Associations between Maternal Nutrition and the Concentrations of Human Milk Oligosaccharides in a Cohort of Healthy Australian Lactating Women.

Human milk oligosaccharides (HMOs) are complex glycans associated with positive infant health outcomes. The concentrations of HMOs in the milk of lactating women are associated with substantial intra- and inter-individual differences and may be influenced by maternal physiological and/or nutrition-related factors. The primary aim of this study was to explore potential influences of short-term maternal diet and current body composition on HMO profiles in mature human milk. Milk samples were collected at 3-4 months postpartum from 101 healthy Australian women using standardised procedures, and analysed for macronutrients (lactose, fat, and protein). In addition, HMO concentrations were analysed using liquid-chromatography mass-spectrometry (LC-MS). Maternal dietary data were collected using three validated 24-h dietary recalls, and the body composition of a subgroup of mothers was assessed by DEXA scans (n = 30). Most (79%) of the women were secretor-positive. Individual nutrients were not significantly correlated with HMO concentrations after correction for multiple comparisons (p > 0.05), except for dietary folate intake. DEXA scans revealed no associations between HMO profiles and maternal body composition during established lactation. The study findings suggest a lack of clear and consistent associations between maternal nutrition and HMO concentrations in mature human milk from healthy lactating women with adequate dietary intake. The prevailing influence of genetic variation in lactating mothers may overshadow any impact of maternal nutritional and/or physiological status on HMO composition in mature human milk.

Postmenopausal women's experiences of weight maintenance following a very low energy diet.

Introduction: Very low energy diets (VLEDs) effectively induce substantial weight loss in people with obesity, yet they are rarely used as a first line treatment. There is a belief that such diets do not teach the lifestyle behavior changes needed for long-term weight maintenance. However, little is known about the lived experiences of people who have lost weight on a VLED in the long term. Methods: This study aimed to explore the behaviors and experiences of postmenopausal women who had followed a 4-month VLED (using total meal replacement products [MRPs]), followed by a food-based, moderately energy-restricted diet for an additional 8 months, as part of the TEMPO Diet Trial. Qualitative in-depth semi-structured interviews were conducted with 15 participants at 12 or 24 months (i.e., at 8 or 20 months post diet completion). Transcribed interviews were analyzed thematically using an inductive approach. Results: Undertaking a VLED was reported by participants to confer advantages in weight maintenance that previous weight loss attempts had not been able to do for them. Firstly, the rapid and significant weight loss, in conjunction with ease of use, was motivational and helped instill confidence in the participants. Secondly, the cessation of a normal diet during the VLED was reported by participants to break weight gain-inducing habits, allowing them to abandon unhelpful habits and to introduce in their place more appropriate attitudes toward weight maintenance. Lastly, the new identity, helpful habits and increased self-efficacy around weight loss supported participants during weight maintenance. Additionally, participants reported that ongoing occasional use of MRPs provided a useful and easy new strategy for countering weight regain and supporting their weight maintenance regimen. Conclusion: Among the participants in this qualitative study, most of whom had maintained a loss of over 10% of their baseline body weight at the time of interview, using a VLED in the context of a clinical weight loss trial conferred confidence, motivation and skills for weight maintenance. These findings indicate that VLEDs with clinical support could be successfully leveraged to set up behaviors that will support weight maintenance in the long term.

Equipping nutrition graduates for the complex realities of practice: Using practitioner perspectives and experiences to inform authentic sustainability curriculum.

BACKGROUND: Nutrition professionals function at the nexus of food, nutrition status and the myriad of determinants influencing these. However, defining our role in food system transformation requires a multifaceted and deep understanding of sustainability in the context of nutrition and dietetics (N&D). Practitioner perspectives and experiences provide a rich source of practice wisdom that can inform authentic curriculum to equip students for the complex realities of practice; however, there is limited understanding of these in the Australian higher education setting. METHODS: Qualitative methodology using semistructured interviews with 10 Australian N&D professionals. Thematic analysis was used to understand how they perceive opportunities and barriers for integrating sustainability into practice. RESULTS: Practitioners' experience in sustainability practice varied. Themes were identified in two categories: opportunities and barriers. Themes that reflected future practice opportunities included "Preparing the workforce" (for academics and practitioners interfacing with students), "Practical individual level work" and "System level and policy interests". Themes that were considered barriers to integrating sustainability in practice included "lack of contextual evidence" and "complexity and competing priorities". CONCLUSIONS: Our findings make a novel contribution to the current literature as we recognise practitioners as a source of experience anticipating where sustainability and nutrition practice intersect. Our work provides practice-informed content and context that may assist educators to create authentic sustainability-focused curriculum and assessment to replicate the complexity of practice.

