Can fortified foods and snacks increase the energy and protein intake of hospitalised older patients? A systematic review

Background

Undernutrition affects over 44% of hospitalised older people, who often dislike oral nutritional supplements (ONS). This review summarises the evidence for an alternative strategy, using energy and protein dense meals (via fortification) or snacks (supplementation) to increase the dietary energy and protein intake of older inpatients.

Methods

A search was conducted through PubMed, EMBASE, CINAHL and the Cochrane database of systematic reviews (May 1996 to May 2016) that used fortification or supplementation to increase the energy or protein intake of patients (mean age ≥60 years) in hospitals or rehabilitation centres.

Results

Ten articles (546 patients, mean age 60–83 years) were identified. Compared with usual nutritional care, six studies using either energy or protein based fortification and supplementation significantly increased intake of energy (250–450 kcal day^?1) or protein (12–16 g day^?1). Two studies enriched menus with both energy and protein, and significantly increased both energy (698 kcal day^?1 and 21 kJ kg^?1) and protein (16 g and 0.2 g kg^?1) intake compared to usual care. ONS was similar to supplementation in one study but superior to fortification in another. Four studies reported good acceptability of enriched products and two studies that found they were cost‐effective.

Conclusions

Compared with usual nutritional care, energy‐ and protein‐based fortification and supplementation could be employed as an effective, well‐tolerated and cost‐effective intervention to improve dietary intake amongst older inpatients. This strategy may be particularly useful for patients with cognitive impairment who struggle with ONS, and clinical trials are required to compare these approaches and establish their impact on functional outcomes.

     

Dietary intake in people consuming a low‐carbohydrate diet in the UK Biobank

Background

Low‐carbohydrate diets are becoming increasingly popular, although their dietary quality outside of clinical studies is unknown. A previous study analysed the dietary intake in people consuming a reduced‐carbohydrate diet (<40% calories). However, it is not clear what foods people consume when carbohydrate is reduced to below 26% of total calories.

Methods

In the present cross‐sectional study, the dietary and nutrient intake collected via up to five consecutive 24‐h dietary recalls and a food frequency questionnaire of 444 individuals (aged 46‐79 years) consuming <26% of calories from carbohydrate (LCHO ) was compared with that of 131 897 individuals consuming ≥45% calories from carbohydrate (NCHO ) using the UK Biobank Dataset. Absolute cut‐offs to define the low‐carbohydrate group (<130 g day^–1; n  = 1953 versus ≥225 g day^–1, n  = 113 036) were also used.

Results

Both NCHO (>45% calories and ≥225 g) groups consumed significantly more high‐sugar, high‐fat snacks [median 6.0, interquartile range (IQR ) = 2.0–11.0 and median 6.0, IQR  = 3.0–11.8, respectively) compared to the LCHO (<26% calories and <130 g) groups (median 0, IQR  = 0–2.8 and median 1, IQR  = 0–3.8, respectively) (P  < 0.0001). Both LCHO groups reported consuming significantly more red meat, oily fish, nuts and seeds but fewer fruits, vegetables and pulses compared to the NCHO groups. In general, the consumption of oily fish, nuts, seeds and pulses was low across the whole cohort and differences in intake between the LCHO and NCHO groups were small. After adjusting for socio‐economic status, most differences remained.

Conclusions

Carbohydrate restriction is associated with both beneficial and potentially deleterious dietary changes compared to a normal carbohydrate intake.

     

Fifteen years of using a second stage protein substitute for weaning in phenylketonuria: a retrospective study

Background

In phenylketonuria (PKU), during weaning, it is necessary to introduce a second stage phenylalanine (Phe)‐free protein substitute (PS) to help meet non‐Phe protein requirements. Semi‐solid weaning Phe‐free PS have been available for >15 years, although no long‐term studies have reported their efficacy.

