Malnutrition, nutritional deficiency and alcohol: A guide for general practice.

BACKGROUND: Alcohol use has an effect on nutritional status, with nutritional deficiencies being a major contributor to morbidity, for example Wernicke's encephalopathy. Currently, there is an absence of best-practice guidelines to support general practitioners (GPs) in the identification and management of malnutrition and nutritional risk factors in patients who drink at risky levels. OBJECTIVE: This article reviews some of the nutritional considerations in patients who drink at risky levels or who have alcohol dependence, with the aim of enhancing GPs' awareness of the nutritional considerations in this patient group. DISCUSSION: Nutritional risk factors extend beyond body mass index (BMI), and patients might present with a healthy BMI and be malnourished. Screening for risk of malnutrition and other nutritional deficiencies followed by supplementation and consideration of referral to multidisciplinary services, including a dietitian, is likely to improve patient outcomes.

The role of multidisciplinary MS care teams in supporting lifestyle behaviour changes to optimise brain health among people living with MS: A qualitative exploration of clinician perspectives.

INTRODUCTION: Healthcare professionals have an important role in advocating for the adoption of a brain-healthy lifestyle for optimal multiple sclerosis (MS) care. Nonetheless, studies to date have mainly focussed on the consumer perspective. Herein, we aimed to explore the current practices of how healthcare professionals support protective, lifestyle-related behaviour changes to optimise brain health among people living with MS (plwMS), and their perspectives of professional roles. METHODS: Australian healthcare professionals were recruited via study advertisements, purposive and snowball sampling, to participate in an online, semi-structured and audio-recorded interview. Clinicians were eligible if they had a minimum of a tertiary Bachelor's degree and 12-months experience working with plwMS, access to the Internet and sufficient time to participant. An inductive, data-driven form of reflexive thematic analysis was undertaken before thematic categorisation of the quotes from transcripts. Data analysis was guided by the methods of Braun and Clark and the study's underpinnings drew on the constructs of the Social Cognitive Theory (SCT). RESULTS: Six physicians, 10 MS nurses, 18 allied health professionals, one exercise therapist and one alternative therapist were interviewed. Three primary themes encompassing the perceived role of healthcare professionals in supporting a brain-healthy lifestyle were identified: (1) the empowering role, (2) collaborative role and (3) communicative role. External factors/forces including time constraints, professional expertise, training and skill set, power dynamics, consumer readiness, health literacy, self-efficacy and motivation are at play, and affect how/when healthcare professionals may support behaviour change to optimise lifelong brain health for plwMS. CONCLUSION: Healthcare professionals recognise their critical role in encouraging and supporting the adoption of a brain-healthy lifestyle to optimise lifelong brain health for plwMS. However, discord is evident when they underestimate the complexity of translating knowledge of lifestyle-related behaviour change(s) into action. Greater awareness must be made in recognising and addressing the bidirectionality of external factors such as those in the SCT, that may influence how behaviour change occurs. PUBLIC CONTRIBUTION: Healthcare professionals volunteered to be interviewed as part of the data collection phase of this study.

Consumer perceptions of nutrient content claims in Australia: A qualitative study.

BACKGROUND: Nutrition and health claims influence consumer purchasing. Claims include content claims, which refer to the amount of a nutrient contained in a product, and health claims, which refer to health benefits of foods or nutrients in a product. Products that display a health claim must meet the Nutrient Profiling Scoring Criterion (NPSC). The present study aimed to explore consumer perceptions of content claims used on food and beverage labelling and advertisements. METHODS: Semi-structured focus groups were conducted with Australian consumers. Analysis involved an inductive, reflexive approach to thematic analysis. RESULTS: Six focus groups involving 26 participants were conducted. Four main interconnected themes were generated: (1) complex factors influence food choice; (2) content claim scepticism; (3) the difference between content and health claims is unclear; and (4) the regulation of content claims is not common knowledge. Content claims were used, although generally viewed through a lens of scepticism and mistrust, and seen as a promotional tool for the food industry. Product complexity appeared to increase content claim use as a result of consumer uncertainty of the content of complex products, such as ultraprocessed foods. Most participants were aware that content and health claims were in some way regulated. Overall, they did not know further detail, including the relevant regulatory body. CONCLUSIONS: For content claims to support the consumer they need to be accurate and their use limited to healthier foods. This can be achieved by requiring products with content claims to meet NPSC thresholds, as required for products making health claims.

