Évaluation des éléments facilitants et des barrières à l’implantation d’un programme d’éducation à la nutrition Camille, Antoine et l’archipel Ôlait tels que perçus par les enseignants du préscolaire

Cette étude vise à évaluer les éléments facilitants et les barrières à l’implantation du programme d’éducation à la nutrition Camille, Antoine et l’archipel Ôlait, développé par les Producteurs laitiers du Canada (PLC), auprès d’enseignants du préscolaire provenant de six régions du Québec et ayant reçu un atelier de formation animé par une diététiste des PLC. Elle vise également à connaître le degré d’implantation et la fidélité du programme ainsi que son appréciation, son utilisation et sa pertinence. Après une moyenne de 5 mois d’implantation, un questionnaire auto-administré a été complété par 37 enseignants (N = 86, 43 %), dont 10 utilisateurs (27 %) et 27 non-utilisateurs (73 %). Puis, des groupes de discussion ont eu lieu avec 13 enseignants (N = 170, 8 %). En moyenne, 11,4 activités sur 30 ont été réalisées (38 %), dont 6,3 telles quelles (55 %) et 5,1 modifiées (45 %), et les enseignants ont rapporté avoir l’intention de refaire 6,1 activités (54 %). L’implantation du programme a été facilitée ou limitée par différentes caractéristiques des enseignants, par l’appréciation de son contenu et son format, par sa pertinence concernant les exigences pédagogiques au préscolaire, la réalité des élèves et des parents et les objectifs d’apprentissages en nutrition, par le milieu scolaire, familial et communautaire ainsi que par la crédibilité et le support des PLC. Plusieurs de ces facteurs sont à la fois des éléments facilitants et des barrières. Les résultats obtenus aideront à ajuster ce programme et guider le développement et l’évaluation de programmes similaires.

Étude cas témoin de la nutrition, du style de vie et du cancer du sein chez les femmes Canadiennes Françaises porteuses d’une mutation fondatrice sur un des gènes BRCA 1 ou BRCA 2

