Malnutrition in hospitalised patients and clinical outcomes : a missed opportunity?

This research programme has resulted in 5 published papers in international peer-reviewed journals and contributed to better outcomes for patients. It has provided clear evidence that the adverse outcomes of malnutrition are not just a consequence of the disease process, and lead to substantial increases in length of hospital stay, readmission rate, mortality and hospitalisation cost when compared with well-nourished patients of similar diagnoses and complexities. The research programme led to the development and validation of a new nutrition screening tool called 3-Minute Nutrition Screening (3-MinNS). It has also implemented quality improvement initiatives which proved successful in improving the compliance to 3-MinNS and ensuring referral of malnourished or 'at risk' patients to dietitians. Finally, this research programme has provided an effective method for following up malnourished patients post-discharge, which resulted in improved nutritional status and quality of life.

Use of a photographic food diary method to document dietary intake in people with Parkinson's Disease

Cognitive impairment and physical disability are common in Parkinson’s disease (PD). As a result diet can be difficult to measure. This study aimed to evaluate the use of a photographic dietary record (PhDR) in people with PD. During a 12-week nutrition intervention study, 19 individuals with PD kept 3-day PhDRs on three occasions using point-and-shoot digital cameras. Details on food items present in the PhDRs and those not photographed were collected retrospectively during an interview. Following the first use of the PhDR method, the photographer completed a questionnaire (n=18). In addition, the quality of the PhDRs was evaluated at each time point. The person with PD was the sole photographer in 56% of the cases, with the remainder by the carer or combination of person with PD and the carer. The camera was rated as easy to use by 89%, keeping a PhDR was considered acceptable by 94% and none would rather use a “pen and paper” method. Eighty-three percent felt confident to use the camera again to record intake. Of the photos captured (n=730), 89% were of adequate quality (items visible, in-focus), while only 21% could be used alone (without interview information) to assess intake. Over the study, 22% of eating/drinking occasions were not photographed. PhDRs were considered an easy and acceptable method to measure intake among individuals with PD and their carers. The majority of PhDRs were of adequate quality, however in order to quantify intake the interview was necessary to obtain sufficient detail and capture missing items.

Defining food literacy and its components

Food literacy has emerged as a term to describe the everyday practicalities associated with healthy eating. The term is increasingly used in policy, practice, research and by the public; however, there is no shared understanding of its meaning. The purpose of this research was to develop a definition of food literacy which was informed by the identification of its components. This was considered from two perspectives: that of food experts which aimed to reflect the intention of existing policy and investment, and that of individuals, who could be considered experts in the everyday practicalities of food provisioning and consumption. Given that food literacy is likely to be highly contextual, this second study focused on disadvantaged young people living in an urban area who were responsible for feeding themselves. The Expert Study used a Delphi methodology (round one n = 43). The Young People’s Study used semi-structured, life-course interviews (n = 37). Constructivist Grounded Theory was used to analyse results. This included constant comparison of data within and between studies. From this, eleven components of food literacy were identified which fell into the domains of: planning and management; selection; preparation; and eating. These were used to develop a definition for the term “food literacy”.

The role of food regulation in promoting health

Food regulations are a series of laws and guidelines that focus on food that can be bought and sold in Australia. This system includes laws and regulations that address, food safety, food handling, what ingredients can go in a food, what a food can be called, what information needs to be included on a label, how a food can be advertised and promoted and developing a food industry that is both economically strong and supports the health of Australia's people and it's environment.

Nutritional influences over the life course on lean body mass of individuals in developing countries

The double burden of childhood undernutrition and adult-onset adiposity in transitioning societies poses a significant public health challenge. The development of suboptimal lean body mass (LBM) could partly explain the link between these two forms of malnutrition. This review examines the evidence on both the role of nutrition in “developmental programming” of LBM and the nutritional influences that affect LBM throughout the life course. Studies from developing countries assessing the relationship of early nutrition with later LBM provide important insights. Overall, the evidence is consistent in suggesting a positive association of early nutritional status (indicated by birth weight and growth during first 2 years) with LBM in later life. Evidence on the impact of maternal nutritional supplementation during pregnancy on later LBM is inconsistent. In addition, the role of nutrients (protein, zinc, calcium, vitamin D) that can affect LBM throughout the life course is described. Promoting optimal intakes of these important nutrients throughout the life course is important for reducing childhood undernutrition as well as for improving the LBM of adults.