Development of the Australian National Meal Guidelines for home-delivered and centre-based meal programs for older adults.

ISSUE ADDRESSED: This research aimed to develop and disseminate National Meal Guidelines for Australian home-delivered and centre-based meal programs. METHODS: Development was led by a project group of dietitians and a steering group of representatives from the Australian Meals on Wheels Association. The process framework included three phases: (1) Review of existing standards and guidelines and systematic literature review (SLR), (2) stakeholder consultation conducted via six workshops, across six states (N = 212) and surveys with service providers, health professionals (N = 289) and customers (N = 337) and (3) review of the draft guidelines by stakeholders. RESULTS: The final guidelines address: nutritional needs of older adults; meal and menu planning including nutrient requirements for meal components; presentation and meal enjoyment; special diets; and enhancing the meal service. CONCLUSION: These guidelines provide consistent guidance to services providing home-delivered and centre-based meal programs. Further evaluation of their uptake and impact on service practices and customer nutrition and satisfaction is required. SO WHAT?: The National Meal Guidelines provide nationally consistent, evidence-based guidance on menu planning and nutritional quality of meals to services providing home-delivered and centre-based meal programs. The guideline development framework outlined here also provides a process for future food service guideline development.

Healthcare professionals' perspectives on the role of dietitians within multidisciplinary head and neck cancer teams: A qualitative multi-site study.

AIM: Evidence-based guidelines provide recommendations on how dietitians should work with patients with head and neck cancer for best outcomes. Research with healthcare professionals from head and neck cancer teams would provide insight into how these recommendations are implemented in practice. Therefore, the aim of this study was to explore how the role of the dietitian is perceived and enacted in different head and neck cancer teams from the perspective of healthcare professionals. METHODS: This qualitative study recruited radiation oncologists, nurses, dietitians and speech pathologists from four different head and neck cancer teams in Australia and the United States. Data were collected via semi-structured interviews and analysed using a grounded-theory approach. RESULTS: Seventeen radiation oncologists, 12 nurses, 11 dietitians and six speech pathologists participated. Perceptions on the role of dietitians were summarised by the category: "Providing expertise in nutritional care: A core role in head and neck cancer." Five categories summarised perceptions of factors that can influence how the role of the dietitian is enacted in practice: "having experience in head and neck cancer"; "initiating nutritional care plans and the role of doctors and nurses"; "clinic structuring"; "an evolving culture in healthcare services" and "the presence of evidence-based guidelines." CONCLUSIONS: While dietitians can be perceived to be the experts in nutritional care, several factors influence how their role is enacted in head and neck cancer teams. Further research on patient nutritional outcomes and on clinic structures that best use dietetic expertise is required to strengthen recommendations on how dietitians should work with head and neck cancer patients internationally.

The views, experiences and expectations of Australian Meals on Wheels customers: A national survey.

OBJECTIVE: To investigate views and expectations of Australian Meals on Wheels (MOW) customers to inform the development of National Meal Guidelines and improve current services. METHODS: A survey was designed through literature review and consultations with key stakeholders. National convenience sampling returned  337 surveys. Descriptive statistics and chi-squared analyses were applied to the survey data. RESULTS: Meals on Wheels customers reported satisfaction with their current service, with the meal itself found to be the most valuable aspect. People living in small country towns were more likely to value the social contact provided by MOW than those in major cities (P = .001). Delivery of pantry items was the most popular additional option for future services. CONCLUSION: Valuable information for inclusion in the development of the National Meal Guidelines was provided: nutritional content of meals, meal variety, packaging and presentation, opportunities for nourishing snacks and pantry items, and social contact.

Collaborative, interprofessional nutritional care within head and neck cancer teams: an international multi-site qualitative study.

Evidence-based guidelines (EBGs) for patients with head and neck cancer (HNC) recommend that nutritional care is delivered by an interprofessional team inclusive of dietitians, doctors, nurses, and speech pathologists. Barriers to collaboration exist within interprofessional teams. However, research on this is currently lacking in the HNC setting, particularly with regard to the provision of nutritional care. This study aimed to explore what facilitates collaborative nutritional care for patients with HNC from the perspectives of different healthcare professionals. This qualitative study used a grounded theory approach. Healthcare professionals from two radiotherapy departments in the United States and two in Australia were interviewed. Forty-six interviews were completed with 17 radiation-oncologists, 12 nurses, eleven dietitians, and 6 speech-pathologists. Collaborative nutritional care for patients with HNC was underpinned by three categories and six sub-categories: access to dietitians (facilitated by funding for dietitians and the strength of evidence), communication (facilitated by team meetings, communication systems, and multidisciplinary clinics), and role-clarity (facilitated by non-clinical activities and respect). This study highlights opportunities for enhancing collaborative nutritional care within HNC teams. Further studies on the impact of the dietitian, interprofessional education, team meetings, and multidisciplinary clinics are required to promote collaborative nutritional care for HNC patients.