Methods

Retrospective data from 31 children with PKU who commenced a weaning PS were collected from clinical records from age of weaning to 2 years, on: gender; birth order; weaning age; anthropometry; blood Phe levels; age commenced and dosage of weaning PS and Phe‐free infant L‐amino acid formula; natural protein intake; and issues with administration of PS or food.

Results

Median commencement age for weaning was 17 weeks (range 12–25 weeks) and, for weaning PS, 20 weeks (range 13–37 weeks). Median natural protein was 4 g day^?1 (range 3–11 g day^?1) and total protein intake was >2 g kg^?1 day^?1 from weaning to 2 years of age. Children started on 2–4 g day^?1 protein equivalent (5–10 g day^?1 of powder) from weaning PS, increasing by 0.2 g kg^?1 day^?1 (2 g day^?1) monthly to 12 months of age. Teething and illness adversely affected the administration of weaning PS and the acceptance of solid foods. Altogether, 32% of children had delayed introduction of more textured foods, associated with birth order (firstborn 80% versus 38%; P = 0.05) and food refusal when teething (80% versus 29%; P = 0.02).

Conclusions

Timing of introduction of solid foods and weaning PS, progression onto more textured foods and consistent feeding routines were important in aiding their acceptance. Any negative behaviour with weaning PS was mainly associated with food refusal, teething and illness. Parental approach influenced the acceptance of weaning PS.

     

Dietary patterns and risk of ulcerative colitis: a case–control study

Background

Recent evidence indicates a role for dietary factors in the pathogenesis of ulcerative colitis (UC ). The aim of the present study was to investigate the relationship between dietary patterns and UC risk.

Methods

Sixty‐two newly diagnosed cases of UC and 124 healthy age and sex‐matched controls were studied. Data on diet was measured using a validated country‐specific food frequency questionnaire. Factor analysis was used to define major dietary patterns based on 28 food groups and nutrient content.

Results

After adjustment for confounding factors, subjects who were in the highest tertile of the healthy dietary pattern had a 79% lower risk of UC (odds ratio = 0.21, 95% confidence interval = 0.07–0.59, P  =  0.003), whereas the consumption of an unhealthy dietary pattern was associated with a significantly increased risk of UC (odds ratio = 3.39, 95% 95% confidence interval = 1.16–9.90, P  =  0.027).

Conclusions

The findings of the present study suggest that dietary patterns are associated with UC risk.

     

Do the contemporary dietary patterns of children align with national food and nutrient recommendations?

Background

Childhood nutrition is important in optimising growth, development and future health. The present study compared dietary intakes of Australian children aged 4–8 years with (i) Australian Guide to Healthy Eating (AGHE) food group recommendations and (ii) age‐specific Nutrient Reference Values (NRVs), in addition to (iii) describing food group intakes of children meeting key NRVs.

Methods

Data were obtained from a representative sample of children (n = 789) from the National Nutrition and Physical Activity Survey between May 2011 and June 2012. Parent‐reported 24‐h recall dietary data were disaggregated into five core food groups, along with energy‐dense, nutrient‐poor (EDNP) foods, with intakes being compared with AGHE recommendations. Food group intakes were compared for children meeting the NRVs for 10 nutrients used for the development of AGHE food groups. Chi‐squared and t ‐tests were performed to determine differences in food group intakes with P < 0.05 considered statistically significant.

Results

Only one child met the recommended daily servings for all AGHE core food groups and none met both core and energy‐dense, nutrient‐poor (EDNP) food group recommendations. The lowest level of alignment (percentage meeting recommendations) was for vegetables (4.6%) and the highest was for fruit (47.7%). Mean (SD) daily intake of EDNP foods [4.7 (3.2) serves day^?1] accounted for 38.4% of total energy intakes. Children meeting key NRVs (n = 395) consumed greater daily servings of fruit [2.2 (1.7)], dairy [2.2 (1.2)] and EDNP foods [5.0 (3.4)] compared to the total sample (n = 789).

