Assessing the potential of Australian indigenous edible halophytes as salt substitutes: From wild to plate.

Increased salt (sodium chloride (NaCl)) consumption contributes to high blood pressure, increasing the risk of cardiovascular disease. Reducing the intake of NaCl could result in significant public health benefits. Australian grown halophytes are consumed traditionally by indigenous communities as food and medicine. The importance of halophytes has been recently "rediscovered" due to their salty taste and crunchy texture. This study aimed to assess the potential of Australian indigenous edible halophytes (AIEH) as salt substitutes. A benchtop test was carried out to establish a sensory lexicon of four important AIEH (samphire, seapurslane, seablite, and saltbush) and to select the most promising halophyte based on sensory attributes and nutritional composition. Samphire and saltbush, the most common and commercially important halophytes, were used as comparisons. Semolina was used to prepare the halophyte-based test food for the benchtop sensory study. Results of the formal sensory study showed that the growing location of samphire and saltbush can significantly affect their sensory attributes. Samphire had the most favorable sensory attributes and nutritional quality, with dry herb and bran aroma and flavor, whereas the saltbush test food preparations had herbaceous, minty dry wood, and green fruit aroma and flavor. The "optimal" concentration of added freeze-dried samphire/saltbush powder was determined based on the saltiness perception of the NaCl-semolina formulation (0.3% table salt equivalent to 1% samphire freeze-dried powder and 1.4%-2.0% saltbush freeze-dried powder, respectively). This study provided novel and crucial information on the potential use of AIEH as natural salt substitutes. PRACTICAL APPLICATION: There is an increasing demand for natural salt substitutes. Halophytes are salt tolerant plants that sustain in arid or semiarid areas and have the potential to be used as natural salt substitutes. To the best of our knowledge, this is the first study reporting the sensory profiles of four important Australian indigenous edible halophytes (samphire, seapurslane, seablite, and saltbush). This study also demonstrated how different growing locations can affect the sensory attributes of halophytes and subsequently their potential food applications. Our findings provide critical information and data to further study halophytes in the context of novel food applications.

Exploring Australian dietitians' experiences and preparedness for working in residential aged care facilities.

BACKGROUND: Dietitians are increasingly working in residential aged care facilities (RACF). As such, supporting the RACF dietetic workforce is imperative. This qualitative study explored dietitians' experiences and preparedness for working in RACFs. METHODS: A qualitative descriptive approach from a non-singular reality relational position was used. Recruitment occurred through convenience and snowball sampling, including contacting a list of dietitians who had previously consented to be contacted for research. The interviews included a semi-structured approach. Data were analysed using constant comparison and reflexive thematic analysis. RESULTS: Thirty-one dietitians (n = 29 female; median age, 39 years) with a range of career experience participated in an interview. Interviews ranged from 25 to 68 min (mean duration, 41 min). Five themes and 14 subthemes were identified. Themes were: (1) joining the aged care workforce was not initially considered a career option, (2) difficulty sustaining satisfaction working in aged care, (3) navigating practical challenges working with residents while prioritising quality care, (4) poor acknowledgement of the dietitian role by staff and (5) grappling with a moral desire to improve the aged care sector. CONCLUSION: Dietitians face many challenges in fulfilling their role in RACFs, including RACF staff's poor understanding of dietitians' scope and a lack of procedural support for their daily activities. Dietitians report that genuine improvements in their job satisfaction and experiences of older adults require structural reform within the government, beyond their locus of control.

The imperative of collaboration: Lived experience perspectives on team approaches in outpatient eating disorder treatment.