Prevalence and Credibility of Nutrition and Health Claims: Policy Implications from a Case Study of Mongolian Food Labels.

Nutrition and health claims should be truthful and not misleading. We aimed to determine the use of nutrition and health claims in packaged foods sold in Mongolia and examine their credibility. A cross-sectional study examined the label information of 1723 products sold in marketplaces in Ulaanbaatar, Mongolia. The claim data were analysed descriptively. In the absence of national regulations, the credibility of the nutrition claims was examined by using the Codex Alimentarius guidelines, while the credibility of the health claims was assessed by using the European Union (EU) Regulations (EC) No 1924/2006. Nutritional quality of products bearing claims was determined by nutrient profiling. Approximately 10% (n = 175) of products carried at least one health claim and 9% (n = 149) carried nutrition claims. The credibility of nutrition and health claims was very low. One-third of nutrition claims (33.7%, n = 97) were deemed credible, by having complete and accurate information on the content of the claimed nutrient/s. Only a few claims would be permitted in the EU countries by complying with the EU regulations. Approximately half of the products with nutrition claims and 40% of products with health claims were classified as less healthy products. The majority of nutrition and health claims on food products sold in Mongolia were judged as non-credible, and many of these claims were on unhealthy products. Rigorous and clear regulations are needed to prevent negative impacts of claims on food choices and consumption, and nutrition transition in Mongolia.

Nutritional Care of Patients Admitted to Hospital for Alcohol Withdrawal: A 5-Year Retrospective Audit.

AIM: The aim of this study was to describe the characteristics and the nutritional approaches implemented with patients undergoing alcohol withdrawal. METHODS: A retrospective analysis of medical records for patients admitted to a tertiary hospital for alcohol withdrawal was completed over a 5-year period 2013-2017. Data on nutrition-related assessment and management were extracted and descriptively analysed. RESULTS: A total of 109 medical records were included (M = 73, F = 36), with the mean age of patients 47.3 years (SD ± 11.2, range 22-70). The average length of stay was 3.7 days (SD ± 3.9, range 0.70-27.8). Approaches towards nutritional care emerged from micronutrient assessment and supplementation and/or dietetic consultation. Nutrition-related biochemistry data was available for most patients, notably serum levels of sodium, urea and creatinine (102 patients; 93.5%) and magnesium and phosphate (66 patients, 60.5%). There was evidence of some electrolyte abnormalities on admission to hospital. Eight patients had serum micronutrient status assessed; no patients had serum thiamine levels assessed. Parenteral thiamine was provided to 96 patients (88.0%) for 1.9 days (SD ± 1.1, range 1.0-6.0) with a mean dose of 2458.7 mg (SD ± 1347.6, range 300-6700 mg). Multivitamin supplementation was provided to 24 patients (22.0%). Only 23 patients (21.2%) were seen by a dietician of whom 16 underwent a comprehensive nutritional assessment and 3 were screened using the malnutrition screening tool. CONCLUSION: Inconsistent nutritional assessment and management practices were identified across a diverse population group, whilst nutritional professionals were underutilized. Future research should benchmark current guidelines and multidisciplinary approaches considering the role of nutritional specialists in the team.

Healthcare Professionals' Perceptions of Feeding Tube Practices for Patients With Head and Neck Cancer Across 4 International Radiation Oncology Departments.