Conclusions

Significant discrepancies exist between contemporary dietary patterns of Australian children and national recommendations. Future AGHE revisions should incorporate greater diversity of consumption patterns, including sub‐categories of EDNP foods.

     

Food addiction and associations with mental health symptoms: a systematic review with meta‐analysis

Background

The present study systematically reviewed the literature aiming to determine the relationships between food addiction, as measured by the Yale Food Addiction Scale (YFAS ), and mental health symptoms.

Methods

Nine databases were searched using keywords. Studies were included if they reported: (i) YFAS diagnosis or symptom score and (ii) a mental health outcome, as well as the association between (i) and (ii). In total, 51 studies were included.

Results

Through meta‐analysis, the mean prevalence of food addiction diagnosis was 16.2%, with an average of 3.3 (range 2.85–3.92) food addiction symptoms being reported. Subanalyses revealed that the mean number of food addiction symptoms in populations seeking treatment for weight loss was 3.01 (range 2.65–3.37) and this was higher in groups with disordered eating (mean 5.2 3.6–6.7). Significant positive correlations were found between food addiction and binge eating [mean r  = 0.602 (0.557–0.643), P  < 0.05], depression, anxiety and food addiction [mean r  = 0.459 (0.358–0.550), r  = 0.483 (0.228–0.676), P  < 0.05, respectively].

Conclusions

A significant, positive relationship exists between food addiction and mental health symptoms, although the results of the present study highlight the complexity of this relationship.

     

Comparing the effectiveness of a multi‐component weight loss intervention in adults with and without intellectual disabilities

Background

The prevalence of obesity in adults with intellectual disabilities (ID) is rising, although the evidence base for its treatment in this population group is minimal. Weight management interventions that are accessible to adults with ID will reduce the inequalities that they frequently experience in health services. This short report compared the effectiveness of weight management in those with and without ID who completed nine sessions of a multi‐component weight management programme.

Methods

TAKE 5 is a 16‐week multi‐component weight management intervention for adults with ID and obesity [body mass index (BMI) ≥30 kg m^–2]. This intervention is an adaption of the weight management programme provided by the Glasgow & Clyde Weight Management Service (GCWMS) for adults without ID and obesity (National Health Service based). Fifty‐two participants of the TAKE 5 programme were individually matched by baseline characteristics (sex, age and BMI) with two participants without ID of the GCWMS programme. Comparisons in terms of weight and BMI change and rate of weight loss were made for those who attended all nine sessions.

Results

There were no significant differences between the groups in the amount of weight loss (median: ?3.6 versus ?3.8 kg, respectively, P = 0.4), change in BMI (median: ?1.5 versus ?1.4 kg m^–2, P = 0.9), success of achieving 5% weight loss (41.3% versus 36.8%, P = 0.9) and rate of weight loss across the 16‐week intervention.

Conclusions

A multi‐component weight loss intervention can be equally effective for adults with and without ID and obesity.

     

Disparities exist between the dietary intake of Indigenous Australian women during pregnancy and the Australian dietary guidelines: the Gomeroi gaaynggal study

Background

Little is known about the adequacy of nutrient intakes and the overall diet quality of Indigenous Australian pregnant women. The aim of this cross‐sectional study was to assess nutrient sufficiency and diet quality, as measured using the Australian Recommended Food Score (ARFS ), in pregnant women from the Gomeroi gaaynggal cohort (n = 58).

Methods

Maternal dietary intake during pregnancy was assessed using the Australian Eating Survey Food Frequency Questionnaire, which was self‐administered in the third trimester. Diet quality was determined using the ARFS . Food group servings and nutrient intakes were compared to the Australian Guide to Health Eating (AGHE ) and Australian Nutrient Reference Values (NRV s). The current analysis examined the adequacy of usual intakes from food sources only, excluding supplements.

