Clare Corish

Dietary and lifestyle habits and the associated health risks in shift workers.

Traditionally only a small proportion of the workforce was engaged in shift work. Changing economic pressures have resulted in increased engagement in shift work, with approximately 17 % of the workforce in Europe engaged in this work pattern. The present narrative review aimed to summarise the data on the effects of shift work on the diet, lifestyle and health of employees, while addressing the barriers to, and opportunities for, improving health among shift workers. Shift work can result in low-quality diet and irregular eating patterns. Adverse health behaviours are also reported; particularly increased smoking and poor sleep patterns. These altered lifestyle habits, in conjunction with disruption to circadian rhythms, can create an unfavourable metabolic phenotype which facilitates the development and progression of chronic disease. Although the data are inconclusive due to issues such as poor study design and inadequate control for confounding factors; shift workers appear to be at increased mental and physical health risk, particularly with regard to non-communicable diseases. Information is lacking on the obstacles to leading a healthier lifestyle while working shifts, and where opportunities lie for intervention and health promotion among this group. In order to provide an informed evidence base to assist shift workers in overcoming associated occupational hazards, this gap must be addressed. This review highlights the unique nutritional issues faced by shift workers, and the subsequent effect on health. In societies already burdened with increased incidence of non-communicable chronic diseases, there is a clear need for education and behaviour change interventions among this group.

Nutritional status of Irish older people in receipt of meals-on-wheels and the nutritional content of meals provided.

BACKGROUND Research has suggested that meals-on-wheels recipients can be at risk for poor nutritional status. Despite this, few countries have statutory minimum requirements for the nutrient content of meals-on-wheels. This study examined both the nutritional status of a sample of Irish recipients and the nutrient content of a sample of meals provided to determine whether Irish recipients would benefit from statutory minimum nutritional standards. METHODS The study had two phases. First, a nutritional assessment was carried out to analyse the nutritional status of a sample of Irish meals-on-wheels recipients (Mini Nutritional Assessment and 24-h dietary recall with 63 self-selected respondents). Second, an assessment of the nutrient content of a sample of 46 meals from eight meals-on-wheels services was undertaken to characterise the nutritional content of the meals. RESULTS Over one-third of recipients (38.5%) were malnourished or at-risk of malnutrition and over half (52.3%) were overweight or obese. The mean (SD) energy [kJ (kcal)] content of the meals assessed was 3008 (498) kJ [719 (119.1) kcal], contributing 35-40% of the recommended dietary allowance (RDA) for males aged 65 years and over and 42-45% of the RDA for females aged 65 years and over. In the meals assessed, the levels of vitamin C (25.3%), vitamin D (11.6%), folate (24.8%) and calcium (20.9%) were below one-third of the Irish RDA for these nutrients. CONCLUSIONS Irish recipients may not be receiving adequate micronutrients from meals-on-wheels. Legislation that sets out minimum standards for the nutrient content of meals-on-wheels and greater variation in the portion sizes offered may benefit recipients.

Nutritional practices in full-day-care pre-schools.

BACKGROUND Full-day-care pre-schools contribute significantly to the nutritional intake and acquisition of dietary habits of the pre-school child. The present study investigated nutritional practices in full-day-care pre-schools in Dublin, Ireland, aiming to determine the nutritional support that pre-school managers deem necessary, thereby facilitating the amelioration of existing pre-school nutritional training and practices. METHODS A telephone questionnaire completed by pre-school managers (n=54) examined pre-school dietary practices, food provision and the association between these and pre-school size, nutritional training attendance, possession of the Food and Nutrition Guidelines for Pre-school Services and having a healthy eating policy. Nutritional training needs were also investigated. RESULTS Twenty-five pre-schools provided all food for attending children; parents were sole providers in six. Thirty-four pre-schools had a written healthy eating policy. Attendance at nutritional training was reported by 40. Possession of the Guidelines (n=40) did not consistently result in their use. Poor parental and staff involvement in policy and menu development was cited. Although the delayed introduction of iron-containing foods and a feeding beaker in infants was clearly evident, inappropriate beverages and snacks were served to children aged 1-5 years in 43 and 37 pre-schools, respectively. Training priorities cited by managers included parental education and the provision of information regarding menu planning and healthy food choices. CONCLUSIONS Nutritional training should advocate whole staff familiarity with and use of current guidelines, in addition to encouraging nutritional policy development and enforcement. Parental education is warranted. Dietary education should focus specifically on appropriate weaning practices, healthy beverage and snack provision and menu planning.