Beyond the BMI: Validity and Practicality of Postpartum Body Composition Assessment Methods during Lactation: A Scoping Review.

The assessment of body composition during lactation is an important indicator of maternal nutritional status, which is central to the overall health of the mother and child. The lactating woman's nutritional status potentially impacts on breastmilk composition and the process of lactation itself. The purpose of this scoping review was to synthesize comparative studies that sought to validate various body composition assessment techniques for use in lactating women in the postpartum period. Using the PRISMA-ScR guidelines, a comprehensive, systematic literature search was conducted using Scopus, Web of Science, and PubMed. Eight comparative studies were included in the review, with data from 320 postpartum women. The design methodologies varied substantially across studies, and included a range of simple techniques to advanced multi-compartment models for assessing body composition. The validity and reliability of measurement tools must be considered alongside issues of safety, practicality, and appropriateness to guide the research design when applied to lactating women.

"Dietitians May Only Have One Chance"-The Realities of Treating Obesity in Private Practice in Australia.

INTRODUCTION: Overweight and obesity are the leading contributors to non-fatal burden of disease in Australia. Very low energy diets (VLEDs) comprising of meal replacement products (MRP) effectively induce substantial weight loss in people with obesity, yet they are rarely used as a first line treatment. Dietitians in private practice are perfectly placed to administer treatments for obesity; however, little is known about the preferred interventions used or their attitudes to incorporating VLEDs and MRPs into their treatments for overweight and obesity. METHODS: This study used descriptive qualitative methods to explore accredited practicing dietitians' (APDs') perspectives and practices regarding obesity and obesity interventions, including the use of VLEDs and MRPs. Qualitative in-depth semi-structured interviews were conducted with 20 dietitians who had experience in private practice and in treating obesity. Transcribed interviews were analysed thematically using the technique of template analysis. RESULTS: In the context within which dietitians' practice was found to be a barrier to using evidence-based practice (EBP) for obesity treatment, four overarching themes were found. These were: (1) patient-centred care is the dietitians' preferred intervention model; (2) VLEDs promote weight loss in specific situations; (3) systemic barriers constrain effective dietetic practice and equitable access to all, and (4) successful outcomes are predicated on working outside of systemic barriers. CONCLUSION: Dietitians in private practice are well placed and able to provide life-enhancing and evidence-based treatments for overweight and obesity and associated chronic disease in the community. However, systemic barriers need to be addressed to provide equitable access to effective care irrespective of socio-economic status.

Low vegetable intake in pregnancy and associated maternal factors: A scoping review.

Healthy eating is identified as a priority in pregnancy. Vegetables are low-energy, nutrient-dense foods that support health. Needs of populations differ by demographics; as such, there is a need to investigate vegetable intake in pregnant women of lower socioeconomic status (SES). The aim of this scoping review was (1) to describe vegetable intake during pregnancy in servings or grams and compare vegetable intake to recommendations and (2) to explore the relationship between vegetable intake during pregnancy and maternal SES characteristics. Using Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, studies were identified in a search of electronic databases (MEDLINE, Web of Science, Global Health, and Scopus) published up to July 2021. All observational studies assessing vegetable intake in pregnancy, written in English, and conducted in an energy-replete context worldwide were included for review. Forty-seven publications met inclusion criteria. Although vegetable intake of pregnant women varies across populations, vegetable intake falls below recommendations worldwide. Studies investigating older age (n =9), higher education (n =7), higher income (n =4), and vegetable intake consistently found a positive association, whereas a negative association with food insecurity (n =4) was identified. Other variables explored that may influence vegetable intake was limited and too fragmented to generalize. Inconsistencies and possible inaccuracies in reporting vegetable intake may be related to the considerable variation in tools used for assessing vegetable intake. In conclusion, low vegetable intake in pregnancy needs to be addressed, with a particular focus on women of lower SES because of greater vulnerability to low vegetable intake.

Sustainability in Nutrition: Potential Guiding Statements for Education and Practice.

