Alison Yaxley

Association of Fat Mass and Adipokines With Foot Pain in a Community Cohort.

To determine, first, if fat mass index (FMI) or fat‐free mass index (FFMI) and serum adipokines tumor necrosis factor (TNF) and interleukin‐6 (IL‐6) are associated with prevalent (stage 2) foot pain, and, second, if they are predictive of future (stage 3) foot pain.

Diet Liberalisation in Older Australians Decreases Frailty without Increasing the Risk of Developing Chronic Disease.

BACKGROUND Successful ageing relies on the prevention of frailty and chronic disease, many of which have a strong link with diet. Despite evidence suggesting diet is important in the management of frailty, there is little evidence investigating the impact of a liberal diet on the prevention of frailty and development of chronic diseases in the elderly. OBJECTIVES To determine the impact of a liberal diet on the development of frailty and whether this affects the incidence of obesity, diabetes, hypertension and hyperlipidaemia. DESIGN Secondary data analysis of the Australian Longitudinal Study of Ageing, 1992 to 2000. SETTING Random selection of older adults from the South Australian electoral roll. PARTICIPANTS 1298 older Australians (629 women, 669 men), mean age 77 years. MEASUREMENTS A validated food frequency questionnaire was used to measure the dietary exposure; liberal diet defined as: energy >10% estimated requirements; sodium >1600mg; total fat >35% energy; saturated fat >10%; refined sugar >10%; fibre <38g males and <28g females. Frailty was determined using the Fried phenotype in combination with Cesaris biological definition of frailty. Chronic disease outcomes were measured by medication usage and obesity defined as BMI >30kg/m². Binary logistic regression was performed using participants free of chronic disease at baseline to determine the impact of each dietary exposure independently, and combined, on the development of frailty and the incidence of chronic disease over the subsequent eight years. RESULTS Incidence of frailty after 8 years of follow up was 14%. The incidence of diabetes after 8 years of follow up was 5.3%, hypertension 39%, hyperlipidaemia 15% and obesity 6%. A liberal energy intake adjusted for age and sex, significantly reduced the risk of developing frailty eight years post baseline (OR 0.48, 95% CI 0.30, 0.77). After adjustment for age, sex and body weight, a liberal saturated fat intake (>10% of energy) increased the risk of hyperlipidaemia (OR 2.11, 95% CI 1.27, 3.54). A liberal intake of sodium, total fat, refined sugar and fibre did not increase the risk of diabetes, hypertension, hyperlipidaemia or obesity. CONCLUSIONS This study suggests that a liberal intake of energy may decrease the risk of developing frailty in the elderly without increasing the risk of developing obesity, diabetes, hypertension or hyperlipidaemia. Caution should remain however in the prescription of diets high in saturated fat as the link established with hyperlipidaemia in young adults appears to be consistent in the elderly. Further research is required to explore the optimal sources of energy for a liberalised diet and the effect of a liberalised diet on other diet related health conditions.

The Challenge of Appropriate Identification and Treatment of Starvation, Sarcopenia, and Cachexia: A Survey of Australian Dietitians

Malnutrition is an umbrella term that includes starvation, sarcopenia, and cachexia; however, differentiating between these terms is infrequent in clinical practice. Given that the effectiveness of treatment depends on the aetiology of unintentional weight loss, it is important that clinicians are aware of the defining characteristics. The aim of this study was to determine whether Australian dietitians understand and use the terms starvation, sarcopenia, and cachexia and provide targeted treatment strategies accordingly. Members of the Dietitians Association of Australia were surveyed to gain information on practices and attitudes to diagnosis and treatment of adult malnutrition. In addition, three case studies were provided to examine understanding of starvation, sarcopenia, and cachexia. 221 dietitians accessed the survey. 81 respondents (43%) indicated the use of at least one alternate term (starvation, sarcopenia, and/or cachexia). Muscle wasting was the most commonly used diagnostic criterion. High-energy high-protein diet was the most common therapy prescribed. Correct diagnoses for case studies were recorded by 6% of respondents for starvation, 46% for sarcopenia, and 21% for cachexia. There is a need for increased awareness of the existence of starvation, sarcopenia, and cachexia amongst Australian dietitians and research into appropriate methods of identification and treatment for each condition.

A trial assessing N-3 as treatment for injury-induced cachexia (ATLANTIC trial): does a moderate dose fish oil intervention improve outcomes in older adults recovering from hip fracture?

