The nutritional content of children's breakfast cereals: a cross-sectional analysis of New Zealand, Australia, the UK, Canada and the USA.

OBJECTIVE: To compare the Nutrition Information Panel (NIP) content, serving size and package size of children's ready-to-eat breakfast cereals (RTEC) available in five different Western countries. DESIGN: NIP label information was collected from RTEC available for purchase in major supermarket chains. Kruskal-Wallis, Mann-Whitney U and χ2 tests were applied to detect differences between countries on manufacturer-declared serving size, total energy (kJ), total protein, fat, saturated fat, carbohydrate, total sugar, Na and fibre content. The Nutrient Profiling Scoring Criterion (NPSC) was used to evaluate the number of products deemed to be 'unhealthy'. SETTING: Supermarkets in Australia, Canada, New Zealand, the UK and the USA. PARTICIPANTS: Children's breakfast cereals (n 636), including those with and without promotional characters. RESULTS: The majority of children's RTEC contained substantial levels of total sugar and differences were apparent between countries. Median sugar content per serving was higher in US cereals than all other countries (10·0 v. 7·7-9·1 g; P < 0·0001). Median fat and saturated fat content were lowest in Australia and New Zealand RTEC, while the Na content of RTEC was 60-120 % higher in the USA and Canada than in Australia and the UK (all P ≤ 0·01). CONCLUSIONS: Across all countries, there was a high proportion of RTEC marketed for children that had an unhealthy nutrient profile. Strategies and policies are needed to improve the nutrient value of RTEC for children, so they provide a breakfast food that meets nutrition guidelines.

The nutritional content of supermarket beverages: a cross-sectional analysis of New Zealand, Australia, Canada and the UK.

OBJECTIVE: To compare the nutritional content, serving size and taxation potential of supermarket beverages from four different Western countries. DESIGN: Cross-sectional analysis. Multivariate regression analysis and χ 2 comparisons were used to detect differences between countries. SETTING: Supermarkets in New Zealand (NZ), Australia, Canada and the UK. SUBJECTS: Supermarket beverages in the following categories: fruit juices, fruit-based drinks, carbonated soda, waters and sports/energy drinks. RESULTS: A total of 4157 products were analysed, including 749 from NZ, 1738 from Australia, 740 from Canada and 930 from the UK. NZ had the highest percentage of beverages with sugar added to them (52 %), while the UK had the lowest (39 %, P<0.001). CONCLUSIONS: There is substantial difference between countries in the mean energy, serving size and proportion of products eligible for fiscal sugar taxation. Current self-regulatory approaches used in these countries may not be effective to reduce the availability, marketing and consumption of sugar-sweetened beverages and subsequent intake of free sugars.

The nutritional quality of New Zealand breakfast cereals: an update.

OBJECTIVE: To compare the nutritional quality of New Zealand breakfast cereals in 2013 and 2017. DESIGN: Nutrition Information Panel data were collected from all cereals available from two large supermarket chains in 2017 and compared with earlier published data collected in 2013. SETTING: Urban New Zealand supermarkets. SUBJECTS: The nutritional content of breakfast cereals ('biscuits and bites', 'brans', 'bubbles, flakes and puffs', 'children's cereals', 'muesli' and 'oats') was analysed for total energy, protein, fat (total and saturated), carbohydrate, sugar, fibre and Na. The Nutrient Profile Scoring Criterion (NPSC) for each cereal was calculated to determine the proportion of 'less healthy' cereals (NPSC≥4) in each product category. RESULTS: The energy and fat content of bubbles, flakes and puffs, muesli and oats were significantly higher in 2017 compared with 2013 (all P≤0·01). However, there was a small reduction in Na overall in 2017 (P<0·05). There was no change between 2013 and 2017 in the proportion of 'healthy' or 'less healthy' breakfast cereals available. CONCLUSIONS: The nutrient profile of breakfast cereals has not improved since 2013, suggesting that industry self-regulation of the nutritional composition of cereals in New Zealand is not working and needs urgent reconsideration.

Regression Equations for Weight Estimation in Paediatric Resuscitation.