Results

None of the women met all AGHE daily food group serving recommendations. The highest alignment rates were for dairy (33%), meat/alternatives (31%) and vegetables (29.3%). Almost 93% of participants exceeded the recommended intake of energy‐dense, nutrient‐poor foods and percentage energy from saturated fat was high (15%). Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the NRV s were zinc (77.6%) and folate (68.9%), whereas iron was the lowest. Only one person achieved all NRV s (folate, iron, calcium, zinc and fibre) important in pregnancy. The median ARFS was 28 points (maximum of 73).

Conclusions

Although the small cohort limits the generalisability of the findings of the present study, the data obtained indicate that the diets of these Indigenous pregnant women are inadequate. Therefore, strategies aiming to optimise nutrient intakes of Indigenous pregnant women are needed urgently.

     

Effect of oropharyngeal colostrum therapy in the prevention of necrotising enterocolitis among very low birthweight neonates: A meta‐analysis of randomised controlled trials

Background

Necrotising enterocolitis (NEC ) is one of the most common life‐threatening emergencies of the gastrointestinal tract in preterm neonates. The present study aimed to determine the efficacy of oropharyngeal colostrum with respect to reducing NEC in preterm neonates.

Methods

A literature search was conducted for various randomised control trials by searching the Cochrane Central Register of Controlled Trials, PubMed, EMBASE and ongoing clinical trials. Randomised or quasi‐randomised trials comparing oropharyngeal colostrum versus placebo in neonates (birthweight ≤ 1500 g or gestational age ≤ 32 weeks) were included in the review. The methodological quality of each trial was independently reviewed by the authors. For categorical and continuous variables, typical estimates for relative risk and typical estimates for weighted mean difference were calculated, respectively. A random effect model was assumed for meta‐analysis.

Results

In total, four eligible trials were included in the review. Oropharyngeal colostrum therapy was not associated with a statistically significant reduction in the incidence of NEC stage ≥2 [typical relative risk (RR ) = 0.64; 95% confidence interval (CI ) = 0.27–1.49], mortality from any cause (typical RR  = 0.86; 95% CI  = 0.15–4.80) and time to reach full feed [typical weighted mean difference (WMD) = ?3.26; 95% CI  = ?8.87 to 2.35]. Duration of hospital stay was significantly less in the control group (typical WMD  = 9.77; 95% CI  = 3.96–15.59).

Conclusions

The current evidence is insufficient for recommending oropharyngeal colostrum as a routine clinical practice in the prevention of NEC . We emphasise the need for large randomised controlled trials with an adequate sample size and validated clinical outcomes in preterm neonates.

     

Fermentable short chain carbohydrate (FODMAP) content of common plant‐based foods and processed foods suitable for vegetarian‐ and vegan‐based eating patterns

Background

The low FODMAP (fermentable, oligo‐, di‐, mono‐saccharides and polyols) diet is an effective strategy to improve symptoms of irritable bowel syndrome. However, combining the low FODMAP diet with another dietary restriction such as vegetarianism/veganism is challenging. Greater knowledge about the FODMAP composition of plant‐based foods and food processing practices common to vegetarian/vegan eating patterns would assist in the implementation of the diet in this patient population. The present study aimed to quantify the FODMAP content of plant‐based foods common in vegetarian/vegan diets and to investigate whether food processing can impact FODMAP levels.

Methods

Total FODMAP content was quantified in 35 foods, including fructose‐in‐excess‐of‐glucose, lactose, sorbitol, mannitol, galacto‐oligosaccharide and total fructan, using high‐performance‐liquid‐chromatography and enzymatic assays. The effects of cooking, sprouting, pickling, fermentation, activation and canning on FODMAP content were assessed. The Monash University criteria to classify foods as low FODMAP was used.