BACKGROUND: Malnutrition is common and debilitating among patients with head and neck cancer (HNC). A feeding tube (FT) can help to minimize this. However, there is debate on FT use, including whether a reactive nasogastric tube (NGT) or prophylactic gastrostomy tube (PGT) approach is best. This study aimed to explore interdisciplinary healthcare professionals' perspectives of FT practices for patients with HNC, across 4 radiation departments in Australia and the United States. METHODS: Healthcare professionals involved in the clinical care of patients undergoing radiotherapy for HNC were recruited from 2 radiation-oncology departments in Australia and 2 in the United States. Individual interviews were recorded and analyzed using a grounded theory approach. RESULTS: Seventeen radiation oncologists, 12 nurses, 11 dietitians, and 6 speech pathologists participated. "Perspectives of FTs for patients with HNC" comprised 4 categories: a valued support, more individualized, no universal practice, and PGT vs NGT. "Placement considerations" comprised 6 patient categories (planned treatment, tumor characteristics, nutrition and swallow status, tube-dependence risk, psychosocial status, and patient preferences) and 4 service-structure categories (dietetic access, speech-pathology access, interdisciplinary collaboration, and nutrition-support infrastructure). CONCLUSION: Although the targeted use of FTs was valued by healthcare professionals, several patient and service-structure factors may influence whether the PGT or reactive NGT approach is perceived to be more efficacious. Further research is needed to explore patient preferences, tube dependence, interdisciplinary collaboration, and department infrastructure to promote consistent evidence-based and patient-centered FT practices.

Systematic review of nutritional interventions for people admitted to hospital for alcohol withdrawal.

AIM: The aim of this review is to describe the nature of nutritional interventions for people admitted to hospital for alcohol withdrawal reported in the scientific literature and the health outcomes achieved. METHODS: The review protocol was registered with PROSPERO (CRD42017081884). The following databases were systematically searched following the PRISMA protocol: CINAHL, MEDLINE, PsycARTICLES, PsycINFO, Scopus and Web of Science. Eligible studies were those published in English, in a hospital inpatient setting with the primary reason for admission being alcohol withdrawal. Studies of patient populations with the diagnosis of pancreatitis or liver cirrhosis were excluded. Studies were screened for eligibility, and data were extracted and descriptively analysed. Identified articles were assessed using the Quality Criteria Checklist for Primary Research produced by the Academy of Nutrition and Dietetics. RESULTS: Fourteen studies met the inclusion criteria. Given the heterogeneity of studies, only a descriptive analysis of interventions could be achieved. Nutrition interventions included supplementation with thiamine, multivitamins, amino acids, antioxidant compounds, probiotics, magnesium or were educational interventions. Outcome measures included memory function, biochemical and anthropometrical indices, withdrawal symptoms, bowel flora levels and nutrition knowledge. However, the overall body of evidence was limited, particularly as there was a wide variation in participant age, study designs and duration of interventions. CONCLUSIONS: A wide range of nutrition interventions were identified, mostly involving nutrient supplements ameliorating inadequacies. Future research might also consider total dietary interventions as well as studies on the perspectives of people undergoing alcohol withdrawal.

The patient experience of having a feeding tube during treatment for head and neck cancer: A systematic literature review.

BACKGROUND AND AIMS: Patients undergoing treatment for head and neck cancer (HNC) can experience severe weight loss, malnutrition and dehydration which can cause treatment delays. Enteral feeding can reduce the risk of these. However, the use of feeding tubes (FT), including FT type and placement timing is debated. This paper aimed to describe the patient experience of having a FT during treatment for HNC. METHODS: A systematic literature review of qualitative studies was undertaken in the databases Web of Science, CINAHL, Scopus and Science Direct using Prospero and Joanna Brigg's Institute guidelines. RESULTS: Nine studies were included providing the perspectives of 159 patients who had a FT during treatment for HNC. 150 findings and 183 illustrations which were primarily patient quotes were extracted. Analysis resulted in 42 categories from which nine synthesized findings were produced. These are summarized as: initial reluctance and fear; different understandings and expectations; individual preferences around choice; physical discomfort; restrictions to social life and daily living; new challenges and responsibilities; gradual acceptance; a challenging but rewarding transition process; and overall a worthwhile decision. CONCLUSION: These findings highlight the nutrition-related burden patients with HNC experience and support the need for interdisciplinary healthcare teams that integrate dietetics and speech pathology. This review supports individualized approaches to FT placement decisions. Further well-designed studies are needed to better understand patient and cancer-service structural factors that may influence the experience of having a FT, to ensure that decisions are evidence-based and patient-centered for best outcomes.

Better cardiac care: health professional's perspectives of the barriers and enablers of health communication and education with patients of Aboriginal and Torres Strait Islander descent.