Le cancer du sein est une maladie multifactorielle, plusieurs facteurs socio-économiques, alimentaires ainsi que le style de vie ayant été incriminés dans son développement. Une mutation germinale sur un des gènes BRCA1 ou BRCA2 serait responsable d’une augmentation du risque de développer un cancer du sein de 50 à 80% chez les femmes porteuses d’une mutation sur BRCA1 ou BRCA2 par comparaison aux non- porteuses. Plusieurs études rapportant l’existence d’une association entre la fréquence des cancers du sein sporadiques, les habitudes alimentaires et le style de vie des femmes atteintes, ceci, nous a amené à nous interroger sur le rôle que pourrait jouer ces mêmes facteurs chez les femmes porteuses d’une mutation sur BRCA1 ou BRCA2. Pour répondre à cette question, nous avons effectué une étude cas-témoin. Nos quarante-quatre cas sont porteuses d’une mutation germinale parmi 6 des 14 mutations fondatrices sur BRCA1 et BRCA2 les plus fréquentes dans la population Canadienne Française. Elles sont issues d’une cohorte de plus de 1000 femmes Canadiennes Françaises atteintes de cancers du sein recrutées depuis 1994 et testées pour ces 6 mutations. Les témoins sont recrutés parmi des femmes de la population Canadienne Française, également porteuses d’une de ces six mutations fondatrices de BRCA1 ou BRCA2, mais indemnes de cancers. Quinze d’entre elles ont été recrutées dans les familles des cas de l’étude initiale. Vingt-neuf ont été recrutées à la clinique des cancers familiaux du CHUM, nous permettant ainsi de totaliser 44 témoins. Deux questionnaires ont été administrés aux cas et aux témoins. Le premier, dit Questionnaire de base, a servi à recenser les informations sociodémographiques et le style de vie, couvrant ainsi les deux années précédant la découverte du cancer du sein pour les cas et les deux années précédant la découverte de la mutation pour les témoins. Le deuxième questionnaire, Questionnaire de nutrition, a permis de colliger les informations sur les habitudes alimentaires durant la même période de recueil de données. Une association positive et significative entre le risque de cancer du sein et le niveau d’éducation a été observé parmi les sujets de niveau universitaire (>14 années d’étude) comparés aux sujets n’ayant pas dépassé le niveau d’études secondaires (<11 années d’études) [OR= 7,82; IC95% : (1,99-30,69); p=0,003]. Nous avons mis en évidence que le risque de cancer du sein augmentait lorsque les sujets atteignaient leur poids maximum à un âge avancé > 48 ans [OR = 4,27 ; IC 95% : (0,82-22,25)]. Nous avons montré que le risque du cancer du sein diminuait pour une durée d’allaitement supérieure à 7 mois par comparaison aux femmes n’ayant jamais allaité [OR= 0,35; IC 95% : (0,12-1,06)] mais cette association est non significative. Les porteuses qui pratiquent plus de 22,45 Met-h-sem d’activité physique modérée, comparativement à celles qui pratiquent moins de 11,45 Met-h-sem voient leur risque de cancer du sein diminué de 72% [OR=0,28- IC 95% : (0,08-0,95); p=0,04]. Celles qui pratiquent plus de 31,95 Met-h-sem d’activité physique totale comparativement à celles qui pratiquent moins de 16,40 Met-h-sem voient leur risque de cancer du sein réduit de 79 % [OR=0,21; IC 95% : (0,06-0,75); p= 0,02]. L’analyse des macro et micronutriments et des groupes alimentaires a démontré qu’une consommation de plus de 23,20 g/j d’acide gras monoinsaturés est responsable d’une augmentation du risque de cancer du sein de 6 fois par comparaison à une consommation inférieure à 17,08 g/j [OR=6,00; IC 95% : (0,97-37,02); p=0,05]. Une consommation de plus de 221,79 µg/j de vitamine K réduit le risque du cancer du sein de 83 % par comparaison à une consommation inférieure à 143,57 µg/j [OR= 0,17; IC95% : (0,05-0,61) ; p=0,007]. La consommation de fruits est associée à une réduction du risque de cancer du sein de 73% chez les porteuses de mutations qui en consomment plus de 563,31 g/j comparée à celles qui en consomment moins de 356,18 g/j [OR= 0,27; IC 95% : (0,07-1,01) ; p=0,05]. Nos résultats confortent l’hypothèse selon laquelle le style de vie et les habitudes alimentaires jouent un rôle dans le développement du cancer du sein chez les Canadiennes Françaises porteuses de mutations d’une des 6 mutations fondatrices de BRCA1 ou 2 étudiées. En effet, un niveau d’éducation élevé, un gain de poids sont associés à un risque élevé de développer un cancer du sein. De plus la pratique de l’allaitement et d’une activité physique modérée sont associées à une réduction de ce risque. Nous montrons aussi que la consommation d’acides gras monoinsaturés est responsable d’une augmentation du risque de ce cancer et que la consommation de vitamine K et de fruits permet de réduire ce risque. Nos résultats ouvrent une nouvelle voie de recherche par rapport au rôle de certains nutriments dans le développement du cancer du sein chez les porteuses de mutation d’un des gènes BRCA. Cette voie pourrait également être explorée chez les non porteuses.

Éducation alimentaire, nutritionnelle et sensorielle combinée au jardinage chez les jeunes : rôle des animateurs non professionnels de la nutrition

Les programmes éducatifs de jardinage alimentaire avec les jeunes offrent l’opportunité d’agir sur leurs connaissances nutritionnelles, préférences pour des légumes, sentiment d'efficacité personnelle à consommer des fruits et légumes, envie d'y goûter et leur consommation. Dans ces activités, certains obstacles peuvent freiner l'éducation alimentaire et nutritionnelle faite par des animateurs qui ne sont pas professionnels de la nutrition ou de la santé. Le présent projet consistait à développer un volet alimentaire et nutritionnel éducatif pour les "Jardins-jeunes" (JJ), un camp d'été en jardinage du Jardin botanique de Montréal, à offrir une courte formation en nutrition à ses animatrices, puis à évaluer leurs niveaux d'intérêt et de confiance personnelle à intégrer ce volet à l'édition 2013. Les méthodes d'évaluation auprès des animatrices comprenaient des entrevues de groupe, des questionnaires et une observation-terrain. La taille d'échantillon permettait uniquement une analyse qualitative des résultats. La formation semble avoir maintenu ou élevé les niveaux de confiance et de connaissances des animatrices sur plusieurs sujets alimentaires et nutritionnels. Les animatrices évoquent que les trois activités de trente minutes en alimentation et nutrition, intégrées aux JJ 2013, auraient favorisé l'éducation nutritionnelle, qui par ailleurs, fut limitée par manque de temps. Elles rapportent avoir perçu des effets positifs du programme sur les connaissances, attitudes et comportements alimentaires des jeunes. Nos résultats suggèrent qu'un volet d’éducation alimentaire et nutritionnelle peut être intégré à un programme de jardinage par des animateurs non spécialisés dans ces domaines, outillés et encadrés pour se sentir motivés et confiants dans leur rôle.