Results

Of the 35 foods, 20 were classified as low FODMAP , including canned coconut milk (0.24 g serve^–1), dulse (0.02 serve^–1), nutritional yeast (0.01 serve^–1), soy cheese (0.03 serve^–1), tempeh (0.26 serve^–1), wheat gluten (0.13 serve^–1) and wheat grass (0.05 serve^–1). No FODMAP s were detected in agar‐agar, egg replacer, vegan egg yolk, kelp noodles and spirulina. Food processing techniques that produced the greatest reduction in FODMAP content included pickling and canning.

Conclusions

The present study provides a greater FODMAP composition knowledge of plant‐based foods that can now be applied to the dietetic management of vegetarians/vegans requiring a low FODMAP diet. Food processing lowered the FODMAP content of foods, thereby increasing options for patients following a low FODMAP diet.

     

Reduced 30‐day gastrostomy placement mortality following the introduction of a multidisciplinary nutrition support team: a cohort study

Background

Percutaneous endoscopic gastrostomy feeding allows patients with dysphagia to receive adequate nutritional support, although gastrostomy insertion is associated with mortality. A nutrition support team (NST ) may improve a gastrostomy service. The present study aimed to evaluate the introduction of a NST for assessment and follow‐up of patients referred for gastrostomy.

Methods

We included adult inpatients referred for gastrostomy insertion consecutively between 1 October 2010 and 31 March 2013. During the first 6 months, a multidisciplinary NST assessment service was implemented. Patient characteristics, clinical condition, referral appropriateness and follow‐up were documented prospectively. We compared the frequencies of appropriate referrals, 30‐day mortality and mental capacity/consent assessment time spent between the 6 months implementation phase and 2 years following establishment of the assessment service (‘established phase’).

Results

In total, 309 patients were referred for gastrostomy insertion and 199 (64%) gastrostomies placed. The percentage of appropriate referrals rose from 72% (61/85) during the implementation phase to 87% (194/224) during the established phase (P  = 0.002). Thirty‐day mortality reduced from 10% (5/52) to 2% (3/147) (P  = 0.01), whereas time allocated to assessment of mental capacity and attainment of informed consent rose from mean 3 days (limits of normal variation 0–7) to mean 6 (0–13) days.

Conclusions

The introduction of a NST to assess and select patients referred for gastrostomy placement was associated with a rise in the frequency of appropriate referrals and a decrease in 30‐day mortality following gastrostomy insertion. Concomitantly, time spent on patient assessment and attainment of informed consent increased.

     

Theory‐informed nutrition education curriculum Tools For Feeling Good promotes healthy eating patterns among fifth grade pupils: cross‐sectional study

Background

The eating patterns of school‐aged children rarely meet recommendations: meal frequency is irregular and the consumption of vegetables is lower and sugar‐sweetened products higher than recommended. Although school is an excellent arena for nutrition education to support pupils eating patterns, teachers usually lack efficient tools. The present study aimed to develop a curriculum for nutrition education to be used by teachers and to examine its efficacy in the school environment with respect to the eating patterns of pupils.

Methods

The curriculum was developed in collaboration with school teachers using self‐determination theory as a theoretical standpoint. The Health at Every Size concept and sensory‐based food education were utilised in the curriculum. Self‐reported questionnaires were used to assess the feasibility and impact of the curriculum. Fourteen teachers implemented the curriculum during 2012–2013 with 194 pupils aged 10–13 years (fifth and sixth grades). The control schools included 140 pupils of the same age not following the curriculum.

Results

The teachers reported that the curriculum was easy to integrate in the school environment. The fifth graders improved their breakfast frequency, increased their consumption of vegetables and reduced their consumption of ice cream, sweets and sugar‐sweetened drinks. No improvement was found in the fifth graders at the control schools. In the sixth graders, no dietary changes were detected in the intervention or control schools.

Conclusions

The pupils in the fifth grade appeared to comprise a responsive target group for nutrition education at schools. The curriculum offers a promising approach for developing healthy eating patterns among fifth graders. Collaboration with teachers in developing the curriculum likely enhanced its feasibility and teacher commitment for implementation.

