Current dietetic practices of obesity management in Saudi Arabia and comparison with Australian practices and best practice criteria

Objective: To describe the dietetic practices of the treatment of obesity in Saudi Arabia and compare this with best practice criteria and the practice in Australia. Methods: Anonymous questionnaires were completed by dietitians in Saudi Arabia. The topics included barriers to obesity management, demand and level of service and strategies and approaches used for weight management. Best practice scores were based on those used to assess Australian dietitians. Results: 253 dietitians participated in the survey. Of these, 175 (69 %) were involved in the management of obesity. The best practice score for Australian dietitians was slightly but significantly greater than the scores of Saudi dietitians (mean 41.6 vs 38.8; p \u3c0.001), (median 43 vs 39). There was also a significant correlation between the best practice score and years of experience (r = 0.26, p \u3c0.001). The most common assessment approaches were assessment of BMI (87%) and exercise habits (81%) while the most common strategies for obesity management were; dietary total fat reduction (92%) and increase incidental daily activity (92%). The major barrier for establishment of a weight management clinic reported by 49% of participants was inadequate resources. Conclusion: Saudi Arabian dietetic practice for the management of obesity does incorporate most best practice recommendations, but some specific elements are rarely used

Socioeconomic disadvantage and its implications for population health planning of obesity and overweight, using cross-sectional data from general practices from a regional catchment in Australia

Objectives To identify smaller geographic and region-specific evidence to inform population health planning for overweight and obesity. Design Cross-sectional secondary analysis of data. Setting Primary healthcare-17 general practices located in the Illawarra-Shoalhaven region of New South Wales (NSW). Participants A subset (n=36 674) of the Sentinel Practices Data Sourcing project adult persons data set (n=118 794) that included information on disease status of all adult patients who had height and weight measurements recorded in their electronic health records and had visited the included general practices within the Illawarra-Shoalhaven region of NSW between September 2011 and September 2013. Main outcome measures Age-adjusted odds ratio (aOR) of overweight and obesity was determined for high and low levels of socioeconomic disadvantage based on Socio-Economic Indexes for Areas (SEIFA)-Index of Relative Socio-Economic Disadvantage (IRSD) scores of patients\u27 residential statistical local area. Results In men, overweight was lowest in areas of highest socioeconomic disadvantage (aOR=0.910; 95% CI 0.830 to 0.998; p\u3c0.001); but no statistically significant association with socioeconomic score was found for women. Overall obesity was associated with high socioeconomic disadvantage (aOR=1.292; 95% CI 1.210 to 1.379; p\u3c0.001). Conclusions This type of data analysis reveals multiple layers of evidence that should be assessed for population health approaches to curb the epidemic of obesity and overweight. It strongly highlights the need for preventive health initiatives to be specific to gender and socioeconomic attributes of the target population

A high prevalence of abnormal nutrition parameters found in predialysis end-stage kidney disease: is it a result of uremia or poor eating habits?

Objective To describe the baseline nutritional characteristics of a cohort of end-stage kidney disease (ESKD) patients attending a pre-dialysis clinic. Setting Outpatient clinic of a metropolitan tertiary teaching hospital in Sydney, Australia. Subjects All ESKD patients attending the multidisciplinary pre-dialysis assessment clinic between April 2002 and March 2008. Methods Retrospective analysis of data extracted from the routine initial nutrition assessment records. These included anthropometric and biochemical measures, Subjective Global Assessment, appetite score, presence of symptoms, dietary energy, protein, and other macro- and micronutrient intakes. Results Of the 210 patients assessed, 60.5% were male; mean age was 65.7 ± 13.6 years with a mean glomerular filtration rate of 17.3 ± 6.5 mL/min/1.73 m2; 17.1% and 62.4% were underweight (body mass index /m2) and overweight or obese (BMI ≥26 kg/m2), respectively; 40.5% were rated as malnourished (Subjective Global Assessment scores B and C) with 19.0% overweight/obese and malnourished. Energy and protein intakes correlated positively with glomerular filtration rate, with r = 0.17, P = .01, and r = 0.29, P \u3c .0001 respectively. Mean energy and protein intakes were 23.7 ± 6.7 kcal/kg IBW/day and 1.18 ± 0.42 g/kg IBW/day, with 62.6% and 13.1% not meeting the recommended intake, respectively. The positive predictive values (95%CI) of self-rated appetite score for energy and protein were 0.41 (0.36-0.45) and 0.92 (0.88-0.95), respectively, indicating subjective rating of a good appetite was associated with adequate protein but not energy intake. Fifty-one percent of the patients experienced the symptoms, whereas 17.5% of the patients self-imposed a dietary regimen inappropriately due to beliefs on dietary needs in ESKD. Suboptimal nutrient intakes were observed, including vitamin B2 (41.2%), vitamin E (61.8%), folate (67.6.2%), vitamin D (100.0%), and zinc (64.2%). Conclusion Patients presented to the pre-dialysis assessment clinic with abnormal nutrition parameters associated with decreased renal function, symptoms burden, and poor dietary intake. This clinic may provide an opportunity to optimize the nutritional status of ESKD patients in the pre-dialysis period