The role of ligneous vegetation for livestock nutrition in the sub-Sahelian and Sudanian zones of West Africa: Potential effects of climate change

Climate change and variability in sub-Saharan West Africa is expected to have negative consequences for crop and livestock farming due to the strong dependence of these sectors on rainfall and natural resources, and the low adaptive capacity of crops farmers, agro-pastoralist and pastoralists in the region. The objective of this PhD research was to investigate the anticipated impacts of expected future climate change and variability on nutrition and grazing management of livestock in the prevailing extensive agro-pastoral and pastoral systems of the Sahelian and Sudanian zones of Burkina Faso. To achieve this, three studies were undertaken in selected village territories (100 km² each) in the southern Sahelian (Taffogo), northern Sudanian (Nobere, Safane) and southern Sudanian (Sokouraba) zone of the country during 2009 and 2010. The choice of two villages in the northern Sudanian zone was guided by the dichotomy between intense agricultural land use and high population density near Safane, and lower agricultural land use in the tampon zone between the village of Nobere and the National Park Kaboré Tambi of Pô. Using global positioning and geographical information systems tools, the spatio-temporal variation in the use of grazing areas by cattle, sheep and goats, and in their foraging behaviour in the four villages was assessed by monitoring three herds each per species during a one-year cycle (Chapter 2). Maximum itinerary lengths (km/d) were observed in the hot dry season (March-May); they were longer for sheep (18.8) and cattle (17.4) than for goats (10.5, p<0.05). Daily total grazing time spent on pasture ranged from 6 - 11 h with cattle staying longer on pasture than small ruminants (p<0.05). Feeding time accounted for 52% - 72% of daily time on pasture, irrespective of species. Herds spent longer time on pasture and walked farther distances in the southern Sahelian than the two Sudanian zones (p<0.01), while daily feeding time was longer in the southern Sudanian than in the other two zones (p>0.05). Proportional time spent resting decreased from the rainy (June - October) to the cool (November - February) and hot dry season (p<0.05), while in parallel the proportion of walking time increased. Feeding time of all species was to a significantly high proportion spent on wooded land (tree crown cover 5-10%, or shrub cover >10%) in the southern Sahelian zone, and on forest land (tree crown cover >10%) in the two Sudanian zones, irrespective of season. It is concluded that with the expansion of cropland in the whole region, remaining islands of wooded land, including also fields fallowed for three or more years with their considerable shrub cover, are particularly valuable pasturing areas for ruminant stock. Measures must be taken that counteract the shrinking of wooded land and forests across the whole region, including also active protection and (re)establishment of drought-tolerant fodder trees. Observation of the selection behaviour of the above herds of cattle and small ruminant as far as browse species were concerned, and interviews with 75 of Fulani livestock keepers on use of browse as feed by their ruminant stock and as remedies for animal disease treatment was undertaken (Chapter 3) in order to evaluate the consequence of climate change for the contribution of browse to livestock nutrition and animal health in the extensive grazing-based livestock systems. The results indicated that grazing cattle and small ruminants do make considerable use of browse species on pasture across the studied agro-ecological zones. Goats spent more time (p<0.01) feeding on browse species than sheep and cattle, which spent a low to moderate proportion of their feeding time on browsing in any of the study sites. As far as the agro-ecological zones were concerned, the contribution of browse species to livestock nutrition was more important in the southern Sahelian and northern Sudanian zone than the southern Sudanian zone, and this contribution is higher during the cold and hot dry season than during the rainy season. A total of 75 browse species were selected on pasture year around, whereby cattle strongly preferred Afzelia africana, Pterocarpus erinaceus and Piliostigma sp., while sheep and goats primarily fed on Balanites aegyptiaca, Ziziphus mauritiana and Acacia sp. Crude protein concentration (in DM) of pods or fruits of the most important browse species selected by goats, sheep and cattle ranged from 7% to 13% for pods, and from 10% to 18% for foliage. The concentration of digestible organic matter of preferred browse species mostly ranged from 40% to 60%, and the concentrations of total phenols, condensed tannins and acid detergent lignin were low. Linear regression analyses showed that browse preference on pasture is strongly related to its contents (% of DM) of CP, ADF, NDF and OM digestibility. Interviewed livestock keepers reported that browse species are increasingly use by their grazing animals, while for animal health care use of tree- and shrub-based remedies decreased over the last two decades. It is concluded that due to climate change with expected negative impact on the productivity of the herbaceous layer of communal pastures browse fodder will gain in importance for animal nutrition. Therefore re-establishment and dissemination of locally adapted browse species preferred by ruminants is needed to increase the nutritional situation of ruminant stock in the region and contribute to species diversity and soil fertility restoration in degraded pasture areas. In Chapter 4 a combination of household surveys and participatory research approaches was used in the four villages, and additionally in the village of Zogoré (southern Sahelian zone) and of Karangasso Vigué (northern Sudanian zone) to investigate pastoralists’ (n= 76) and agro-pastoralists’ (n= 83) perception of climate change, and their adaptation strategies in crop and livestock production at farm level. Across the three agro-ecological zones, the majority of the interviewees perceived an increase in maximum day temperatures and decrease of total annual rainfall over the last two decades. Perceptions of change in climate patterns were in line with meteorological data for increased temperatures while for total rainfall farmers’ views contrasted the rainfall records which showed a slight increase of precipitation. According to all interviewees climate change and variability have negative impacts on their crop and animal husbandry, and most of them already adopted some coping and adaptation strategies at farm level to secure their livelihoods and reduce negative impacts on their farming system. Although these strategies are valuable and can help crop and livestock farmers to cope with the recurrent droughts and climate variability, they are not effective against expected extreme climate events. Governmental and non-governmental organisations should develop effective policies and strategies at local, regional and national level to support farmers in their endeavours to cope with climate change phenomena; measures should be site-specific and take into account farmers’ experiences and strategies already in place.

