Shawn Somerset

Dietary Flavonoid Sources in Australian Adults

Evidence from laboratory-based in vitro studies provides compelling evidence supporting the involvement of dietary flavonoid intake in human cancer risk. Associations between intakes of individual flavonoids and disease outcomes at the population level are emerging from recent epidemiological studies. As an important step in the development of methods to assess flavonoid intakes across populations, the major sources of dietary flavonoids in the adult Australian population were identified. Data from a 24-h diet recall questionnaire used in a national nutrition survey (NNS95—comprising a sample of 10,851 subjects aged 19 yr and over) were combined with U.S. Department of Agriculture data on flavonoid content of foods to identify key sources. Black and green teas clearly were the dominant sources of the flavonols kaempferol, myricetin, and quercetin. Other significant flavonol sources included onion (isorhamnetin and quercetin), broccoli (kaempferol and quercetin), apple (quercetin), grape (quercetin), coffee (myrcetin), and beans (quercetin). Black and green teas also were dominant sources of flavon-3-ols, with wine, apples, and pears contributing somewhat. In terms of flavanone consumption, oranges (hesperetin and naringenin), lemon (eriodictyol), mandarin (hesperetin), and grapefruit (naringenin) were the major sources. Parsley (apigenin), celery (apigenin and luteolin), and English spinach (luteolin) were the major flavone sources. Wine was the major anthocyanadin source (delphinidin, malvidin, peonidin and petunidin), with smaller amounts from cherry (peonidin) and blueberry (delphinidin, malvidin, peonidin and petunidin). It is suggested that the relatively small number of aforementioned key foods form the basis of food frequency questionnaires to assess flavonoid intake.

Impact of a school-based food garden on attitudes and identification skills regarding vegetables and fruit: a 12-month intervention trial

OBJECTIVE To determine changes in ability to identify specific vegetables and fruits, and attitudes towards vegetables and fruit, associated with the introduction of a school-based food garden. DESIGN A 12-month intervention trial using a historical control (control n 132, intervention n 120), class-based, self-administered questionnaires requiring one-word answers and 3-point Likert scale responses. SETTING A state primary school (grades 4 to 7) in a low socio-economic area of Brisbane, Australia. INTERVENTION The introduction of a school-based food garden, including the funding of a teacher coordinator for 11 h/week to facilitate integration of garden activities into the curriculum. MAIN OUTCOME MEASURES Ability to identify a series of vegetables and fruits, attitudes towards vegetables and fruit. ANALYSIS Frequency distributions for each item were generated and chi2 analyses were used to determine statistical significance. Exploratory factor analysis was employed to detect major trends in data. RESULTS The intervention led to enhanced ability to identify individual vegetables and fruits, greater attention to origins of produce (garden-grown and fresh), changes to perceived consumption of vegetables and fruits, and enhanced confidence in preparing fruit and vegetable snacks, but decreased interest in trying new fruits. CONCLUSIONS The introduction of this school-based food garden was associated with skill and attitudinal changes conducive to enhancing vegetable and fruit consumption. The ways in which such changes might impact on dietary behaviours and intake require further analysis.

The clinical significance of the gut microbiota in cystic fibrosis and the potential for dietary therapies

Cystic fibrosis (CF) is characterised by many comorbidities related to aberrant mucosa and chronic inflammation in the respiratory and digestive systems. The intestinal mucosa serves as the primary interface between the gut microbiota and endocrine, neural and immune systems. There is emerging evidence that aberrant intestinal mucosa in CF may associate with an altered gut microbiota. Compared to healthy subjects, the overall bacterial abundance and species richness seems to be reduced in CF, accompanied by a trend in suppression of Firmicutes and Bacteroidetes spp. and an augmentation of potentially pathogenic species. There is also some concordance of gut and respiratory microbiotas in CF infants over time. The clinical significance of these observations awaits investigation. The gut microbiota have some potential in CF management by affecting inflammatory and immune responses, and influencing aberrant mucosa. As an important modifiable factor, diet therapies such as probiotics and prebiotics have shown initial promise in improving CF related conditions associated with chronic inflammation. More studies are needed to confirm this, as well as the efficacy of other dietary strategies such as modulating dietary fat and indigestible carbohydrate. Similarly, dietary modification of gut microbiota to optimise nutritional status in CF may be feasible, although more CF-specific studies are warranted.