BACKGROUND: Across healthcare broadly, team treatment approaches range from siloed multidisciplinary treatment to synergistic Interprofessional Collaborative Practice (IPCP), with IPCP increasingly favored. In eating disorders, clinical practice guidelines endorse team outpatient treatment, and these approaches are widely used in clinical practice. However, there is limited evidence to describe attitudes toward and experiences of team approaches, including IPCP, among individuals with a lived experience. METHOD: Twenty-seven participants (aged 20-51 years) with a formal eating disorder diagnosis were recruited. Each had received outpatient eating disorder treatment from a team or teams comprising a mental health professional, dietitian, and general practitioner (GP) in the past 2 years. Qualitative data were collected via semi-structured interviews and analyzed using Braun and Clarke's reflexive thematic analysis. RESULTS: Four themes were derived from the qualitative analysis. Themes included: (1) working together is better; (2) the linchpin of teamwork is communication; (3) teams should foster autonomy with limit-setting; and (4) systemic failures negatively affect team treatment. Participants favored highly collaborative treatment from a team including a mental health professional, dietitian, and GP at a minimum, where the team engaged in high-quality communication and fostered autonomy with limit-setting. Systemic failures negatively affecting team treatment were reported across the care continuum. DISCUSSION: Findings endorse the application of IPCP to outpatient eating disorder treatment as a strategy to improve treatment satisfaction, engagement, and outcomes. Given the paucity of evidence exploring IPCP in this field, however, the development and evaluation of interprofessional education and treatment models is a foundational necessity. PUBLIC SIGNIFICANCE: Team eating disorder treatment is widely used in clinical practice, although there is limited evidence to guide interventions. This study explores attitudes toward and experiences of team outpatient eating disorder treatment among individuals with a lived experience. Understanding preferred team treatment characteristics delivers important information to improve treatment satisfaction, engagement, and outcomes for individuals receiving outpatient eating disorder treatment.

Australian dietitians' confidence in their knowledge and skills working with older adults in aged care: A national survey.

AIM: This study aimed to describe dietitians' confidence in their knowledge and skills working with older adults in residential aged care facilities or home care services. METHODS: A novel, quantitative online survey was distributed to aged care dietitians. Activities, knowledge, and skills areas outlined by the Dietitians Australia 'Older Persons and Aged Care Dietitian Role Statement' were included in the 23-item survey. Likert scales captured participant responses. Median responses (n, %) are presented. Associations between participants' confidence in their knowledge and skills and years of experience working in aged care were explored using Pearson's chi-squared tests. RESULTS: Dietitians completed the survey (N = 125; age: 40 ± 13 years [mean ± SD]; 97.6% female). Dietitians reported they "always" worked collaboratively (n = 65%, 52%) and 'often' prescribed supplements (n = 52%, 41.6%) and utilised a food-first approach (n = 36%, 28.8%). Dietitians 'sometimes' conducted malnutrition screening (n = 28%, 22.4%), audits (n = 36%, 28.8%), nutrition education (n = 53%, 42.4%) and quality improvement activities (n = 28%, 22.4%). Dietitians 'rarely' utilised food service/standards (n = 38%, 30.4%) and nutrition/hydration procedures (n = 35%, 28.0%). Dietitians with ≥6 years of experience were more confident than dietitians with 0-5 years in providing support programs (p = 0.003), utilising healthcare policies (p = 0.013), interpreting quality assessment (p = 0.014) and communication skills (p = 0.047). Dietitians felt 'completely' or 'fairly' confident in all knowledge and skill areas, except for government and community support programs (n = 38%, 30.4%) rated 'somewhat' confident. CONCLUSION: Aged care dietitians are confident in most aspects of their role but have opportunities to be better supported. Developing the confidence of higher-level systems and communication in early career dietitians is warranted.

Collaborative dietetic and psychological care in Interprofessional Enhanced Cognitive Behaviour Therapy for adults with Anorexia Nervosa: a novel treatment approach.

Clinical practice guidelines for anorexia nervosa (AN) and atypical anorexia nervosa recommend treatment from a team including a mental health professional and a dietitian. To date, however, AN treatment models such as Enhanced Cognitive Behaviour Therapy (CBT-E) seldom include dietitians and have low to moderate treatment efficacy. Given interprofessional approaches to healthcare have been shown to improve treatment outcomes and enhance patient and clinician satisfaction, formalising collaborative dietetic and psychological treatment may be a feasible strategy to improve treatment outcomes and the patient and clinician experience of treatment. Moreover, malnutrition is a serious consequence of AN, and dietitians are considered experts in its diagnosis and treatment. This paper proposes a novel treatment approach, Interprofessional Enhanced Cognitive Behaviour Therapy (CBT-IE), an adaptation of CBT-E where dietitians deliver content related to malnutrition and dietary restraint and mental health professionals deliver content related to cognitive and behavioural change. The rationale for developing CBT-IE, treatment structure, and future research directions is discussed.

Malnutrition in older adults.

Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.

"We'd be really motivated to do something about it": A qualitative study of parent and clinician attitudes towards predicting childhood obesity in practice.

