, and the rapidly changing composition of the Australian food supply in response to changes in food regulation, indicate that there is a need for regular monitoring of nutrient intake from supplements. The use of TGA registration numbers to identify supplements provides a practical way to address this need.

Growth and nutrient utilization of Murray cod Maccullochella peelii peelii (Mitchell) fingerlings fed diets with varying levels of soybean meal and blood meal

The Australian native freshwater fish Murray cod, Maccullochella peelii pellii (Mitchell), currently supports a fledgling inland aquaculture industry, which is thought to have considerable growth potential. The aim of this study was to evaluate the suitability of two alternate protein sources [blood meal (BM) and defatted soybean meal (SBM)] as substitutes for fish meal at various levels of inclusion in diets for juvenile Murray cod. The growth performance of juvenile Murray cod in response to nine isonitrogenous and isocalorific diets (50% protein, 14% lipid, 20.2 kJ g⁻¹) consisting of a control diet in which protein was supplied from fish meal, and test diets in which the fish meal protein was substituted at levels of 8%, 16%, 24%, and 32% with BM or SBM was evaluated from a 70-day growth experiment. The per cent apparent dry matter (% ADC_dm) and percentage protein digestibility (% ADC_p) of the test diets were also determined using Cr₂O₃ as a marker. Survival in all the SBM dietary treatments was high but that of fish on the BM dietary treatments was significantly (P < 0.05) lower than in all the other dietary treatments. Specific growth rate (% day−1) of Murray cod fed SBM incorporated diets ranged from 1.63 ± 0.06 to 1.78 ± 0.10 and even at the highest level tested (32% of the dietary protein from SBM) was not significantly different (P > 0.05) from the fish fed the control diet (1.65 ± 0.09). Feed conversion ratios of the SBM dietary treatments ranged from 1.36 ± 0.08 to 1.45 ± 0.07. The protein efficiency ratios and protein conversion efficiencies of Murray cod in the soybean meal treatments were also good and for a majority of the SBM diets were better than those for the control diet. Per cent ADC_dm and ADC_p of the SBM diets tested ranged from 70.6 ± 1.46 to 72.3 ± 1.81% and 88.6 ± 0.57 to 90.3 ± 0.17%, respectively, and was not significantly different (P > 0.05) from the control diet (% ADC_dm 74.3 ± 1.63; % ADC_p 91.3 ± 0.55). The reasons for significantly poor survival and growth of Murray cod reared on BM incorporated diets, and relatively poor digestibility of these diets are discussed. The study shows that for Murray cod diets in which fish meal protein is substituted up to 32% performance or carcass composition is not compromised.

Consumers` sensory and nutritional perceptions of three types of milk

Objective: To identify consumer perceptions of whole milk, reduced-fat milk and soy milk, and to investigate demographic influences on perceptions and types of milk consumption.

Design and setting: Questionnaires covering nutritional and sensory perceptions of three types of milk.

Subjects: Three hundred and sixty-one randomly selected shoppers in Melbourne, Australia.

Results: Generally, respondents held positive perceptions about milk. Milk was considered as having good sensory properties, providing a good source of nutrients, and being a convenient and safe product. However, despite these findings, misperceptions and unawareness about the nutrient content of milk were prevalent. Negative perceptions were most common for whole milk and were mostly related to its perceived high fat, cholesterol and energy contents. Soy milk received lower ratings on sensory quality and convenience than dairy milk. There were few sociodemographic differences in consumers' perceptions. Although reduced-fat milk consumption was more frequent among elderly people and type of milk consumption was related to parenthood, no other significant effects of demographic variables were found on the consumption of specific milk types.

Conclusion: Although positive perceptions were common, negative perceptions and misperceptions appear to be prevalent, presenting a challenge for nutrition education. Sociodemographic factors were not shown to be important predictors of perceptions and type of milk consumption.

The consequences of land use change on nutrient exports: a regional scale assessment in south-west Victoria, Australia

Estimation of nutrient load production based on multi-temporal remotely sensed land use data for the Glenelg–Hopkins region in south-west Victoria, Australia, is discussed. Changes in land use were mapped using archived Landsat data and computerised classification techniques. Land use change has been rapid in recent history with 16% of the region transformed in the last 22 years. Total nitrogen and phosphorus loads were estimated using an export coefficient model. The analysis demonstrates an increase in modelled nitrogen and phosphorus loadings from 1980 to 2002. Whilst such increases were suspected from past anecdotal and ad-hoc evidence, our modelling estimated the magnitude of such increases and thus demonstrated the enormous potential of using remote sensing and GIS for monitoring regional scale environmental processes.

A comparative study of the contents of corporate codes of ethics in Australia, Canada and Sweden

This paper reports on and analyzes the contents of 197 corporate codes of ethics (78 Australian, 80 Canadian and 39 Swedish). Among other things, it was found that the contents of the Australian and Canadian codes were similar, reflecting the similar histories and cultures (as measured by Hofstede's dimensions) of these two countries. Further, the contents of the Swedish codes were found to be very different from the Australian and Canadian codes in some areas, reflecting the cultural differences between Sweden and the other two countries.