Whole grain, bran and cereal fibre consumption and CVD: A systematic review

Whole grain intake is associated with lower CVD risk in epidemiological studies. It is unclear to what extent cereal fibre, located primarily within the bran, is responsible. This review aimed to evaluate association between intake of whole grain, cereal fibre and bran and CVD risk. Academic databases were searched for human studies published before March 2018. Observational studies reporting whole grain and cereal fibre or bran intake in association with any CVD-related outcome were included. Studies were separated into those defining whole grain using a recognised definition (containing the bran, germ and endosperm in their natural proportions) (three studies, seven publications) and those using an alternative definition, such as including added bran as a whole grain source (eight additional studies, thirteen publications). Intake of whole grain, cereal fibre and bran were similarly associated with lower risk of CVD-related outcomes. Within the initial analysis, where studies used the recognised whole grain definition, results were less likely to show attenuation after adjustment for cereal fibre content. The fibre component of grain foods appears to play an important role in protective effects of whole grains. Adjusting for fibre content, associations remained, suggesting that additional components within the whole grain, and the bran component, may contribute to cardio-protective association. The limited studies and considerable discrepancy in defining and calculating whole grain intake limit conclusions. Future research should utilise a consistent definition and methodical approach of calculating whole grain intake to contribute to a greater body of consistent evidence surrounding whole grain

Analyzing weight loss intervention studies with missing data: which method should be used?

Objective: Missing data due to study dropout is common in weight loss trials and several statistical methods exist to account for it. The aim of this study was to identify methods in the literature and to compare the effects of methods of analysis using simulated data sets. Methods: Literature was obtained for a 1-y period to identify analytical methods used in reporting weight loss trials. A comparison of methods with large or small between-group weight loss, and missing data that was, or was not, missing randomly was conducted in simulated data sets based on previous research. Results: Twenty-seven studies, some with multiple analyses, were retrieved. Complete case analysis (n ¼ 17), last observation carried forward (n ¼ 6), baseline carried forward (n ¼ 4), maximum likelihood (n ¼ 6), and multiple imputation (n ¼ 2) were the common methods of accounting for missing data. When comparing methods on simulated data, all demonstrated a significant effect when the between-group weight loss was large (P \u3c 0.001, interaction term) regardless of whether the data was missing completely at random. When the weight loss interaction was small, the method used for analysis gave considerably different results with mixed models (P ¼ 0.180) and multiple imputations (P ¼ 0.125) closest to the full data model (P ¼ 0.033). Conclusion: The simulation analysis showed that when data were not missing at random, treatment effects were small, and the amount of missing data was substantial, the analysis method had an effect on the significance of the outcome. Careful attention must be paid when analyzing or appraising studies with missing data and small effects to ensure appropriate conclusions are drawn

Malnutrition, poor food intake, and adverse healthcare outcomes in non-critically ill obese acute care hospital patients

Obesity, defined as a BMI\ua0≥\ua030\ua0kg/m, has demonstrated protective associations with mortality in some diseases. However, recent evidence demonstrates that poor nutritional status in critically ill obese patients confounds this relationship. The purpose of this paper is to evaluate if poor nutritional status, poor food intake and adverse health-related outcomes have a demonstrated association in non-critically ill obese acute care hospital patients.This is a secondary analysis of the Australasian Nutrition Care Day Survey dataset (N\ua0=\ua03122), a prospective cohort study conducted in hospitals from Australia and New Zealand in 2010. At baseline, hospital dietitians recorded participants' BMI, evaluated nutritional status using Subjective Global Assessment (SGA), and recorded 24-h\ua0food intake (as 0%, 25%, 50%, 75%, and 100% of the offered food). Post-three months, participants' length of stay (LOS), readmissions, and in-hospital mortality data were collected. Bivariate and regression analyses were conducted to investigate if there were an association between BMI, nutritional status, poor food intake, and health-related outcomes.Of the 3122 participants, 2889 (93%) had eligible data. Obesity was prevalent in 26% of the cohort (n\ua0=\ua0750; 75% females; 61\ua0±\ua015 years; 37\ua0±\ua07\ua0kg/m). Fourteen percent (n\ua0=\ua0105) of the obese patients were malnourished. Over a quarter of the malnourished obese patients (N\ua0=\ua030/105, 28%) consumed ≤25% of the offered meals. Most malnourished obese patients (74/105, 70%) received standard diets without additional nutritional support. After controlling for confounders (age, disease type and severity), malnutrition and intake ≤25% of the offered meals independently trebled the odds of in-hospital mortality within 90 days of hospital admission in obese patients.Although malnourished obese experienced significantly adverse health-related outcomes they were least likely to receive additional nutritional support. This study demonstrates that BMI alone cannot be used as a surrogate measure for nutritional status and warrants routine nutritional screening for all hospital patients, and subsequent nutritional assessment and support for malnourished patients