ISSUE ADDRESSED: In Australia, one in four (24.9%) children live with overweight or obesity (OW/OB). Identifying infants at risk of developing childhood OW/OB is a potential preventive pathway, but its acceptability is yet to be investigated in Australia. This study aimed to (1) investigate the acceptability of predicting childhood OW/OB with parents of infants (aged 0-2 years) and clinicians and (2) explore key language to address stigma and maximise the acceptability of predicting childhood OW/OB in practice. METHODS: This was a cross-sectional and qualitative design, comprising individual semi-structured interviews. Participants were multidisciplinary paediatric clinicians (n = 18) and parents (n = 13) recruited across public hospitals and health services in Queensland, Australia. Data were analysed under the Framework Method using an inductive, thematic approach. RESULTS: Five main themes were identified: (1) Optimism for prevention and childhood obesity prediction, (2) parent dedication to child's health, (3) adverse parent response to risk for childhood obesity, (4) language and phrasing for discussing weight and risk and (5) clinical delivery. Most participants were supportive of using a childhood OW/OB prediction tool in practice. Parents expressed dedication to their child's health that superseded potential feelings of judgement or blame. When discussing weight in a clinical setting, the use of sensitive (ie, "overweight", "above average", "growth" versus "obesity") and positive, health-focused language was mostly supported. CONCLUSIONS: Multidisciplinary paediatric clinicians and parents generally accept the concept of predicting childhood OW/OB in practice in Queensland, Australia. SO WHAT?: Clinicians, public health and health promotion professionals and policymakers can act now to implement sensitive communication strategies concerning weight and obesity risk.

Mediterranean Style Dietary Pattern with High Intensity Interval Training in Men with Prostate Cancer Treated with Androgen Deprivation Therapy: A Pilot Randomised Control Trial.

Background: Androgen deprivation therapy (ADT) in prostate cancer has been shown to deteriorate body composition (reduced lean mass and increased body and fat mass) and increase the risk of cardiovascular morbidity. The Mediterranean style dietary pattern (MED-diet) and high intensity interval training (HIIT) may synergistically alleviate these side effects and improve quality of life in men treated with ADT. Methods: Twenty-three men (65.9 ± 7.8 years; body mass index: 29.6 ± 2.7 kg/m2; ADT duration: 33.8 ± 35.6 months) receiving ADT for ≥3 months were randomly assigned (1:1) to 20 weeks of usual care or the MED-diet (10 nutrition consults) with HIIT (4 × 4 min 85−95% heart rate peak, 3× week, starting at 12 weeks). Results: The MED-diet with HIIT significantly improved cardiorespiratory fitness (+4.9 mL·kg−1·min, p < 0.001), and body mass (−3.3 kg, p < 0.001) compared to the usual care group at 20 weeks. Clinically meaningful (≥3 points) improvements were seen in quality of life and cancer-related fatigue after 20 weeks. Conclusions: The MED-diet with HIIT increased cardiorespiratory fitness and reduced body weight in men with prostate cancer treated with ADT. Larger trials determining whether the MED-diet with HIIT translates to cardiovascular benefits are warranted.

i-PATHWAY: Development and validation of a prediction model for childhood obesity in an Australian prospective birth cohort.

AIM: To develop and validate a model (i-PATHWAY) to predict childhood (age 8-9 years) overweight/obesity from infancy (age 12 months) using an Australian prospective birth cohort. METHODS: The Transparent Reporting of a multivariable Prediction model for individual Prognosis or Diagnosis (TRIPOD) checklist was followed. Participants were n = 1947 children (aged 8-9 years) from the Raine Study Gen2 - an Australian prospective birth cohort - who had complete anthropometric measurement data available at follow up. The primary outcome was childhood overweight or obesity (age 8-9 years), defined by age- and gender-specific cut-offs. Multiple imputation was performed to handle missing data. Predictors were selected using 2000 unique backward stepwise logistic regression models. Predictive performance was assessed via: calibration, discrimination and decision-threshold analysis. Internal validation of i-PATHWAY was conducted using bootstrapping (1000 repetitions) to adjust for optimism and improve reliability. A clinical model was developed to support relevance to practice. RESULTS: At age 8-9 years, 18.9% (n = 367) of children were classified with overweight or obesity. i-PATHWAY predictors included: weight change (0-1 year); maternal pre-pregnancy body mass index (BMI); paternal BMI; maternal smoking during pregnancy; premature birth; infant sleep patterns; and sex. After validation, predictive accuracy was acceptable: calibration slope = 0.956 (0.952-0.960), intercept = -0.052 (-0.063, -0.048), area under the curve = 0.737 (0.736-0.738), optimised sensitivity = 0.703(0.568-0.790), optimised specificity = 0.646 (0.571-0.986). The clinical model retained acceptable predictive accuracy without paternal BMI. CONCLUSIONS: i-PATHWAY is a simple, valid and clinically relevant prediction model for childhood overweight/obesity. After further validation, this model can influence state and national health policy for overweight/obesity screening in the early years.

