Philippa Lyons-Wall

Evaluation of a mobile phone image-based dietary assessment method in adults with type 2 diabetes

Image-based dietary records have limited evidence evaluating their performance and use among adults with a chronic disease. This study evaluated the performance of a 3-day mobile phone image-based dietary record, the Nutricam Dietary Assessment Method (NuDAM), in adults with type 2 diabetes mellitus (T2DM). Criterion validity was determined by comparing energy intake (EI) with total energy expenditure (TEE) measured by the doubly-labelled water technique. Relative validity was established by comparison to a weighed food record (WFR). Inter-rater reliability was assessed by comparing estimates of intake from three dietitians. Ten adults (6 males, age: 61.2 ± 6.9 years old, BMI: 31.0 ± 4.5 kg/m2) participated. Compared to TEE, mean EI (MJ/day) was significantly under-reported using both methods, with a mean ratio of EI:TEE 0.76 ± 0.20 for the NuDAM and 0.76 ± 0.17 for the WFR. Correlations between the NuDAM and WFR were mostly moderate for energy (r = 0.57), carbohydrate (g/day) (r = 0.63, p < 0.05), protein (g/day) (r = 0.78, p < 0.01) and alcohol (g/day) (rs = 0.85, p < 0.01), with a weaker relationship for fat (g/day) (r = 0.24). Agreement between dietitians for nutrient intake for the 3-day NuDAM (Intra-class Correlation Coefficient (ICC) = 0.77–0.99) was lower when compared with the 3-day WFR (ICC = 0.82–0.99). These findings demonstrate the performance and feasibility of the NuDAM to assess energy and macronutrient intake in a small sample. Some modifications to the NuDAM could improve efficiency and an evaluation in a larger group of adults with T2DM is required.

Factors that influence consumption of fish and omega-3-enriched foods: A survey of Australian families with young children

Aim The present study aimed to identify factors that influence the consumption of fish and foods that are enriched with omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA), in order to inform the development of effective nutrition education strategies. Methods A cross-sectional, 10-item self-administered survey was conducted to 262 parents of children aged 9–13 years from a regional centre in New South Wales. Parents were asked questions related to frequency of consumption, and to identify factors that either encouraged or prevented the provision of fish/seafood and/or n-3 LCPUFA-enriched foods for their families. Results Salmon, canned tuna, prawn and take-away fish were the most commonly eaten variants of fish/seafood, at approximately once a month. Perceived health benefits and the influence of media and health professionals in health promotion were identified as the primary motivators for consumption of fish/seafood and foods enriched with n-3 LCPUFA. Among families who consume fish, taste was valued as having a major positive influence, as well as preferences of individual family members, but the latter was perceived as an obstacle in non-fish consumers. Price was the main barrier to consumption of fresh, but not canned, fish and n–3-enriched foods, in both those that do and do not consume these foods. Conclusion Despite Australian parents’ knowledge of the health benefits n-3 LCPUFA, only a fifth of households meet the recommended two serves of fish per week, hence nutrition education strategies are warranted.

Effect of replacing bread, egg, milk, and yogurt with equivalent ω-3 enriched foods on ω-3 LCPUFA intake of Australian children.

OBJECTIVE In countries with traditionally low fish consumption such as Australia, foods enriched with ω-3 long-chain polyunsaturated fatty acids (ω-3 LCPUFA) may play a role in meeting ω-3 LCPUFA intakes for optimal health. The aim of this study was to assess the effect of replacing bread, egg, milk, and yogurt with ω-3 LCPUFA enrichment of these foods on total ω-3 LCPUFA intake in Australian childrens diets. METHODS Dietary modeling was undertaken using survey data from a nationally representative sample of 4487 children (2249 boys, 2238 girls) ages 2 to 16 y in whom the Multiple Source Method was used to estimate usual ω-3 LPUFA intakes distributions from two 24-h dietary recalls, corrected for within-person variation; 15 models were constructed. RESULTS The adjusted mean ± SD and median and interquartile range (IQR) of usual dietary intakes of ω-3 LCPUFA gradually increased from 2.5 ± 0.8 to 7.1 ± 4.9 mg/d and 2.3 (1.9-2.9) to 5.4 (3.6-9.2), respectively, after the modeling (P = 0.001 for each model). Median (IQR) intake of total ω-3 LCPUFAs in non-fish eaters and fish eaters was 1.4 (0.8-2.3) and 2.3 (1.0-6.1) mg/d, respectively, which increased threefold to 4.3 (2.6-7.8) and 7.5 (3.9-13) mg/d, respectively, after replacement of all four ω-3 enriched foods. CONCLUSION Replacement of four core foods with ω-3 enriched alternatives resulted in improved simulated ω-3 LCPUFA intakes in Australian children but not to optimal levels of intake. Increased fish consumption is still the most effective strategy for increasing ω-3 LCPUFA intake.