BACKGROUND: Weight estimation is critical in paediatric resuscitation, as stopping to weigh a child could influence their survival. Weight estimation methods used in New Zealand (NZ) are not accurate for the population, increasing the complexity of prescribing medication and selecting equipment. AIM: Develop regression equations (RE) to predict the weight of NZ children based on height, sex, age and ethnicity to be deployed in a mobile application (Weight Estimation Without Waiting). METHODS: The RE was derived from retrospective regression modelling of a large existing dataset. Data were presented using descriptive statistics and calculation of means, limits of agreement and the proportion of weight estimates within a percentage of actual weight. CONCLUSION: The RE developed in this study outperformed existing age-based weight estimation methods while providing a method to ensure that weight estimation techniques evolve with NZ children.

Effect of an educational programme on critical care nurses' competence at two tertiary hospitals in Malawi.

Background: Critical care specialty deals with the complex needs of critically ill patients. Nurses who provide critical care are expected to possess the appropriate knowledge and skills required for the care of critically ill patients. The aim of this study was to assess the effect of an educational programme on the competence of critical care nurses at two tertiary hospitals in Lilongwe and Blantyre, Malawi. Methods: A quantitative pre- and post-test design was applied. The training programme was delivered to nurses (n = 41) who worked in intensive care and adult high dependency units at two tertiary hospitals. The effect of the training was assessed through participants' self-assessment of competence on the Intensive and Critical Care Nursing Competence Scale and a list of 10 additional competencies before and after the training. Results: The participants' scores on the Intensive and Critical Care Nursing Competence Scale before the training, M = 608.2, SD = 59.6 increased significantly after the training, M = 684.7, SD = 29.7, p <.0001 (two-tailed). Similarly, there was a significant increase in the participants' scores on the additional competencies after the training, p <.0001 (two-tailed). Conclusion: The programme could be used for upskilling nurses in critical care settings in Malawi and other developing countries with a similar context.

Contextual issues that influence preparedness of nurses for critical care nursing practice in Malawi.

Background: There are no critical care nurse training programs in Malawi despite the high burden of diseases which culminate in critical illness. This paper presents contextual issues that influence preparedness of nurses for critical care nursing practice in Malawi. The qualitative findings presented are part of a larger mixed methods study which explored learning needs of critical care nurses as a way of informing the development of a training program for the critical care nurses in Malawi. Methods: Interpretive descriptive design was used. Data were gathered through 10 key informant interviews with nurse leaders (n=8) and anaesthetists (n=2); and two focus group discussions with registered nurses and nurse midwife technicians working in intensive care and adult high dependency units at two tertiary hospitals. Transcribed data were analyzed manually and through the use of NVivo data management software utilizing Thorne's steps of analysis1. Results: Being unprepared to work in intensive care and high dependency units was a dominant theme. Factors that contributed to this sense of unpreparedness were lack of educational preparation, organisational factors and workforce issues. The consequences of nurses' perceptions of being unprepared were fearfulness, a change of nurses' attitudes and elevation of risk to patients. The nurses managed unpreparedness by relying on other health professionals and learning on the job. Conclusion: The findings illuminated contextual issues to be considered when developing programs for upskilling nurses in hospitals within Malawi and contributes to the developing body of knowledge related to nursing education and practice development within developing countries.

Added sugar and sodium levels in New Zealand processed fruit and vegetable-based products.

AIM: Fruit and vegetables are strongly promoted because of the nutrients they provide; many processed products contain added sugar and sodium. The present study aims to quantify the sugar and sodium content of pre-packaged fruit and vegetable-based products that are available in New Zealand supermarkets. METHODS: Nutrition Information Panel data were collected from non-frozen, processed fruit and vegetable products in New Zealand supermarkets (including soups, sauces, jams and spreads, pickles, chutneys and dips, and canned/bottled fruit and vegetables) where fruit and/or vegetables were the majority ingredient(s). RESULTS: With the exception of canned/bottled vegetables, more than 60% of products contained added sugar. Per serve, the median sugar content was highest in canned/bottled fruit (17.8 g). More than 75% of soups, vegetable-based sauces, pickles/chutneys and canned/bottled vegetables contained added sodium, with soups (722 mg) recording the highest median values per serve. CONCLUSIONS: Consumers need to be aware that although they are encouraged to eat a diet high in fruit and vegetables, there may be large quantities of added sugar and sodium in manufactured fruit and vegetable products that can have significant negative impacts on their health. Government health promotion campaigns encouraging the consumption of fruit and vegetables should be careful to target fresh, frozen and home-prepared foods, and work on educating the public about the lower nutritional quality associated with most processed fruit and vegetable products.

