A systematic review of interventions targeting modifiable factors that impact dietary intake in athletes.

Appropriate dietary intake has been found to positively impact athletes' performance, body composition and recovery from exercise. Strategies to optimise dietary intake often involve targeting one or more of the many factors that are known to influence dietary intake. This review aims to investigate the types and effectiveness of interventions used to impact modifiable factors of dietary intake in athletes. MEDLINE, CINAHL, SPORTDiscus and Web of Science were searched from inception to May 2022 for intervention studies that measured dietary intake with a quantitative tool and explored at least one factor thought to influence the dietary intake of adult athletes. Study quality was assessed using the ADA Quality Criteria Checklist: Primary Research. Twenty-four studies were included. The most common interventions focused on nutrition education (n 10), macronutrient adjustment (n 7) and physical activity (n 5). The three most common factors thought to influence dietary intake addressed were nutrition knowledge (n 12), hunger and appetite (n 8), and body composition (n 4). Significant changes in dietary intake were found in sixteen studies, with nutrition education interventions returning significant results in the largest proportion of studies (n 8). Study quality within this review was mostly average (n 4 < 50 %, n 19 50-80 %, n 1 > 80 %). As studies included were published between 1992 and 2021, interventions and factors explored in older studies may require up-to-date research to investigate possible differences in results due to time-related confounders.

Understanding the challenges of injury in providing sport programmes for physically inactive women: concept mapping insights from programme deliverers.

OBJECTIVES: Injury/poor health is an important barrier to women's participation in sport and physical activity. This study aimed to identify perceived challenges sport programme deliverers face when supporting physically inactive women to prevent/manage injury. METHODS: Sport programme deliverers, targeting physically inactive women in Victoria, participated in concept mapping to brainstorm, sort and rate (impact on their ability to prevent/manage injury, frequency of and difficulty to overcome the challenge on a 1 (low)-5 (high) scale) the challenges faced. Analysis included multidimensional scaling, hierarchical cluster analysis and descriptive statistics (eg, mean ratings). RESULTS: Twenty-five deliverers brainstormed 82 injury prevention/management-related challenges. An eight cluster map was considered the most appropriate representation of the participants' sorting data (mean cluster impact, frequency and difficulty to overcome rating (1-5)): time constraints (3.42, 3.69, 3.12); perceived competence in injury prevention/management (3.36, 3.50, 3.27); navigating participant perceptions and knowledge (3.35, 3.74, 3.49); information and responsibility (3.32, 3.50, 3.26); session planning and structure (3.25, 3.45, 3.07); participant engagement (3.13, 3.47, 3.08); responding to individual needs (3.07, 3.42, 2.92) and access to injury management resources (2.87, 3.25, 3.17). CONCLUSION: Limited time created injury prevention/management challenges for programme deliverers when planning and modifying sport programmes for physically inactive women. Injury prevention/management should be integrated into programme design and delivery principles. Programme deliverers need education/training and access to injury prevention/management resources (eg, activity modification) and engagement/communication strategies tailored for physically inactive women. Public health funders, coaching course accreditors, programme designers and deliverers can use these insights to develop strategies to minimise injury risk and effect systemic change in sport programme delivery.

Malnutrition defined by GLIM criteria identifies a higher incidence of malnutrition and is associated with pulmonary complications after oesophagogastric cancer surgery, compared to ICD-10-defined malnutrition.

