Kelly Lambert

Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up

Background/Objectives:Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up.Subjects/Methods:A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n=476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates.Results:At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P<0.001). Hazard rate for death in the malnourished group is 3.41 (95% confidence interval: 1.07–10.87; P=0.038) times the well-nourished group. Discharge to a higher level of residential care was 33.1%, 16.9% and 4.9% for malnourished, at-risk and well-nourished patients, respectively; P⩽0.001).Conclusion:Malnutrition in elderly subacute patients predicts adverse clinical outcomes and identifies a need to target this population for nutritional intervention following hospital discharge.

A Cross-Sectional Comparison of Health Literacy Deficits Among Patients With Chronic Kidney Disease

Inadequate health literacy in people with chronic kidney disease (CKD) is associated with poorer disease management and greater complications. There are limited data on the health literacy deficits of people with CKD. The aim of this study was to investigate the types and extent of health literacy deficits in patients with CKD using the multidimensional Health Literacy Management Scale (HeLMS) and to identify associations between patient characteristics and the domains of health literacy measured by the HeLMS. Invitations to participate were sent to patients with CKD attending the renal unit of a regional Australian hospital. These patients included predialysis, dialysis (peritoneal and hemodialysis), and kidney transplant patients. This study identified that inadequate health literacy—especially in the domains relating to attending to ones health needs, understanding health information, social support, and socioeconomic factors—was common. Male gender and education level were significantly associated with inadequate health literacy. The type and extent of health literacy deficits varied among CKD groups, and transplant patients had more deficits than other CKD patient groups. This study provides useful information for health professionals treating patients with CKD, especially with regard to the design of self-management interventions and health information.

The prevalence of hyperglycaemia in pregnancy in Australia.

The Australasian Diabetes in Pregnancy Society (ADIPS) has recently endorsed the World Health Organization (WHO) terminology and classification of hyperglycaemia in pregnancy. The prevalence is likely to increase, but no prospective data are available for a representative Australian population.

Seasonal Changes in the Prevalence of Gestational Diabetes Mellitus

OBJECTIVE To determine the effect of different seasons on the prevalence of gestational diabetes mellitus (GDM) by using World Health Organization criteria. RESEARCH DESIGN AND METHODS The results of all pregnancy glucose tolerance tests (GTTs) were prospectively collected over a 3-year period in a temperate climate, and the results were grouped by season. RESULTS The results of 7,369 pregnancy GTTs were available for consideration. In winter, the median 1-h and 2-h glucose results after GTT were significantly (P < 0.0001) lower than the overall 1-h and 2-h results. The prevalence of GDM at the 1-h diagnostic level was 29% higher in summer and 27% lower in winter than the overall prevalence (P = 0.02). The prevalence of GDM at the 2-h diagnostic level was 28% higher in summer and 31% lower in winter than the overall prevalence (P = 0.01). CONCLUSIONS The prevalence of GDM varies according to seasons, which leads to the possible overdiagnosis of GDM in summer and/or underdiagnosis in winter. Further research into standardization of the GTT or seasonal adjustment of the results may need to be considered.

A comparison of the extent and pattern of cognitive impairment among predialysis, dialysis and transplant patients: a cross sectional study from Australia.

The aim of this study was to compare the extent of cogntive impairment and the types of cognitive deficits in an Australian cohort of four patient groups with end stage kidney disease. Characteristics predicting the presence of cognitive impairment were also evaluated.

Evaluation of the quality and health literacy demand of online renal diet information

BACKGROUND Dietary modification is critical in the self-management of chronic kidney disease. The present study describes the accuracy, quality and health literacy demand of renal diet information for adults with kidney disease obtained from the Internet and YouTube (www.youtube.com). METHODS A comprehensive content analysis was undertaken in April and July 2015 of 254 eligible websites and 161 YouTube videos. The accuracy of the renal diet information was evaluated by comparing the key messages with relevant evidence-based guidelines for the dietary management of people with kidney disease. The DISCERN tool (www.discern.org.uk) was used to evaluate the quality of the material. Health literacy demand was evaluated using the Patient Education Material Assessment Tool (www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/pemat/index.html) and seven validated readability calculators. RESULTS The most frequent renal diet topic found online was generic dietary information for people with chronic kidney disease. The proportion of renal diet information obtained from websites that was accurate was 73%. However, this information was mostly of poor quality with extensive shortcomings, difficult to action and written with a high health literacy demand. By contrast, renal diet information available from YouTube was highly understandable and actionable, although only 18% of the videos were accurate, and a large proportion were of poor quality with extensive shortcomings. The most frequent authors of accurate, good quality, understandable, material were government bodies, dietitians, academic institutions and medical organisations. CONCLUSIONS Renal diet information found online that is written by government bodies, dietitians, academic institutions and medical organisations is recommended. Further work is required to improve the quality and, most importantly, the actionability of renal diet information found online.