Evaluation of Over- and Underfeeding Following the Introduction of a Protocol for Weaning From Parenteral to Enteral Nutrition in the Intensive Care Unit

BACKGROUND Over- and underfeeding critically ill patients have significant clinical consequences. These patients are often given a combination of enteral nutrition (EN) and parenteral nutrition (PN), potentially increasing their risk of overfeeding. No published protocol describing the process for weaning from parenteral to enteral feeding and its effects on over- and underfeeding exists. This study aimed to evaluate the introduction of such a protocol. MATERIALS AND METHODS A prospective, 2-phase observational study was performed in a 10-bed medical/surgical intensive care unit on patients ventilated for >72 hours and receiving EN and/or PN. Data were collected 6 months before and 2 years after the implementation of a weaning protocol. Underfeeding was defined as energy intake <80% and overfeeding as >110% of estimated requirements. RESULTS Twenty-two patients were fed for a total of 118 days in phase 1, and 29 patients were fed for a total of 272 days in phase 2. Overfeeding occurred more frequently than underfeeding prior to the introduction of the protocol (24.6% vs 19.5% of feeding days) and significantly more often on days when patients were fed by a combination of routes (P < .05). After implementing the protocol, the incidence of overfeeding reduced almost 3-fold to 9.1% (P < .001), and feeding via a combination of routes was no longer a significant cause. Underfeeding did not change and patients being adequately fed increased from 56% to 71% (P < .001). CONCLUSION A structured protocol for weaning patients from PN to EN can reduce overfeeding in critically ill patients given nutrition support via a combination of routes.

Tackling the increasing problem of malnutrition in older persons: The Malnutrition in the Elderly (MaNuEL) Knowledge Hub

In order to tackle the increasing problem of malnutrition (i.e. protein-energy malnutrition) in the older population, the Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub has been recently launched as part of the Strategic Research Agenda of the Joint Programming Initiative (JPI) A Healthy Diet for a Healthy Life (HDHL). This paper introduces this new European initiative and describes its objectives and design. The MaNuEL consortium consists of 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand). The Consortium aims to extend scientific knowledge; strengthen evidence-based practice in the management of malnutrition in older persons; build a sustainable, transnational, competent network of malnutrition experts; and harmonise research and clinical practice. MaNuEL is built on five interconnected work packages that focus on (i) defining treatable malnutrition; (ii) screening of malnutrition in different settings; (iii) determinants of malnutrition; (iv) prevention and treatment of malnutrition; and (v) policies and education regarding malnutrition screening and treatment in older persons across Europe. Systematic literature reviews will be performed to assess current research on malnutrition and identify potential knowledge gaps. Secondary data analyses of nutritional intervention trials and observational studies will also be conducted. Using Web-based questionnaires, MaNuEL will provide insight into current clinical practice, policies and health professionals’ education on malnutrition and will make recommendations for improvement. MaNuEL is being advised by a stakeholder board of five experts in geriatric nutrition who represent relevant European professional societies.

Subjective and objective taste and smell changes in cancer

Context Malnutrition is highly prevalent in cancer patients and an important predictor of morbidity, mortality, treatment response, and toxicity. Taste and smell changes (TSCs) are common and may contribute to malnutrition. Research has previously focused on patients receiving chemotherapy (CT) or head and neck radiotherapy (RT). However, TSCs may occur pre-treatment, with other treatment modalities, and in cancer survivors. This review evaluates objective and subjective assessment of taste and smell, discusses the prevalence of TSCs in cancer, and reviews the clinical sequelae of TSCs in cancer patients. Objectives To critically evaluate objective and subjective assessment of TSCs, and the prevalence and clinical sequelae of TSCs in cancer. Methods A literature search was conducted using PubMed, CINAHL and Embase for English-language articles published January 2009-June 2016. Search terms included combinations of the following: chemosensory, taste, smell, cancer, chemotherapy, radiotherapy, hormone therapy, immunotherapy, survivors. Reference lists of articles retrieved were also reviewed. Results Variation in objective and subjective assessment methodologies has resulted in difficulties interpreting the literature. TSC prevalence varies depending on stage of disease and treatment regimens, from 16% to 70% and 50% to 70% during CT and RT, respectively. TSCs in patients who are treatment-naïve, receiving hormone or immunotherapy treatment, post-treatment and cancer survivors have not been adequately studied. TSCs are associated with impaired nutritional status. The relationship between cancer-associated symptoms and nutritional status is not clearly defined. Conclusion There is no gold standard assessment tool for TSCs. Heterogeneity in study methods hinders conclusive identification of the most appropriate way to measure TSCs. Subjective measures may reflect the patient experience and more reliably predict changes in dietary behaviour. Evaluation of TSCs should form part of all nutritional assessments in cancer patients. The true prevalence and severity of TSCs at all stages of cancer could then be established.