BACKGROUND & OBJECTIVES: Low muscle mass, measured using computed tomography (CT), is associated with poor surgical outcomes. We aimed to include CT-muscle mass in malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) criteria, compare it to the International Classification of Diseases 10th Revision (ICD-10) criteria, and assess the impact on postoperative outcomes after oesophagogastric (OG) cancer surgery. METHODS: One hundred and eight patients who underwent radical OG cancer surgery and had preoperative abdominal CT imaging were included. GLIM and ICD-10 malnutrition data were assessed against complication and survival outcomes. Low CT-muscle mass was determined using predefined cut-points. RESULTS: GLIM-defined malnutrition prevalence was significantly higher than ICD-10-malnutrition (72.2% vs. 40.7%, p < 0.001). Of the 78 patients with GLIM-defined malnutrition, low muscle mass (84.6%) was the predominant phenotypic criterion. GLIM-defined malnutrition was associated with pneumonia (26.9% vs. 6.7%, p = 0.010) and pleural effusions (12.8% vs. 0%, p = 0.029). Postoperative complications did not correlate with ICD-10 malnutrition. Severe GLIM (HR: 2.51, p = 0.014) and ICD-10 (HR: 2.15, p = 0.039) malnutrition were independently associated with poorer 5-year survival. CONCLUSIONS: GLIM criteria appear to identify more malnourished patients and more closely relate to surgical risk than ICD-10 malnutrition, likely due to incorporating objective muscle mass assessment.

An online exploratory survey of Australian athletes' and exercisers' use of and attitudes towards ultra-processed sports foods.

Sports foods are convenient alternatives to everyday foods to fuel performance. Strong scientific evidence supports their use; however, commercial sports foods are classified by the NOVA system as ultra-processed foods (UPF). Consumption of UPF has been associated with poor mental and physical health, but little is known about athletes' consumption of and attitudes towards sports foods as a source of UPF. The aim of this cross-sectional study was to assess Australian athletes' intake of and attitudes towards sports foods and UPF. Adult athletes were recruited to complete an anonymous online survey via social media between October 2021 and February 2022. Data were analysed using descriptive statistics, and Pearson's χ2 test was used to assess potential relationships between categorical demographic variables and consumption of sports foods. One hundred forty Australian adults participating in recreational (n 55), local/regional (n 52), state (n 11), national (n 14) or international (n 9) sports completed the survey. Ninety-five percent reported consuming sports foods within the past 12 months. Participants consumed sports drinks most commonly (73 %) and isolated protein supplements most frequently (40 % at least once per week). Participants reported everyday foods to be more affordable, taste better, present less risk of banned substances, but less convenient and greater risk of spoilage. Half (51 %) of participants reported concern about health effects of UPF. Participants reported regular UPF consumption despite taste and cost-related preferences for everyday foods and health concerns regarding UPF intake. Athletes may need support to identify and access safe, affordable, convenient, minimally processed alternatives to sports foods.

A Mediterranean and low-fat dietary intervention in non-alcoholic fatty liver disease patients: Exploring participant experience and perceptions about dietary change.

BACKGROUND: A Mediterranean diet (MD) appears to be beneficial in non-alcoholic fatty liver disease (NAFLD) patients in Mediterranean countries; however, the acceptability of a MD in non-Mediterranean populations has not been thoroughly explored. The present study aimed to explore the acceptability through understanding the barriers and enablers of the MD and low-fat diet (LFD) interventions as perceived by participating Australian adults from multicultural backgrounds with NAFLD. METHODS: Semi-structured telephone interviews were performed with 23 NAFLD trial participants at the end of a 12-week dietary intervention in a multicentre, parallel, randomised clinical trial. Data were analysed using thematic analysis. RESULTS: Participants reported that they enjoyed taking part in the MD and LFD interventions and perceived that they had positive health benefits from their participation. Compared with the LFD, the MD group placed greater emphasis on enjoyment and intention to maintain dietary changes. Novelty, convenience and the ability to swap food/meals were key enablers for the successful implementation for both of the dietary interventions. Flavour and enjoyment of food, expressed more prominently by MD intervention participants, were fundamental components of the diets with regard to reported adherence and intention to maintain dietary change. CONCLUSIONS: Participants randomised to the MD reported greater acceptability of the diet than those randomised to the LFD, predominantly related to perceived novelty and palatability of the diet.

A systematic review update of athletes' nutrition knowledge and association with dietary intake.