BACKGROUND: A body of knowledge continues to grow regarding Aboriginal perspectives on current challenges and barriers to health literacy and access to health services. However, less is known from the perspectives of health professionals who work in cardiac care. Given their role in delivering patient education, health practitioners could provide useful insights into potential solutions to improve patient-practitioner communication. The primary aim was to explore perspectives of health professionals who work in coronary care units regarding the enablers, barriers and potential solutions for patient-practitioner communication with patients of Aboriginal and Torres Strait Islanders descent. The secondary aim was to evaluate the acceptability and value of two videos developed with key stakeholders to provide culturally appropriate education. METHODS: Participants were recruited from two major regional hospitals. In-depth, semi-structured interviews were conducted with 17 health professionals (11 Nurses, five Cardiologists and one Aboriginal Health Worker). Interviews were recorded, de-identified and transcribed verbatim. Transcripts were analysed using constant comparison, interpreted through inductive thematic analysis and final themes were agreed through consensus with secondary researcher. RESULTS: Health professionals acknowledged that existing barriers resulted from organisational structures entrenched in the healthcare system, impacted on the practitioners' ability to provide culturally appropriate, patient-centred care. Lack of time, availability of culturally appropriate resources and the disconnection between Western medical and Aboriginal views of health were the most common challenges reported. The two videos evaluated as part of this study were found to be a useful addition to practice. Strengths in the videos design were the use of Aboriginal and Torres Strait Islander actors and positive messaging to convey health related topics. Further improvements included additional information related to common tests and procedures to allow for realistic expectations of patient care. CONCLUSION: Re-modelling of organisational structures is required in order to promote a more culturally-friendly and welcoming environment to encourage Aboriginal and Torres Strait Islanders to engage with mainstream cardiac care services. The videos that were developed using principles that are sensitive to Aboriginal health views, may offer an additional way in which to overcome existing barriers to effective patient-practitioner communication with Aboriginal and Torres Strait Islanders.

Service providers' and health professionals' views and suggestions for the Australian National Meal Guidelines for the Commonwealth Home Support Program.

AIM: To summarise the views and suggestions of service providers and health professionals on issues related to the development of National Meal Guidelines. METHODS: A national online survey of meal service providers and health professionals in Australia was conducted. Potential participants were identified from previously conducted workshop consultations. Snowball sampling was used whereby participants were encouraged to share the survey link with relevant colleagues. De-identified data were collated and closed responses calculated based on the proportion of participants answering each question. Open-ended responses were systematically examined to identify common themes within the data. RESULTS: The 289 participants were mostly female (83%) and service providers (47%). Most participants described their services to be home-delivery (57%), sourcing meals from external providers (47%), were providing menu choice (59%), and were able to cater for special diets (95%). Participants felt that National Meal Guidelines would be beneficial in improving meal service provision and promoting consistency between organisations but were concerned that they may be impractical and costly. They also identified priority areas for inclusion in the guidelines including nutrition recommendations for customers, dietary modifications for special needs, menu variety/structure and considerations about meal types. Nourishing mid-meal snacks, food fortification and screening and monitoring of malnutrition are future considerations for service activities. CONCLUSIONS: Future research should examine the uptake and satisfaction of service providers and health professionals with the National Meal Guidelines.

'Breaking Barriers, Breaking Bread': Pilot study to evaluate acceptability of a school breakfast program utilising donated food.

AIM: One in seven Australian schoolchildren do not consume breakfast. School-based breakfast programs assist at-risk children to meet their nutritional requirements and provide cognitive and behavioural benefits, but may result in significant food costs and waste. The present study aimed to explore acceptability and perceived benefits of a novel free primary school-based breakfast program utilising donated food. METHODS: Process evaluation included quantification of amount of food donated, number of meals provided and nutritional analysis of some of the meal items. Impact evaluation was based on thematic analysis of focus groups held with students, parents and teachers to explore their perspectives about the program. Breakfast diaries and hunger rating visual analogue scales were used to evaluate students' breakfast habits at home over five consecutive days. RESULTS: The program saved 14.4 t of food from landfill through conversion into 44 000 meals. One-fifth of children interviewed arrived at school without having breakfast at least once per week while one-third of students reported being hungry on arrival at school. Benefits of participation in the program included increased willingness to attend school, improved alertness and behaviour, as well as creation of an equitable, supportive environment beneficial for low income or food insecure families. CONCLUSIONS: This novel breakfast program based on donated food was widely accepted by students, teachers and parents, providing benefits beyond the mere provision of food. It provides a model for school-based interventions to combine breakfast programs with sustainable food production approaches.

Factors Influencing Food Choice for Independently Living Older People-A Systematic Literature Review.