Mediterranean-style dietary pattern improves cancer-related fatigue and quality of life in men with prostate cancer treated with androgen deprivation therapy: A pilot randomised control trial.

BACKGROUND & AIMS: Cancer-related fatigue (CRF) is a prevalent and persistent symptom from androgen deprivation therapy (ADT) in prostate cancer. The Mediterranean-style dietary pattern (MED-diet) offers a plausible mechanism to mitigate CRF through reducing inflammation and improving body composition. This study aimed to evaluate the effects of a 12-week MED-diet, compared to usual care, on CRF and quality of life in men with prostate cancer treated with ADT. METHODS: Twenty-three men (65.9 ± 7.8 years; body mass index: 29.6 ± 2.7 kg/m2; ADT duration: 33.8 ± 35.6 months) receiving ADT for ≥3 months were randomly assigned (1:1) to 12-weeks of usual care or the MED-diet involving six individualised nutrition consults. Primary outcomes included CRF [Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale (FACIT-F) and quality of life [FACIT-General (FACIT-G)], secondary outcomes included body mass/composition and interleukin (IL)-6 and IL-8 concentrations measured at baseline, 8-weeks and 12 weeks. Intervention feasibility was measured by intervention safety, study completion rate, consult attendance, and adherence to the MED-diet through the Mediterranean-diet adherence screener (MEDAS). Intention to treat linear mixed models were used to determine changes in outcomes between the MED-diet and usual care at baseline, 8-weeks and 12-weeks. RESULTS: The MED-diet improved CRF (FACIT-F) at 8-weeks [+4.8 (0.0, 9.8); P = 0.05] and 12-weeks [+7.2 (2.2, 12.0); P = 0.005], quality of life (FACIT-G) at 12-weeks [+9.2 (2.7, 15.8); P = 0.006], reduced total body mass at 8-weeks [-2.51 kg (-4.25, -0.78); P = 0.005] and 12-weeks [-2.97 kg (-4.71, -1.25); P = 0.001], lean mass at 8-weeks [-1.50 kg (-2.91, -0.10); P = 0.036], and IL-8 at 8-weeks [-0.18 ng/ml (-0.34, -0.02); P = 0.029] compared to usual care. The MED-diet demonstrated zero adverse events, 91% study completion, 100% attendance, and 81% adherence to the MEDAS. CONCLUSION: The MED-diet is safe and feasible, and has the potential to improve CRF and quality of life in overweight men treated with ADT compared to usual care. Further exploration of the MED-diet is warranted in a larger powered sample size to consolidate these findings.

Adherence to the Mediterranean Diet and Chronic Disease in Australia: National Nutrition and Physical Activity Survey Analysis.

The Mediterranean diet (MD) is linked to decreased risk of chronic disease, such as cardiovascular disease, obesity, hypertension, diabetes mellitus and cognitive disease. Given the health promoting aspects of this diet, we conducted a secondary analysis of data from the National Nutrition and Physical Activity Survey (NNPAS), which is the largest health study in Australia and the first nutrition-specific national-based study. The primary aim of this analysis was to determine the proportion of Australian adults adhering to the MD and to examine the association between adherence to the MD and markers of noncommunicable diseases, such as cardiovascular disease, diabetes mellitus and chronic kidney disease. Out of the 9435 participants included in the study (mean age = 48.6 ± 17.6 years), 65% were in the middle tertile of the MD score. Participants who were married, employed, of a high-socioeconomic level, nonsmokers, educated and had a healthy body mass index (BMI) and waist circumference were more likely to have higher adherence levels to the MD, which was associated with lower diastolic blood pressure (p < 0.05). Multivariate logistic regression analysis showed that, even after accounting for all possible confounders, higher adherence to the MD was associated with lower risk of dyslipidaemia, OR = 1.06 (1.01-1.10). In conclusion, this analysis is the first to assess adherence to the MD on a national level. Our results indicated that MD adherence may contribute to reducing the prevalence of dyslipidaemia, cerebrovascular disease and elevated blood pressure in a multi-ethnic, non-Mediterranean country.

Nutrition therapy for the management of cancer-related fatigue and quality of life: a systematic review and meta-analysis.