Athletes' dietary intakes sometimes do not meet sports nutrition guidelines. Nutrition knowledge (NK) is one factor that may influence dietary intake, but NK measurement tools are often outdated or unvalidated, and results regarding athletes' NK are equivocal. The aims of this systematic review were to update previous systematic reviews by examining athletes' NK and to assess the relationship between athletes' general NK, sport NK and dietary intake. MEDLINE, CINAHL, Scopus, SPORTDiscus, Web of Science and Cochrane were searched for studies published between November 2015 and November 2020 that provided a quantitative measure of NK and described the NK tool used. Twenty-eight studies were included, study quality was assessed using JBI checklists and data on NK score and diet intake was extracted. Eight studies utilised validated, up-to-date NK measurement tools. Mean general and sport NK% scores varied between 40·2% ± 12·4 and 70 % ± 9. Mean protein and carbohydrate consumption was 1·1-3·4 g/kg.bw/d and 2·4-4·6 g/kg.bw/d, respectively. Weak-to-moderate, positive associations were found between NK and positive dietary behaviours. Due to a wide variety of NK measurement tools used, it is difficult to synthesise results to determine overall NK in athletes. Overall, there appears to be a low standard of knowledge. Quality of measurement tools for NK has improved but remains an issue. Future studies should use relevant, current validated NK tools or validate tools in their study population. More research is needed into the relationship between NK and other modifiable factors influencing dietary intake.

Social media analytics in nutrition research: a rapid review of current usage in investigation of dietary behaviours.

OBJECTIVE: Social media analytics (SMA) has a track record in business research. The utilisation in nutrition research is unknown, despite social media being populated with real-time eating behaviours. This rapid review aimed to explore the use of SMA in nutrition research with the investigation of dietary behaviours. DESIGN: The review was conducted according to rapid review guidelines by WHO and the National Collaborating Centre for Methods and Tools. Five databases of peer-reviewed, English language studies were searched using the keywords 'social media' in combination with 'data analytics' and 'food' or 'nutrition' and screened for those with general population health using SMA on public domain, social media data between 2014 and 2020. RESULTS: The review identified 34 studies involving SMA in the investigation of dietary behaviours. Nutrition topics included population nutrition health investigations, alcohol consumption, dieting and eating out of the home behaviours. All studies involved content analysis with evidence of surveillance and engagement. Twitter was predominant with data sets in tens of millions. SMA tools were observed in data discovery, collection and preparation, but less so in data analysis. Approximately, a third of the studies involved interdisciplinary collaborations with health representation and only two studies involved nutrition disciplines. Less than a quarter of studies obtained formal human ethics approval. CONCLUSIONS: SMA in nutrition research with the investigation of dietary behaviours is emerging, nevertheless, if consideration is taken with technological capabilities and ethical integrity, the future shows promise at a broad population census level and as a scoping tool or complementary, triangulation instrument.

Validity of multi-frequency bioelectric impedance methods to measure body composition in obese patients: a systematic review.

OBJECTIVE: Excessive lean tissue loss following bariatric surgery may pose serious metabolic consequences. Accurate methods to assess body composition following bariatric surgery are required. This review aimed to investigate if multi-frequency bioelectric impedance (MF-BI) is a valid tool to determine body composition in obese patients. METHODS: MEDLINE, EMBASE, CINAHL and CENTRAL databases were searched until March 2017. Included studies were published in English with obese (body mass index (BMI) ≥ 30 kg/m2) adults measuring body composition with MF-BI methods in comparison with reference methods. Exclusions were pregnancy, animal studies, non-English language studies, single frequency BI. A total of 6395 studies were retrieved. RESULTS: Sixteen studies were eligible for inclusion. Sample sizes ranged from 15 to 157, with BMI 26-48 kg/m2. MF-BI underestimated fat mass (FM) in 11 studies and overestimated fat-free mass (FFM) in nine studies in comparison with reference methods. Correlations of absolute values from MF-BI and reference methods for FM and FFM were high, however, agreement was lower at an individual level. When adjustments for BMI were made to machine algorithms, measurement accuracy improved. Significant heterogeneity was evident among included studies. CONCLUSIONS: This review found that MF-BI is reliable for use at a group level. Obese-specific adjustment of algorithms for MF-BI machines increases the accuracy of absolute measures of body composition in obese individuals, improving their utility in the clinical setting. Multiple variables contributed a lack of consistency among studies included, highlighting the need for more robust studies that control confounding variables to establish clear validity assessment.

