Increasing Children's Vegetable Consumption: Translating a Review of the Evidence Base to Develop Best Practice Guidelines.

Introduction: Dietary guidelines worldwide emphasize the importance of consuming vegetables as part of a healthy diet. Despite this, translating this information into messages for consumers that change behavior has been difficult. There have been population-level social marketing campaigns as well as several smaller campaigns directed specifically toward children, which have demonstrated small increases in consumption. However, achieving meaningful and sustained increases in children's vegetable consumption remains a challenge. This article describes the process of synthesizing the published literature and translating these findings to inform the development of 7 best practice guidelines to increase children's vegetable intake. Methods: The first step in this process was a systematic review of scientific literature to identify the components of interventions that were associated with successfully increasing vegetable intake. The synthesis of effective intervention components was guided by the Behavior Change Wheel. These scientific findings were translated to guidelines for best practice. This process involved a team of nutrition and behavioral researchers and nutrition practitioners translating the science into actionable advice that could be adopted by a range of stakeholders. The 6 selected stakeholders included long daycare centers, after-hours school care providers, primary schools, industry groups and growers, researchers, and government policy makers. Stakeholders were involved in the development process through surveys and interviews to understand their requirements for resources to support adoption of the best practice guidelines within each setting and within the context of existing practice. Results: The guidelines center on coordination of effort, with a focus on components such as planning, environmental restructuring, barrier reduction, feedback, and monitoring. In consultation with key stakeholders, a range of resources were developed for each setting to support the implementation of best practice, with the aim of achieving meaningful increases in intake. The resources and tools have been made available at http://www.vegkit.com.au. Conclusions: The translation of knowledge into practice is not traditionally included as part of the research process. Therefore, combining the process of reviewing the science and translating the evidence to stakeholder resources to influence practice in 1 research study is novel, and the study could be used to guide future research translation activities within and beyond the field of public health nutrition.

Working together to increase Australian children's liking of vegetables: a position statement by the Vegetable Intake Strategic Alliance (VISA).

Children need to be repeatedly and consistently exposed to a variety of vegetables from an early age to achieve an increase in vegetable intake. A focus on enjoyment and learning to like eating vegetables at an early age is critical to forming favourable lifelong eating habits. Coordinated work is needed to ensure vegetables are available and promoted in a range of settings, using evidence-based initiatives, to create an environment that will support children's acceptance of vegetables. This will help to facilitate increased intake and ultimately realise the associated health benefits. The challenges and evidence base for a new approach are described.

Co-design of a cancer nutrition care pathway by patients, carers, and health professionals: the CanEAT pathway.

PURPOSE: Limited practical resources exist to guide optimal nutrition care for patients, carers, and health professionals (HPs). This study aimed to co-design a cancer nutrition care pathway to guide and improve the provision of consistent, evidence-based care with consumers and HPs. METHODS: This study utilised an experienced-based co-design (EBCD) approach over five stages. Stage 1 involved stakeholder engagement and a literature review. Stage 2 included a survey and focus groups with patients/carers. Co-design workshops were conducted within stage 3, key stakeholder consultation within stage 4, and the finalisation and dissemination of the cancer nutrition care pathway formed stage 5. Results of stages 3 to 5 are the focus of this paper. RESULTS: Two co-design workshops were held with patients, carers, and HPs (n = 32 workshop 1; n = 32 workshop 2), who collectively agreed on areas of focus and key priorities. Following this, a consultation period was completed with patients, carers, and HPs (n = 45) to refine the pathway. The collective outcome of all study stages was the co-design of a cancer nutrition care pathway (the CanEAT pathway) defining optimal cancer nutrition care that combines evidence-based practice tips into a centralised suite of resources, tools, and clinical guidance. CONCLUSION: The CanEAT pathway was co-designed by patients, carers, and HPs. The EBCD approach is a meaningful way to develop targeted improvements in cancer care. The CanEAT pathway is freely available to guide and support patients, carers, and HPs to aid the implementation of optimal nutrition care into clinical practice.

Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points.

BACKGROUND: The prevention and management of malnutrition is increasingly recognised as a significant element of cancer care. By identifying and comparing cancer malnutrition in two large cross-sectional cancer populations, this study aims to provide a greater understanding of clinical characteristics and trajectories relating to cancer malnutrition. METHODS: A multi-centre point prevalence study was conducted in Victoria, Australia at two time points (March 2012, May 2014). Adults with cancer receiving ambulatory chemotherapy, radiotherapy and multi-day inpatients were included. The presence of malnutrition was determined using Patient Generated-Subjective Global Assessment (PG-SGA). Demographic, clinical information and 30-day outcomes were collected. RESULTS: The study included 1677 patients in 2012 (17 sites) and 1913 patients in 2014 (27 sites). Older age, ≥5% weight loss, hospital admission and metastatic disease were factors significantly associated with malnutrition. Patients with upper gastrointestinal, head and neck and lung cancers were more likely to be malnourished. Malnutrition was associated with infection and poor outcomes at 30-days. Malnutrition prevalence reduced from 31% in 2012 to 26% in 2014 (p = 0.002). This reflects a reduction in patients with malnutrition receiving ambulatory chemotherapy, those with upper gastrointestinal or colorectal cancers and those residing in regional areas. CONCLUSION: The study has provided a comprehensive description of cancer malnutrition prevalence representative of all treatment settings, tumour types and stages of disease. This provides valuable insight into cancer malnutrition enabling oncology services to identify opportunities to embed identification and prevention strategies into models of care, resulting in improved patient outcomes and reduced health care costs.