OBJECTIVE: To explore and synthesize local and practice-based perspectives of sustainability to develop a set of proposed guiding thematic statements that will assist academics to contextualize, prioritize, and integrate sustainability-focused activities or a sustainability lens in a nutrition and dietetic (N&D) program. DESIGN: Participatory action research process using an online survey, workshop, and interviews. SETTING: Australian Regional University. PARTICIPANTS: A total of 95 N&D undergraduate students, 7 N&D academics, and 10 Australian nutrition practitioners. PHENOMENON OF INTEREST: Sustainability in N&D learning, teaching, and practice. ANALYSIS: Qualitative inductive content analysis of responses from each participant group and combined themes. RESULTS: There were 4 key themes, each comprising 4-8 subthemes, identified as follows: sustainability thinking, future-focused views, stewardship, and sustaining the nutrition profession. CONCLUSIONS AND IMPLICATIONS: There may be opportunities for N&D competencies in Australia to better reflect the ways of being that sustainability in nutrition practice means. Confirmation of these findings among other N&D professionals (academics and practitioners) and students, both in Australia and elsewhere, is warranted to further develop these proposed statements. Future research is needed to describe more explicitly what sustainability looks like in practice, providing specific examples to assist educators to frame sustainability authentically.

Human Milk Oligosaccharide Profiles and Associations with Maternal Nutritional Factors: A Scoping Review.

Human milk oligosaccharides (HMOs) are complex unconjugated glycans associated with positive infant health outcomes. This study has examined current knowledge of the effect of maternal diet and nutritional status on the composition of HMOs in breast milk. Using the PRISMA-ScR guidelines, a comprehensive, systematic literature search was conducted using Scopus, Web of Science, Global Health (CABI), and MEDLINE. Titles and abstracts were screened independently by two reviewers against predefined inclusion and exclusion criteria. Fourteen studies met the inclusion criteria and reported on maternal dietary intake (n = 3), maternal body composition indices (n = 9), and dietary supplementation interventions (n = 2). In total, data from 1388 lactating mothers (4011 milk samples) were included. Design methodologies varied substantially across studies, particularly for milk sample collection, HMO analysis, dietary and body composition assessment. Overall, this review has identified potential associations between maternal dietary intake and nutritional status and the HMO composition of human milk, though an abundance and sufficiency of evidence is lacking. Standardised procedures for human milk sample collection and HMO analysis, along with robust and validated nutrition assessment techniques, should be employed to further investigate the impact of maternal nutritional factors on HMO composition.

Mothers' experiences with complementary feeding: Conventional and baby-led approaches.

AIM: Lifelong eating behaviours are shaped in infancy with the introduction of solid foods (complementary feeding). A conventional approach to complementary feeding, encompassing spoon feeding of pureed foods, has long been the standard. Baby-led weaning is a contemporary approach whereby the infant is encouraged to choose what and how much they eat. Mothers navigate decisions about what and how to introduce foods to their infant in diverse ways. This study set out to explore the complementary feeding approaches of women. METHODS: A qualitative study utilising photovoice and focus groups generated data that provided insight into women's lived experiences of complementary feeding. Thirteen women were purposively sampled and data were analysed in line with descriptive phenomenology. RESULTS: Three recurrent themes emerged from the data. Women's approaches to complementary feeding were mediated by "trust," "convenience" and making decisions that were "value based versus practical based." Trust manifested in various forms including trusting the infant, trusting women's own instincts and the tension between social pressures and trust of self. CONCLUSIONS: Differences between women following a conventional vs baby-led approach were also seen in perceptions of convenience, and the decision-making process. This study provides insight into how and why women choose certain feeding practices and can be used to better equip health professionals to work with new mothers in providing realistic and nuanced feeding support.

Dietetics students' construction of competence through assessment and placement experiences.

AIM: Competency standards are widely adopted as a framework to describe standards of performance required in the workplace. Little is known, however, about how students construct competence. This qualitative study aimed to explore how dietetics students ready to graduate construct the concept of competence and the role of assessment in developing professional competence. METHODS: A qualitative description was used to gather data from a convenience sample of students ready to graduate from universities with accredited dietetics programs across Australia (10 out of 15 at the time of the study). A total of 11 focus groups were conducted to explore perspectives of competence and experiences of 'competency-based' assessment. Data were audio-recorded, transcribed and analysed using a thematic analysis approach. RESULTS: A total of 81 (n = 81) participants across 10 universities representing 22% of total students participated in the focus groups. Themes revealed that: (i) there is no shared understanding of competence; (ii) current work placement experiences may not reflect current standards or workforce needs; (iii) assessment approaches may not fully support the development of competence; and (iv) the competent performance of supervising dietitians/clinical educators in the workplace influences the construction of competence. CONCLUSIONS: There is a need to work towards a shared understanding of dietetic entry-level competence in the profession. 'Work-based' learning experiences may need to be modified to ensure students meet current competency standards. Practitioners involved in student supervision need to acknowledge the influential role they have in the development of the future workforce.