A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE II >= 66)

Background: Total enteral nutrition (TEN) within 48 h of admission has recently been shown to be safe and efficacious as part of the management of severe acute pancreatitis. Our aim was to ascertain the safety of immediate TEN in these patients and the effect of TEN on systemic inflammation, psychological state, oxidative stress, plasma glutamine levels and endotoxaemia. Methods: Patients admitted with predicted severe acute pancreatitis (APACHE II score 15) were randomised to total enteral (TEN; n = 8) or total parenteral nutrition (TPN; n = 9). Measurements of systemic inflammation (C-reactive protein), fatigue ( visual analogue scale), oxidative stress ( plasma thiobarbituric acid- reactive substances), plasma glutamine and anti-endotoxin IgG and IgM antibody concentrations were made on admission and repeated on days 3 and 7 thereafter. Clinical progress was monitored using APACHE II score. Organ failure and complications were recorded. Results: All patients tolerated the feeding regime well with few nutrition-related complications. Fatigue improved in both groups but more rapidly in the TEN group. Oxidative stress was high on admission and rose by similar amounts in both groups. Plasma glutamine concentrations did not change significantly in either group. In the TPN group, 3 patients developed respiratory failure and 3 developed non-respiratory single organ failure. There were no such complications in the TEN group. Hospital stay was shorter in the TEN group [ 7 (4-14) vs. 10 (7-26) days; p = 0.05] as was time to passing flatus and time to opening bowels [1 (0-2) vs. 2 (1-5) days; p = 0.01]. The cost of TEN was considerably less than of TPN. Conclusion: Immediate institution of nutritional support in the form of TEN is safe in predicted severe acute pancreatitis. It is as safe and as efficacious as TPN and may be beneficial in the clinical course of this disease. Copyright (C) 2003 S. Karger AG, Basel and IAP.

