Michelle Ann Palmer

Association between eating frequency, weight and health

There is speculation amongst health professionals, the media, and the public regarding eating frequency (EF) and its impact on weight and health. Nutritional weight-loss and -maintenance interventions of longer than 1 weeks duration were reviewed for associations between EF and weight and health. Of the 176 studies identified, 25 relevant studies matched the criteria and only 10 of these were weight-loss interventions. Generally, sample sizes were small, interventions were short-term, and a wide array of definitions was used to define an eating occasion. Several key outcomes such as physical activity, adherence to assigned EF, and hunger were often not measured. The limited evidence available suggests there is no association between EF and weight or health in either weight-loss or -maintenance interventions, with a possible inverse association between EF and lipids in weight-maintenance interventions. Longer term, larger studies that include important weight and health outcomes are needed.

Malnutrition associated with increased risk of frail mechanical falls among older people presenting to an emergency department.

Objective:u2003 To identify associations between malnutrition falls risk and hospital admission among older people presenting to ED.

Hormonal contraceptive practices in young Australian women (≤ 25 years) and their possible impact on menstrual frequency and iron requirements.

OBJECTIVESnTo investigate the hormonal contraceptive practices of female university students aged ≤ 25 years, their menstrual bleeding frequency, and interest in contraceptive regimens that reduce menstrual frequency or duration.nnnSTUDY DESIGNnA 20-item questionnaire was distributed to female students at Griffith University, Gold Coast campus. This included questions relating to: demographics, menstrual bleeding frequency, current contraceptive practices, and interest in future oral contraceptive regimens that reduce menstrual bleeding frequency and duration.nnnMAIN OUTCOME MEASURESnDetermination of hormonal contraceptive practices and menstrual bleeding frequency undertaken by the sample population.nnnRESULTSnEight hundred and fifty one participants completed the questionnaire, ~ 2/3rds of respondents are currently using a hormonal contraceptive (66% of all respondents), with the oral contraceptive pill (OCP) being most common. Most women (73%) reported monthly menstruation, although 16% indicated that they sometimes missed their monthly period, with bleeding every two months. Of all OCP users, approximately 2/3rds have skipped their monthly period at some time, the most common reasons being for convenience (89%). Approximately 70% of respondents were interested in OCP regimens that reduced frequency or duration of menstruation.nnnCONCLUSIONnOCP use is popular amongst Australian university women, with many being interested in the concept of using the OCP to delay menstruation. Given this interest and the availability of hormonal contraceptives that reduce menstrual frequency and duration, assessing the impact of reduced menstrual blood loss on iron stores may be warranted.

Short‐term body weight fluctuations in older well‐hydrated hospitalised patients

BACKGROUNDnThe usual daily weight fluctuations of well-hydrated older hospitalised people have not been documented internationally. To date, dehydration assessments based on a short-term body weight change defined as >2% have been drawn from healthy population data. The present pilot study aimed to describe usual body weight fluctuation at the same time of day over a 3-day time frame in well-hydrated older hospitalised adults.nnnMETHODSnAn observational study of non-acute inpatients (n = 10) admitted to a Geriatric and Rehabilitation Unit, aged ≥60 years, assessed as well-hydrated, mobile, non-amputee and without conditions that influenced fluid status, was conducted. Participants were weighed hourly over a 9-h period for 3 days. Food and fluid intake, clothing items added or removed, and urine and faecal output were recorded.nnnRESULTSnWeight fluctuation for each participant [mean (SD) 80.2 (4.2) years; male 60.0%, n = 10] over 3 days ranged from 1.1% to 3.6%. Over 3 days, 40.0% (4/10) of participants had weight fluctuations of >2% and 20% (2/10) had weight fluctuations of >3%. Time of weigh-in accounted for 99.8% of the variation in weight fluctuation (P < 0.05), with the lowest fluctuations observed when weights were compared at the same time each day (≤0.4 kg).nnnCONCLUSIONSnWeights recorded at the same time daily had the greatest accuracy. Given that the range 1.1-3.6% was within normal weight fluctuations for well-hydrated older hospitalised participants, the weight change indicative of dehydration remains to be established in this setting but appears greater than conventionally used figures.

Effects of Dietary Folate Intake on Migraine Disability and Frequency

Migraine is a highly disabling disease affecting a significant proportion of the Australian population. The methylenetetrahydrofolate reductase (MTHFR) C677T variant has been associated with increased levels of homocysteine and risk of migraine with aura (MA). Folic acid (FA), vitamin B6, and B12 supplementation has been previously shown to reduce increased levels of homocysteine and decrease migraine symptoms. However, the influence of dietary folate intake on migraine has been unclear. The aim of the current study was to analyze the association of dietary folate intake in the form of dietary folate equivalent, FA, and total food folate (TFF) on migraine frequency, severity, and disability.

Evaluation of a curriculum initiative designed to enhance the research training of dietetics graduates

Aim: To qualitatively evaluate a learning and teaching intervention for developing research and evaluation competencies, structured around the experience of having to conduct a significant research project. Methods: A qualitative study utilising semi-structured interviews among a sample of 25 recent graduates from Griffith Universitys Master of Nutrition and Dietetics Program. Interviews explored student motivations for doing the research major, the students experience of the full-time semester long research project, and the actual and perceived outcomes of this experience. Interviews were audiotaped, transcribed verbatim, and thematically analysed via open coding and triangular analysis by three of the authors. Results: All of the graduates interviewed had conducted research projects across a range of practice settings. Motivations for electing to do the research major varied from disinterest in other options to an opportunity to taste-test research, to develop research competencies and secure pathways to later research studies. The student learning experience was described as intense, stressful but rewarding and a steep learning curve. Graduates reported that they learned much more than research competencies during this process and many converted this research activity into a research output (journal article or conference abstract). Students reflected on the strong sense of achievement associated with research outputs and the competitive advantage it had provided on seeking graduate employment. Conclusions: It is possible to develop graduate dietitians research and evaluation competencies using curriculum initiatives that exploit experiential learning. Exposing students to the research practice cycle culminating in peer-reviewed publication builds research self-efficacy and positions students for good employment outcomes.

Energy and protein intakes of hospitalised patients with acute respiratory failure receiving non-invasive ventilation

BACKGROUND & AIMnNutritional intake of patients in acute respiratory failure receiving non-invasive ventilation has not previously been described, and no protocols have been developed to guide practice to optimise nutritional status. We aimed to measure energy and protein intakes of patients in acute respiratory failure requiring non-invasive ventilation receiving standard hospital nutritional care.nnnMETHODSnFood and fluid intake forms were completed by nursing staff for all meals and mid meals for patients admitted with respiratory failure commencing on non-invasive ventilation. Intake was converted from quartiles of food consumed into energy and protein to enable comparison with estimated daily requirements using descriptive statistics. Multinomial stepwise regression analysis was used to determine factors associated with inadequate protein and energy intake.nnnRESULTSnOver 283 total days of intake, 36 participants (67% female, aged 65xa0±xa09 years) achieved on average 1434xa0±xa0627xa0kcal and 63xa0±xa029xa0g protein daily. Overall, 28 patients (78%, 95% CI: 61-90%) met less than 80% of estimated energy requirements and 27 patients (75%, 95% CI: 58-88%) met less than 80% of estimated protein requirements. Being fed orally, longer time on non-invasive ventilation and higher BMI were associated with poorer intakes. Better nutritional status on admission and measuring intake closer to hospital discharge was associated with improved intakes.nnnCONCLUSIONnPatients with acute respiratory failure requiring non-invasive ventilation often had inadequate oral intake, particularly with increasing time on non-invasive ventilation, and earlier during their hospital admission. Development of protocols to optimise nutritional intake for these patients may improve outcomes and reduce regular readmission rates.

Purchase rates and energy content of nutritionally promoted and traditional fast foods purchased at lunchtime in Australia - a pilot study

OBJECTIVEnNutritionally promoted foods are now available at fast-food establishments. Little is known about their popularity, who is purchasing them, or their impact on dietary intake. Our study aimed to determine: how often nutritionally promoted fast foods were purchased; the demographic characteristics of people purchasing these foods; and if purchasing these foods resulted in reduced energy, and increased vegetable, content of lunches compared with those who purchased traditional fast foods.nnnDESIGNnA survey collecting lunchtime fast-food purchases and demographic details was administered over two months. Nutritionally promoted products included the McDonalds Heart Foundation Tick Approved range and Subways Six grams of fat or less range. Energy and vegetable contents were estimated using information from fast-food companies websites. Differences in demographics, energy and vegetable contents between individuals purchasing nutritionally promoted and traditional lunches were assessed using χ2 and t tests.nnnSETTINGnQueensland, Australia.nnnSUBJECTSnLunchtime diners aged over 16 years at Subway and McDonalds.nnnRESULTSnSurveys were collected from 927 respondents (58 % male, median age 25 (range 16-84) years; 73 % response rate). Only 3 % (n 24/910) of respondents who ordered a main option had purchased a nutritionally promoted item. Purchasers of nutritionally promoted foods were ∼13 years older, predominantly female (79 %), and more often reported involvement in a health-related profession (29 % v. 11 %) than purchasers of traditional foods (P < 0·05). Purchasers of nutritionally promoted foods ordered 1·5 fewer megajoules and 0·6 more vegetable servings than purchasers of traditional foods (P < 0·05).nnnCONCLUSIONSnNutritionally promoted fast foods may reduce lunchtime energy content, however these foods were infrequently chosen.

Agreement between student dietitians' identification of refeeding syndrome risk with refeeding guidelines, electrolytes and other dietitians: a pilot study.

BACKGROUNDnLimited research exists concerning how consistently and accurately student and newly-graduated dietitians are identifying refeeding syndrome risk in hospitalised patients. The present study aimed to determine the consistency of students and newly-graduated dietitians classification of refeeding syndrome risk, as well as agreement with the application of comparison tools such as the National Institute for Health and Care Excellence guidelines, patients electrolytes and supplementation, and clinical dietitians previously surveyed.nnnMETHODSnRecently-graduated and final-year Griffith University dietetics students were invited to complete an online survey. The survey questioned demographics and asked respondents to classify the level of refeeding syndrome risk (i.e. none, some, high, unsure) in 13 case studies. Electrolytes and supplementation data were sourced from electronic patient records. Chi-squared tests, t-tests and linear regression analyses were conducted.nnnRESULTSnFifty-three eligible people responded [n = 53 of 112, mean (SD) age 26 (4) years, 89% female, 34% graduates]. Respondents answers were generally more consistent and more likely to agree with comparison tools when two tools showed the same level of refeeding syndrome risk (49-98%, β = 0.626-1.0994, P < 0.001) than when they differed (11-49%). Respondents level of agreement with refeeding identification guidelines, electrolyte levels, supplementation and dietitians previously surveyed did not differ by graduate status, degree level, clinical placement status or having read refeeding syndrome guidelines recently (P > 0.05).nnnCONCLUSIONSnStudents and new graduates identification of refeeding syndrome risk improved when there was consistency between guidelines, electrolytes and dietitians responses. More research is needed to improve the evidence behind refeeding guidelines, with the aim of enhancing the accuracy and consistency of assessment.

Throw caution to the wind: is refeeding syndrome really a cause of death in acute care?

Background/Objectives:Refeeding syndrome (RFS), a life-threatening medical condition, is commonly associated with acute or chronic starvation. While the prevalence of patients at risk of RFS in hospital reportedly ranges from 0 to 80%, the prevalence and types of patients who die as a result of RFS is unknown. We aimed to measure the prevalence rate and examine the case histories of patients who passed away with RFS listed as a cause of death.Subjects/Methods:Patients were eligible for inclusion provided their death occurred within a Queensland hospital. Medical charts were reviewed, for medical, clinical and nutrition histories with results presented using descriptive statistics.Results:Across 18 years (1997–2015) and ~260000 hospital deaths, five individuals (4F, 74 (37–87)yrs) were identified. No patient had a past or present diagnosis, such as anorexia nervosa, that would classify them as at high risk for RFS. RFS was not listed as the primary cause of death for any patient. No individual consumed >3400u2009kJ per day. Limited consensus was observed in the signs and symptoms used to diagnose RFS, although all patients experienced low levels of potassium, phosphate and/or magnesium. Eighty percent of electrolytes improved before death.Conclusions:RFS was a rare underlying cause of death, despite reported high prevalence rates of risk. Patient groups usually considered to be at high risk were not identified, suggesting a level of imprecision with the interpretation of criteria used to identify RFS risk. More detailed research is warranted to assist in the identification of those distinctly at risk of RFS.