     

Carbohydrate knowledge,lifestyle and insulin: an observational study of their association with glycaemic control in adults with type 1 diabetes

Background

The ability to achieve optimal glycaemic control varies widely among individuals with type 1 diabetes. The present study aimed to explore the factors that are associated with optimal glycaemic control compared to suboptimal control.

Methods

An observational study design was used to explore the association of various factors with glycaemic control. Surveys were completed by individuals who attended the type 1 diabetes clinic at a tertiary hospital in New South Wales (NSW), Australia. Clinical and demographic information and attendance at dietary review were also collected.

Results

One hundred and three individuals completed the survey. Those with optimal control [glycated haemoglobin ≤7.0% (53 mmol mol^?1)] had a significantly shorter mean (SD) duration of diabetes [10.1 (12.6) years versus 18.8 (12.8) years, P  = 0.005), were less likely to omit basal and bolus insulin (18.2% versus 47.5%, P  = 0.016; 36.4% versus 61.8%, P  = 0.034, respectively), and were less likely to report low confidence in managing their diabetes (9.1% versus 35.4%, P  = 0.017). Participants who were able to identify carbohydrate sources were significantly more likely to have attended dietary review in the past 12 months (60.5% versus 20.0%, P  = 0.001). However, they were not more likely to have better glycaemic control.

Conclusions

The present study identified that consistency in taking insulin and confidence in self‐management was associated with better glycaemic control. An association was also found between recent dietary review and better carbohydrate knowledge, although this did not translate into better glycaemic control. Future investigation into the application of carbohydrate knowledge is required.

     

The effect of pre‐pregnancy lifestyle counselling on food intakes and association between food intakes and gestational diabetes in high‐risk women: results from a randomised controlled trial

Background

Healthy diets before and during pregnancy have been suggested to reduce the risk of gestational diabetes (GDM ). Several lifestyle intervention studies for pregnant women have reported dietary improvements after counselling. However, evidence concerning the effect of counselling initiated before pregnancy on diets is limited.

Methods

This randomised controlled study explored whether pre‐pregnancy lifestyle counselling influenced food intakes, as well as whether changes in food intakes were associated with GDM . The participants comprised 75 women with prior GDM and/or a body mass index ≥ 30 kg m^–2. Women were randomised into a control or an intervention group, and their food intakes were followed from pre‐pregnancy to early pregnancy using a food frequency questionnaire. The control and intervention groups were combined to assess the association between changes in food intakes and GDM . The diagnosis of GDM was based on a 75‐g oral glucose tolerance test conducted in the first and second trimester of pregnancy.

Results

Pre‐pregnancy lifestyle counselling showed no major overall effect on food intakes. The intake of low‐fat cheese increased significantly in women who did not develop GDM compared to women who did after adjusting for potential confounders (P = 0.028). This association was not observed for regular‐fat cheese.

Conclusions

The findings obtained in the present study suggest that an increased intake of low‐fat but not regular‐fat cheese between pre‐pregnancy and early pregnancy is associated with a lower risk of GDM in high‐risk women.

     

A pilot intervention to reduce postpartum weight retention and central adiposity in first‐time mothers: results from the mums OnLiNE (Online,Lifestyle, Nutrition & Exercise) study

Background

Postpartum weight retention (PPWR ) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour.

Methods

A subsample of first‐time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n  =  28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n  =  48; n  =  43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self‐reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum.

Results

Mean PPWR decreased in the (I) group (?1.2 kg) and the C2 group (?1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (?6.4 cm) compared to C1 (?1.1 cm; P  =  0.002) and C2 (?3.3 cm; P  =  0.001). Changes in diet, physical activity or sedentary behaviour were not significant.

Conclusions

The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.