The effect of high-polyphenol extra virgin olive oil on cardiovascular risk factors: A systematic review and meta-analysis.

The polyphenol fraction of extra-virgin olive oil may be partly responsible for its cardioprotective effects. The aim of this systematic review and meta-analysis was to evaluate the effect of high versus low polyphenol olive oil on cardiovascular disease (CVD) risk factors in clinical trials. In accordance with PRISMA guidelines, CINAHL, PubMed, Embase and Cochrane databases were systematically searched for relevant studies. Randomized controlled trials that investigated markers of CVD risk (e.g. outcomes related to cholesterol, inflammation, oxidative stress) were included. Risk of bias was assessed using the Jadad scale. A meta-analysis was conducted using clinical trial data with available CVD risk outcomes. Twenty-six studies were included. Compared to low polyphenol olive oil, high polyphenol olive oil significantly improved measures of malondialdehyde (MD: -0.07µmol/L [95%CI: -0.12, -0.02µmol/L]; I2: 88%; p = 0.004), oxidized LDL (SMD: -0.44 [95%CI: -0.78, -0.10µmol/L]; I2: 41%; P = 0.01), total cholesterol (MD 4.5 mg/dL [95%CI: -6.54, -2.39 mg/dL]; p<0.0001) and HDL cholesterol (MD 2.37 mg/dL [95%CI: 0.41, 5.04 mg/dL]; p = 0.02). Subgroup analyses and individual studies reported additional improvements in inflammatory markers and blood pressure. Most studies were rated as having low-to-moderate risk of bias. High polyphenol oils confer some CVD-risk reduction benefits; however, further studies with longer duration and in non-Mediterranean populations are required.

Australian Football Athletes Lack Awareness of Current Sport Nutrition Guidelines.

Sports nutrition is an evolving field, but there is a lack of data on Australian athletes' knowledge of current sports nutrition guidelines. Additionally, several tools used to assess nutrition knowledge (NK) have not undergone adequate validation. The purpose of this study was to assess and compare the sports NK of elite and nonelite Australian football (AF) athletes using a newly validated questionnaire-The Nutrition for Sport Knowledge Questionnaire. Elite AF players (n = 46) were recruited directly from their club dietitian and nonelite AF players (n = 53) were invited to participate via e-mail from their club president or secretary. The mean NK score of elite and nonelite AF players was 46 ± 16% and 51 ± 11%, respectively (p = .041). In both groups, knowledge of macronutrients, weight management, and alcohol was better than knowledge of supplements, micronutrients, and sports nutrition. Nonelite athletes achieved statistically significantly higher scores on the questionnaire subsections testing weight management (elite: 48 ± 18; nonelite: 57 ± 19, p = .019), micronutrients (elite: 39 ± 19; nonelite: 50 ± 16, p = .004), and alcohol (elite: 52 ± 13; nonelite: 71 ± 17, p = .002). While overall NK of Australian athletes was poor, scores varied greatly among individuals (range: 10-70%) and across the six subsections (topics) being assessed. Professionals working with athletes should undertake an assessment of the athletes' NK so that they can provide targeted education programs.

Expanding collaborative care: integrating the role of dietitians and nutrition interventions in services for people with mental illness.

OBJECTIVE: This article aims to draw mental health clinicians' attention to the connections between nutrition and mental health, and the roles that Accredited Practising Dietitians play in improving mental and physical health through dietary change. METHODS: Selective narrative review. RESULTS: Unhealthy dietary practices are common in high prevalence and severe mental illness. Epidemiological evidence demonstrates that nutrients and dietary patterns impact on mental health. In addition, poor physical health is well documented in people with mental illness and the greatest contributor to the mortality gap. Dietary intervention studies demonstrate improved mental and physical health outcomes. Accredited Practising Dietitians translate nutrition science into practical advice to improve the nutritional status of patients with mental illness, and prevent and manage comorbidities in a variety of care settings. CONCLUSIONS: Medical Nutrition Therapy offers opportunities to improve the physical and mental health of people living with mental illness.

