Skye Marshall

Systematic review of diet quality indices and their associations with health-related outcomes in children and adolescents.

BACKGROUNDnDiet quality indices add an important dimension to dietary assessment. The aim of this systematic review was to: (i) identify and describe the attributes and applications of diet quality indices developed for use or used in paediatric populations; (ii) describe associations between these diet quality indices and health-related variables in paediatric populations; and (iii) identify factors that are associated with diet quality in paediatric populations worldwide.nnnMETHODSnStudies were identified by searching electronic databases for relevant papers from 1980 to October 2013 using keywords. Inclusion criteria were original studies that utilised a quantitative measure of diet quality in children and adolescents aged 0-18xa0years.nnnRESULTSnOne hundred and nineteen studies met the inclusion criteria, from which 80 different diet quality indices were identified. The majority of studies had >1000 participants and were of acceptable quality. Of the 56 studies that investigated health-related outcomes, weight status was the most researched. Europe produced the most number of diet quality indices (nxa0=xa027 indices). Of the 119 studies, seven intervention studies were identified. Paediatric diet quality indices were found to be associated with environmental, behavioural and maternal factors.nnnCONCLUSIONSnThe use of diet quality indices in paediatric populations is a rapidly expanding area of research in diverse populations internationally. In economically disadvantaged countries, diet quality indices may be predictive of child growth. However, prospective cohort, intervention and validation studies are required to draw stronger conclusions concerning risk of future disease in paediatric populations in general.

The consequences of malnutrition following discharge from rehabilitation to the community: A systematic review of current evidence in older adults

BACKGROUNDnThe prevalence of malnutrition in the rehabilitation setting is estimated to be 30-50%, with older adults at higher nutritional risk. Malnutrition also exists in the community setting, where 10-30% of adults are malnourished; however, the relationship between the two settings has been little explored. The present study aimed to determine the association between malnutrition in older adults admitted for rehabilitation and nutrition status, functional status, quality of life, institutionalisation, acute care admissions and mortality once discharged to the community.nnnMETHODSnSix electronic databases were searched for relevant publications (1990-2013) using controlled vocabulary. Longitudinal papers were included in which older adults (≥65xa0years) were admitted for rehabilitation if nutrition assessment was performed during admission with relevant outcomes measured following discharge to the community.nnnRESULTSnFive observational studies were eligible for review which had similar populations. The five reviews comprised 1020 participants in total and, once discharged, follow-up ranged from immediate to 26xa0months. Malnutrition during rehabilitation was negatively associated with physical function and quality of life, and positively associated with risk of institutionalisation, hospitalisation and mortality. Although these studies were of high quality and strength, the overall contribution to the evidence is limited as a result of the small number of heterogenic studies. No intervention studies were identified.nnnCONCLUSIONSnMalnutrition in older adults admitted for rehabilitation has a negative effect on functional recovery and quality of life following discharge to the community. This review highlights an evidence gap along the continuum of care for malnourished older adults, where further observational and intervention research is needed following discharge from rehabilitation to the community.

The development and evaluation of the Australian child and adolescent recommended food score: A cross-sectional study

BackgroundDiet quality tools have been developed to assess the adequacy of dietary patterns for predicting future morbidity and mortality. This study describes the development and evaluation of a brief food-based diet quality index for use with children at the individual or population level. The Australian Child and Adolescent Recommended Food Score (ACARFS) was developed to reflect adherence to the Dietary Guidelines for Children and Adolescents in Australia and modelled on the approach of the US Recommended Food Score.MethodsThe ACARFS has eight sub-scales and is scored from zero to 73. The diet quality score was evaluated by assessing correlation (Spearman’s correlations) and agreement (weighted κ statistics) between ACARFS scores and nutrient intakes, derived from a food frequency questionnaire in 691 children (mean age 11.0, SD 1.1) in New South Wales, Australia. Nutrient intakes for ACARFS quartiles were compared with the relevant Australian nutrient reference values.ResultsACARFS showed slight to substantial agreement (κ 0.13-0.64) with nutrient intakes, with statistically significant moderate to strong positive correlations with all vitamins, minerals and energy intake (ru2009=u20090.42-0.70). ACARFS was not related to BMI.Participants who scored less than the median ACARFS were more likely to have sub-optimal intakes of fibre, folic acid and calcium.ConclusionACARFS demonstrated sufficient accuracy for use in future studies evaluating diet quality. Future research on its utility in targeting improvements in the nutritional quality of usual eating habits of children and adolescents is warranted.

