Systematic review of nutritional interventions for people admitted to hospital for alcohol withdrawal

Aim: The aim of this review is to describe the nature of nutritional interventions for people admitted to hospital for alcohol withdrawal reported in the scientific literature and the health outcomes achieved. Methods: The review protocol was registered with PROSPERO (CRD42017081884). The following databases were systematically searched following the PRISMA protocol: CINAHL, MEDLINE, PsycARTICLES, PsycINFO, Scopus and Web of Science. Eligible studies were those published in English, in a hospital inpatient setting with the primary reason for admission being alcohol withdrawal. Studies of patient populations with the diagnosis of pancreatitis or liver cirrhosis were excluded. Studies were screened for eligibility, and data were extracted and descriptively analysed. Identified articles were assessed using the Quality Criteria Checklist for Primary Research produced by the Academy of Nutrition and Dietetics. Results: Fourteen studies met the inclusion criteria. Given the heterogeneity of studies, only a descriptive analysis of interventions could be achieved. Nutrition interventions included supplementation with thiamine, multivitamins, amino acids, antioxidant compounds, probiotics, magnesium or were educational interventions. Outcome measures included memory function, biochemical and anthropometrical indices, withdrawal symptoms, bowel flora levels and nutrition knowledge. However, the overall body of evidence was limited, particularly as there was a wide variation in participant age, study designs and duration of interventions. Conclusions: A wide range of nutrition interventions were identified, mostly involving nutrient supplements ameliorating inadequacies. Future research might also consider total dietary interventions as well as studies on the perspectives of people undergoing alcohol withdrawal

The nutritional management of burns Australian dietitians

This project focused on investigating the nutritional management of burn patients by Australian dietitians. A questionnaire was used to explore current practices in the nutritional assessment, support and the formulation of care plans for this dynamic group of patients. Twenty six (86.7 percent) of the thirty questionnaires were returned

An Audit of Australian Bread with a Focus on Loaf Breads and Whole Grain

Bread is a vehicle for a range of nutrients within the Australian diet, but has been the target of negative press. The aim of this study was to examine bread products, particularly white, whole grain and gluten-free loaves, including nutrients, health claims and Health Star Rating (HSR). An audit of four supermarkets and a bakery franchise (2017) was compared with 2014 data. Median and range was calculated for whole grain content, dietary fibre, sodium, protein, carbohydrate and sugar. Of all breads (n = 456), 29% were eligible to make a whole grain claim with 27% very high in whole grain (≥24 g/serve), an 18% increase from 2014. Within loaves (n = 243), 40% were at least a source of whole grain (≥8 g/serve), 79% were at least a source of dietary fibre, 54% met the sodium reformulation target (≤400 mg/100 g), 78% were a \u27source\u27 and 20% were a \u27good source\u27 of protein (10 g/serve), and 97% were low in sugar. Despite significant differences between loaves for all nutrients assessed, HSR did not differ between white and whole grain varieties. Compared to 2014, there were 20 fewer white loaves and 20 additional whole grain loaves which may assist more Australians achieve the 48 g whole grain daily target intake

Comprehensive nutrition review of grain-based muesli bars in Australia: An audit of supermarket products

Muesli bars are consumed by 16% of children, and 7.5% of adults, and are classified as discretionary in Australian Dietary Guidelines, containing higher fat and added sugars compared with core food choices. This study aimed to provide a nutritional overview of grain-based muesli bars, comparing data from 2019 with 2015. An audit of muesli bars, grain-based bars, and oat slices was undertaken in January 2019 (excluding fruit, nut, nutritional supplement, and breakfast bars) from the four major supermarkets in metropolitan Sydney. Mean and standard deviation was calculated for all nutrients on-pack, including whole grain per serve and per 100g. Health Star Rating (HSR) was calculated if not included on-pack. Of all bars (n = 165), 63% were ≤ 600 kJ (268-1958 kJ), 12% were low in saturated fat, 56% were a source of dietary fibre, and none were low in sugar. Two-thirds (66%) were whole grain (≥8 g/serve), with an average of 10 g/serve, 16% of the 48 g Daily Target Intake. HSR featured on 63% of bars (average 3.2), with an overall HSR of 2.7. Compared to 2015, mean sugars declined (26.6 g to 23.7 g/100 g; p \u3c 0.001), and 31% more bars were whole grain (109 up from 60 bars). Although categorised as discretionary, there were significant nutrient differences across grain-based muesli bars. Clearer classification within policy initiatives, including HSR, may assist consumers in choosing products high in whole grain and fibre at the supermarket shelf

Health Star Rating in Grain Foods - Does It Adequately Differentiate Refined and Whole Grain Foods?