Cancer-related fatigue (CRF) is one of the most commonly reported disease- and treatment-related side effects that impede quality of life. This systematic review and meta-analysis describes the effects of nutrition therapy on CRF and quality of life in people with cancer and cancer survivors. Studies were identified from four electronic databases until September 2017. Eligibility criteria included randomised trials in cancer patients and survivors; any structured dietary intervention describing quantities, proportions, varieties and frequencies of food groups or energy and macronutrient consumption targets; and measures of CRF and quality of life. Standardised mean differences (SMD) were pooled using random-effects models. The American Dietetic Association's Evidence Analysis Library Quality Checklist for Primary Research was used to evaluate the methodological quality and risk of bias. A total of sixteen papers, of fifteen interventions, were included, comprising 1290 participants. Nutrition therapy offered no definitive effect on CRF (SMD 0·18 (95 % CI -0·02, 0·39)) or quality of life (SMD 0·07 (95 % CI -0·10, 0·24)). Preliminary evidence indicates plant-based dietary pattern nutrition therapy may benefit CRF (SMD 0·62 (95 % CI 0·10, 1·15)). Interventions using the patient-generated subjective global assessment tool and prescribing hypermetabolic energy and protein requirements may improve quality of life. However, the heterogeneity seen in study design, nutrition therapies, quality-of-life measures and cancer types impede definitive dietary recommendations to improve quality of life for cancer patients. There is insufficient evidence to determine the optimal nutrition care plan to improve CRF and/or quality of life in cancer patients and survivors.

New insights into the anorexia of ageing: from prevention to treatment.

PURPOSE OF REVIEW: Undernutrition in older adults is associated with frailty, functional decline, and mortality. The 'anorexia of ageing' is the age-related appetite and weight loss underpinning such undernutrition. This review examines the latest evidence for its prevention and treatment. RECENT FINDINGS: Existing nutritional therapies for the anorexia of ageing include supporting nutritional intake with fortified food or supplements, including protein, omega-3 fatty acids, multivitamins, and vitamin D. The Mediterranean diet provides high fat intake and nutrient density in a moderate volume of colourful and flavoursome food and is strengthening in evidence for healthy ageing. Studies of the gut microbiome, which potentially regulates normal appetite by acting on the brain-gut communication axis, are pertinent. Utilisation of the genetic profile of individuals to determine nutritional needs is an exciting advancement of the past decade and may become common practice. SUMMARY: Prevention or early treatment of the anorexia of ageing in older adults is critical. Latest evidence suggests that once significant weight loss has occurred, aggressive nutritional support may not result in improved outcomes.

The role of vitamin D in adipogenesis.

Vitamin D, a secosteroid predominately obtained by endogenous production, has in recent years been linked to obesity and its comorbidities. The purpose of this review is to draw conclusions from animal and human studies on the effects of vitamin D on adipogenesis to identify the molecular links between vitamin D and obesity. The information presented herein was obtained from 4 databases (PubMed, CINAHL, Cochrane Library, Scopus) using predefined search terms, as well as research literature and other reviews. The effects of vitamin D on adipogenesis have been researched in several animal models, and the majority of these studies suggest vitamin D plays an inhibitory role in adipogenesis. Studies into vitamin D status and obesity in humans are limited, with the majority being observational epidemiological studies that provide no conclusions on cause and effect or clear links on the molecular mechanisms. The few cell culture and supplementation studies that have investigated adipogenesis in human cells indicate that, in contrast to findings from rodent studies, vitamin D is proadipogenic. There is insufficient evidence to determine whether 1) vitamin D deficiency is associated with a lean or obese phenotype, 2) vitamin D deficiency is a consequence of obesity, or (3) the effects of vitamin D on fat tissue are due to interactions with calcium.

Association of Sun Exposure, Skin Colour and Body Mass Index with Vitamin D Status in Individuals Who Are Morbidly Obese.

Vitamin D deficiency is a common issue, particularly in obese populations, and is tested by assessing serum 25(OH)D concentrations. This study aimed to identify factors that contribute to the vitamin D status in fifty morbidly obese individuals recruited prior to bariatric surgery. Data collected included serum 25(OH)D concentrations, dietary and supplement intake of vitamin D, sun exposure measures, skin colour via spectrophotometry, and genotype analysis of several single nucleotide polymorphisms in the vitamin D metabolism pathway. Results showed a significant correlation between serum 25(OH)D concentrations and age, and serum 25(OH)D and ITAC score (natural skin colour). Natural skin colour accounted for 13.5% of variation in serum 25(OH)D, with every 10° increase in ITAC score (i.e., lighter skin) leading to a 9 nmol/L decrease in serum 25(OH)D. Multiple linear regression using age, ITAC score, and average UV index in the three months prior to testing, significantly predicted serum 25(OH)D concentrations (R² = 29.7%). Single nucleotide polymorphisms for all vitamin D genes tested, showed lower serum 25(OH)D for those with the rare genotype compared to the common genotype; this was most pronounced for fok1 and rs4588, where those with the rare genotype were insufficient (<50 nmol/L), and those with the common genotype were sufficient (≥50 nmol/L). Assessing vitamin D status in individuals with morbid obesity requires testing of 25(OH)D, but potential risk factors for this population include natural skin colour and age.

