Review of Nutrition Guidelines and Evidence on Diet and Survival Outcomes for Cancer Survivors: Call for Integrating Nutrition into Oncology Care.

Several organizations have published nutrition guidelines for cancer survivors during and after treatment. This review compared nutrition guidelines for cancer survivors published in the United States for the topics that are covered in the guidelines and evaluated the evidence that these guidelines are based upon. A team of researchers, patient stakeholders, and healthcare providers collectively identified 5 nutrition guidelines for cancer survivors in the United States: the 2022 American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors, the 2018 American Institute for Cancer Research Cancer Nutrition Guide, the 2022 National Cancer Institute Physician Data Query and Eating Hints, the 2024 National Comprehensive Cancer Network Guidelines for Cancer Survivors, and the 2020 American Society for Clinical Oncology Guidelines. The 5 guidelines cover a comprehensive list of nutrition topics but overall promote to follow those recommendations for cancer prevention. This review also evaluated the current evidence from meta-analyses on dietary patterns and intakes of foods and nutrients in relation to survival outcomes among cancer survivors. Although the evidence on dietary patterns is strong, the evidence on most dietary factors is still limited and the current research was primarily conducted among breast and colorectal cancer survivors. Although nutrition recommendations are available for cancer survivors, practical strategies need to be implemented to integrate nutrition into oncology care and help cancer survivors follow these recommendations. Further research is warranted to provide additional evidence on the role of nutrition in the health outcomes of cancer survivors and guide the development of evidence-based nutrition recommendations. The protocol is registered in PROSPERO: CRD42023429240.

The influence of birthweight and breastfeeding status on BMI outcome at first year of primary school: a retrospective study of an Irish child cohort.

Recent data shows one in four children in Ireland are classified as having overweight or obesity, putting them at increased risk of health complications in both childhood and adulthood. The primary aim of this study was to retrospectively investigate the association between body mass index (BMI) outcome at first year of primary school and sex, birthweight and breastfeeding status in a cohort of Irish children. A secondary aim was to assess whether parents were concerned about their child's growth. This study examined data from the National Child Health Screening Programme on 3739 children in their first year of primary school education in the Irish counties of Sligo, Leitrim and Donegal. This data was collected between March 2013 and December 2016. 10.8% and 7.1% of the children included in this study were classified as having overweight and obese BMI outcomes, respectively. A greater proportion of males had underweight, overweight or obese BMI outcomes compared to females, and this was statistically significant (p ≤ 0.001). Overweight and obese BMI outcomes were significantly more common among those born with a high birthweight, compared to those with a low or healthy birthweight (p ≤ 0.001). There was a greater proportion of obese BMI outcome in those who were never breastfed compared to those who were ever breastfed, and this difference was statistically significant (p = 0.041). Among those who were ever breastfed, there was a statically significant (p = 0.009) difference between BMI outcome at first year of primary schooling and the duration of time they were breastfed for. When asked whether they were concerned about their child's growth, the majority of parents who responded expressed no concern (96.1%). CONCLUSION: This study found an association between BMI outcome at first year of primary school education and sex, birthweight and breastfeeding status in a cohort of children in the North-West of Ireland. The majority of parents did not express concern related to their child's growth at first year of primary education. WHAT IS KNOWN: • One in every four children in Ireland are classified as having overweight or obesity. • Birthweight and breastfeeding status are factors known to be associated with weight status in childhood. WHAT IS NEW: • This study investigated whether there was an association between sex, birthweight and breastfeeding status and the BMI outcome of a cohort of Irish children in their first year of primary school education (median age: 5.2 years). • This study also included an exploration of parents concern related to their child's growth at first year of primary school education.

Nutrition support and intervention preferences of cancer survivors.