Digestive system dysfunction in cystic fibrosis: challenges for nutrition therapy.

Cystic fibrosis can affect food digestion and nutrient absorption. The underlying mutation of the cystic fibrosis trans-membrane regulator gene depletes functional cystic fibrosis trans-membrane regulator on the surface of epithelial cells lining the digestive tract and associated organs, where Cl(-) secretion and subsequently secretion of water and other ions are impaired. This alters pH and dehydrates secretions that precipitate and obstruct the lumen, causing inflammation and the eventual degradation of the pancreas, liver, gallbladder and intestine. Associated conditions include exocrine pancreatic insufficiency, impaired bicarbonate and bile acid secretion and aberrant mucus formation, commonly leading to maldigestion and malabsorption, particularly of fat and fat-soluble vitamins. Pancreatic enzyme replacement therapy is used to address this insufficiency. The susceptibility of pancreatic lipase to acidic and enzymatic inactivation and decreased bile availability often impedes its efficacy. Brush border digestive enzyme activity and intestinal uptake of certain disaccharides and amino acids await clarification. Other complications that may contribute to maldigestion/malabsorption include small intestine bacterial overgrowth, enteric circular muscle dysfunction, abnormal intestinal mucus, and intestinal inflammation. However, there is some evidence that gastric digestive enzymes, colonic microflora, correction of fatty acid abnormalities using dietary n-3 polyunsaturated fatty acid supplementation and emerging intestinal biomarkers can complement nutrition management in cystic fibrosis.

Refined sugar intake in Australian children

OBJECTIVE To estimate the intake of refined sugar in Australian children and adolescents, aged 2-18 years. DESIGN Foods contributing to total sugar intake were identified using data from the National Nutrition Survey 1995 (NNS95), the most recent national dietary survey of the Australian population. The top 100 foods represented means of 85% (range 79-91%) and 82% (range 78-85%) of total sugar intake for boys and girls, respectively. Using published Australian food composition data (NUTTAB95), the proportion of total sugar being refined sugar was estimated for each food. Where published food composition data were not available, calculations from ingredients and manufacturers information were used. SUBJECTS The NNS95 assessed the dietary intake of a random sample of the Australian population, aged 2-18 years (n=3007). RESULTS Mean daily intakes of refined sugar ranged from 26.9 to 78.3 g for 2-18-year-old girls, representing 6.6-14.8% of total energy intake. Corresponding figures for boys were 27.0 to 81.6 g and 8.0-14.0%, respectively. Of the 10 highest sources of refined sugar for each age group, sweetened beverages, especially cola-type beverages, were the most prominent. CONCLUSION Refined sugar is an important contributor to dietary energy in Australian children. Sweetened beverages such as soft drinks and cordials were substantial sources of refined sugar and represent a potential target for campaigns to reduce refined sugar intake. Better access to information on the amounts of sugar added to processed food is essential for appropriate monitoring of this important energy source.

Refugees Connecting with a New Country through Community Food Gardening

Refugees are a particularly vulnerable population who undergo nutrition transition as a result of forced migration. This paper explores how involvement in a community food garden supports African humanitarian migrant connectedness with their new country. A cross-sectional study of a purposive sample of African refugees participating in a campus-based community food garden was conducted. Semi-structured interviews were undertaken with twelve African humanitarian migrants who tended established garden plots within the garden. Interview data were thematically analysed revealing three factors which participants identified as important benefits in relation to community garden participation: land tenure, reconnecting with agri-culture, and community belonging. Community food gardens offer a tangible means for African refugees, and other vulnerable or marginalised populations, to build community and community connections. This is significant given the increasing recognition of the importance of social connectedness for wellbeing.