Screening for inadequate dietary vitamin B-12 intake in South Asian women using a nutrient-specific, semi-quantitative food frequency questionnaire.

BACKGROUND AND OBJECTIVES: A high prevalence of vitamin B-12 (B-12) deficiency among young women of South Asian origin predisposes to significant health risks for these women and their future offspring. Vegetarian or low-meat based dietary practices contribute to B-12 deficiency. This study validated a nutrient-specific, semi-quantitative food frequency questionnaire (B12FFQ), developed to estimate dietary B-12 intake in South Asian women. METHODS AND STUDY DESIGN: The B12FFQ was developed, then tested in 60 apparently healthy South Asian women aged 18-50 years, living in Auckland, New Zealand. Participants recalled the frequency and quantity of vitamin B-12-containing foods consumed in the preceding three months. Pearson's correlations measured the associations between dietary B-12 intake and B-12 biomarkers (serum B-12 and holotranscobalamin [holoTC]). Likelihood of B12 insufficiency was calculated for vegetarian and non-vegetarian dietary practices. RESULTS: The B12FFQ was a valid measure of dietary B-12 intake - supported by moderate positive associations with serum B-12 (r=0.50, p<0.001, 95% CI [0.28, 0.67]) and holoTC (r=0.55, p<0.001, 95% CI [0.34, 0.71]). A dietary B-12 intake of less than 2.4 µg/day increased the likelihood of serum B-12 (X2 (1)=11.79, p=0.001) or holoTC (X2 (1)=6.33, p=0.012) insufficiency. A dietary B-12 intake of less than the recommended dietary allowance (2.4 µg/day), occurred in 61% (n=20/33) of participants with vegetarian and 22% (n=6/27) with non- vegetarian dietary practices. CONCLUSIONS: The B12FFQ provides a valid estimate of dietary B-12 intake. This easily administered food frequency questionnaire has the potential to identify low dietary B-12 intake as a contributor to B-12 depletion or deficiency.

Health and Nutritional Literacy of New Zealand Nursing Students.

BACKGROUND: The published literature suggests that RNs are more overweight and obese than the general population. This research investigates associations between nutrition literacy, anthropometry measures, and nutritional biomarkers in an undergraduate nursing student population. METHOD: Year-one nursing students from two tertiary education institutions in New Zealand were invited to participate in an observational, convenience sample study. Data collection from participants (N = 103) included a nutrition literacy questionnaire, anthropometry measures, and blood lipid, glucose, and HbA1c concentrations. RESULTS: Approximately 51% of participants were either overweight or obese, which is a similar prevalence to the New Zealand demographic-matched population. Mean body mass index was 26.7 ± 6.3 kg/m2 and body fat was 29% ± 8.3%. The mean literacy score was 56.7% ± 13.2%. The literacy score was inversely associated with anthropometry measures and total cholesterol/high-density lipoprotein cholesterol ratio and positively associated with high-density lipoprotein cholesterol. CONCLUSIONS: Nutrition literacy had a statistically significant influence on anthropometry and lipid measures. [J Nurs Educ. 2017;56(1):43-48.].

Evaluation of the Nutritional Knowledge of Undergraduate Nursing Students.

BACKGROUND: Obesity is prevalent in health care workers, but it is unknown whether a lack of nutritional knowledge contributes to this. This study measured the nutrition knowledge of undergraduate nursing students to identify knowledge gaps that could be addressed through nutrition teaching in an updated undergraduate nursing curriculum. METHOD: Undergraduate nursing students (N = 197) completed a nutrition knowledge survey with questions on demographics, body composition, nutrition labels, food packaging claims, and healthy food-purchasing choices. RESULTS: Mean overall nutritional knowledge scores were low, but overall scores were higher for students who had received nutrition teaching (60.5% versus 52.5%; F[1, 187] = 7.2, p < 0.001). Improvements in nutrition knowledge were consistent across all ethnic groups, and no effects of age were observed. CONCLUSION: To sufficiently prepare nurses for their public health role in obesity prevention, more nutrition education is needed in undergraduate nursing education programs, with emphasis on ethnic-specific educational requirements.