The Australian front-of-pack labelling system, Health Star Rating (HSR), does not include whole grain (WG) in its algorithm, but uses dietary fibre (DF), despite Dietary Guidelines recommending WG over refined grain (RG) foods. This study aimed to determine how effectively HSR differentiates WG and RG foods. Product label data were collected 2017-18 from bread, rice, pasta, noodles, flour and breakfast cereals (n = 1127). Products not displaying HSR, DF per 100 g, and %WG ingredients were excluded, leaving a sample of 441 products; 68% were WG (≥8 g/manufacturer serving). There was a significant difference (p \u3c 0.001) in HSR between WG bread and breakfast cereal over RG varieties, yet the mean difference in stars depicted on the pack was only 0.4 for bread and 0.7 for breakfast cereal. There was no difference for rice (p = 0.131) or flour (p = 0.376). Median HSR also poorly differentiated WG. More WG foods scored 4-5 stars compared to RG, yet there was notable overlap between 3.5-5 stars. DF content between RG and WG subcategories was significantly different, however wide variation and overlap in DF highlights that this may not be a sufficient proxy measure, raising concerns that the HSR algorithm may not adequately communicate the benefits for consumers of swapping to WG foods

Plant-based meat substitutes in the flexitarian age: An audit of products on supermarket shelves

Demand for plant-based meat substitutes is growing globally for nutritional and environmental reasons, with Australia the third-fastest growing vegan market worldwide. This study aimed to profile and compare plant-based meat substitutes (mimicking meat) with equivalent meat products, and 2015 data. An audit undertaken in May (updated in September 2019) from four metropolitan Sydney supermarkets (Coles, Woolworths, Aldi, IGA), collected nutrition information and Health Star Rating (HSR) from 137 products (50 burgers, 10 mince, 29 sausages, 24 chicken, 9 seafood, 15 other). Mean (± standard deviation (SD)) and median (range) was calculated for nutrients and HSR. Plant-based options were generally lower in kilojoules, total and saturated fat, higher in carbohydrate, sugars, and dietary fibre compared with meat. Only 4% of products were low in sodium (58-1200 mg/100 g). Less than a quarter of products (24%) were fortified with vitamin B12, 20% with iron, and 18% with zinc. HSR featured on 46% (3.6-4.4 stars). On-pack claims were vegetarian/vegan/plant-based (80%), protein (63%), non-genetically modified/organic (34%), gluten free (28%). Product numbers increased five-fold (↑429%) in four years. The plant protein trend has prompted innovation in meat substitutes, however wide nutrient ranges and higher sodium levels highlights the importance of nutrition guidelines in their development to ensure equivalence with animal-based proteins

Growing the business of whole grain in the Australian market: A 6-year impact assessment

The Australia New Zealand Food Standards Code does not regulate on-pack claims describing the amount of whole grain in foods. In July 2013, The Grains & Legumes Nutrition Council™ (GLNC) established a voluntary Code of Practice for Whole Grain Ingredient Content Claims (the Code) providing guidance for whole grain claims, with cut-off values and suggested wording ≥8 g, ≥16 g, and ≥24 g per manufacturer serve (contains; high and very high in whole grain), based on a 48 g whole grain daily target intake. The aim of this impact assessment was to report the uptake of the Code by manufacturers, changes in numbers of whole grain products, and claims on-pack since 2013, including compliance. The impact assessment was undertaken in August 2019, comparing current registered manufacturers (“users”) and their products to the total number of products in the market deemed eligible for registration through GLNC product audits since 2013. Reporting included breakfast cereals, bread products, crispbreads, crackers, rice/corn cakes, rice, pasta, noodles, couscous, other grains (e.g., quinoa, buckwheat, freekeh), and grain-based muesli bars. As of 30 June 2019, there were 33 registered users and 531 registered products in Australia and New Zealand representing 43% of the eligible manufacturers and 65% of the eligible whole grain foods. Three-quarters (78% and 74%) of the eligible breakfast cereals and bread products were registered with the Code in 2019, followed by 62% of grain-based muesli bars. Only 39% of crispbread, crackers, rice/corn cakes, and rice, pasta, noodles, couscous, and other grains were registered. From 2013 there has been a 71% increase in the number of whole grain foods making claims, demonstrating strong uptake by industry, with clearer, more consistent, and compliant on-pack communication regarding whole grain content