Improved nutritional status is related to improved quality of life in Parkinson’s disease

Background: Quality of life is poorer in Parkinson’s disease than in other conditions and in the general population without Parkinson’s disease. Malnutrition also results in poorer quality of life. This study aimed at determining the relationship between quality of life and nutritional status. Methods: Community-dwelling people with Parkinson’s disease >18 years old were recruited. The Patient-Generated Subjective Global Assessment (PG-SGA) assessed nutritional status. The Parkinson’s Disease Questionnaire 39 (PDQ-39) measured quality of life. Phase I was cross-sectional. The malnourished in Phase I were eligible for a nutrition intervention phase, randomised into 2 groups: standard care (SC) with provision of nutrition education materials only and intervention (INT) with individualised dietetic advice and regular weekly follow-up. Data were collected at baseline, 6 weeks, and 12 weeks. Results: Phase I consisted of 120 people who completed the PDQ-39. Phase II consisted of 9 in the SC group and 10 in the INT group. In Phase I, quality of life was poorer in the malnourished, particularly for mobility and activities of daily living domains. There was a significant correlation between PG-SGA and PDQ-39 scores (Phase I, rs = 0.445, p = .000; Phase II, rs = .426, p = .002). In Phase II, no significant difference in the PDQ-39 total or sub-scores was observed between the INT and SC groups; however, there was significant improvement in the emotional well-being domain for the entire group, X2(2) = 8.84, p = .012. Conclusions: Malnourished people with Parkinson’s disease had poorer quality of life than the well-nourished, and improvements in nutritional status resulted in quality of life improvements. Attention to nutritional status is an important component of quality of life and therefore the total care of people with Parkinson’s disease.

Household food insecurity, diet, and weight status in a disadvantaged district of Ho Chi Minh City, Vietnam: A cross-sectional study

Background Food security exists when all people, at all times, have physical, economic and socially acceptable access to safe, sufficient, and adequately nutritious food in order to meet their dietary needs for an active and healthy life. For high income countries and those experiencing the nutrition transition, food security is not only about the quantity of available food but also the nutritional quality as related to over- and under-nutrition. Vietnam is currently undergoing this nutrition transition, and as a result the relationship between food insecurity, socio-demographic factors and weight status is complex. The primary objective of this study was to therefore measure the prevalence of household food insecurity in a disadvantaged urban district in Ho Chi Minh City (HCMC) in Vietnam using a more comprehensive tool. This study also aims to examine the relationships between food insecurity and socio-demographic factors, weight status, and food intakes. Methods A cross-sectional study was conducted using multi-stage sampling. Adults who were mainly responsible for cooking were interviewed in 250 households. Data was collected on socioeconomic and demographic factors using previously validated tools. Food security was assessed using the Latin American and Caribbean Household Food Security Scale (ELCSA) tool and households were categorized as food secure or mildly, moderately or severely food insecure. Questions regarding food intake were based on routinely used and validated questions in HCMC, weight status was self-reported. Results Cronbach’s alpha coefficient was 0.87, showing the ELCSA had a good internal reliability. Approximately 34.4% of households were food insecure. Food insecurity was inversely related to total household income (OR = 0.09, 95% CI = 0.04 - 0.22) and fruit intakes (OR = 2.2, 95% CI 1.31 - 4.22). There was no association between weight and food security status. Conclusions Despite rapid industrialization and modernization, food insecurity remains an important public health issue in large urban areas of HCMC, suggesting that strategies to address food insecurity should be implemented in urban settings, and not just rural locations. Fruit consumption among food insecure households may be compromised because of financial difficulties, which may lead to poorer health outcomes particularly related to non-communicable disease prevention and management.