Developing and validating a nutrition knowledge questionnaire: key methods and considerations.

OBJECTIVE: To outline key statistical considerations and detailed methodologies for the development and evaluation of a valid and reliable nutrition knowledge questionnaire. DESIGN: Literature on questionnaire development in a range of fields was reviewed and a set of evidence-based guidelines specific to the creation of a nutrition knowledge questionnaire have been developed. The recommendations describe key qualitative methods and statistical considerations, and include relevant examples from previous papers and existing nutrition knowledge questionnaires. Where details have been omitted for the sake of brevity, the reader has been directed to suitable references. RESULTS: We recommend an eight-step methodology for nutrition knowledge questionnaire development as follows: (i) definition of the construct and development of a test plan; (ii) generation of the item pool; (iii) choice of the scoring system and response format; (iv) assessment of content validity; (v) assessment of face validity; (vi) purification of the scale using item analysis, including item characteristics, difficulty and discrimination; (vii) evaluation of the scale including its factor structure and internal reliability, or Rasch analysis, including assessment of dimensionality and internal reliability; and (viii) gathering of data to re-examine the questionnaire's properties, assess temporal stability and confirm construct validity. Several of these methods have previously been overlooked. CONCLUSIONS: The measurement of nutrition knowledge is an important consideration for individuals working in the nutrition field. Improved methods in the development of nutrition knowledge questionnaires, such as the use of factor analysis or Rasch analysis, will enable more confidence in reported measures of nutrition knowledge.

Engaging athletes as research participants. A document analysis of published sport science literature.

Sport science practitioners utilise findings from peer reviewed research to inform practice. Fewer studies are conducted with high performance athletes, however, than those involving recreationally active participants. Noting that research findings from recreational athletes may not be generalisable to the elite, there is a need to engage the latter cohort in research with better potential to influence health and performance. This study identified methods used to engage and recruit highly trained, elite and world class athletes as research participants. A document analysis was conducted using a purposive sample of peer-reviewed sport science literature. All articles published in 2022 from 18 highly ranked sport science journals were screened for inclusion. Studies investigating athletes ranked as highly trained/national level or above were included. All details related to participant recruitment were extracted from included articles, with the content being coded and thematically analysed using an interpretivist approach. A total of 439 studies from the 2356 screened were included in the analysis. Five primary themes of recruitment strategies were identified, beneath an overarching strategy of purposeful, convenience sampling. Recruitment themes related to the use of a gatekeeper, the research environment providing convenient access to athletes, promoting the study electronically, utilising professional networks and recruiting at training or competition. Engaging athletes through a gatekeeper is a prominent strategy to involve elite athletes in research. It is suggested that researchers work collaboratively with team or organisation personnel to promote recruitment, creating co-designed approaches that address issues most relevant to athletes and staff.

The Relationship of Hedonic Hunger, Macronutrient Balance, Nutrition Knowledge, and Body Image and Weight Control with Dietary Intake in Student Athletes and Exercisers.

Dietary intake is known to impact athletic performance. The factors that influence dietary intake have been investigated widely, but their collective effect has not been examined. The primary aim of this cross-sectional study was to assess the relationship between dietary intake and nutrition knowledge, body image, weight control, macronutrient balance, and hedonic hunger. Forty-two student athletes or active individuals were recruited through contact with sporting organisations and course coordinators, advertising via twitter, and flyers posted within university buildings. Nutrition knowledge, body image, weight control, macronutrient balance, and hedonic hunger were measured using the Abridged Nutrition for Sport Knowledge Questionnaire, Body Image Disturbance Questionnaire and Contour Drawing Rating Scale, a Weight Fluctuation Measure, Australian Eating Score, and Power of Food Scale, respectively. Hierarchical regression analysis, correlation testing, and mean difference testing were applied. Carbohydrate intake, body image disturbance scores, weight fluctuation, and hedonic hunger for food tasted had a significant relationship (R2 = 64.6%, Adj R2 = 0.608%, p < 0.001) with dietary energy intake. Student athletes' dietary intakes are influenced by multiple potentially modifiable factors. Future studies should use larger sample sizes, with interventions focusing on individual modifiable factors to determine how dietary intake can be most significantly impacted.