     

Efficacy of vitamin D supplementation in combination with conventional antiviral therapy in patients with chronic hepatitis C infection: a meta‐analysis of randomised controlled trials

Background

Although a contributory role of vitamin D levels for the development of chronic hepatitis C has been suggested, the efficacy of vitamin D supplementation in combination with conventional antiviral therapy consisting of pegylated interferon‐α (Peg‐IFN ‐α) injection and oral ribavirin (RBV ) remains unclear. We investigated its efficacy in the treatment of chronic hepatitis C via a meta‐analysis of randomised controlled trials.

Methods

We searched PubMed, EMBASE , the Cochrane Library, ClinicalTrials.gov and the bibliographies of relevant articles to locate additional publications in September 2016. Three evaluators independently reviewed and selected eligible studies based on predetermined selection criteria.

Results

Of 522 articles meeting our initial criteria, a total of seven open‐label, randomised controlled trials involving 548 participants, were included in the final analysis. Vitamin D supplementation in combination with Peg‐IFN ‐α injection and oral RBV significantly increased the rate of viral response for hepatitis C at 24 weeks after treatment in a random‐effects meta‐analysis (relative risk = 1.30; 95% confidence interval = 1.04–1.62; I ² = 75.9%). Also, its significant efficacy was observed in patients with hepatitis C virus genotype 1, which is known to be refractory to antiviral therapy.

Conclusions

In summary, we observed that additional use of vitamin D has a positive effect on sustained viral response rates of patients with chronic hepatitis C infection. However, we cannot establish the efficacy because of substantial heterogeneity, a small sample size and a low methodological quality.

     

Diets with a low glycaemic load have favourable effects on prediabetes progression and regression: a prospective cohort study

Background

To date, no study assessing the associations among glycaemic index (GI ), glycaemic load (GL ) and progression to diabetes has focused specifically on prediabetes. Moreover, the available data on the association between these variables and regression to normal glucose regulation (NGR ) are insufficient. Therefore, the present study aimed to evaluate the longitudinal associations among GI , GL and prediabetes outcomes.

Methods

This prospective study included 640 adults aged 40–79 years with prediabetes at baseline. Dietary data were assessed using a previously validated 3‐day food record. The participants were divided into three groups according to GI and GL tertiles. Outcomes were defined based on annual oral glucose tolerance test results.

Results

During a median of 5 years of follow‐up, 127 incident cases of diabetes and 249 incident cases of NGR were identified. Dietary GL was positively associated with the risk of developing diabetes and negatively associated with the likelihood of reaching NGR at least once. Comparing the highest and lowest tertiles of GL , the multivariable‐adjusted hazard ratios (95% confidence intervals) were 1.85 (1.07–3.21) for progression and 0.65 (0.44‐0.96) for regression. No association was observed between GI and prediabetes outcomes in the fully adjusted models.

Conclusions

Among patients with prediabetes, high dietary GL was positively associated with diabetes risk. Furthermore, a low‐GL diet contributed to an increased incidence of reaching NGR .

     

Eicosapentaenoic acid and docosahexaenoic acid containing supplements modulate risk factors for cardiovascular disease: a meta‐analysis of randomised placebo‐control human clinical trials

Background

Over 200 clinical trials have examined the effect of eicosapentaenoic acid (EPA ) and docosahexaenoic acid (DHA ) supplements on risk factors associated with cardiovascular disease. However, an updated analysis of the evidence is lacking. The aim of the present meta‐analysis was to quantify the effect of supplements containing EPA and DHA on risk factors for cardiovascular disease.

Methods

An analysis was carried on 171 clinical trials with acceptable quality (Jadad score ≥3) that were identified from a comprehensive electronic search strategy of two databases (Pubmed and Cochrane Library). A random effect model was used to obtain an overall estimate on outcomes of interest. Heterogeneity between trial results was tested for using a standard chi‐squared test.