Are informal carers and community care workers effective in managing malnutrition in the older adult community? A systematic review of current evidence

BackgroundEnhancing the effectiveness of the community and aged care workforce to prevent malnutrition and functional decline is important in reducing hospital and aged care facility demand.ObjectiveTo investigate the impact of nutrition-related interventions delivered to or by informal carers and non-clinical community care workers on malnutrition-related health outcomes of community-dwelling older adults (≥65years).MethodsIntervention studies were searched for using six electronic databases for English-language publications from January 1980 to 30 May 2012.ResultsNine studies were eligible for inclusion. The strength and quality of the evidence was moderate (six studies with level II intervention evidence, five with positive quality). Types of interventions used were highly varied. The majority of interventions were delivered to informal carers (6 studies), with three of these studies also involving older adult care recipients. Five interventions were targeted at identifying, preventing and/or treating malnutrition specifically (two positive quality, three neutral quality, n=2368). As a result of these interventions, nutritional status improved or stabilized (two positive quality, two neutral quality, n=2333). No study reported an improvement in functional status but two successfully prevented further decline in their participants (two neutral quality, n=1097).ConclusionInterventions targeted at identifying, preventing and/or treating malnutrition were able to improve or prevent decline in nutritional and functional status, without increasing informal carer burden. The findings of this review support the involvement of non-clinical community care workers and informal carers as part of the nutritional care team for community-dwelling older adults.

Malnutrition in geriatric rehabilitation: Prevalence, patient outcomes, and criterion validity of the scored patient-generated subjective global assessment and the mini nutritional assessment

BACKGROUNDnAccurate identification and management of malnutrition is essential so that patient outcomes can be improved and resources used efficaciously.nnnOBJECTIVESnIn malnourished older adults admitted to rehabilitation: 1) report the prevalence, health and aged care use, and mortality of malnourished older adults; 2) determine and compare the criterion (concurrent and predictive) validity of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and the Mini Nutritional Assessment (MNA) in diagnosing malnutrition; and 3) identify the Scored PG-SGA score cut-off value associated with malnutrition.nnnDESIGNnObservational, prospective cohort.nnnPARTICIPANTS/SETTINGnParticipants were 57 older adults (65 years and older; mean±standard deviation age=79.1±7.3 years) from two rural rehabilitation units in New South Wales, Australia.nnnMEASUREMENTS/STATISTICAL ANALYSISnScored PG-SGA; MNA; and the International Statistical Classification of Diseases and Health Related Problems, 10th revision, Australian Modification (ICD-10-AM) classification of malnutrition were compared to establish concurrent validity and report malnutrition prevalence. Length of stay, discharge location, rehospitalization, admission to a residential aged care facility, and mortality were measured to report health-related outcomes and to establish predictive validity.nnnRESULTSnMalnutrition prevalence varied according to assessment tool (ICD-10-AM: 46%; Scored PG-SGA: 53%; MNA: 28%). Using the ICD-10-AM as the reference standard, the Scored PG-SGA ratings (sensitivity 100%, specificity 87%) and score (sensitivity 92%, specificity 84%, ROC AUC [receiver operating characteristics area under the curve]=0.910±0.038) showed strong concurrent validity, and the MNA had moderate concurrent validity (sensitivity 58%, specificity 97%, receiver operating characteristics area under the curve=0.854±0.052). The Scored PG-SGA rating, Scored PG-SGA score, and MNA showed good predictive validity. Malnutrition can increase the risk of longer rehospitalization length of stay, admission to a residential aged care facility, and discharge to hospital or residential aged care facility instead of home.nnnCONCLUSIONSnMalnutrition prevalence in the geriatric rural rehabilitation population is high, and is associated with increased health and aged care use. The Scored PG-SGA ratings and score are suitable for nutrition assessment in geriatric rehabilitation. The MNA may be suitable for nutrition assessment in geriatric rehabilitation, but care should be taken to ensure all malnourished patients are identified. Additional examination of the criterion validity of the Scored PG-SGA and MNA will lend confidence to these findings.