Cost and affordability of a nutritionally balanced gluten-free diet: is following a gluten-free diet affordable?

Aim To determine the cost and affordability of a gluten-free healthy food basket for four reference families in Australia. A secondary aim was to determine the price differential between commonly available gluten-free and gluten-containing food staples. Methods Exploratory study using an amalgamation of two commonly used food basket costing methods. Two food basket types were constructed for four common Australian family types. These were designated the Healthy Food Basket and modified (gluten-free) Healthy Food Basket. Baskets were priced at five locations and costs as a proportion of the Equivalised Household Disposable Income and average weekly earnings for welfare recipients were calculated. The price differential for four common bread and cereal staples were also calculated per 100 g. Results The gluten-free healthy food basket was significantly more expensive compared to a gluten-containing healthy food basket for all family types. The gluten-free basket was considered unaffordable for three of the four common family types. Gluten-free staples are significantly more expensive than their gluten-containing counterparts. Conclusions Compliance to a gluten-free diet may be more difficult for some families due to the significant price discrepancy of gluten-free items. Families on welfare with people who require a gluten-free diet are particularly vulnerable to food insecurity. Consideration should be given to the creation of a national subsidised medical foods program to enable equitable access to affordable gluten-free staple foods via prescription.

An integrative review of the methodology and findings regarding dietary adherence in end stage kidney disease

BackgroundDietary modification is an important component of the management of end stage kidney disease (ESKD). The diet for ESKD involves modifying energy and protein intake, and altering sodium, phosphate, potassium and fluid intake. There have been no comprehensive reviews to date on this topic. The aims of this integrative review were to (i) describe the methods used to measure dietary adherence (ii) determine the rate of dietary adherence and (iii) describe factors associated with dietary adherence in ESKD.MethodsThe Web of Science and Scopus databases were searched using the search terms ‘adherence’ and ‘end stage kidney disease’. Of the 787 potentially eligible papers retrieved, 60 papers of 24,743 patients were included in this review. Of these papers, 44 reported the rate of dietary adherence and 44 papers described factors associated with adherence.ResultsMost of the evidence regarding dietary adherence is derived from studies of hemodialysis patients (72% of patients). The most common method of measuring dietary adherence in ESKD was subjective techniques (e.g. food diaries or adherence questionnaires). This was followed by indirect methods (e.g. serum potassium, phosphate or interdialytic weight gain). The weighted mean adherence rate to ESKD dietary recommendations was 31.5% and 68.5% for fluid recommendations. Adherence to protein, sodium, phosphate, and potassium recommendations were highly variable due to differences in measurement methods used, and were often derived from a limited evidence base. Socioeconomic status, age, social support and self-efficacy were associated with dietary adherence. However, factors such as taste, the impact of the diet on social eating occasions; and dietetic staffing also appear to play a role in dietary adherence.ConclusionDietary adherence rates in people with ESKD are suboptimal. Further research is required on dietary adherence in patients with ESKD from different social, educational, economic and ethnic groups. This research may identify other factors which may impact upon adherence, and could be used to inform the design of future strategies to improve dietary adherence. Future research that reports not just the rate of adherence to individual components of the nutrient prescription but also the overall quality of the diet would be useful.

Diet quality in patients with end‐stage kidney disease undergoing dialysis

BACKGROUND People on haemodialysis (HD) are at risk of consuming a poor quality diet. This includes inadequate intake of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA). OBJECTIVE This study aims to investigate diet quality, with a particular focus on n-3 LCPUFA intake, in a population of incentre HD patients. DESIGN Dietary intake was measured using three 24 hour recalls; the Polyunsaturated food frequency questionnaire (PUFA FFQ) and the Total Diet Score (TDS). Dietary intake was also compared to evidence based practice guidelines (EBPG). Nutritional status was assessed using the Patient Generated Subjective Global Assessment (PG SGA). SUBJECTS A total of 32 dialysis patients were recruited, from two regional HD centres in New South Wales, Australia. MAIN OUTCOME MEASURE Diet quality was the main outcome measure. RESULTS Diet quality of study participants was poor, with the majority not meeting the EBPG for energy, protein and potassium. All participants exceeded the recommended amount of saturated fat. The mean TDS of the dialysis cohort was 10.2, which was significantly higher than the TDS of 9.3 of a healthy disease free cohort (p < 0.05). Positive correlations were found between TDS and LC omega-3 intake (r = 0.392) and TDS and total omega-6 intake (r = 0.363). Only 22% of participants met the suggested dietary target for n-3 LCPUFA intake. CONCLUSION Dialysis patients in this study had suboptimal diet quality. Improvements are required for better adherence to the EBPG. Increased consumption of n-3 LCPUFA fatty acids may also be of benefit.

Weight management strategies for those with chronic kidney disease – a consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting

The aim of the present study was to develop a consensus report to guide dietetic management of overweight or obese individuals with chronic kidney disease (CKD).