INTRODUCTION: Ascertaining cancer survivors' specific needs and preferences regarding nutrition information delivery is important in developing and designing future health interventions in oncology. The present study aimed to explore the nutrition information needs of cancer survivors and their preferences regarding intervention delivery. METHODS: The present study is a mixed-methods study comprising a cross-sectional survey and focus groups. Participants were eligible for inclusion if they were aged ≥ 18 years, living in Ireland with a cancer diagnosis and had completed treatment at least 6 months previously. Cancer support centres promoted the online survey on social media. Focus groups were conducted with 20 individuals. RESULTS: The cohort (n = 56) was predominantly female (n = 50; 89.3%) breast cancer survivors (n = 42; 75%). Seven (12.5%) had received nutrition advice from a dietitian. Most were interested in receiving nutrition advice (n = 52; 92.9%), with variability in delivery mode. There was interest in improving sleep quality (n = 35; 62.5%), making positive lifestyle changes (n = 28; 50%) and accessing cancer-specific physical activity classes (n = 27; 48.2%). The best time to deliver information was throughout the cancer journey (n = 31; 55.4%). Time and motivation (n = 15; 26.8%) were the main barriers. Facilitators were keeping healthy (n = 42; 75%) and weight maintenance (n = 31; 55.4%). Four themes emerged from thematic analysis: lack of nutrition guidance, an abundance of misinformation, one size does not fit all and dietitians as the preferred source of advice. CONCLUSIONS: There is a desire for evidence-based nutrition advice and for dietitians to be integrated into cancer clinics and cancer survivorship care. This research guides future nutrition interventions to improve cancer survivorship outcomes.

Sources of nutrition advice and desired nutrition guidance in oncology care: Patient's perspectives.

BACKGROUND: The present study aimed to describe the proportion of cancer patients and survivors who receive nutrition advice, the sources of that advice and to explore the nutrition advice this cohort would like to have received. METHODS: A descriptive cross-sectional survey was completed by 211 cancer patients and survivors recruited through two hospitals in the North-West of Ireland. The survey consisted of open-ended and closed questions that aimed to explore the provision of and sources of nutrition advice and desired guidance in this cohort. Descriptive analysis was conducted using SPPS, while open-ended questions underwent thematic analysis. RESULTS: Respondents were mainly female (n = 133; 63%), aged 50-69 years old (n = 118; 56%), attending the outpatient department (n = 128; 60.7%) and < 5 years since diagnosis (n = 150; 71.7%). Breast (n = 69; 32.7%) was the most common cancer type. Respondents experienced a mean ± SD of 5 ± 3.1 nutrition impact symptoms. The most common was changes in taste/smell (n = 122; 57.8%). Although 53.6% (n = 113) reported being given advice, only 34.1% (n = 72) received this advice from a dietitian. The main sources of nutritional advice were friends and family. Respondents expressed their desire for nutrition advice from a dietitian and that this should be individualised, clear and practical. There was also a desire to avoid misinformation and uncertainty. CONCLUSIONS: The results of the present study can be used to help tailor nutrition support for this group. There is a need to ensure that patients and survivors consistently receive evidence-based advice tailored to their needs, cancer type and treatment stage.

A qualitative study into cancer survivors' relationship with nutrition post-cancer treatment.

In Ireland, one in every 25 individuals is living with and beyond cancer, placing survivorship care at the forefront of strategic planning and service requirements. Several unmet needs of cancer survivors were identified in the National Cancer Strategy 2017-2026. Further reports from national bodies have highlighted how these unmet needs, including those of a nutritional nature, have not been prioritised. In Ireland, little information is available on how cancer diagnosis changes cancer survivors' perceptions of food and nutrition. Thus, this study aimed to describe cancer survivors' relationship with nutrition. Survivors who lived on the Island of Ireland and were at least 6 months post-treatment were eligible. Five semi-structured focus groups and two individual interviews were conducted online (n = 20). Focus groups and interviews were analysed using thematic analysis. The cohort was mostly female breast cancer survivors (n = 12) with an average age of 51.3 ± 12 years. Emergent themes illustrated how a cancer diagnosis appears to motivate cancer survivors to immediate positive dietary changes. Many new dietary introductions were in line with cancer survivor recommendations, while dietary supplement use and some nonevidence-supported actions were revealed. A minority of participants continued their original dietary intake prior to their diagnosis. Participants reported the impact of treatment-related side effects on their relationship with nutrition. The participants emphasised a desire to receive dietary advice from health professionals while undergoing treatment and survivorship.

Online nutrition information for cancer survivors.