Protein-energy malnutrition in the rehabilitation setting: Evidence to improve identification

Methods of identifying malnutrition in the rehabilitation setting require further examination so that patient outcomes may be improved. The purpose of this narrative review was to: (1) examine the defining characteristics of malnutrition, starvation, sarcopenia and cachexia; (2) review the validity of nutrition screening tools and nutrition assessment tools in the rehabilitation setting; and (3) determine the prevalence of malnutrition in the rehabilitation setting by geographical region and method of diagnosis. A narrative review was conducted drawing upon international literature. Starvation represents one form of malnutrition. Inadequate energy and protein intake are the critical factor in the aetiology of malnutrition, which is distinct from sarcopenia and cachexia. Eight nutrition screening tools and two nutrition assessment tools have been evaluated for criterion validity in the rehabilitation setting, and consideration must be given to the resources of the facility and the patient group in order to select the appropriate tool. The prevalence of malnutrition in the rehabilitation setting ranges from 14-65% worldwide with the highest prevalence reported in rural, European and Australian settings. Malnutrition is highly prevalent in the rehabilitation setting, and consideration must be given to the patient group when determining the most appropriate method of identification so that resources may be used efficaciously and the chance of misdiagnosis minimised.

Optimising nutrition in residential aged care: A narrative review

In developed countries the prevalence of protein-energy malnutrition increases with age and multi-morbidities increase nutritional risk in aged care residents in particular. This paper presents a narrative review of the current literature on the identification, prevalence, associated risk factors, consequences, and management of malnutrition in the residential aged care (RAC) setting. We performed searches of English-language publications on Medline, PubMed, Ovid and the Cochrane Library from January 1, 1990 to November 25, 2015. We found that, on average, half of all residents in aged care are malnourished as a result of factors affecting appetite, dietary intake and nutrient absorption. Malnutrition is associated with a multitude of adverse outcomes, including increased risk of infections, falls, pressure ulcers and hospital admissions, all of which can lead to increased health care costs and poorer quality of life. A number of food and nutrition strategies have demonstrated positive nutritional and clinical outcomes in the RAC setting. These strategies extend beyond simply enhancing the nutritional value of foods and hence necessitate the involvement of a range of committed stakeholders. Implementing a nutritional protocol in RAC facilities that comprises routine nutrition screening, assessment, appropriate nutrition intervention, including attention to food service systems, and monitoring by a multidisciplinary team can help prevent decline in residents nutritional status. Food and nutritional issues should be identified early and managed on admission and regularly in the RAC setting.

Nutrition Screening in Geriatric Rehabilitation: Criterion (Concurrent and Predictive) Validity of the Malnutrition Screening Tool and the Mini Nutritional Assessment−Short Form

BACKGROUNDnNutrition screening is required for early identification and treatment of patients at risk for malnutrition so that clinical outcomes can be improved and health care costs reduced.nnnOBJECTIVEnTo determine the criterion (concurrent and predictive) validity of the Malnutrition Screening Tool (MST) and Mini Nutritional Assessment-Short Form (MNA-SF) in older adults admitted to inpatient rehabilitation facilities.nnnDESIGNnObservational, prospective cohort.nnnPARTICIPANTS/SETTINGnParticipants were 57 adults aged 65 years and older (mean±standard deviation age=79.1±7.3 years) from two rural rehabilitation units in New South Wales, Australia.nnnMAIN OUTCOME MEASUREMENTSnMST; MNA-SF; International Statistical Classification ofxa0Diseases and Health Related Problems, 10th revision, Australian Modification (ICD-10-AM) classification of malnutrition; rehospitalization; admission to a residential aged care facility (institutionalization); and discharge location.nnnSTATISTICAL ANALYSIS PERFORMEDnMeasures of diagnostic accuracy with 95% CIs generated from a contingency table, Mann-Whitney U test, and χ(2) test.nnnRESULTSnWhen compared with the ICD-10-AM criteria, the MST showed stronger diagnostic accuracy (sensitivity 80.8%, specificity 67.7%) than the MNA-SF (sensitivity 100%, specificity 22.6%). Neither the MST nor the MNA-SF was able to predict rehospitalization, institutionalization, or discharge location.nnnCONCLUSIONSnThe MST showed good concurrent validity and can be considered an appropriate nutrition screening tool in geriatric rehabilitation. The MNA-SF may overestimate the risk of malnutrition in this population. The predictive validity could not be established for either screening tool.

The Effect of Polyphenol-Rich Interventions on Cardiovascular Risk Factors in Haemodialysis: A Systematic Review and Meta-Analysis

End-stage kidney disease is a strong risk factor for cardiovascular-specific mortality. Polyphenol-rich interventions may attenuate cardiovascular disease risk factors; however, this has not been systematically evaluated in the hemodialysis population. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the following databases were searched: Cochrane Library (http://www.cochranelibrary.com/), MEDLINE (https://health.ebsco.com/products/medline-with-full-text), Embase (https://www.elsevier.com/solutions/embase-biomedical-research), and CINAHL (https://www.ebscohost.com/nursing/products/cinahl-databases/cinahl-complete). Meta-analyses were conducted for measures of lipid profile, inflammation, oxidative stress, and blood pressure. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool and quality of the body of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Twelve studies were included for review. Polyphenol-rich interventions included soy, cocoa, pomegranate, grape, and turmeric. Polyphenol-rich interventions significantly improved diastolic blood pressure (Mean Difference (MD) −5.62 mmHg (95% Confidence Interval (CI) −8.47, −2.78); I2 = 2%; p = 0.0001), triglyceride levels (MD −26.52 mg/dL (95% CI −47.22, −5.83); I2 = 57%; p = 0.01), and myeloperoxidase (MD −90.10 (95% CI −135.84, −44.36); I2 = 0%; p = 0.0001). Included studies generally had low or unclear risks of bias. The results of this review provide preliminary support for the use of polyphenol-rich interventions for improving cardiovascular risk markers in haemodialysis patients. Due to the limited number of studies for individual polyphenol interventions, further studies are required to provide recommendations regarding individual polyphenol intervention and dose.

Role of domiciliary and family carers in individualised nutrition support for older adults living in the community

Protein-energy malnutrition is common amongst people aged 65 years and older, has a multifactorial aetiology, and numerous negative outcomes. Domiciliary carers (non-clinical paid carers) and family carers (including family, friends and neighbours) are required to support the increasing demand for in-home assistance with activities of daily living due to the ageing population. This review provides insight into the role of both domiciliary and family carers in providing individualised nutrition support for older, community-dwelling adults with malnutrition. Four electronic databases were searched for intervention studies from database inception to December 2016. Both domiciliary and family carers are well placed to monitor the dietary intake and nutritional status of older adults; to assist with many food-related tasks such as the sourcing and preparation of meals, and assisting with feeding when necessary; and to act as a conduit between the care recipient and formal nutrition professionals such as dietitians. There is moderate evidence to support the role of domiciliary carers in implementing nutrition screening and referral pathways, and emerging evidence suggests they may have a role in malnutrition interventions when supported by health professionals. Moderate evidence also supports the engagement of family carers as part of the nutrition care team for older adults with malnutrition. Interventions such as group education, skill-development workshops and telehealth demonstrate promise and have significantly improved outcomes in older adults with dementia. Further interventional and translational research is required to demonstrate the efficacy of engaging with domiciliary and family carers of older adults in the general community.