Online nutrition information seeking among Australian primigravid women.

BACKGROUND: optimal nutrition in pregnancy is crucial for short and long term health in both mother and child. While a large proportion of pregnant women utilise the internet for informational support during pregnancy, little is known about online practices relating to food and nutrition in pregnancy. METHODS: a qualitative study; Semi-structured interviews were undertaken with 16 primigravid women to explore their approaches and preferences when accessing and engaging with pregnancy-related nutrition information online. Women who had accessed the Internet for pregnancy related nutrition and food information were recruited via snowball sampling from South East Queensland, Australia. Data were analysed in accordance with descriptive phenomenology. FINDINGS: food and nutrition information-seeking practices were highly varied but followed a similar overall pathway. Six broad themes were identified "triggers", "access and navigation", "appraisal", "changes in searching frequency", "preferred features" and "engagement with communication approaches". Women preferred online sources that were easy to navigate and presented information clearly. Experience as well as fact based communication appeared to satisfy different informational needs. KEY CONCLUSIONS AND IMPLICATIONS: women search for food and nutrition information online in similar ways to other pregnancy issues. Opportunity for engaging with women online regarding a range of food and nutrition topics may be limited to early in pregnancy unless prompted to via conversations with antenatal service providers. Health practitioners have a role to play in helping women source evidence-based web sites. There is opportunity for organisations with mandates to support women to optimise diet quality during pregnancy, to improve user experience building on key preferences identified in this study to increase appeal and engagement by pregnant women.

Investigating Philosophies Underpinning Dietetic Private Practice.

There is limited theory or knowledge regarding dietitians' practice philosophies and how these philosophies are generated and incorporated into their professional practices. For the purposes of this study, a conceptual framework will explain and define the 'philosophies' as three different types of knowledge; episteme, techne, and phronesis. This study aimed to develop an explanatory theory of how dietitians in private practice source, utilise, and integrate practice philosophies. A grounded theory qualitative methodology was used to inform the sampling strategy, data collection, and analytical processes. Semi-structured interviews with dietitians in private practice were undertaken and data were collected and analysed concurrently. The results show that dietitians form collaborative relationships with their clients, in order to nurture change over time. They use intrinsic and intertwined forms of episteme, techne, and phronesis, which allow them to respond both practically and sensitively to their clients' needs. The learning and integration of these forms of knowledge are situated in their own practice experience. Dietitians adapt through experience, feedback, and reflection. This study highlights that private practice offers a unique context in which dietitians deal with complex issues, by utilising and adapting their philosophies.

Online nutrition information for pregnant women: a content analysis.

Pregnant women actively seek health information online, including nutrition and food-related topics. However, the accuracy and readability of this information have not been evaluated. The aim of this study was to describe and evaluate pregnancy-related food and nutrition information available online. Four search engines were used to search for pregnancy-related nutrition web pages. Content analysis of web pages was performed. Web pages were assessed against the 2013 Australian Dietary Guidelines to assess accuracy. Flesch-Kincaid (F-K), Simple Measure of Gobbledygook (SMOG), Gunning Fog Index (FOG) and Flesch reading ease (FRE) formulas were used to assess readability. Data was analysed descriptively. Spearman's correlation was used to assess the relationship between web page characteristics. Kruskal-Wallis test was used to check for differences among readability and other web page characteristics. A total of 693 web pages were included. Web page types included commercial (n = 340), not-for-profit (n = 113), blogs (n = 112), government (n = 89), personal (n = 36) and educational (n = 3). The accuracy of online nutrition information varied with 39.7% of web pages containing accurate information, 22.8% containing mixed information and 37.5% containing inaccurate information. The average reading grade of all pages analysed measured by F-K, SMOG and FOG was 11.8. The mean FRE was 51.6, a 'fairly difficult to read' score. Only 0.5% of web pages were written at or below grade 6 according to F-K, SMOG and FOG. The findings suggest that accuracy of pregnancy-related nutrition information is a problem on the internet. Web page readability is generally difficult and means that the information may not be accessible to those who cannot read at a sophisticated level. © 2016 John Wiley & Sons Ltd.