Cardiovascular, Metabolic Effects and Dietary Composition of Ad-Libitum Paleolithic vs. Australian Guide to Healthy Eating Diets: A 4-Week Randomised Trial.

(1) Background: The Paleolithic diet is popular in Australia, however, limited literature surrounds the dietary pattern. Our primary aim was to compare the Paleolithic diet with the Australian Guide to Healthy Eating (AGHE) in terms of anthropometric, metabolic and cardiovascular risk factors, with a secondary aim to examine the macro and micronutrient composition of both dietary patterns; (2) Methods: 39 healthy women (mean ± SD age 47 ± 13 years, BMI 27 ± 4 kg/m2) were randomised to either the Paleolithic (n = 22) or AGHE diet (n = 17) for four weeks. Three-day weighed food records, body composition and biochemistry data were collected pre and post intervention; (3) Results: Significantly greater weight loss occurred in the Paleolithic group (−1.99 kg, 95% CI −2.9, −1.0), p < 0.001). There were no differences in cardiovascular and metabolic markers between groups. The Paleolithic group had lower intakes of carbohydrate (−14.63% of energy (E), 95% CI −19.5, −9.7), sodium (−1055 mg/day, 95% CI −1593, −518), calcium (−292 mg/day 95% CI −486.0, −99.0) and iodine (−47.9 μg/day, 95% CI −79.2, −16.5) and higher intakes of fat (9.39% of E, 95% CI 3.7, 15.1) and β-carotene (6777 μg/day 95% CI 2144, 11410) (all p < 0.01); (4) Conclusions: The Paleolithic diet induced greater changes in body composition over the short-term intervention, however, larger studies are recommended to assess the impact of the Paleolithic vs. AGHE diets on metabolic and cardiovascular risk factors in healthy populations.

Lean Body Mass Associated with Upper Body Strength in Healthy Older Adults While Higher Body Fat Limits Lower Extremity Performance and Endurance

Impaired strength adversely influences an older person’s ability to perform activities of daily living. A cross-sectional study of 117 independently living men and women (age = 73.4 ± 9.4 year; body mass index (BMI) = 27.6 ± 4.8 kg/m2) aimed to assess the association between body composition and: (1) upper body strength (handgrip strength, HGS); (2) lower extremity performance (timed up and go (TUG) and sit to stand test (STS)); and (3) endurance (6-minute walk (SMWT). Body composition (% fat; lean body mass (LBM)) was assessed using bioelectrical impedance. Habitual physical activity was measured using the Minnesota Leisure Time Physical Activity Questionnaire (MLTPA) and dietary macronutrient intake, assessed using 24 h recalls and 3-day food records. Regression analyses included the covariates, protein intake (g/kg), MLTPA, age and sex. For natural logarithm (Ln) of right HGS, LBM (p < 0.001) and % body fat (p < 0.005) were significant (r2 = 46.5%; p < 0.000). For left LnHGS, LBM (p < 0.000), age (p = 0.036), protein intake (p = 0.015) and LnMLTPA (p = 0.015) were significant (r2 = 0.535; p < 0.000). For SMW, % body fat, age and LnMLTPA were significant (r2 = 0.346; p < 0.000). For STS, % body fat and age were significant (r2 = 0.251; p < 0.000). LBM is a strong predictor of upper body strength while higher % body fat and lower physical activity are associated with poorer outcomes on tests of lower extremity performance.