Effects of fish oil substitution with a mix blend vegetable oil on nutrient digestibility in Murray cod, Maccullochella peelii peelii

The replacement of fish oil with vegetable based oils is a strategy which is increasingly being adopted by the aquafeed industry as an essential component to reduce the reliance on a limited supply of a natural resource, which in turn also provides cost benefits. The aim of the present investigation was to evaluate the lipid and fatty acid digestibility of a mix blend vegetable oil in juvenile Murray cod; an emerging species of increasing interest in the Australian aquaculture sector. Five semi purified experimental diets were formulated with 17% lipid originating from fish oil (FO) which was substituted in 25% increments by blended vegetable oil (VO), formulated using olive oil (12%), palm oil (43%) and linseed oil (45%) to match the major fatty acid classes of the FO.

Significant differences between the dietary treatments with regard to the lipid and individual fatty acid digestibility were recorded. This study clearly demonstrated that in Murray cod fatty acid digestibility decreases with chain length, and inversely increases relative to the degree of unsaturation. The combination of chain length, degree of unsaturation and the melting point of individual fatty acids resulted in the digestibility of PUFA > MUFA > SFA and short chain > longer chain fatty acids. Therefore, the inclusion of a mixed blend vegetable oil resulted in significantly reduced lipid digestibility in juvenile Murray cod.

Nutritional aspects of food extrusion: a review

Extrusion cooking, as a multi-step, multi-functional and thermal/mechanical process, has permitted a large number of food applications. Effects of extrusion cooking on nutritional quality are ambiguous. Beneficial effects include destruction of antinutritional factors, gelatinisation of starch, increased soluble dietary fibre and reduction of lipid oxidation. On the other hand, Maillard reactions between protein and sugars reduce the nutritional value of the protein, depending on the raw material types, their composition and process conditions. Heat-labile vitamins may be lost to varying extents. Changes in proteins and amino acid profile, carbohydrates, dietary fibre, vitamins, mineral content and some non-nutrient healthful components of food may be either beneficial or deleterious. The present paper reviews the mechanisms underlying these changes, as well as the influence of process variables and feed characteristics. Mild extrusion conditions (high moisture content, low residence time, low temperature) improve the nutritional quality, while high extrusion temperatures (200 °C), low moisture contents (<15%) and/or improper formulation (e.g. presence of high-reactive sugars) can impair nutritional quality adversely. To obtain a nutritionally balanced extruded product, careful control of process parameters is essential.

Altering dietary nutrient intake that reduces glycogen content leads to phosphorylation of nuclear p38 MAP kinase in human skeletal muscle: association with IL-6 gene transcription during contraction

To determine the effect of glycogen availability and contraction on intracellular signaling and IL-6 gene transcription, eight males performed 60 min of exercise on two occasions: either with prior ingestion of a normal (Con) or low carbohydrate (LCHO) diet that reduced pre-exercise muscle glycogen content. Muscle biopsies were obtained and analyzed for IL-6 mRNA. In addition, nuclear proteins were isolated from the samples and analyzed for the mitogen- activated protein kinases (MAPK) c-jun amino-terminal kinase (JNK) 1 and 2 and p38 MAPK. Nuclear fractions were also analyzed for the phosphorylated forms of JNK (p-JNK) and p38 MAPK (p-p38 MAPK) and the abundance of the nuclear transcription factors nuclear factor of activated T cells (NFAT) and nuclear factor kappa-β (NF-κβ). No differences were observed in the protein abundance of total JNK 1/2, p38 MAPK, NFAT, or NF-κβ before exercise, but the nuclear abundance of p-p38 MAPK was higher (P<0.05) in LCHO. Contraction resulted in an increase (P<0.05) in nuclear p-JNK 1/2, but there were no differences when comparing CON with LCHO. The fold increase in IL-6 mRNA with contraction was potentiated (P<0.05) in LCHO. A correlation between pre-exercise nuclear phosphorylated p38 MAPK and contraction-induced fold increase in IL-6 mRNA was performed, revealing a highly significant correlation (r=0.96; P<0.01). We next incubated L6 myotubes in ionomycin (a compound known to induce IL-6 mRNA) with or without the pyridinylimidazole p38 MAPK inhibitor SB203580. Treatments did not affect total nuclear p38 MAPK, but ionomycin increased (P<0.05) both nuclear p-p38 MAPK and IL-6 mRNA. The addition of SB203580 to ionomycin decreased (P<0.05) nuclear p-p38 MAPK and totally abolished (P<0.05) the ionomycin- induced increase in IL-6 mRNA. These data suggest that reduced carbohydrate intake that results in low intramuscular glycogen leads to phosphorylation of p38 MAPK at the nucleus. Furthermore, phosphorylation of p38 MAPK in the nucleus appears to be an upstream target for IL-6, providing new insights into the regulation of IL-6 gene transcription.

Consumption of 'extra' foods (energy-dense, nutrient poor) among children aged 16-24 months from western Sydney, Australia

Objective: This study evaluates the contribution of energy-dense, nutrient-poor ‘extra’ foods to the diets of 16–24-month-old children from western Sydney, Australia.

Design:   An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either ‘core’ or ‘extras’ according to the Australian Guide to Healthy Eating.

Setting:  Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants’ homes at the 18-month assessment.

Participants: Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.

Results:  The mean consumption of ‘extra’ foods was xs223C150 g day− 1 and contributed 25–30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. ‘Extra’ foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of ‘extra’ foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of ‘extra’ foods was inversely associated with the intake of core foods.

Conclusions:  The high percentage of energy contributed by ‘extra’ foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1–2 years. These preliminary data on commonly consumed ‘extra’ foods and portion sizes may inform age-specific dietary assessment methods.