Developing a nutrition assessment tool for Irish pre-schools

Purpose – The provision of nutritious food to children in full day care pre‐schools is essential to ensure adequate child growth and development. The purpose of this paper is to outline the development of a nutrition assessment tool (scored evaluation form (SEF)) for this setting, and describe the nutrition practice findings measured by this tool in full day child care in Ireland.Design/methodology/approach – This study involved two phases: first, a comprehensive literature review carried out on each criterion in the SEF to ensure best practice; and second, use of the SEF in full day care pre‐schools to assess their nutrition practice.Findings – Use of the SEF demonstrated that portion sizes provided to infants and toddlers were inadequate. Poor provision of iron containing, vegetable and dairy foods was noted, as were poor meal time practices. The phrasing of certain criteria needs modification to avoid misinterpretation of portion size.Research limitations/implications – With small modifications to clar...

Low Energy Availability in Athletes: A Review of Prevalence, Dietary Patterns, Physiological Health, and Sports Performance

In a high-performance sports environment, athletes can present with low energy availability (LEA) for a variety of reasons, ranging from not consuming enough food for their specific energy requirements to disordered eating behaviors. Both male and female high-performance athletes are at risk of LEA. Longstanding LEA can cause unfavorable physiological and psychological outcomes which have the potential to impair an athlete’s health and sports performance. This narrative review summarizes the prevalence of LEA and its associations with athlete health and sports performance. It is evident in the published scientific literature that the methods used to determine LEA and its associated health outcomes vary. This contributes to poor recognition of the condition and its sequelae. This review also identifies interventions designed to improve health outcomes in athletes with LEA and indicates areas which warrant further investigation. While return-to-play guidelines have been developed for healthcare professionals to manage LEA in athletes, behavioral interventions to prevent the condition and manage its associated negative health and performance outcomes are required.

Researching young children’s perception of food in Irish pre-schools: An ethical dilemma

Poor nutrition habits have been reported in the childcare setting. While the literature advocates the need to carry out ‘Voice of the Child’ research, few studies have explored this methodology with regard to children and food, in particular in the pre-school setting. This article aims to outline the ethical issues raised by a research ethics committee and to discuss the impact of these issues on a study that hoped to determine the food perceptions of children (aged three to four years) within an ongoing nutrition and lifestyle pre-school project in Ireland. Ethical approval was granted for this study but only upon the clarification of two aspects: that only hedonic symbols previously used in the literature could be included in the study; and that parental consent be obtained from both parents of each child. Children were shown food pictures and asked to use the hedonic symbols to answer questions posed to them on the food. Owing to the ethical constraints imposed by the requirement for two-parent consent, seven children, from a potential sample of 85, were eligible to partake in the study. These children did not seem to understand the hedonic symbols recommended for use by the ethics committee, therefore preventing the collection of in-depth qualitative data. The ethical constraints placed on this study impacted on both its design and its methodology and are discussed in relation to national and international ethical guidance and legislation. Future research with children regarding food choice must balance the need for strict ethical standards with the need to explore children’s views on this subject.

Predictors of Incident Malnutrition in Older Irish Adults from the Irish Longitudinal Study on Ageing Cohort—A MaNuEL study

Older adults are at increased risk of malnutrition which is associated with poorer health, quality of life, and worse disease outcomes. This study identifies predictors of incident malnutrition using data from a sub-sample (n=1,841) of The Irish Longitudinal Study on Ageing (TILDA). Participants were excluded if they were <65 years, missing BMI data at baseline/follow-up, missing baseline weight loss (WL) data or malnourished at baseline (BMI <20kg/m2 or unplanned WL ≥4.5kg in the previous year). Logistic regression analysis was performed with incident malnutrition (BMI <20kg/m2 and/or calculated WL >10% over follow-up) as the dependent variable. Factors showing significant (p<0.05) univariate associations with incident malnutrition were entered into a multivariate model. The analysis was then repeated, stratified by sex. The 2-year incidence of malnutrition was 10.7%. Unmarried/separated/divorced status (vs.married but not widowed), hospitalisation in the previous year, difficulties walking 100m or climbing stairs independently predicted incident malnutrition at follow-up. When examined by sex, hospitalisation in the previous year, falls during follow-up and self-reported difficulties climbing stairs predicted malnutrition in males. Receiving social support and cognitive impairment predicted malnutrition in females.The development of malnutrition has a range of predictors. These can be assessed using simple questions to identify vulnerable persons.