Unyielding, disproportionate growth in the 65 years and older age group has precipitated serious concern about the propensity of health and aged-care services to cope in the very near future. Preservation of health and independence for as long as possible into later life will be necessary to attenuate demand for such services. Maintenance of nutritional status is acknowledged as fundamental for achievement of this aim. Determinants of food choice within this age group need to be identified and better understood to facilitate the development of pertinent strategies for encouraging nutritional intakes supportive of optimal health. A systematic review of the literature consistent with PRISMA guidelines was performed to identify articles investigating influences on food choice among older people. Articles were limited to those published between 1996 and 2014 and to studies conducted within countries where the dominant cultural, political and economic situations were comparable to those in Australia. Twenty-four articles were identified and subjected to qualitative analysis. Several themes were revealed and grouped into three broad domains: (i) changes associated with ageing; (ii) psychosocial aspects; and (iii) personal resources. Food choice among older people is determined by a complex interaction between multiple factors. Findings suggest the need for further investigations involving larger, more demographically diverse samples of participants, with the inclusion of a direct observational component in the study design.

Role of dietary protein and thiamine intakes on cognitive function in healthy older people: a systematic review.

The effectiveness of nutritional interventions to prevent and maintain cognitive functioning in older adults has been gaining interest due to global population ageing. A systematic literature review was conducted to obtain and appraise relevant studies on the effects of dietary protein or thiamine on cognitive function in healthy older adults. Studies that reported on the use of nutritional supplementations and/or populations with significant cognitive impairment were excluded. Seventeen eligible studies were included. Evidence supporting an association between higher protein and/or thiamine intakes and better cognitive function is weak. There was no evidence to support the role of specific protein food sources, such as types of meat, on cognitive function. Some cross-sectional and case-control studies reported better cognition in those with higher dietary thiamine intakes, but the data remains inconclusive. Adequate protein and thiamine intake is more likely associated with achieving a good overall nutritional status which affects cognitive function rather than single nutrients. A lack of experimental studies in this area prevents the translation of these dietary messages for optimal cognitive functioning and delaying the decline in cognition with advancing age.

Baby leafy green vegetables: providing insight into an old problem? An exploratory qualitative study examining influences on their consumption.

ISSUE ADDRESSED: Populations in many developed countries continue to fail to meet vegetable consumption recommendations despite ongoing health promotion activities supported by public health policies. Novel ways to encourage vegetable consumption may help address this concern. The aim of the present study was to describe female consumers' perceptions about leafy green vegetables and identify consumption issues. METHODS: Three age-stratified semistructured focus groups were conducted with 23 female participants. Food shopping habits, reported consumption and/or knowledge, and the perceived benefits of and/or issues associated with the consumption of leafy green vegetables were explored. Focus groups were transcribed verbatim. Two researchers examined each transcript in conjunction with accompanying observers' notes. Content and thematic analysis was conducted to identify final themes. RESULTS: Three key themes were identified: (1) food selection is influenced by time limitations, convenience factors and quality considerations; (2) the repertoire of vegetables is influenced by acceptability within households, familiarity and culinary confidence; and (3) connection with nutritional value is influenced by existing beliefs and knowledge of the nutrient content of leafy green vegetables. Variations found on self-reported intake and acceptability were related to life stage and needs. CONCLUSIONS: Leafy green varieties were perceived as important contributors to a healthy diet. Key barriers to consumption identified in the thematic review related to time constraints, culinary skills and variations in nutritional knowledge. So what? Primary awareness of vegetables as being critical to a healthy diet has been established. Future health promotion activities could focus more on convenience, nutrient quality and versatility of leafy green vegetables, and other similar vegetables, as a way to increase total consumption.

Reviewing the meanings of wellness and well-being and their implications for food choice.

Wellness and well-being are terms found in a broad range of literature such as economics, social science, food marketing and general social commentary. These terms are often used in contexts that encompass mental, physical and emotional health as well as broader more esoteric aspects of life satisfaction such as happiness. The terms wellness and well-being are also used ubiquitously and variably in health practice. However, there is limited understanding about how they are used in the broader health promotion context and how consumers might interpret these terms in the context of food and nutrition messages. The primary aim of this paper is to review how the terms wellness and well-being are being used within a number of disciplines and describe implications for food choice. It is proposed that identifying the way these terms are used by key players in the food industry would enable more effective communication across sectors. This may assist in the collaborative development of public health food and nutrition messages with a consistent meaning.