The nutritional profile of baby and toddler food products sold in Australian supermarkets

Background/Aims To examine the nutritional profile of baby and toddler foods sold in Australia. Methods Nutrient information for baby and toddler foods available at Australian supermarkets was collected between August and December 2013. Levels of declared energy, total fat, saturated fat, total sugar, sodium and estimated added sugar were examined, as well as the presence of additional micronutrients on the label. The Health Star Rating (HSR) system was used to determine nutritional quality. The range of products on offer was also examined by product type and by the age category for which the product was marketed. Results Of the 309 products included, 29 % were fortified. On a per 100 g basis, these 309 products provided a mean (±SD) of 476 ± 486 kJ, 1.6 ± 2.4 g total fat, 10.7 ± 12.2 g total sugar, 2.7 ± 7.4 g added sugar, and 33.5 ± 66.5 mg sodium. Fruit-based products or products with fruit listed as an ingredient (58 %) were the predominant product type. On the nutrition label, 42 % displayed at least one additional micronutrient while 37 % did not display saturated fat. The most common HSR was four stars (45 %) and 6? months was the most commonly identified targeted age group (36 %). Conclusions The majority of baby and toddler foods sold in Australian supermarkets are ready-made fruit-based products aimed at children under 12 months of age. Baby and toddler foods are overlooked in public policy discussions pertaining to population nutrient intake but their relatively high sugar content deriving from fruits requires close attention to ensure these foods do not replace other more nutrient dense foods, given children have an innate preference for sweet tastes.

ANF guidelines for healthy food choices

The Australian Nutrition Foundation (ANF) was one of the first community service organisations to work with food industry , having pioneered the concept of corporate membership since its inception in 1982. ANF has worked closely and successfully with industry - the development of the ANF Food Selection Guidelines for Children and Adolescents is one example of this collaboration. While the guidelines were initially developed for use in school canteens, they can be used in a range of institutions where caterers wish to have tender specifications for purchase of healthy food for children and adolescents.

Food literacy

The term 'food literacy' is increasingly being used to describe the knowledge, skills and behaviours needed to feed yourself. In the last five years the use of this specific term has more than tripled in the research literature. The term is now commonly used in food and nutrition policy(Department of Agriculture Fisheries and Forestries, 2013; Glickman, Parker, Sim, Del Valle Cook, & Miller, 2012; Vandenbroeck, Goossens, & Clemens, 2007) and by a range of different industries, including, health, education and sustainable agriculture (Colatruglio, 2015; Piscopo, 2015; Voget-Kleschin, 2014). This article will look at what has led to the emergence of this term and then go on to define it based on the author's own PhD research which involved two studies, one of food experts and one of 16-25 year olds which aimed to identify the components of food literacy.

Food literacy: Definitions, components, learning and links to diet and health outcomes

Recently, the term ‘food literacy’ has emerged in policy, research and practice to describe the collection of knowledge, skills and behaviours required to practically meet food needs. This presentation will described research undertaken to empirically define the term and propose its impact on nutrition

Improving food supply

Improving the availability, accessibility and affordability of healthy food equitably is fundamental to improving nutrition and health. While theoretical models abound, in real world complex systems rarely are there opportunities to address leverage points systematically to improve food supply. This presentation describes efforts over the last 30 years to do just that by remote Australian Aboriginal communities, where a single community store is usually the major dietary source. Areas addressed include store governance and infrastructure, wholesale supply, transport and pricing policies including cross-subsidization. However, while there have been dramatic improvements in the availability, quality and price of fruit, vegetables and most other healthy foods over this time, the proportion of communities' energy intake from energy-dense nutrient-poor foods and drinks has increased. One cause may be the disproportionate increase in supply of unhealthy choices in terms of variety and shelf-space, consistent with changes in the food supply in broader Australia. The impact of changing social and environmental factors, food preferences and price elasticity will also be explored briefly. Clearly much more needs to be done to reduce the high prevalence of diet-related chronic disease in some vulnerable groups. In particular, efforts to continually improve the availability and affordability of healthy food also need to address the predominance of unhealthy choices in the food supply.

Introduction: Food literacy for contemporary food and eating

This chapter provides an introduction to the term “food literacy”. Its use in the literature, policy and practice, implies that the term is an attempt to encapsulate the knowledge, skills and behaviours needed for everyday eating. This chapter will first review the use of the term in policy and practice, then go on to review what is known about contemporary food and eating and its influence on the emergence of this term and conclude with an overview of the key ideas to be explored in this book.