BackgroundProximal femoral fractures are associated with increased morbidity and mortality. Pre-existing malnutrition and weight loss amongst this patient group is of primary concern, with conventional nutrition support being largely ineffective. The inflammatory response post proximal femoral fracture surgery and the subsequent risk of cachexia may explain the inability of conventional high energy high protein management to produce an anabolic response amongst these patients. Omega-3 fatty acids derived from fish oils have been extensively studied for their anti-inflammatory benefits. Due to their anti-inflammatory properties, the benefit of fish oil combined with individualized nutrition support amongst proximal femoral fracture patients post surgery is an attractive potential therapeutic strategy. The aim of the ATLANTIC trial is to assess the potential benefits of an anti-inflammatory dose of fish oil within the context of a 12 week individualised nutrition program, commencing seven days post proximal femoral fracture surgery.Methods/DesignThis randomized controlled, double blinded trial, will recruit 150 community dwelling elderly patients aged ≥65 years, within seven days of surgery for proximal femoral fracture. Participants will be randomly allocated to receive either a 12 week individualized nutrition support program complemented with 20 ml/day anti-inflammatory dose fish oil (~3.6 g eicosapentaenoic acid, ~2.4 g docosahexanoic acid; intervention), or, a 12 week individualized nutrition support program complemented with 20 ml/day low dose fish oil (~0.36 g eicosapentaenoic acid, ~0.24 g docosahexanoic acid; control).DiscussionThe ATLANTIC trial is the first of its kind to provide fish oil combined with individualized nutrition therapy as an intervention to address the inflammatory response experienced post proximal femoral fracture surgery amongst elderly patients. The final outcomes of this trial will assist clinicians in the development of effective and alternative treatment methods post proximal femoral fracture surgery which may ultimately result in a reduction in systemic inflammation, loss of weight and lean muscle and improvements in nutritional status, mobility, independence and quality of life among elderly patients.Trial RegistrationACTRN12609000241235

Systematic review of the evidence for a liberalized diet in the management of diabetes mellitus in older adults residing in aged care facilities.

A systematic review of the literature was conducted to review and evaluate the evidence supporting a liberalized diet for the management of diabetes mellitus in aged care homes and examine the effect of this on glycaemia, nutritional status and diabetes comorbidity risk factors. A 3 step search of eight databases followed by independent data extraction and quality assessment by two authors was undertaken. Studies which compared therapeutic diets to a liberalized diet or observation studies reviewing the effects of therapeutic diets on glycaemia and nutritional status were included. Of the 546 studies identified, six met the inclusion criteria. Methodological quality of the studies was rated poor and the majority concluded no statistically significant change in diabetes management outcomes with a liberalized diet, but modest increases in glycaemia were observed. Inadequate data was available to determine effects of diet change on nutritional status or diabetes risk factors. Overall studies were in support of a liberalized diet but due to the low quality of the evidence and a lack of significant findings it may not be appropriate to extrapolate these conclusions to inform dietetic practice.

Evaluation of tools used to measure calcium and/or dairy consumption in children and adolescents

OBJECTIVE To identify and critique tools that assess Ca and/or dairy intake in children to ascertain the most accurate and reliable tools available. DESIGN A systematic review of the literature was conducted using defined inclusion and exclusion criteria. Articles were included on the basis that they reported on a tool measuring Ca and/or dairy intake in children in Western countries and reported on originally developed tools or tested the validity or reliability of existing tools. Defined criteria for reporting reliability and validity properties were applied. SETTING Studies in Western countries. SUBJECTS Children. RESULTS Eighteen papers reporting on two tools that assessed dairy intake, ten that assessed Ca intake and five that assessed both dairy and Ca were identified. An examination of tool testing revealed high reliance on lower-order tests such as correlation and failure to differentiate between statistical and clinically meaningful significance. Only half of the tools were tested for reliability and results indicated that only one Ca tool and one dairy tool were reliable. Validation studies showed acceptable levels of agreement (<100 mg difference) and/or sensitivity (62-83 %) and specificity (55-77 %) in three Ca tools. With reference to the testing methodology and results, no tools were considered both valid and reliable for the assessment of dairy intake and only one tool proved valid and reliable for the assessment of Ca intake. CONCLUSIONS These results clearly indicate the need for development and rigorous testing of tools to assess Ca and/or dairy intake in children and adolescents.

Pharmacological interventions for geriatric cachexia: A narrative review of the literature

ObjectiveThe objective of this review was to investigate the range of pharmacological interventions that have been studied for treatment of geriatric cachexia, and to evaluate their effect on selected clinical outcomes in this population.MethodsDatabases including Medline and Cochrane Central Register of Controlled Trials were searched up to March 2010 with search terms including “cache*”, “intervention”, “megestrol acetate” and “cytokine inhibitors”. Studies investigating subjects with mean age <60y or disease-related cachexia were excluded. Outcomes assessed were weight or BMI, body composition, appetite and laboratory parameters indicative of cachexia.ResultsFifteen publications met the selection criteria, reporting on ten studies. Seven studies investigated use of megestrol acetate (MA): two randomised controlled trials, one case control study, two pre-test/post-test studies and two retrospective chart reviews. Weight/BMI was common amongst outcomes and these studies showed an improvement in weight compared with baseline. MA studies which investigated body composition, appetite and/or laboratory parameters provided some evidence for improvement in these outcomes. Three randomised controlled trials investigated the use of other interventions: ghrelin, growth hormone and vitamin supplementations. All demonstrated a significant increase in lean body mass. The only other outcome of interest in these three trials was weight in one study with a significant increase demonstrated.ConclusionLittle investigation has been conducted in this population and the diagnosis of cachexia is problematic however these trials provide preliminary evidence for beneficial outcomes in older adults likely to have cachexia. Further high quality adequately powered prospective studies are necessary to provide effective treatment for geriatric cachexia.