Can nutrition be promoted through agriculture-led food price policies? A systematic review

Abstract Objective: To systematically review the available evidence on whether national or international agricultural policies that directly affect the price of food influence the prevalence rates of undernutrition or nutrition-related chronic disease in children and adults. Design: Systematic review. Setting: Global. Search strategy: We systematically searched five databases for published literature (MEDLINE, EconLit, Agricola, AgEcon Search, Scopus) and systematically browsed other databases and relevant organisational websites for unpublished literature. Reference lists of included publications were hand-searched for additional relevant studies. We included studies that evaluated or simulated the effects of national or international food-price-related agricultural policies on nutrition outcomes reporting data collected after 1990 and published in English. Primary and secondary outcomes: Prevalence rates of undernutrition (measured with anthropometry or clinical deficiencies) and overnutrition (obesity and nutrition-related chronic diseases including cancer, heart disease and diabetes). Results: We identified a total of four relevant reports; two ex post evaluations and two ex ante simulations. A study from India reported on the undernutrition rates in children, and the other three studies from Egypt, the Netherlands and the USA reported on the nutrition related chronic disease outcomes in adults. Two of the studies assessed the impact of policies that subsidised the price of agricultural outputs and two focused on public food distribution policies. The limited evidence base provided some support for the notion that agricultural policies that change the prices of foods at a national level can have an effect on population-level nutrition and health outcomes. Conclusions: A systematic review of the available literature suggests that there is a paucity of robust direct evidence on the impact of agricultural price policies on nutrition and health.

Understanding consumer evaluations of personalised nutrition services in terms of the privacy calculus: a qualitative study

Background: Personalised nutrition (PN) may provide major health benefits to consumers. A potential barrier to the uptake of PN is consumers’ reluctance to disclose sensitive information upon which PN is based. This study adopts the privacy calculus to explore how PN service attributes contribute to consumers’ privacy risk and personalisation benefit perceptions. Methods: Sixteen focus groups (n = 124) were held in 8 EU countries and discussed 9 PN services that differed in terms of personal information, communication channel, service provider, advice justification, scope, frequency, and customer lock-in. Transcripts were content analysed. Results: The personal information that underpinned PN contributed to both privacy risk perception and personalisation benefit perception. Disclosing information face-to-face mitigated the perception of privacy risk and amplified the perception of personalisation benefit. PN provided by a qualified expert and justified by scientific evidence increased participants’ value perception. Enhancing convenience, offering regular face-to face support, and employing customer lock-in strategies were perceived as beneficial. Conclusion: This study suggests that to encourage consumer adoption, PN has to account for face-to-face communication, expert advice providers, support, a lifestyle-change focus, and customised offers. The results provide an initial insight into service attributes that influence consumer adoption of PN.

The effect of exercise and nutrition on the mechanostat

In this review, we discuss the effect of increased and decreased loading and nutrition deficiency on muscle and bone mass and strength (and bone length and architecture) independently and combined. Both exercise and nutrition are integral components of the mechanostat model but both have distinctly different roles. Mechanical strain imparted by muscle action is responsible for the development of the external size and shape of the bone and subsequently the bone strength. In contrast, immobilization during growth results in reduced growth in bone length and a loss of bone strength due to large losses in bone mass (a result of endosteal resorption in cortical bone and trabecular thinning) and changes in geometry (bone shafts do not develop their characteristic shape but rather develop a rounded default shape). The use of surrogate measures for peak muscle forces acting on bone (muscle strength, size, or mass) limits our ability to confirm a cause-and-effect relationship between peak muscle force acting on bone and changes in bone strength. However, the examples presented in this review support the notion that under adequate nutrition, exercise has the potential to increase peak muscle forces acting on bone and thus can lead to a proportional increase in bone strength. In contrast, nutrition alone does not influence muscle or bone in a dose-dependent manner. Muscle and bone are only influenced when there is nutritional deficiency – and in this case the effect is profound. Similar to immobilization, the immediate effect of malnutrition is a reduction in longitudinal growth. More specifically, protein and energy malnutrition results in massive bone loss due to endosteal resorption in cortical bone and trabecular thinning. Unlike loading however, there is indirect evidence that severe malnutrition when associated with menstrual dysfunction can shift the mechanostat set point upward, thus leading to less bone accrual for a given amount of bone strain.

The infant feeding activity and nutrition trial (INFANT) an early intervention to prevent childhood obesity : cluster-randomised controlled trial

Background : Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.

Methods/Design : This cluster-randomised controlled trial, with first-time parent groups as the unit of randomisation, will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents' group at Maternal and Child Health Centres. Using a two-stage sampling process, local government areas in Victoria, Australia will be randomly selected at the first stage. At the second stage, a proportional sample of first-time parent groups within selected local government areas will be randomly selected and invited to participate. Informed consent will be obtained and groups will then be randomly allocated to the intervention or control group.