The Effect of Nutrition Therapy and Exercise on Cancer-Related Fatigue and Quality of Life in Men with Prostate Cancer: A Systematic Review.

BACKGROUND: Improvements in diet and/or exercise are often advocated during prostate cancer treatment, yet the efficacy of, and optimal nutrition and exercise prescription for managing cancer-related fatigue and quality of life remains elusive. The aim of this study is to systematically review the effects of nutrition and/or exercise on cancer-related fatigue and/or quality of life. METHODS: A literature search was conducted in six electronic databases. The Delphi quality assessment list was used to evaluate the methodological quality of the literature. The study characteristics and results were summarized in accordance with the review's Population, Intervention, Control, Outcome (PICO) criteria. RESULTS: A total of 20 articles (one diet only, two combined diet and exercise, and seventeen exercise only studies) were included in the review. Soy supplementation improved quality of life, but resulted in several adverse effects. Prescribing healthy eating guidelines with combined resistance training and aerobic exercise improved cancer-related fatigue, yet its effect on quality of life was inconclusive. Combined resistance training with aerobic exercise showed improvements in cancer-related fatigue and quality of life. In isolation, resistance training appears to be more effective in improving cancer-related fatigue and quality of life than aerobic exercise. Studies that utilised an exercise professional to supervise the exercise sessions were more likely to report improvements in both cancer-related fatigue and quality of life than those prescribing unsupervised or partially supervised sessions. Neither exercise frequency nor duration appeared to influence cancer-related fatigue or quality of life, with further research required to explore the potential dose-response effect of exercise intensity. CONCLUSION: Supervised moderate-hard resistance training with or without moderate-vigorous aerobic exercise appears to improve cancer-related fatigue and quality of life. Targeted physiological pathways suggest dietary intervention may alleviate cancer-related fatigue and improve quality of life, however the efficacy of nutrition management with or without exercise prescription requires further exploration.

Vitamin D: Australian dietitian's knowledge and practices.

AIM: To survey dietitians on their knowledge and practices regarding vitamin D (VitD) intake, sources, supplementation and effect on disease state. METHODS: An online survey was disseminated to members of the Dietitian Association Australia via the weekly online state newsletter during April 2015. Response rate was 3%, with 134 respondents completing the survey. The survey included questions about knowledge and current practices. Descriptive statistics were used to analyse the results. RESULTS: Dietitians have good knowledge regarding dietary sources of VitD and roles in the body, but there is confusion around supplement doses for treatment and prevention of deficiency and sun exposure guidelines. CONCLUSIONS: Dietitians are well positioned to provide patients with advice on VitD supplementation and sun exposure practices, but not all are confident to provide this care. There is a need for clear and well-disseminated guidelines for VitD management by dietitians.

The Association between the Mediterranean Dietary Pattern and Cognitive Health: A Systematic Review.

The ageing population is accompanied by increased rates of cognitive decline and dementia. Not only does cognitive decline have a profound impact on an individual's health and quality of life, but also on that of their caregivers. The Mediterranean diet (MD) has been known to aid in reducing the risk of cardiovascular diseases, cancer and diabetes. It has been recently linked to better cognitive function in the elderly population. The purpose of this review was to compile evidence based data that examined the effect of adherence to the MD on cognitive function and the risk of developing dementia or Alzheimer's disease. This review followed PRISMA guidelines and was conducted using four databases and resulted in 31 articles of interest. Cross-sectional studies and cohort studies in the non-Mediterranean region showed mixed results. However, cohort studies in the Mediterranean region and randomized controlled trials showed more cohesive outcomes of the beneficial effect of the MD on cognitive function. Although more standardized and in-depth studies are needed to strengthen the existing body of evidence, results from this review indicate that the Mediterranean diet could play a major role in cognitive health and risk of Alzheimer's disease and dementia.