Public perceptions of dietetics services in Australia and New Zealand.

AIM: The aim of this study was to examine expectations, perceptions and attitudes about dietetics services among the Australian and New Zealand public, to provide insights for building a future dietetics workforce that will meet consumer needs. METHODS: A cross-sectional, anonymous, online survey was employed to gain perspectives of a representative sample of Australian and New Zealand adults. Questions were purposely designed to collect views regarding sources of dietary information, expectations of dietetics service providers and factors influencing choice of dietetics service provider. Data were analysed descriptively and using Pearson's chi-square test to assess relationships between categorical variables. Free-text responses were analysed using content analysis. RESULTS: Of 2601 respondents, approximately one third (32%) had seen a dietitian. Doctors were the most trusted sources of dietary information (87%), particularly with participants over 60 years (χ(1) = 44.168, V = 0.130, p < 0.001). Cost was the most frequently reported factor influencing choice of dietetics services (56%), with 88% of respondents interested in accessing a dietitian, preferably in-person (64%), if they could do so for no cost. Participants anticipated that dietitians would offer services like meal plans (59%) and nutritional analysis (48%) as well as weight and other body measurements (56%). Some expectations such as blood tests (54%) were outside the usual scope of dietetic practice. CONCLUSION: The results of this study have implications for practising dietitians, dietetics educators, and funders of dietetics services. Cost as a barrier suggests that advocacy to government for funding type, duration and number of visits to dietitians is still required.

The multi-dimensional impacts of injury on physically inactive women's participation in sport and physical activity: Insights from concept mapping.

OBJECTIVES: To explore how injury, as a primary barrier, impacts physically inactive Australian women's engagement in sport and physical activity. DESIGN: Concept mapping. METHODS: Participants used online concept mapping to brainstorm the meaning of injury, then sorted and rated statements for impact and importance (1 (low)-5 (high) scale). Multi-dimensional scaling, hierarchical cluster analysis and descriptive statistics were applied. RESULTS: Forty-five Australian women, aged 25-64, brainstormed 94 statements representing the meaning of an injury. Nine clusters emerged from analysis of the sorting data (highest to lowest mean cluster impact order): Fear and frustration; Physical implications of injury; Activity restrictions; Financial implications; Modification and management; Recovery; Mental and emotional wellbeing; Impact on daily life; and Social impact and engagement. A high correlation was found between rating scales (r = 0.92). CONCLUSIONS: A holistic approach is fundamental to understanding how the multi-dimensional impacts of injury and recovery affect physically inactive women. This approach should extend beyond the medical/physical aspects to other challenges and contextual factors (i.e. environmental and personal) impacting women's functioning. Understanding the diverse needs and experiences of physically inactive women is crucial for tailoring interventions that can effectively support recovery and sustained engagement, through person-centred strategies focused on injury prevention/management. Furthermore, this understanding is essential to fostering collaborative system-wide understanding and change, involving diverse stakeholders (e.g. health practitioners, those in delivery/practice settings, insurance) to improve long-term health and wellness outcomes, and promote greater participation in sport/physical activity.

Validity and Educational Impact of Clinical Entrustable Professional Activities Linked to the Nutrition Care Process for Work-Based Assessment of Entry-Level Dietetics Students: Evaluation of a 3-Year Implementation Study in Australia.