Nutrition education: towards a whole-school approach.

Purpose – Schools are widely accepted as having the potential to make substantial contributions to promoting healthy eating habits in children and adolescents. This paper aims to present a case study from an Australian school of how a whole‐school approach, planned and implemented through a health promoting school framework, can foster improved nutrition in schools by creating a supportive environment for healthy eating habits.Design/methodology/approach – A case study approach was used to investigate the influence of a health promoting school approach on improvements to nutrition in the school environment. Data were collected using in‐depth interviews, student focus groups and documentary evidence, such as school planning documents and observations of health promoting school activities.Findings – This study illustrates how initiatives to promote a healthier school environment increased demand for nutritious food in the school community, which in turn impacted the supply of these foods at the school tucks...

Variations in prevalence and conduct of school food gardens in tropical and subtropical regions of north-eastern Australia.

OBJECTIVES To determine the prevalence and usage of food gardens in primary schools in three distinct climatic regions of north-eastern Australia. DESIGN Cross-sectional surveys combining quantitative and qualitative data collection. Two separate telephone questionnaires were developed and implemented, according to the presence or absence of a food garden within the school. Main outcome measures were answers to scaled response and open-ended questions related to factors supporting and inhibiting the establishment and sustainability of school food gardens. SETTING All state primary schools in three disparate regions of the north-eastern Australian state of Queensland were asked to participate in the study. RESULTS A total of 71% (n 128) of schools agreed to participate. Of these, thirty-seven primary schools had functioning food gardens. The variations in prevalence between regions combined with respondent views indicated climate as a major factor affecting the success of food gardens. Gardens were often used as a tool by schools to teach science, environment or social skills. Gardening activities were generally linked to curriculum studies on plants, fruit and vegetable intake, and healthy eating. The main issues for schools and teachers in establishing food gardens were the time required and the lack of personnel to coordinate garden activities. Of the schools with food gardens, 92% believed their garden had been a success. CONCLUSIONS The study revealed strong grass-roots support for school-based food gardens. Although climate and location were important factors associated with the presence of a functioning food garden, respondents nominated teacher involvement and sustained motivation as essential factors for successful school food gardens.

Towards best practice in acute stroke care in Ghana: A survey of hospital services

BackgroundStroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice.MethodsA multi-site, hospital-based survey was conducted in 11 major referral hospitals (regional and tertiary - teaching hospitals) in Ghana from November 2015 to April 2016. Respondents included neurologists, physician specialists and medical officers (general physicians). A pre-tested, structured questionnaire was used to gather data on available hospital-based acute stroke services in the study sites, using The World Stroke Organisation Global Stroke Services Guideline as a reference for global standards.ResultsAvailability of evidence-based services for acute stroke care in the study hospitals were varied and limited. The results showed one tertiary-teaching hospital had a stroke unit. However, thrombolytic therapy (thrombolysis) using recombinant tissue plasminogen activator for acute ischemic stroke care was not available in any of the study hospitals. Aspirin therapy was administered in all the 11 study hospitals. Although eight study sites reported having a brain computed tomographic (CT) scan, only 7 (63.6%) were functional at the time of the study. Magnetic resonance imaging (MRI scan) services were also limited to only 4 (36.4%) hospitals (only functional in three). Acute stroke care by specialists, especially neurologists, was found in 36.4% (4) of the study hospitals whilst none of the study hospitals had an occupational or a speech pathologist to support in the provision of acute stroke care.ConclusionThis study confirms previous reports of limited and variable provision of evidence based stroke services and the low priority for stroke care in resource poor settings. Health policy initiatives to enhance uptake of evidence-based acute stroke services is required to reduce stroke-related mortality and morbidity in countries such as Ghana.

Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals

Objective Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals’ views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings. Design A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes. Setting A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana. Participants A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian. Results Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals. Conclusion Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes.