Mary T. Hannan-Jones

Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia.

BACKGROUND Studies amongst older people with acute dysphagic stroke requiring thickened fluids have assessed fluid intakes from combinations of beverage, food, enteral and parenteral sources, but not all sources simultaneously. The present study aimed to comprehensively assess total water intake from food, beverages, enteral and parenteral sources amongst dysphagic adult in-patients receiving thickened fluids. METHODS Patients requiring thickened fluid following dysphagia diagnosis were recruited consecutively from a tertiary teaching hospitals medical and neurosurgical wards. Fluid intake from food and beverages was assessed by wastage, direct observation and quantified from enteral and parenteral sources through clinical medical records. RESULTS No patients achieved their calculated fluid requirements unless enteral or parenteral fluids were received. The mean daily fluid intake from food was greater than from beverages whether receiving diet alone (food: 807 +/- 363 mL, food and beverages: 370 +/- 179 mL; P < 0.001) or diet with enteral or parenteral fluid support (food: 455 +/- 408 mL, food and beverages: 263 +/- 232 mL; P < 0.001). Greater daily fluid intakes occurred when receiving enteral and parenteral fluid in addition to oral dietary intake, irrespective of age group, whether assistance was required, diagnosis and whether stage 3 or stage 2 thickened fluids were required (P < 0.05). After enteral and parenteral sources, food provided the most important contribution to daily fluid intakes. CONCLUSIONS The greatest contribution to oral fluid intake was from food, not beverages. Designing menus and food services that promote and encourage the enjoyment of fluid dense foods, in contrast to thickened beverages, may present an important way to improve fluid intakes of those with dysphagia. Supplemental enteral or parenteral fluid may be necessary to achieve minimum calculated fluid requirements.

Prevalence of diet-related risk factors for chronic disease in male prisoners in a high secure prison

Background/Objectives:Research on prisoners is limited and demonstrates a group with disproportionate numbers from disadvantaged backgrounds, known to have a high burden of disease, much of which is diet related. The aim of this study was to gauge the presence of markers of chronic disease, as a basis for food and nutrition policy in prisons.Subjects/Methods:A cross-sectional study design was used with a convenience sample of prisoners in a male 945 bed high secure facility. Face-to-face interviews with physical measures of height, weight, body fat, waist circumference and blood pressure were collected along with fasting bloods. Data were confirmed with facility records, observations and staff interviews. Full ethics approval was obtained. Results were compared with studies of Australian prisoners and the general population.Results:The mean age was 35.5 years (n=120). Prevalence rates were as follows: obesity 14%, diabetes 5%, hypertension 26.7% and smoking 55.8%. Self-report of daily physical activity was 84%, with 51% participating ⩾2 times daily. Standard food provision was consistent with dietary recommendations, except that sodium was high. Where fasting bloods were obtained (n=78), dyslipidaemia was 56.4% with the metabolic syndrome (MS) present in 26%.Conclusions:Prevalence of diabetes and heart disease risk appear similar to the general population; however, obesity was lower and smoking higher. The data provide evidence that markers of chronic disease are present, with this the first study to describe the MS in prisoners. Food and nutrition policy in this setting is complex and should address the duty of care issues that exist.

A controlled dietary trial for improving bowel function in a group of training centre residents with severe or profound intellectual disability

A nutritional assessment project at a training centre for people with intellectual disability identified chronic constipation as a problem. Thirty-seven residents with bowel dysfunction took part in the study. Estimates of fibre and fluid intakes yielded mean intakes of 18.6g fibre per day (range 14-23g) and 2.2 litres of fluid (range 1.8-2.4 litres). A randomly selected sample received 7g additional dietary fibre per day for two weeks in the form of a dietary supplement. During the experimental period, those not receiving the supplement experienced a significant reduction in the number of bowel motions and a worsening of stool texture, while those receiving the supplement did not. Results suggest that, even when there is chronic constipation, dietary intervention may be warranted.

What do prisoners eat? Nutrient intakes and food practices in a high-secure prison

There are limited studies on the adequacy of prisoner diet and food practices, yet understanding these are important to inform food provision and assure duty of care for this group. The aim of this study was to assess the dietary intakes of prisoners to inform food and nutrition policy in this setting. This research used a cross-sectional design with convenience sampling in a 945-bed male high-secure prison. Multiple methods were used to assess food available at the group level, including verification of food portion, quality and practices. A pictorial tool supported the diet history method. Of 276 eligible prisoners, 120 dietary interviews were conducted and verified against prison records, with 106 deemed plausible. The results showed the planned food to be nutritionally adequate, with the exception of vitamin D for older males and long-chain fatty acids, with Na above upper limits. The Australian dietary targets for chronic disease risk were not achieved. High energy intakes were reported with median 13·8 (se 0·3) MJ. Probability estimates of inadequate intake varied with age groups: Mg 8 % (>30 years), 2·9 % (70 years), 1·5 % (<70 years); folate 3·5 %; Zn and I 2·7 %; and vitamin A 2·3 %. Nutrient intakes were greatly impacted by self-funded snacks. Results suggest the intakes to be nutritionally favourable when compared with males in the community. This study highlights the complexity of food provision in the prison environment and also poses questions for population-level dietary guidance in delivering appropriate nutrients within energy limits.

Moderation of a foodservice assessment artefact in nutrition and dietetics programs

AIM Foodservice is a key component of dietetics education and practice internationally yet benchmarks for competency are limited. This study sought to review and moderate an assessment artefact of foodservice work integrated learning (WIL) to develop a shared understanding of one tool which may be used in a suite of evidence to demonstrate competence. METHODS The foodservice curricula and assessment artefacts were described for the foodservice program at each of four participating universities. An assessment artefact from WIL, the report, was identified as an indicator of foodservice competence common to each program. Each university provided four purposively sampled WIL reports, assessed in duplicate by two academics from other participating universities using the corresponding university assessment rubric. Collated assessment results, along with the original assessment, were presented back to assessors. A semi-structured group discussion explored variations in assessment results, factors influencing decisions, and potential changes needed for assessment documentation. RESULTS There was variation in assessment outcomes between independent assessors. In some instances assessors did not consistently deliver the same assessment outcome, nor rank students in sequential order of performance. This variation was less where an absolute ranking of satisfactory/unsatisfactory was applied. The assessor discussion revealed three key concepts: importance of understanding the project scope; challenges which influence assessment decision making; importance of understanding the broader program of assessment. CONCLUSIONS Assessment inconsistencies emphasise the importance of multiple assessors and assessment artefacts across a programmatic assessment model, and the need for a clear understanding of competence in nutrition and dietetics.

Validity of four nutritional screening tools against subjective global assessment for inpatient adults in a low-middle income country in Asia

Background/objectivesHospital malnutrition is a common problem worldwide. This study aims to assess the validity of widely used nutritional screening tools for hospitalized adults in acute care settings in Ho Chi Minh City, Vietnam.Subjects/methodsParticipants in this study were 693 adult patients from six general public hospitals, in a multi-center survey undertaken in April and May, 2016. The criterion validity of the Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screening (NRS-2002) and Mini Nutrition Assessment—Short Form (MNA-SF), modified MST (MST combined with low BMI), and BMI as independent tools were assessed using Subjective Global Assessment (SGA) or low BMI (<18.5 kg/m2) as the reference method. Area under curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the ROC curve method to determine the validity of screening tools.ResultsNRS-2002, modified MST (MST + low BMI), MUST, and BMI at 21 kg/m2 showed moderate/fair validity compared to the reference method (SGA or BMI). MST alone and MNA-SF showed poor validity due to low sensitivity (41.8 and 35.0% for MST and MNA-SF, respectively).ConclusionsBased on specificity and sensitivity, the first choice for the most appropriate screening tool for use in Vietnam is the NRS-2002, following by the MST + BMI, MUST, and BMI alone at the cut-off value of 21 kg/m2. Further investigation on the feasibility and acceptability are required to determine the most appropriate screening tools for use within the Vietnamese context.