The effect of a calorie controlled diet containing walnuts on substrate oxidation during 8-hours in a room calorimeter

Objective Dietary macronutrient proportions affect substrate utilization, but in practice people consume foods. We hypothesized that in overweight adults, a calorie controlled diet based on core foods and including walnuts may be advantageous in promoting greater use of fat stores. Methods This crossover study tested the effects of diet-related energy expenditure and fat oxidation in 16 overweight individuals over an 8-hour period. The 2 diets included breakfast and lunch meals during the measurement period and an evening meal the night before. They comprised core foods of bread/cereals, fruit, vegetables, milk/yogurt, and meat, and either walnuts (walnut diet) or olive oil (control diet). There was no difference in the energy and macronutrient composition of the diets in the measurement period. Energy expenditure, respiratory quotient (RQ), and macronutrient oxidation were assessed during two 8-hour stays in a room calorimeter facility. Results During the 8-hour measurement period, no difference in energy expenditure was noted between the diets, but a significant difference in RQ was observed between diets (control 0.908 ± 0.046 vs. walnut 0.855 ± 0.036, p = 0.029). Carbohydrate oxidation was lower and fat oxidation was higher during the walnut period than during the control period. Conclusions A calorie controlled diet of core foods including walnuts may be advantageous in promoting the use of body fat stores, at least under acute conditions

Improving blood pressure control in primary care: The ImPress study

Background Hypertension is a preventable risk factor for cardiovascular disease, the leading cause of death globally. When hypertension is present with tobacco smoking, poor nutrition, physical inactivity or excessive alcohol consumption, risk of cardiovascular disease is increased. Given the prolonged engagement and ongoing relationship with patients, general practice nurses are ideally situated to actively engage with patients about optimal blood pressure control and lifestyle risk reduction. Objectives This study will test the effectiveness of a nurse-led intervention to reduce blood pressure in adults with hypertension and high cardiovascular risk. Design A multi-site, cluster randomised control trial where the general practice is the unit of randomisation. Methods General Practices (n = 20) will be block randomised to the intervention or usual care group. Adults with hypertension and high cardiovascular risk will be identified through an audit of electronic medical records and invited to attend an assessment visit. Eligible consenting patients will be recruited to the study. The intervention involves three face-to-face consultations and two telephone consultations with the nurse to assess lifestyle risk and develop an action plan. An appointment with the general practitioner will optimise pharmacotherapy. The primary outcome is blood pressure, with secondary outcomes of lifestyle risk factors; smoking, nutrition, alcohol and physical activity body mass index and medication adherence. Patients will have outcome measures evaluated at 6 and 12 months. Discussion ImPress is innovative in its proactive approach of identifying those at greatest risk of cardiovascular disease in combination with the emerging role of the general practice nurse to target care towards improved blood pressure control. If successful, findings from this trial could enhance the nursing role, improve health outcomes, inform health policy and provide an evidence base from which to transform blood pressure management in general practice

The effect of a calorie controlled diet containing walnuts on substrate oxidation during 8-hours in a room calorimeter

Objective Dietary macronutrient proportions affect substrate utilization, but in practice people consume foods. We hypothesized that in overweight adults, a calorie controlled diet based on core foods and including walnuts may be advantageous in promoting greater use of fat stores. Methods This crossover study tested the effects of diet-related energy expenditure and fat oxidation in 16 overweight individuals over an 8-hour period. The 2 diets included breakfast and lunch meals during the measurement period and an evening meal the night before. They comprised core foods of bread/cereals, fruit, vegetables, milk/yogurt, and meat, and either walnuts (walnut diet) or olive oil (control diet). There was no difference in the energy and macronutrient composition of the diets in the measurement period. Energy expenditure, respiratory quotient (RQ), and macronutrient oxidation were assessed during two 8-hour stays in a room calorimeter facility. Results During the 8-hour measurement period, no difference in energy expenditure was noted between the diets, but a significant difference in RQ was observed between diets (control 0.908 ± 0.046 vs. walnut 0.855 ± 0.036, p = 0.029). Carbohydrate oxidation was lower and fat oxidation was higher during the walnut period than during the control period. Conclusions A calorie controlled diet of core foods including walnuts may be advantageous in promoting the use of body fat stores, at least under acute conditions