Results

Compared with control, EPA and DHA supplements produced significant reductions of triglycerides of 0.368 mmol L^?1 [95% confidence interval (CI) = ?0.427 to ?0.309], systolic blood pressure of 2.195 mmHg (95% CI = ?3.172 to ?1.217), diastolic blood pressure of 1.08 mmHg (95% CI = ?1.716 to ?0.444), heart rate of 1.37 bpm (95% CI = ?2.41 to ?0.325) and C‐reactive protein of 0.343 mg L^?1 (95% CI = ?0.454 to ?0.232). This analysis indicates an increase in both low‐density lipoprotein cholesterol (mean difference = 0.150 mmol L^?1; 95% CI = 0.058–0.243) and high‐density lipoprotein cholesterol (mean difference = 0.039 mmol L^?1; 95% CI = 0.024–0.054). The triglyceride‐lowering effect was dose‐dependent.

Conclusions

The lipid‐lowering, hypotensive, anti‐arrhythmic and anti‐inflammatory actions of EPA and DHA supplements were confirmed in this analysis of randomised placebo‐control blinded clinical trials.

     

Future Dietitian 2025: informing the development of a workforce strategy for dietetics

Background

Healthcare is changing and the professions that deliver it need to adapt and change too. The aim of this research was to inform the development of a workforce strategy for Dietetics for 2020–2030. This included an understanding of the drivers for change, the views of stakeholders and recommendations to prepare the profession for the future.

Methods

The research included three phases: (i) establishing the context which included a literature and document review (environmental scan); (ii) discovering the profession and professional issues using crowd‐sourcing technology; and (iii) articulating the vision for the future using appreciative inquiry.

Results

The environmental scan described the current status of the dietetic profession, the changing healthcare environment, the context in which dietitians work and what future opportunities exist for the profession. The online conversation facilitated by crowd‐sourcing technology asked the question: ‘How can dietitians strengthen their future role, influence and impact?’ Dietitians and interested stakeholders (726 and 109, respectively) made 6130 contributions. Seven priorities were identified and fed into the appreciative inquiry event. The event bought together 54 dietitians and analysis of the discussions generated five themes: (i) professional identity; (ii) strong foundations‐creating structure and direction for the profession; (iii) amplifying visibility and influence; (iv) embracing advances in science and technology; and (v) career advancement and emerging opportunities.

Conclusions

A series of recommendations were made for the next steps in moving the workforce to a new future. The future for dietetics looks bright, embracing technology, as well as exploring different ways of working and new opportunities, as this dynamic profession continues to evolve.

     

Correlates of toenail selenium and its cross‐sectional association with metabolic syndrome

Background

The present study aimed to identify independent correlates of toenail selenium levels and to examine the association between toenail selenium levels and metabolic syndrome in Korean adults.

Methods

Cross‐sectional analysis was conducted using baseline data from the Trace Element Study of Korean Adults in the Yeungnam area, an ongoing cohort study of Korean adults over the age of 35 years. The baseline survey consisted of questionnaires on demographics, lifestyle characteristics and medical information. Dietary information was obtained through a validated semi‐quantitative food frequency questionnaire. Toenail selenium levels were quantified using neutron activation analysis. Biomarkers associated with metabolic syndrome were obtained from biennial medical check‐ups.

Results

In the multivariable‐adjusted analyses, independent lifestyle and dietary correlates of higher selenium levels were alcohol drinking (4.62% higher than nondrinking) and egg intake (0.43% higher per weekly serving), whereas current smoking (5.42% lower than nonsmoking) and vegetable consumption (0.05% lower per weekly serving) were associated with lower toenail selenium levels. In the multivariable adjusted logistic regression, no significant association was observed between toenail selenium levels and metabolic syndrome (odds ratio = 1.33, 95% confidence interval = 0.58–3.05).

Conclusions

Multiple lifestyle and dietary factors influenced toenail selenium levels, although no meaningful association was observed between toenail selenium levels and metabolic syndrome in Korean adults. Future prospective large‐scale cohort studies are required to determine whether there is a causal relationship between selenium levels and metabolic syndrome in Korean adults.