BACKGROUND: This research aims to systematically review a comprehensive sample of websites (English-language) that provide information on nutrition after cancer treatment. METHODS: In consultation with cancer survivors and experts, we developed search strings for an internet search (incognito mode in Google Chrome) to be completed in six English-speaking countries (Ireland, the United Kingdom, Australia, New Zealand, Canada and the United States); the first 10 results were chosen for each search). Websites/web pages were included if the links related to sites/content that provided information on health post-treatment in English and aimed at adults (aged above 18 years). Several tools were applied to test the quality, readability and usability of the websites/weblinks. RESULTS: Initially, 720 links were found, with 159 eligible for inclusion. Those eligible for review were charity/support/non-governmental organisation weblinks (49.1%) that originated in the United States (42.8%) and did not specify a particular cancer type (65.4%). One-third (n = 59, 37.1%) of these links contained nutrition guidance; however, these lacked practical implementation strategies. Most of the websites/web pages were not Health On the Net certified and lacked overall quality, with a mean International Patient Decision Aids Standards score of 20.4/40 and a Journal of the American Medical Association score of 1/4. Readability failed to meet ideal levels. Only 32.5% (n = 13) of the web pages/weblinks met the benchmark for usability. CONCLUSION: Cancer survivors seeking nutrition information online may encounter difficulty locating advice, and where they do, it is unlikely to contain guidance on implementation into day-to-day life. This is concerning, given the important role nutrition can play in cancer survivorship.

Use of Ripple Effects Mapping to assess student-perceived benefits of undergraduate research and learning objective attainment with Irish nutrition students.

Ripple Effects Mapping (REM) is a qualitative data analysis approach that combines mind mapping with inductive analysis to condense data obtained from group interviews. One benefit of REM is the ability to identify unintended outcomes, or "ripples," of the intervention of interest. Ripples are visually represented by a mind map created during the REM session. Mind maps connect related concepts, typically with the main concept in the center of the map and supporting ideas radiating from a central node. This project applied REM to undergraduate course evaluation. The purpose of this study was threefold: to use REM to identify undergraduate student-perceived benefits of research projects, to assess whether REM could be used to confirm achievement of course learning objectives, and to compare the themes identified from the mind mapping component of REM to those identified by inductive analysis. Mind maps were generated with Xmind (Xmind Ltd., Hong Kong) during online sessions by two groups of students, those who completed a "mandatory" research project (n = 11) and those who chose to participate in an additional "optional" research project (n = 9). There was considerable overlap in identified themes between mind mapping and inductive analysis, with skills, relationships, career direction, and unexpected benefits identified by both techniques. Mind mapping identified several additional themes. Findings from both approaches were compared to course learning objectives, and both confirmed that all objectives were met. In situations where time is a limiting factor, mind mapping could be superior to the complete REM approach for course learning objective assessments.NEW & NOTEWORTHY This study used Ripple Effects Mapping (REM) to identify undergraduate student-perceived benefits of research projects, to assess whether REM could confirm achievement of course learning objectives for a research project-based course, and to compare themes identified from the mind mapping component of REM to those identified by inductive analysis. Mind mapping confirmed achievement of course objectives and may be a better choice compared to inductive reasoning when time is limited.

Cancer survivorship, excess body fatness and weight-loss intervention-where are we in 2020?

Earlier diagnosis and more effective treatments mean that the estimated number of cancer survivors in the United Kingdom is expected to reach 4 million by 2030. However, there is an increasing realisation that excess body fatness (EBF) is likely to influence the quality of cancer survivorship and disease-free survival. For decades, the discussion of weight management in patients with cancer has been dominated by concerns about unintentional weight loss, low body weight and interventions to increase weight, often re-enforced by the existence of the obesity paradox, which indicates that high body weight is associated with survival benefits for some types of cancer. However, observational evidence provides strong grounds for testing the hypothesis that interventions for promoting intentional loss of body fat and maintaining skeletal muscle in overweight and obese cancer survivors would bring important health benefits in terms of survival outcomes and long-term impact on treatment-related side effects. In this paper, we outline the need for studies to improve our understanding of the health benefits of weight-loss interventions, such as hypocaloric healthy-eating plans combined with physical activity. In particular, complex intervention trials that are pragmatically designed are urgently needed to develop effective, clinically practical, evidence-based strategies for reducing EBF and optimising body composition in people living with and beyond common cancers.

Plant- and animal-based diet quality and mortality among US adults: a cohort study.