Discussion : The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge this will be the first randomised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating, physical activity and reduced sedentary behaviours. If proven to be effective, INFANT may protect children from the development of obesity and its associated social and economic costs.

Critical evaluation of cashmere nutrition experiments and suggestions for the design and conduct of successful experiments

Cashmere fibre production is an order of magnitude less than fibre production of Merino sheep or Angora goats and is more difficult to measure. Based on a comparison between cashmere experiments reporting responses to nutrition and those reporting no response, 13 design and management characteristics were identified that are related to the ability of experiments to discriminate among treatments. Methods must be adopted to reduce the variance in cashmere production within treatments, by using sufficient. animals per treatment, having enough replication to provide plenty of degrees of freedom to reduce error terms in analysis, and using pre-experimental cashmere production attributes as co-variants in analysis. It is preferable to use more productive and older goats, and goats that are used to handling, and to the conditions and feed to be used. Nutrition treatments need to produce different live weight growth curves and an appropriate control is needed such as live weight maintenance. As the raw cashmere fleece is composed primarily of hair and other contaminants, careful attention is required to measure, sample and test cashmere. Cashmere growth experiments should start by midsummer and last for at least four and preferably six months. These requirements make it more difficult for many university students to plan, undertake and complete long-term cashmere nutrition experiments without considerable management support.

Associations of maternal long-chain polyunsaturated fatty acids, methyl mercury, and infant development in the Seychelles Child Development Nutrition Study

Fish consumption during gestation can provide the fetus with long-chain polyunsaturated fatty acids (LCPUFA) and other nutrients essential for growth and development of the brain. However, fish consumption also exposes the fetus to the neurotoxicant, methyl mercury (MeHg). We studied the association between these fetal exposures and early child development in the Seychelles Child Development Nutrition Study (SCDNS). Specifically, we examined a priori models of Ω-3 and Ω-6 LCPUFA measures in maternal serum to test the hypothesis that these LCPUFA families before or after adjusting for prenatal MeHg exposure would reveal associations with child development assessed by the BSID-II at ages 9 and 30 months. There were 229 children with complete outcome and covariate data available for analysis. At 9 months, the PDI was positively associated with total Ω-3 LCPUFA and negatively associated with the ratio of Ω-6/Ω-3 LCPUFA. These associations were stronger in models adjusted for prenatal MeHg exposure. Secondary models suggested that the MeHg effect at 9 months varied by the ratio of Ω-6/Ω-3 LCPUFA. There were no significant associations between LCPUFA measures and the PDI at 30 months. There were significant adverse associations, however, between prenatal MeHg and the 30-month PDI when the LCPUFA measures were included in the regression analysis. The BSID-II mental developmental index (MDI) was not associated with any exposure variable. These data support the potential importance to child development of prenatal availability of Ω-3 LCPUFA present in fish and of LCPUFA in the overall diet. Furthermore, they indicate that the beneficial effects of LCPUFA can obscure the determination of adverse effects of prenatal MeHg exposure in longitudinal observational studies.

Community nutrition : providing for older citizens

Diet quality is a contributing factor to the health of the increasing number of aged. A fortnightly small group meal program focusing on social interaction was trialled. It was concluded that the program had strong support from participants and that there is scope for expansions of existing food service programs to include alternative styles of presentations; and that the principle of the Community Meals Program should be continued and endorsed.

A review of cashmere nutrition experiments with suggestions for improving their design and conduct