Flour for Home Baking: A Cross-Sectional Analysis of Supermarket Products Emphasising the Whole Grain Opportunity

Flour, typically derived from wheat, rye, corn and rice is a pantry staple, providing structure to bread and baked goods. This study aimed to provide a cross-sectional analysis of flour for home baking, highlighting the nutrition composition of whole grain flour and identifying novel categories. An audit was undertaken in February 2020, in four major supermarkets in metropolitan Sydney (Aldi, Coles, IGA and Woolworths). Ingredient lists, Nutrition Information Panel, claims, and country of origin were collected. The median and range were calculated for energy, protein, fat, saturated fat, carbohydrate, sugars, dietary fibre and sodium. Overall, 130 products were collected, including 26 plain flour, 12 self-raising, 17 plain wholemeal, 4 wholemeal self-raising, 20 bread-making mixes (4 were whole grain), 20 other refined grain (including corn and rice flour), 17 gluten-free, 3 legume, 4 fruit/vegetable, 4 coconut and 3 other non-grain (e.g., hemp seed, cricket flour) products. Plain wheat flour dominated the category, while whole grain (wholemeal) made up 19% of products, yet they contained significantly more dietary fibre (p \u3c 0.001) and protein (p \u3c 0.001). Self-raising flours were significantly higher in sodium (p \u3c 0.001) and gluten-free products were lower in protein and dietary fibre, making legume, buckwheat and quinoa flour a better choice. Sustainability principles in fruit and vegetable production and novel insect products have driven new product development. There is a clear opportunity for further on-pack promotion of whole grain and dietary fibre within the category via food product labelling

The effects of legume consumption on markers of glycaemic control in individuals with and without diabetes mellitus: A systematic literature review of randomised controlled trials

Legumes are a rich source of dietary fibre, plant protein, and low‐Glycaemic Index (GI) carbohydrate. Evidence suggests a positive effect on glycaemic control following a single meal; however, the effects of habitual consumption are less clear. This review aimed to investigate whether medium‐to‐long‐term legume consumption had an effect on markers of glycaemic control in individuals with diabetes mellitus, without diabetes mellitus, or with prediabetes. As per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) protocol, the online databases MEDLINE, Embase, CENTRAL, and CINAHL were searched from inception through to 31 March 2020. Randomised controlled trials (RCTs) ≥6 weeks in duration, reporting ≥1 of the following: fasting blood glucose (FBG), fasting blood insulin (FBI), glycosylated haemoglobin (HbA1c), homeostatic model assessment‐insulin resistance (HOMA‐IR), or 2‐h postprandial glucose (2‐h PPG), were deemed eligible. The overall quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment. A total of 18 RCTs were included, of which, 5 focused on individuals with diabetes mellitus, 12 on individuals without diabetes mellitus, and one on individuals with prediabetes. Only studies of those with type 2 diabetes mellitus (n = 5) reported significant effects for legume interventions, three of which consistently reported reductions in FBG, two reported reductions in HbA1c, one reported a reduction in FBI, and another a reduction in 2‐h PPG (p \u3c 0.05); however, the overall quality of evidence was very low. The findings of this review support the dietary inclusion of legumes; however, the need for further high‐quality RCTs to be conducted is also highlighted, particularly among individuals with prediabetes, gestational diabetes mellitus and type 1 diabetes mellitus