Not all plant-based and animal foods exert the same health effects due to their various nutrient compositions. We aimed to assess the quality of plant-based v. animal foods in relation to mortality in a prospective cohort study. Using data collected from a nationally representative sample of 36 825 adults in the National Health and Nutrition Examination Survey 1999-2014, we developed a de novo Comprehensive Diet Quality Index (cDQI) that assesses the quality of seventeen foods based on the healthfulness and separately scored the quality of eleven plant-based foods in a plant-based Diet Quality Index (pDQI) and six animal foods in an animal-based Diet Quality Index (aDQI). Mortality from all causes, heart disease and cancer were obtained from linkage to the National Death Index up to 31 December 2015. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95 % CI after multivariable adjustments. During a median follow-up of 8·3 years, 4669 all-cause deaths occurred, including 798 deaths due to heart disease and 1021 due to cancer. Compared with individuals in the lowest quartile, those in the highest quartile of cDQI had a lower risk of all-cause mortality (HR 0·75, 95 % CI 0·65, 0·86; Ptrend < 0·001), which largely reflected the inverse relationship between quality of plant-based foods (pDQI) and all-cause mortality (HR 0·66, 95 % CI 0·58, 0·74; Ptrend < 0·001). No independent association was found for the quality of animal foods (aDQI) and mortality. Our results suggest that consuming healthy plant-based foods is associated with lower all-cause mortality among US adults.

Applying the thresholds for clinical importance for fourteen key domains of the EORTC QLQ-C30: a latent class analysis of cancer survivors.

A person's quality of life is impacted from the beginning of their oncology experience. One of the most common tools to measure quality of life is the EORTC QLQ-C30. The absolute scores it produces can be difficult to interpret in the clinical setting, and thresholds to help identify those who require intervention have recently been introduced. The aim of this research was to identify heterogeneity of these thresholds for clinical importance using latent class analysis in cancer survivors (those undergoing and those who have completed treatment) attending a hospital in the northwest of Ireland. We identified 3 distinct classes of cancer survivors, using Mplus 6.11: high clinical impact (13.9%), compromised physical function (40.3%) and low clinical impact (45.9%). The compromised physical function group were slightly more likely to be older (OR = 1.042, p < .05, CI = 1.000-1.086), not employed (OR = 8.347, p < .01, CI = 2.092-33.305), have lower PG-SGA scores (OR = .826, p < .001, CI = .755-.904), and not have been diagnosed in the last 2 years (OR = .325, p < .05, CI = .114-.923) compared to the high clinical impact group. The low clinical impact group were more likely to be female (OR = 3.288, p < .05, CI = 1.281-1.073), not employed (OR = 10.129, p < .01, CI = 2.572-39.882), have a lower BMI (OR = .921, p < .05, CI = .853-.994), and lower PG-SGA scores (OR = .656, p < .001, CI = .573-.750) than the high clinical impact group. Functional and symptom issues impact on quality of life, and therefore, identifying those of clinical importance is crucial for developing supportive care strategies.

Providing nutrition advice in the oncology setting: A survey of current practice, awareness of guidelines and training needs of Irish healthcare professionals in three hospitals.

OBJECTIVE: To determine the current practices of Irish healthcare professionals working in the oncology setting of three hospitals in the north-west of Ireland with regard to nutrition screening, provision of nutrition advice and training needs. METHODS: This cross-sectional study distributed a questionnaire to healthcare professionals in the oncology departments of three hospitals between November 2018 and April 2019. Data were analysed using SPSS, and one open-ended question underwent thematic analysis. RESULTS: Fifty-one individuals completed the survey. 98.1% rated nutrition as very or critically important in cancer management. 74.5% nutritionally screen inpatients while only 17.6% screen outpatients. The majority (86.3%) provide nutrition advice to patients, yet only 19.6% collect data on nutrition status. Doctors and nurses report low levels of confidence and lack of awareness of guidelines. 78.4% of respondents were interested in further training in oncology nutrition, preferably through a conference study day. Respondents reported that early nutrition intervention and integration into current practice is important, there is a current lack of resources and they recognised a need for different interventions depending on cancer type and stage. CONCLUSION: Current practice varies; however, positive attitudes towards nutrition and interest in additional training were found.

A review of iPhone and Android apps for cancer patients and survivors: assessing their quality, nutrition information and behaviour change techniques.