The scientific literature contains divergent views about the effects of nutrition on cashmere. The consequences of ignoring nutrition will be an increase in the number of goats suffering lower production, increased welfare risks and premature mortality. This review evaluated published reports to identify current knowledge and best practice in regard to the design and management of cashmere nutrition experiments. The ability of experiments to distinguish between treatments was evaluated based on their statistical evidence. Many experiments had serious deficiencies in their design, conduct and reporting. Six of 16 papers did not provide statistical information that would enable a reader to verify differences between treatments. For most experiments to detect nutrition affects at P < 0.05, they required a difference between treatments of 0.2–0.8 μm in cashmere mean fibre diameter and 15–42 g in clean cashmere production. Government Research Institutes research was characterised by more experienced authors conducting longer (P < 0.05) and larger (P < 0.05) experiments than those conducted by Universities. Much of the “debate” regarding the affects of nutrition on cashmere production arises from the misinterpretation of both experiments that did not detect statistically significant effects and of experiments that did detect statistically significant effects. Based on a comparison between experiments reporting responses to nutrition with those reporting no response, 13 design and management features were identified that are related to the ability of experiments to detect significant treatment affects. Methods must be adopted to reduce the variance in cashmere production within treatments, by using sufficient animals per treatment, and having replication to provide sufficient degrees of freedom to reduce error terms in analysis. The power of experimental designs should be evaluated before experiments commence. Cashmere production records from a previous full production year could be used as co-variants during statistical analyses but this requires that potential experimental goats are managed in one flock, without variations resulting from different grazing, reproduction or other management for a year prior to an experiment. It is preferable to use more productive and older goats, and goats that are used to handling, and to the conditions and feed to be used. Allocation of animals to treatments must take into account live weight. Nutrition treatments need to be sufficiently different to produce different growth curves. An appropriate control is needed such as live weight maintenance. Evidence of both nutrition intake and growth curves must be published with cashmere production data so the claims made can be verified by the actual responses. As cashmere production is an order of magnitude less than fibre production of Merino sheep or Angora goats and is more difficult to measure, the requirements for measurement, sampling and testing cashmere fleeces are summarised. The use of mid side cashmere patches to determine cashmere growth and quality is seriously biased and must be avoided, preferably by shearing goats prior to and at the end of experiments. In order to obtain higher fleece growth responses and improve the ability of experiments to detect treatment effects it is preferable to start cashmere growth experiments by midsummer and conduct experiments for at least 4 months. These requirements make it difficult for many university students to plan, undertake and complete long-term cashmere nutrition experiments without considerable management support. It is not possible for experiments to disprove the Null hypothesis regarding the effects of nutrition on cashmere production as they can only report a failure to detect treatment effects. Researchers and journals need to be more rigorous in providing statistical information including: degrees of freedom for error terms, treatment variances, standard error of differences or similar to enable readers to compare treatment effects. Publications that do not provide sufficient statistical information should be disregarded from future discussions. Claims that an experiment shows no responses to nutrition should be subject to rigorous examination using the issues identified in this review.

An audit of local government planning tools for their potential use in addressing community food and nutrition issues

Issues addressed: This project aimed to identify how local government planning tools could be used to influence physical and policy environments to support healthy eating behaviours in communities.
Methods: An audit of Queensland's legislative and non-legislative local government planning tools was conducted by a public health nutritionist to assess their potential use in addressing strategies to achieve positive nutrition outcomes. Ten strategies were identified and covered the following themes: improving access to healthy foods and drinks; increasing access to breastfeeding facilities; decreasing fast food outlet density; and unhealthy food advertising. 
Results: The audit found that all of the 10 strategies to achieve positive nutrition outcomes could be considered through three or more of the planning tools.
Conclusion: Based on the findings of this audit, local government planning tools provide opportunities to address food and nutrition issues and contribute toward creating physical and policy environments that support healthy eating behaviours.

A simple nutrition screening tool for hemodialysis nurses

Objective : To assess the reliability of a nurse-performed nutrition screening tool (NST) for hemodialysis (HD) patients to identify nutritionally at-risk patients.

Design : Tool reliability assessment.

Setting and Participants : The setting was nine non-hospital private (n = 3) and public (n = 6) HD units in Australia (two rural and seven metropolitan). Participants were 112 HD patients.

Results : A total of 112 HD patients (male = 65, female = 47) from 9 non-hospital HD units in Australia (seven metropolitan and two rural) were screened with the NST and the outcome of dietitian referral compared with Standard Dietitians Assessment. The mean age of patients was 57.6 years. Overall, the NST showed a sensitivity of 0.84 (range, 0.71 to 0.94; P < .05) and a specificity of 0.9 (range, 0.82 to 0.98; P < .05). The NST was more sensitive (sensitivity, 0.93 [range, 0.87 to 0.99; P < .05]) and was more specific for men (specificity, 0.92 [range, 0.85 to 0.99; P < .05]). Specificity was very strong in metropolitan patients (specificity, 0.94 [range, 0.87 to 1.01; P < .05]).

Conclusions : The tool was more sensitive and specific than the NST previously reported by the same investigators. The tool is particularly specific in that it screens those patients not requiring dietitian intervention. The use of this tool may benefit HD units that do not have on-site or regular dietetic support to prioritize patients needing dietitian intervention.