Individuals' perceptions and expectations of nutrition care provided by doctors in Australia: A focus group study.

BACKGROUND AND OBJECTIVES: Doctors are well placed to facilitate nutrition care to support dietary improvements due, in part, to their regular contact with their patients. Limited literature exists which explores the perspective of patients regarding the nutrition care provided by medical professionals across the continuum of care. This article explores the perspective of patients regarding perceptions of nutrition advice and care received from doctors and expectations of this care, including key skills and attributes the patients perceive as important. METHOD: Six online focus groups were conducted with Australian service users (n=32). RESULTS: Framework analysis identified four key themes: perceptions of doctors' role in nutrition care, expectations and experiences; the importance of individualised care; barriers and enablers to nutrition care; and topics, skills and attributes perceived as important in nutrition care. DISCUSSION: Patients have a desire for individualised and collaborative nutrition care but experienced systemic barriers in practice.

Aligning front-of-pack labelling with dietary guidelines: including whole grains in the health star rating.

PURPOSE: Front-of-pack labelling systems, such as the Health Star Rating (HSR), aim to aid healthy consumer dietary choices and complement national dietary guidelines. Dietary guidelines aim to be holistic by extending beyond the individual nutrients of food, including other food components that indicate diet quality, including whole grains. We aimed to test the feasibility of including whole grains in the HSR algorithm, to better inform dietary guidance in Australia coherent with existing dietary guidelines. METHODS: We assigned whole-grain points as a favourable component of the HSR based on the whole-grain content of foods. We compared the original, and three modified HSR algorithms (including altered thresholds for star ratings) using independent-samples median tests. Finally, we used Spearman's correlation to measure the strength of association between an item's nutritional composition (all components of the HSR algorithm including all favourable and unfavourable components) and their HSR using each algorithm. RESULTS: Up to 10 points were added for products with ≥ 50% whole-grain content, with no points for products with < 25%. Adjusting the HSR score cut-off by 3 points for grain products created the greatest difference in median HSR between refined and whole-grain items (up to 2 stars difference), compared to the original algorithm (a maximum of 1 star). CONCLUSIONS: The addition of whole grains to the HSR algorithm improved the differentiation of refined and whole-grain items, and therefore better aligned with dietary guidelines. Holistic approaches to food guidance systems are required to provide consistent messaging and inform positive food choices.

Dietary Intakes of Recipients of Faecal Microbiota Transplantation: An Observational Pilot Study.

This study reports on the dietary intake of recipients of faecal microbiota transplantation (FMT), comparing this with dietary guidelines, and investigates the relationship between dietary intake and clinical outcomes. Males and females aged ≥ 16 years with irritable bowel syndrome or inflammatory bowel disease undergoing FMT were invited to complete validated symptom and quality of life (QOL) questionnaires and three-day weighed food diaries. Descriptive statistics were calculated for symptom scores, QOL scores, nutrients, and food group servings, and compared to Australian population norms, nutrient reference values, and dietary guidelines. The relationship between dietary intake, symptoms, and QOL was assessed. Participants (n = 18) reported baseline symptoms of urgency, abdominal pain, nausea, and bloating and reduced QOL. Of the participants who completed food diaries, 8/14 met the recommended 30 g of fibre when including supplements. Participants met the recommendations for micronutrients and food groups except calcium, fruit, and dairy/dairy alternatives. There was a non-significant trend towards lower symptom severity scores in participants who met the fibre target. The high degree of variability in participant fibre intakes highlights diet as a key variable that has not been previously controlled for in FMT intervention studies. Future studies examining FMT should include dietary analysis of habitual intake of the recipients and donors.

Nutrition competencies for medicine: an integrative review and critical synthesis.