BACKGROUND: The present study reviewed the quality, nutrition content and behaviour change techniques (BCTs) of apps aimed at those with cancer. METHODS: The Apple App Store and Androids' Google Play were searched in March 2020. Apps were scored for accountability as per Silberg's standards, quality as per the Mobile Application Rating Scale, and BCTs using the CALO-RE Taxonomy. Nutrition content was summarised and a checklist developed from the European Society for Parenteral and Enteral Nutrition (ESPEN) cancer and nutrition guidelines and the World Cancer Research Fund (WCRF) guidelines for Cancer Survivors. RESULTS: Twelve apps were identified, mean (SD) accountability score was 2.7/8 (2.0) (range 0-6) and quality score was 2.9/5 (0.6) (range 1.7-3.7). Overall, 11 BCTs were used (range 0-8 per app). Nutrition content focussed on healthy eating and meeting energy needs. There was a lack of strategies for implementation and no indication of whether the advice was more suited for specific cancer types, stages or treatment. Limited reference was made to recommendations of ESPEN and the WCRF. A strong positive relationship between quality and number of BCTs was found (r = 0.805, n = 9, P = 0.01). CONCLUSIONS: Little nutrition information is currently included on publicly available apps aimed at those with a cancer diagnosis.

Female cancer survivors are more likely to be at high risk of malnutrition and meet the threshold for clinical importance for a number of quality of life subscales.

BACKGROUND: The present study aimed to explore malnutrition risk, handgrip strength and quality of life (QOL) in cancer survivors. METHODS: In total, 232 individuals completed a demographic questionnaire, Patient-Generated Subjective Global Assessment Short Form and the European Organization for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C30). Handgrip strength was determined using a spring-loaded handgrip dynamometer and anthropometric measurements were taken by an oncology nurse. Frequencies and distribution data, analysis of variance and chi-squared tests were then conducted. RESULTS: The majority of the cohort were female (n = 141; 60.8%) had breast cancer (n = 62; 26.7%) and the mean ± SD body mass index (BMI) was 26.6 ± 6.2 kg m-2 . Less than a one-third reported seeing a dietitian (n = 68; 29.3%). Over one-third reported recent weight loss (n = 88; 37.3%). Some 40.9% (n = 95) were at moderate to high risk of malnutrition, with women more likely than men to be classified as high risk (p < 0.05). Mean ± SD handgrip strength was 25 ± 15 kg and this differed significantly by gender (p = 0.00), cancer type (p = 0.01) and BMI classification (p = 0.01). One-fifth of individuals were classified as having dynapenia (n = 48; 21.1%). Median (interquartile range) QOL score was 66.7 (33.3). The proportion of individuals meeting the threshold for clinical importance for QOL subscales ranged from 12.5% (constipation) to 42.7% (physical functioning). Females were more likely than males to meet the threshold for physical functioning (p = 0.00), fatigue (p = 0.02) and pain (p = 0.01). CONCLUSIONS: Females are more likely than males to be at high risk of malnutrition and meet the threshold for clinical significance for several QOL subscales.

Future trends in social inequalities in obesity in England, Wales and Scotland.

BACKGROUND: Previous studies have shown persistent or increasing socioeconomic inequalities in obesity in many European countries. The aim of this study was to project trends in social inequalities in obesity to 2035 in male and female adults (aged 16+) in the UK to ascertain if the gap is widening or narrowing. METHODOLOGY: BMI data for the UK were extracted from the Health Survey for England (2004-14), Scottish Health Survey (2008-14) and the Welsh Health Survey (2004-14), respectively. A non-linear multivariate regression model was fitted to cross-sectional risk factor data to create longitudinal projections to 2035 stratified by sex, and occupational status or education level. RESULTS: Individuals in routine and manual jobs are projected to have the highest prevalence of obesity by 2035 and to experience the highest increases in obesity prevalence to 2035. Social inequalities based on occupation are projected to widen (except in English females). Social inequalities based on education are projected to decrease (except in Welsh females). DISCUSSION: A population strategy of prevention focused on the structural determinants of obesity is needed to change the trajectory of obesity prevalence trends and to tackle health inequalities.

Morbid obesity in the UK: A modelling projection study to 2035.