Compliance, Palatability and Feasibility of PALEOLITHIC and Australian Guide to Healthy Eating Diets in Healthy Women: A 4-Week Dietary Intervention

(1) Background/Objectives: The Paleolithic diet has been receiving media coverage in Australia and claims to improve overall health. The diet removes grains and dairy, whilst encouraging consumption of fruits, vegetables, meat, eggs and nuts. Our aim was to compare the diet to the Australian Guide to Healthy Eating (AGHE) in terms of compliance, palatability and feasibility; (2) Subjects/Methods: 39 healthy women (age 47 ± 13 years, BMI 27 ± 4 kg/m2) were randomised to an ad-libitum Paleolithic (n = 22) or AGHE diet (n = 17) for 4-weeks. A food checklist was completed daily, with mean discretionary consumption (serves/day) calculated to assess compliance. A 12-item questionnaire was administered post intervention to assess palatability and feasibility; (3) Results: The AGHE group reported greater daily consumption of discretionary items (1.0 + 0.6 vs. 0.57 + 0.6 serves/day, p = 0.03). Compared to the AGHE group, the Paleolithic group reported a significantly greater number of events of diarrhoea (23%, 0%, p = 0.046), costs associated with grocery shopping (69%, 6% p < 0.01) and belief that the diet was not healthy (43%, 0% p < 0.01); (4) Conclusions: Compliance to both diets was high but the potential side effects and increased cost suggest that the Paleolithic diet may not be practical in clinical/public health settings. Further studies are required to assess longer term feasibility.

Development and validation of a food frequency questionnaire to assess omega-3 long chain polyunsaturated fatty acid intake in Australian children aged 9-13 years

BACKGROUND The present study aimed to develop a food frequency questionnaire (FFQ) assessing dietary omega-3 long chain polyunsaturated fatty acid (n-3 LCPUFA) intake in Australian children and to validate the FFQ against a 7-day food diary. METHODS The investigation comprised a cross-sectional and validation study. The study setting was two private primary schools in the in the Illawarra region of New South Wales. Twenty-two Australian children, aged 9-13 years, who were not on a special diet or receiving medical care that limited their food choice in the 3 months prior to recruitment, were recruited into the study. RESULTS A total of 131 items, classified according to seven food group categories, was included in the n-3 LCPUFA FFQ, as identified from published dietary surveys and a supermarket survey. Good correlations between the FFQ and the 7-day food diary were observed for eicosapentaenoic acid (EPA) [r = 0.691, 95% confidence interval (CI) = 0.51-0.83, P < 0.001], docosahexaenoic acid (DHA) (r = 0.684, 95% CI = 0.45-0.84, P < 0.001) and total n-3 LCPUFA (r = 0.687, 95% CI = 0.48-0.85, P < 0.001). Bland-Altman plots showed an acceptable limit of agreement between the FFQ and the average 7-day food diary. However, the mean EPA, DHA and total n-3 LCPUFA intakes estimated from the FFQ were significantly higher than those from the average 7-day food diary estimates (P < 0.001). CONCLUSIONS A novel n-3 LCPUFA FFQ that has been developed to estimate dietary n-3 LCPUFA intakes in Australian children has been shown to have relative validity. The FFQ provides a useful contribution to dietary assessment methodology in this age group; however, reproducibility remains to be demonstrated.

Delayed postoperative diet is associated with a greater incidence of prolonged postoperative ileus and longer stay in hospital for patients undergoing gastrointestinal surgery

AIM Recent evidence favours a move away from delaying postoperative nutrition towards early feeding practices for better patient outcomes after gastrointestinal surgery. The aim of the present study was to investigate postoperative diet progression and patient outcomes in a secondary hospital with a view to inform future practice. METHODS This was a retrospective study of gastrointestinal surgery patients (n = 69) at a Western Australian general hospital. Demographic data and outcomes were collected from patient records and included presence or absence of prolonged postoperative ileus, length of stay in hospital, days on minimal nutrition and days until first flatus or stool. RESULTS A significant positive association was observed between number of days a patient remained on minimal nutrition and length of stay in the overall group (r = 0.66, P < 0.01). Patients who developed prolonged postoperative ileus (n = 18, 26%) had a greater number of days on minimal nutrition (20.0 vs 8.0 days, P < 0.01), longer stay in hospital (15.0 vs 8.0 days, P < 0.01) and increased number of days to first flatus or stool (4.0 vs 2.4 days, P < 0.01) compared with those who did not develop prolonged postoperative ileus (n = 51, 74%). CONCLUSIONS This retrospective study of current practice in a secondary-care general hospital highlights the gap between traditional care and the improved outcomes reported in the literature when early feeding practices are adopted after GI surgery. Further investigation of barriers and enablers is necessary to provide insight into developing the most appropriate strategy to achieve this.