Community pharmacy as a setting for public health nutrition action: Australian nutritionists' perspectives.

OBJECTIVE: To explore public health nutritionists' perceptions of nutrition and its place in community pharmacy (CP) presently and into the future; and to explore perceived opportunities, feasibility and scope of public health nutrition (PHN) interventions in CP, with a focus on maternal and infant nutrition. DESIGN: Qualitative data were gathered through semi-structured interviews and drew on hermeneutics as the theoretical framework for analysis and interpretation. SETTING: Queensland, Australia. SUBJECTS: Public health nutritionists, identified through purposive, criterion sampling, were chosen due to (i) their role as potential stakeholders, (ii) their knowledge and emphasis on nutrition and (iii) their practice experience. RESULTS: Opportunities for PHN action focused primarily on actions relating to early nutrient supplementation in pregnancy and breast-feeding protection and promotion. Opportunities in CP were constrained by practitioners' perception of (i) conflict between health care and commercial interests in CP, (ii) problematic practices in CP and (iii) values and motivations of practitioners and other stakeholders in the CP sector. Strategies were suggested to improve practices and enhance the setting from a PHN perspective. Participants suggested both collaborative and regulatory approaches to achieve settings-based changes, identifying the need for these to coexist for effective outcomes. CONCLUSIONS: Public health nutritionists suggest that opportunities for PHN action are constrained by perceived conflicted interests and that consumers need to be adequately protected from the influence of commercial interests. PHN action in this setting needs adequate reflection on evidence as well as ethics ensuring that practices are 'for the good' of mothers and infants.

Understanding community pharmacy intervention practice: lessons from intervention researchers.

BACKGROUND: Community pharmacy (CP) is a setting with health promotion and public health potential which could include strategies with a nutrition promotion focus. Research embedded in this setting has explored and produced evidence to inform practice change to develop this potential. The experience of undertaking research in this setting may provide insight into the challenges and key features of intervention research practice. Exploring experienced-based knowledge presents as a productive area of research, extending what can be known beyond the bounds of what is measurable. OBJECTIVES: This study aimed to understand the experience of intervention research in CP with a focus on nutrition and to develop guidance for future research practice (intervention design and implementation) in CP based on interventionists' reflections and practice wisdom. METHODS: Semi-structured interviews were conducted with 9 researchers with experience in undertaking intervention research in CP with a nutrition component. Content analysis, constant comparison and interpretive description were used in the analysis and interpretation of interview data. RESULTS: Five key lessons were identified - 1) utilize existing capacity; 2) navigate and utilize social power and interests; 3) personalize engagement and recruitment; 4) consider the logistics and 5) intervention type considerations. Key challenges for translating research into practice and sustaining change included financial sustainability, physical constraints, logistics, collaboration, and practice change enablers. Personal reflections on research practice identified qualities, such as determination and skills in networking, as key for researching in CP. CONCLUSIONS: CP-embedded research is challenging given the complexity of the practice environment. The social context of CP appears central to intervention research and a nuanced understanding of the social context needs to be the basis for intervention design to inform successful implementation. Experience-based and insider knowledge is useful and needed for nuanced design and development of intervention research in CP.

Nutrition and physical activity guidance for women in the pre- and post-natal period: a continuing education needs assessment in primary health care.

The study objective was to assess primary health care (PHC) providers' exposure to women in the pre- and post-natal period, current nutrition and physical activity guidance practices, confidence and perceived needs for continuing education relevant to nutrition and physical activity guidance in the peri-natal period. A self-administered cross-sectional questionnaire survey amongst a purposively recruited sample of 226 local primary health care providers evenly distributed across general practice, community nursing, pharmacist and pharmacy assistant worker groups. The questionnaire contained 106 items about primary health care providers' exposure to women in the pre- and post-natal life-stage, their current nutrition and physical activity guidance practices, confidence and perceived needs for continuing education relevant to nutrition and physical activity guidance in the peri-natal period. Results indicate that PHC providers across general practice, community nursing and pharmacy service settings are frequently accessed by women during this life-stage, and regularly and variably provide guidance on nutrition and physical activity, and report different continuing education needs. Continuing education interventions need to be tailored to match the needs of each PHC group. Pharmacy-based staff are a priority for PHC continuing education about nutrition and physical activity if the potential of the community-based pharmacy as a primary health setting is to be realised.