Background: Morbid obesity (body mass index ⩾40 kg/m2) carries a higher risk of non-communicable disease and is associated with more complex health issues and challenges than obesity body mass index ≥30kg/m2 and <40kg/m2, resulting in much higher financial implications for health systems. Although obesity trends have previously been projected to 2035, these projections do not separate morbid obesity from obesity. This study therefore complements these projections and looks at the prevalence and development of morbid obesity in the UK. Methods: Individual level body mass index data for people aged >15 years in England, Wales (2004-2014) and Scotland (2008-2014) were collated from national surveys and stratified by sex and five-year age groups (e.g. 15-19 years), then aggregated to calculate the annual distribution of healthy weight, overweight, obesity and morbid obesity for each age and sex group. A categorical multi-variate non-linear regression model was fitted to these distributions to project trends to 2035. Results: The prevalence of morbid obesity was predicted to increase to 5, 8 and 11% in Scotland, England and Wales, respectively, by 2035. Welsh women aged 55-64 years had the highest projected prevalence of 20%. In total, almost five million people are forecast to be classified as morbidly obese across the three countries in 2035. Conclusions: The prevalence of morbid obesity is predicted to increase by 2035 across the three UK countries, with Wales projected to have the highest rates. This is likely to have serious health and financial implications for society and the UK health system.

Nutrition guidance for cancer patients and survivors-A review of the websites of Irish healthcare and charitable organisations and cancer centres.

OBJECTIVE: To determine availability of nutrition information for cancer patients and survivors from Irish healthcare organisations, cancer charity and support groups and assess its quality and readability. DESIGN: Cross-sectional. SETTING: The National Health Service Executive websites were searched, as were the sites of the ten largest cancer charities/support groups identified through the Benefacts website. An additional internet search was conducted to ensure no large organisations/support groups were missed (February 2019). Quality of nutrition content was assessed using an evidence-based checklist and readability assessed using two validated formulas. RESULTS: Thirty-two websites were identified, five contained nutrition information for cancer patients (15.6%), and three for cancer survivors (9.3%). The quality of the nutrition content ranged from 19.5 to 29/40 (mean ± SD, 23.2 ± 3.2; median = 21, interquartile range (IQR) = 7). There was a lack of practical strategies for implementation. Only 40% of material had an acceptable readability level (sixth-seventh grade level). Readability scores (mean ± SD) were 68.5 ± 6.0 for Flesch Reading Ease Score and 7.8 ± 1.1 for Flesch-Kincaid Grade Level Score. CONCLUSION: There is limited nutrition information on Irish health and cancer websites and in particular very few tailored to cancer survivors. Irish health and cancer organisations should consider providing nutrition information that is easily accessible to all.

Are dietary interventions with a behaviour change theoretical framework effective in changing dietary patterns? A systematic review.

BACKGROUND: The term 'whole dietary pattern' can be defined as the quantity, frequency, variety and combination of different foods and drinks typically consumed and a growing body of research supports the role of whole dietary patterns in influencing the risk of non-communicable diseases. For example, the 'Mediterranean diet', which compared to the typical Western diet is rich in fruits and vegetables, whole grains, and oily fish, is associated with reduced risk of cardiovascular disease and cancer. Social Cognition Models provide a basis for understanding the determinants of behaviour and are made up of behavioural constructs that interventions target to change dietary behaviour. The aim of this systematic review was to provide a comprehensive assessment of the effectiveness and use of psychological theory in dietary interventions that promote a whole dietary pattern. METHODS: We undertook a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis to synthesize quantitative research studies found in Embase, Medline, PsycInfo, CINAHL and Web of Science. The studies included were randomised and non-randomised trials published in English, involving the implementation of a whole dietary pattern using a Social Cognition Model to facilitate this. Two independent reviewers searched the articles and extracted data from the articles. The quality of the articles was evaluated using Black and Down quality checklist and Theory Coding Scheme. RESULTS: Nine intervention studies met the criteria for inclusion. Data from studies reporting on individual food group scores indicated that dietary scores improved for at least one food group. Overall, studies reported a moderate application of the theory coding scheme, with poor reporting on fidelity. CONCLUSION: To our knowledge, this is the first review to investigate psychological theory driven interventions to promote whole dietary patterns. This review found mixed results for the effectiveness of using psychological theory to promote whole dietary pattern consumption. However, the studies in this review scored mostly moderate on the theory coding scheme suggesting studies are not rigorously applying theory to intervention design. Few studies reported high on treatment fidelity, therefore, translation of research interventions into practice may further impact on effectiveness of intervention. Further research is needed to identify which behaviour change theory and techniques are most salient in dietary interventions.

Energy drinks available in Ireland: a description of caffeine and sugar content.

