'Feta is obviously very dangerous stuff looking at all those reds': Can nutrition labelling help people living with type 2 diabetes to self-manage their condition?

BACKGROUND: The consumption of a healthy balanced diet is the cornerstone of treatment for people living with type 2 diabetes (PLWT2DM). The United Kingdom recommends a standardised voluntary front-of-pack food labelling system which uses the green-amber-red colour coding to indicate the presence of nutrients in a food item. Research with PLWT2DM suggests that they may find it challenging to interpret the information on food labels. This paper draws from a larger study exploring nutrition information practices for PLWT2DM. The aim of this paper is to explore the experiences of using nutrition information found on food labels among PLWT2DM and their partners/carers. METHODS: This study used a qualitative and mixed methods design, using a solicited 4-week unstructured diary followed by a qualitative interview with each participant. The theoretical framework drew on practice theory. Data were analysed using thematic analysis. RESULTS: Nineteen PLWT2DM and one partner took part. Data consisted of 19 diaries and interviews. Almost all participants used food labels to help manage their condition; however, the colour-coding link with traffic lights appeared to overemphasise the need to avoid foods with red labels. Participants' beliefs about sugar influenced their food choices which in turn could impact on their nutritional intake. Highly developed mathematical skills were needed to interpret information about portion sizes. CONCLUSIONS: Healthcare professionals and patient support groups should focus more on educating PLWT2DM about how to interpret food labels so that they are able to apply these to their own food choices. Future research and development of subsequent versions of the food labelling system should include PLWT2DM to ensure that labels are both clear and relevant to them.

Dietary management of older people with diabetes.

Diabetes UK's revised nutrition guidelines for the prevention and management of diabetes, published recently, encourage education in self-management and include additional guidance for older people with diabetes. The incidence of diabetes in older people is increasing. Many older people with diabetes are healthy and mobile, and live in the community, but a number are frail and living in care homes. Those who are frail are at increased risk of malnutrition from a range of causes. Older people with diabetes should be assessed for malnutrition risk and referred to a dietitian if required. Management of these patients focuses on foods that are high in protein and energy foods. A case study gives an example of how a community nurse may be involved.

BMI calculation in older people: The effect of using direct and surrogate measures of height in a community-based setting.

BACKGROUND & AIMS: There is currently no consensus on which measure of height should be used in older people's body mass index (BMI) calculation. Most estimates of nutritional status include a measurement of body weight and height which should be reliable and accurate, however at present several different methods are used interchangeably. BMI, a key marker in malnutrition assessment, does not reflect age-related changes in height or changes in body composition such as loss of muscle mass or presence of oedema. The aim of this pilot study was to assess how the use of direct and surrogate measures of height impacts on BMI calculation in people aged ≥75 years. METHODS: A cross-sectional study of 64 free-living older people (75-96 yrs) quantified height by two direct measurements, current height (HC), and self-report (HR) and surrogate equations using knee height (HK) and ulna length (HU). BMI calculated from current height measurement (BMIC) was compared with BMI calculated using self-reported height (BMIR) and height estimated from surrogate equations for knee height (BMIK) and ulna length (BMIU). RESULTS: Median difference of BMIC-BMIR was 2.31 kg/m2. BMIK gave the closest correlation to BMIC. The percentage of study participants identified at increased risk of under-nutrition (BMI < 20 kg/m2) varied depending on which measure of height was used to calculate BMI; from 5% (BMIC), 7.8% (BMIK), 12.5% (BMIU), to 14% (BMIR) respectively. CONCLUSIONS: The results of this pilot study in a relatively healthy sample of older people suggest that interchangeable use of current and reported height in people ≥75 years can introduce substantial significant systematic error. This discrepancy could impact nutritional assessment of older people in poor health and lead to misclassification during nutritional screening if other visual and clinical clues are not taken into account. This could result in long-term clinical and cost implications if individuals who need nutrition support are not correctly identified. A consensus is required on which method should be used to quantify height in older people to improve accuracy of nutritional assessment and clinical care.

Dietary Advice and Collaborative Working: Do Pharmacists and Allied Health Professionals Other Than Dietitians Have a Role?

Long term health conditions either wholly or partly diet-related continue to increase. Although pharmacists and allied health professionals (AHPs) have a role in the management of patients with long term conditions, there is limited research exploring whether pharmacists and AHPs other than dietitians have a role in the delivery of dietary advice. This research aimed to explore their views regarding the provision of dietary advice to patients. The research involved a qualitative methodology utilising five uni-professional focus groups with a total of 23 participants. All groups considered the provision of dietary advice in the context of their own professional roles, discussed issues relating to referral to the dietitian for specialist advice and most discussed the need for written information. Interprofessional and collaborative working is needed to maximise the role in the delivery of dietary advice, access to evidence based nutritional information and utlisation of referral pathways across pharmacists and AHPs to ensure the timely provision of nutritional advice to patients. There is a potential role for dietitians to take the lead and further research should focus on this area.

Practitioner and patient experiences of giving and receiving healthy eating advice.

This article explores the content of discussion by patients and practitioners where they were invited to talk about food and diet. A qualitative methodology using focus groups was employed within one Primary Care Trust in the east of England. Patients described their desire for access to nutritional guidance in primary care and their feelings of powerlessness when following dietary advice. Primary care practitioners discussed their experiences of giving information alongside their scepticism about patients' adherence to dietary advice. Without prompting from the interviewer, patients and practitioners independently chose weight management to illustrate their experiences. Frustrations were expressed by patients and practitioners groups who felt unmotivated to seek or give information respectively on weight management.

Practitioner and lay perspectives of the service provision of nutrition information leaflets in primary care.

BACKGROUND: In primary care, leaflets are often used to communicate health information. Increasingly, primary healthcare practitioners need to provide dietary advice. There is limited research exploring how nutrition information leaflets are used in primary care. The present study explored practitioner and lay experiences with respect to providing and receiving nutrition information in primary care, focusing in particular on the use of leaflets for nutrition information. METHODS: A qualitative design was used incorporating focus groups with 57 practitioners based at seven general practitioner practices and a purposive sample of 30 lay participants attending six Consumer Health Organisations within one primary care trust. Focus groups were taped and transcribed verbatim and data were analysed thematically, assisted by computer software n6® (QSR International Pty Ltd, Melbourne, Australia). RESULTS: Practitioners discussed barriers to giving nutritional advice, access to leaflets, lay receptiveness to advice and their perceptions about the value of leaflets to lay people. Food was not considered in terms of its nutritional components by lay participants and the need for nutritional information was not perceived to be relevant until they had received a medical diagnosis. Lay participants discussed the importance of receiving nutritional advice relating to their medical diagnosis and the altered status of written information that was delivered personally. Practitioner and lay groups suggested improvements to ensure that nutritional advice be supported by relevant and appropriate written information. CONCLUSIONS: This research has underlined the continuing importance of nutrition information leaflets and concludes that there is particular value in involving lay participants in the development of nutrition information leaflets.