OBJECTIVE: Globally, 11 million deaths are attributable to suboptimal diet annually, and nutrition care has been shown to improve health outcomes. While medically trained clinicians are well-placed to provide nutrition care, medical education remains insufficient to support clinicians to deliver nutrition advice as part of routine clinical practice. Competency standards provide a framework for workforce development and a vehicle for aligning health priorities with the values of a profession. Although, there remains an urgent need to establish consensus on nutrition competencies for medicine. The aim of this review is to provide a critical synthesis of published nutrition competencies for medicine internationally. DESIGN: Integrative review. DATA SOURCES: CINAHL, Medline, Embase, Scopus, Web of Science and Global Health were searched through April 2020. ELIGIBILITY CRITERIA: We included published Nutrition Competency Frameworks. This search was complemented by handsearching reference lists of literature deemed relevant. DATA EXTRACTION AND SYNTHESIS: Data were extracted into summary tables and this matrix was then used to identify common themes and to compare and analyse the literature. Miller's pyramid, the Knowledge to Action Cycle and the Dreyfus model of skill acquisition were also used to consider the results of this review. RESULTS: Using a predetermined search strategy, 11 articles were identified. Five common themes were identified and include (1) clinical practice, (2) health promotion and disease prevention, (3) communication, (4) working as a team and (5) professional practice. This review also identified 25 nutrition competencies for medicine, the majority of which were knowledge-based. CONCLUSIONS: This review recommends vertical integration of nutrition competencies into existing medical education based on key, cross-cutting themes and increased opportunities to engage in relevant, skill-based nutrition training.

Australian and New Zealand Medical Students' Attitudes and Confidence Towards Providing Nutrition Care in Practice.

The prevalence of lifestyle-related chronic disease is increasing. Doctors in primary care are ideally placed to support patient nutrition care, but recent reviews show education is still lacking. This study aimed to identify medical students' attitudes towards the role of nutrition in health, nutrition knowledge, and perceptions of nutrition education, in postgraduate (Australia) and undergraduate (New Zealand) programs in order to identify gaps in nutrition knowledge and skills to better inform future education. Second-year graduate and third-year undergraduate students participated in semi-structured focus groups and interviews. A general inductive approach was used to investigate students' 1) attitudes toward the role of nutrition in health, 2) nutrition knowledge based on nutrition-specific competencies and 3) perceived adequacy of nutrition education received. Interviews (nine) and focus groups (seven) identified four common themes: 1) role of medical practitioners in nutrition care, 2) barriers to nutrition education, 3) nutrition knowledge, and 4) nutrition-related skills. Students perceive that doctors are well-placed to provide some level of nutrition care, but poor translation of nutrition knowledge to clinical contexts is a key limitation in nutrition education. In summary, nutrition education may be insufficient to support the nutrition-related competency development of the undergraduate and postgraduate student participants in this study. Focusing on the integration of these skills into the curriculum may be a priority.

Dietary intake and diet quality in children receiving treatment for cancer.

This narrative synthesis aims to examine the dietary intake, diet quality, and dietary preferences of pediatric cancer patients during cancer treatment. Thirteen studies were eligible for review. Studies mostly investigated nutrient intake, with 7 reporting on children's food intake. There was consensus among studies, which reported suboptimal fruit and vegetable intake and a preference for savory, carbohydrate-based foods. Results suggest that pediatric cancer patients consume a limited variety of foods, with a high intake of noncore foods. Future research should aim to examine dietary food data against dietary guidelines to assess adequacy and variety within core food groups.

Physiological Effects Associated with Quinoa Consumption and Implications for Research Involving Humans: a Review.

Quinoa is a pseudo-grain consumed as a dietary staple in South America. In recent years, consumer demand for quinoa in the developed world has grown steadily. Its perceived health benefits have been cited as a driving force behind this trend, but there are very few human studies investigating the impact of quinoa consumption. The aim of this review was to identify physiological effects of quinoa consumption with potential for human health. A critical evaluation of animal model studies was conducted. The quality of identified studies was assessed using a methodological quality assessment tool and summative conclusions were drawn to guide the direction of future human research. The majority of studies were of fair quality. Purported physiological effects of quinoa consumption included decreased weight gain, improved lipid profile and improved capacity to respond to oxidative stress. These physiological effects were attributed to the presence of saponins, protein and 20-hydroxyecdysone in the quinoa seed. The implications of these findings are that human studies should investigate the impact of quinoa consumption on weight gain and lipid levels. The role of quinoa as an antioxidant is still unclear and requires further elucidation in animal models.

Cholesterol-lowering effects of oat ß-glucan: a meta-analysis of randomized controlled trials.