OBJECTIVE: To describe the caffeine and sugar content of all energy drinks available on the island of Ireland. DESIGN: Two retail outlets were selected from each of: multinational, convenience and discount stores in Northern Ireland and the Republic of Ireland, and all available single-serve energy drinks were purchased. The cross-sectional survey was conducted in February 2015 and brand name, price, volume, caffeine and sugar content were recorded for each product. Descriptive analysis was performed. RESULTS: Seventy-eight products were identified on the island of Ireland (regular, n 59; diet/sugar-free/light, n 19). Caffeine and sugar content was in the range of 14-35 mg and 2·9-15·6 g per 100 ml, respectively. Mean caffeine content of 102·2 mg per serving represents 25·6 % of the maximum intake advised for adults by the European Food Safety Authority. Per serving, mean sugar content of regular energy drinks was 37 g. This exceeds WHO recommendations for maximum daily sugar intake of <5 % of total energy intake (25 g for adults consuming 8368 kJ (2000 kcal) diet). If displaying front-of-pack labelling, fifty-seven of the fifty-nine regular energy drinks would receive a Food Standards Agency 'red' colour-coded label for sugar. CONCLUSIONS: Energy drinks are freely available on the island of Ireland and all products surveyed can be defined as highly caffeinated products. This has potential health issues particularly for children and adolescents where safe limits of caffeine have not been determined. Energy drinks surveyed also contained high levels of sugar and could potentially contribute to weight gain and adverse dental health effects.

Effects of daily consumption of one or varied peanut flavors on acceptance and intake.

To realize the health benefits associated with peanut consumption, it is important that they remain acceptable with regular intake. Peanuts are marketed with various flavorings so that consumers will not become fatigued by frequent consumption of any single flavor. This study sought to determine whether liking of peanuts or compliance to a peanut feeding intervention would differ based on receiving an individual flavor or a variety of flavors. Participants (n=151) were directed to consume 42 g peanuts/d for 12 weeks as 14-g servings of 3 different flavors (n=50) or a single flavor (n=25-26/group). The trial was randomized, with a parallel-group design. Neither the peanut flavor consumed nor the presence of variety had an impact on liking of the peanuts or compliance with the study protocol (p>0.05). Men had significantly greater compliance and liking ratings than women (p<0.05), but liking declines did not differ based on sex. Eating attitudes and dietary restraint did not correlate with liking or compliance. Peanuts were generally well-liked in the study, with a mean liking of 69 on a 100-mm visual analogue scale and a decrease of less than 15% over 12 weeks. Overall compliance to the protocol was 96.9%, suggesting participants were able to incorporate peanuts into their diet on a daily basis. These findings suggest a recommendation to regularly consume peanuts would be well-tolerated, facilitating their contribution to a healthy diet. The study was conducted between February 2010 and May 2012 at Purdue University, West Lafayette, IN, USA. This trial was registered at clinicaltrials.gov as NCT01886326.

Qualitative Analysis Following the Delivery of a Farmer Lifestyle Program.

BACKGROUND: Irish farmers are adversely affected by noncommunicable diseases. Although there has been an increase in farmer health promotion activities in Ireland, farmers views on lifestyle programs are currently unknown. OBJECTIVES: To qualitatively analyze the impact of the previously mentioned 6-week physical activity and health education intervention on farmer health and to investigate how best to support this cohort moving forward. METHODS: A qualitative study was conducted online (two interviews, three focus groups) with fourteen Irish farmers (53.5 ± 6.5 years) who completed the 6-week program in December 2019. Interviews and focus groups were recorded, transcribed, and analyzed for themes. RESULTS: The main themes that emerged from this study were barriers, facilitators, and recommendations for lifestyle programs aimed to improve farmer health. Additional views on health and lifestyle behaviors were mentioned. Time of year was reported as the main barrier for farmers to engage in lifestyle programs. The key facilitators reported by farmers were the social health benefits obtained from the program and the farmer-specific nature of the program. Farmers suggested that physical activity and health education programs that are farmer-specific, delivered locally and catering for all fitness abilities should be more widely available to them. Although some farmers reported that they maintained the lifestyle behaviors they established during the initial 6-week program, follow-up supports are needed to encourage sustainable behavior change. CONCLUSIONS: Interventions that are farmer-specific, community-based, and feasible within the context of available resources may be effective in improving farmer health. Working in partnership with organizations that support farmers has the potential to improve farmer health.