Evaluation of tools used to measure calcium and/or dairy consumption in adults.

OBJECTIVE To identify and critique tools for the assessment of Ca and/or dairy intake in adults, in order to ascertain the most accurate and reliable tools available. DESIGN A systematic review of the literature was conducted using defined inclusion and exclusion criteria. Articles reporting on originally developed tools or testing the reliability or validity of existing tools that measure Ca and/or dairy intake in adults were included. Author-defined criteria for reporting reliability and validity properties were applied. SETTING Studies conducted in Western countries. SUBJECTS Adults. RESULTS Thirty papers, utilising thirty-six tools assessing intake of dairy, Ca or both, were identified. Reliability testing was conducted on only two dairy and five Ca tools, with results indicating that only one dairy and two Ca tools were reliable. Validity testing was conducted for all but four Ca-only tools. There was high reliance in validity testing on lower-order tests such as correlation and failure to differentiate between statistical and clinically meaningful differences. Results of the validity testing suggest one dairy and five Ca tools are valid. Thus one tool was considered both reliable and valid for the assessment of dairy intake and only two tools proved reliable and valid for the assessment of Ca intake. CONCLUSIONS While several tools are reliable and valid, their application across adult populations is limited by the populations in which they were tested. These results indicate a need for tools that assess Ca and/or dairy intake in adults to be rigorously tested for reliability and validity.

Identifying Malnutrition in an Elderly Ambulatory Rehabilitation Population: Agreement between Mini Nutritional Assessment and Validated Screening Tools.

Malnutrition is common in older adults and often goes unrecognised and untreated. Australian evidence-based guidelines for the management of malnutrition indicate that only the Mini Nutritional Assessment short form (MNA-sf) and Rapid Screen are recommended for use as malnutrition screening tools in the rehabilitation setting. The aim of this secondary analysis was to assess the validity and reliability of two malnutrition screening tools, validated in other adult sub-groups, in a rehabilitation population aged ≥60 years. The Council on Nutrition Appetite Questionnaire (CNAQ) and the Simplified Nutritional Appetite Questionnaire (SNAQ), were completed by 185 ambulatory rehabilitation patients (48% male; median age 78 years) and results compared to the full MNA as a reference technique. Prevalence of risk of malnutrition was 63% according to the MNA. For identification of risk of malnutrition the CNAQ had sensitivity of 54%, specificity 81%, positive predictive value 83% and negative predictive value 51%, compared to 28%, 94%, 89% and 44%, respectively, using SNAQ. Assessment of reliability indicated significant slight to fair agreement between MNA with CNAQ (κ = 0.309, p < 0.001) and SNAQ (κ = 0.176, p < 0.001). Neither the CNAQ nor the SNAQ have a high level of validity or reliability in this elderly population and are therefore not recommended for use in the ambulatory rehabilitation setting. Further work is necessary to assess the validity and reliability of other malnutrition screening tools to establish their usefulness in this population.

Eating occasions and the contribution of foods to sodium and potassium intakes in adults

OBJECTIVE To examine dietary Na and K intake at eating occasions in Australian adults and identify the contribution of major food sources to Na and K at different eating occasions. DESIGN Secondary analysis of 24 h recall diet data from the Australian Health Survey (2011-2013). SETTING Nationally representative survey in Australia. SUBJECTS Male and female Australians aged 18-84 years (n 7818). RESULTS Dinner contributed the greatest proportion to total daily Na intake (33 %) and K intake (35 %). Na density was highest at lunch (380 mg/MJ) and K density highest at between-meal time eating occasions (401 mg/MJ). Between-meal time eating occasions provided 20 % of daily Na intake and 26 % of daily K intake. The major food group sources of Na were different at meal times (breads and mixed dishes) compared with between-meal times (cakes, muffins, scones, cake-type desserts). The top food group sources of K at meal times were potatoes and unprocessed meat products and dishes. CONCLUSIONS Foods which contributed to Na and K intake differed according to eating occasion. Major food sources of Na were bread and processed foods. Major food sources of K were potatoes and meat products and dishes. Public health messages that emphasise meal-based advice and diet patterns high in vegetables, fruits and unprocessed foods may also aid reduction in dietary Na intake and increase in dietary K intake.