BACKGROUND: Health claims regarding the cholesterol-lowering effect of soluble fiber from oat products, approved by food standards agencies worldwide, are based on a diet containing ≥3 g/d of oat ß-glucan (OBG). Given the number of recently published randomized controlled trials (RCTs), it is important to update the findings of previous meta-analyses. OBJECTIVE: The objective was to quantify the effect of ≥3 g OBG/d on serum cholesterol concentrations in humans and investigate potential effect modifiers. DESIGN: A meta-analysis was performed on 28 RCTs comparing ≥3 g OBG/d with an appropriate control. Systematic searches were undertaken in PubMed, AGRICOLA, and Scopus between 1 January 1966 and 6 June 2013, plus in-house study reports at CreaNutrition AG. Studies were assessed with regard to inclusion/exclusion criteria, and data were extracted from included studies by reviewers working independently in pairs, reconciling differences by consensus. Estimates of the mean reduction in serum cholesterol from baseline between the OBG and control diets were analyzed by using random-effects meta-analysis models and meta-regression. RESULTS: OBG in doses of ≥3 g/d reduced low-density lipoprotein (LDL) and total cholesterol relative to control by 0.25 mmol/L (95% CI: 0.20, 0.30; P < 0.0001) and 0.30 mmol/L (95% CI: 0.24, 0.35; P < 0.0001), respectively, with some indication of heterogeneity (P = 0.13 and P = 0.067). There was no significant effect of OBG on high-density lipoprotein (HDL) cholesterol or triglycerides and no evidence that dose (range across trials: 3.0-12.4 g/d) or duration of treatment (range: 2-12 wk) influenced the results. LDL cholesterol lowering was significantly greater with higher baseline LDL cholesterol. There was a significantly greater effect for both LDL and total cholesterol in subjects with diabetes compared with those without (although based on few studies). CONCLUSIONS: Adding ≥3 g OBG/d to the diet reduces LDL and total cholesterol by 0.25 mmol/L and 0.30 mmol/L, respectively, without changing HDL cholesterol or triglycerides.

Oat beta-glucan supplementation does not enhance the effectiveness of an energy-restricted diet in overweight women.

Epidemiological evidence shows an inverse relationship between dietary fibre intake and body weight gain. Oat beta-glucan, a soluble fibre alters appetite hormones and subjective satiety in acute meal test studies, but its effects have not been demonstrated with chronic consumption. The present study aimed to test the effects in women of two different doses of oat beta-glucan on weight loss and hormones associated with appetite regulation. In a 3-month parallel trial, sixty-six overweight females were randomised into one of three 2 MJ energy-deficit diets: a control and two interventions including 5-6 g or 8-9 g beta-glucan. Anthropometric and metabolic variables (blood glucose level, insulin, total cholesterol (TC), LDL, HDL, TAG and leptin), together with markers of appetite regulation (cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), ghrelin, peptide YY (PYY) and PYY3-36) were measured at baseline and at 3 months. After 3 months, all groups lost weight (P < 0.001) and showed a reduced waist circumference (P < 0.001). The study sample also showed reductions in TC, LDL, HDL, leptin, PYY, GLP-1 values (all P < 0.001) and an increase in CCK levels (P < 0.001). No significant differences were noted between the groups for all outcome values except PYY levels (P = 0.018). In broad terms, the addition of oat beta-glucan did not enhance the effect of energy restriction on weight loss in mildly overweight women, although wide variations in observed results suggests that individual responsiveness may be an issue.

Increases in peptide Y-Y levels following oat beta-glucan ingestion are dose-dependent in overweight adults.

Peptide Y-Y (PYY) is an anorexigenic hormone implicated in appetite control, and beta-glucan is a fiber known to affect appetite. We hypothesized that plasma PYY levels would increase in overweight human adults consuming increasing doses of beta-glucan. The objective was to test whether the effect could be seen with beta-glucan delivered through extruded cereals containing a high beta-glucan oat bran with demonstrated high molecular weight and solubility. Fourteen subjects consumed a control meal and 3 cereals of varying beta-glucan concentration (between 2.2 and 5.5 g), and blood samples were collected over 4 hours. Analysis of raw PYY data showed a trend toward significant increases over 4 hours. An increasing dose of beta-glucan resulted in higher levels of plasma PYY, with significant differences between groups from 2 to 4 hours post test-meal. Data for the area under the curve analysis also approached significance, with post hoc analysis showing a difference (P = .039) between the control and the highest dose of beta-glucan (5.5 g). The PYY levels at 4 hours were significantly different between the control and high-dose meal test (P = .036). There was a significant dose response, with a positive correlation between the grams of beta-glucan and PYY area under the curve (r(2) = 0.994, P = .003). The optimal dose of beta-glucan appears to lie between 4 and 6 g, with the effects on PYY mediated by viscosity and concentration. Meal-test studies examining a range of hormones should measure hormones over a minimum of 4 hours and record meal intake for even longer time frames.