BACKGROUND: Entrustable professional activities (EPAs) describe key workplace activities and are increasingly being used for student work-based assessment. An EPA-based work-based assessment tool offers potential to increase understanding of dietetics student skill development and opportunity for standardised work-based student assessment. OBJECTIVE: To determine construct validity and educational impact of an EPA work-based assessment tool for dietetics placement students in clinical settings. DESIGN: Using a time series design, supervisor and student self-assessment data collected from an EPA-based assessment tool from three cohorts of dietetics students and supervisors from 2017-2019 was analyzed. PARTICIPANTS AND SETTING: Dietetics students (n = 145) from an accredited dietetic training program in Australia and affiliated metropolitan and rural hospitals. MAIN OUTCOME MEASURES: Construct validity was determined through analysis of supervisor evaluation of student performance against EPAs over time. Educational impact was determined through comparing student performance across EPAs to predicted milestones to identify areas of least entrustment. STATISTICAL ANALYSES PERFORMED: Student performance over time and differences between student self-assessment and supervisor assessment for each EPA were investigated using Wilcoxon signed-rank tests and linear mixed-model analysis. Descriptive statistics summarised student performance against each EPA. RESULTS: Performance significantly increased over time in 35 out of 37 EPAs. Significant differences between supervisor and student self-assessment were evident in 9 out of 37 EPAs. Dietetics student performance varied across EPAs with 88.2% of students achieving entrustment for nutrition management EPAs compared with 100% for professionalism EPAs. CONCLUSIONS: The tool's construct validity was established. EPAs identified areas of Nutrition Care Process skills development requiring additional support. Data collected by the tool can inform teaching.

Nutrition status of primary care patients with depression and anxiety.

The objective of this study was to evaluate the nutrition status of people referred to a nutrition and physical activity program for the management of mental health in general practice. Patients currently being treated for depression and/or anxiety were referred by their GPs to a lifestyle intervention program. The nutrition status was assessed during a comprehensive assessment at the commencement of the program. The lifestyle intervention program, including all assessments, was offered at multiple sites including GP clinics in the Illawarra, and in clinic rooms at the University of Wollongong. Thirty-two men and seventy-seven women completed the assessment. Patients were referred with depression (52%), anxiety (19%) or both (28%). Eighty percent of participants were overweight or obese. All participants completed an assessment that included a diet history, anthropometric measurements and the completion of several questionnaires including the Depression, Anxiety and Stress Scale (DASS). Nutrition status was assessed using mean nutrient intakes and Australian modified Healthy Eating Index scores evaluated against the National Nutrition Survey intakes and DASS scores. Participants met the estimated average requirements for all nutrients except folate (17%), magnesium (78%) and calcium (57%). Intakes were similar to those reported in the National Nutrition Survey. Only magnesium intakes were significantly related to depression (r=-0.26). Australian modified Healthy Eating Index scores were significantly negatively correlated with DASS scores (P<0.01). The associations presented here support the existing body of literature. Nutrition recommendations for patients with depression and anxiety should be based on the Australian Guide to Healthy Eating with particular attention to fruit, vegetables and wholegrains.

Development and evaluation of Entrustable Professional Activities embedded in an e-portfolio for work-based assessment in community and public health dietetics.

Entrustable professional activities (EPAs) is a recent concept that helps operationalise competency-based education. In this paper, we report on the development of EPAs and incorporation into an e-portfolio for work-based assessment of final year dietetics students in a community and public health professional placement. We aimed to determine the utility of the EPAs for work-based assessment in this context. We used action research methodology to conduct broad consultation with students and supervisors using anonymous surveys and focus groups to understand their beliefs and attitudes towards work-based assessment. Consequently, 40 EPAs with an accompanying four-point entrustment scale were developed and mapped to the National Competency Standards for Dietitians in Australia. The EPAs and assessment tool were piloted and evaluated via an anonymous online user survey across three cohorts of students (n = 133) and supervisors (n = 67). Following mediocre pilot year evaluation results, EPAs were revised and reduced in number. While students positively evaluated the e-portfolio, their appraisal of the EPAs and entrustment scale was less positive compared to supervisors. Supervisor evaluation of the EPA-based e-portfolio supported the validity, feasibility and acceptability of this novel assessment method in a community and public health setting. Assessment using EPAs, and the resulting educational data collected by the tool, offers potential for individual learners to identify areas needing development during placement, as well as potential to inform curriculum improvements and increase understanding of learning opportunities and outcomes for dietetic students in community and public health settings.