Functional Foods: definition and commercialisation

This paper outlines the framework for a working definition of functional foods utilised by the National Centre of Excellence in Functional Foods, considers trends in the areas of influence, and raises issues for the successful commercialisation of functional foods by the Australian food industry

Nutrition in the prevention of chronic disease

Increasing prevalence rates of chronic disease requires a more sophisticated view of the effects of food on health. This review examines the evidence base for the effects of food on health and discusses food based health strategies

A Self-Administered Dietary Assessment Website for Use in Primary Health Care: Usability Testing and Evaluation

A dietary assessment website for use in the primary healthcare setting has been developed. The website allows patients, referred from their GP, to self-report their dietary intake. Data from the website feeds to a dietitian who develops individualised dietary advice for the patient. The aim of this paper is to describe the usability testing of the dietary assessment website with its potential users. Testing was broken into two phases. Forty-two free-living adults with metabolic syndrome volunteered, 17 completed phase one and 10 completed phase two, with a 64% rate of completion. Phase one participants spoke aloud as they progressed through the self-administered dietary assessment website under researcher observation. Observed difficulties in website use and need for assistance was recorded and the website underwent modifications between phases. Only four participants in phase 1 required large amounts of assistance. Phase two participants progressed through the website without observation or using the think-aloud protocol. This simulated the environment in the GP practice within which the website was to be implemented. All participants completed pre- and post-use questionnaires assessing feelings toward use, computer experience and problems encountered. Questionnaires were thematically analysed for relationships between website use and participant feelings. Time taken to use the website was recorded automatically. Website features were grouped into ‘action classes’ e.g. selecting food items, and times taken were calculated for each class. Comparisons (t-tests) were made between the action classes for the two phases. Average time taken to select the food items was 31mins and 24mins for phase one and two respectively. Total time taken was approximately 1 hour and varied by four minutes between phases. Time taken to complete the dietary assessment was comparable to a face-to-face diet history with a dietitian. The website was found to be highly user-friendly with little assistance being required for most levels of computer experience. Dietary management may be overlooked by GPs, yet by offering different methods of accessing dietitians, management may improve

Development of food groupings to guide dietary advice in people with diabetes

Foods commonly consumed by 16 adults with diabetes were grouped according to macrinutrient value and type of fat to form 13 categories of which 10 would form the focus of dietary advice. Dietary modeling demonstrated that the food group pattern provided adequate nutrition and low variation in dietary targets. Idealised proportions of fat types were achieved only when daily servings of foods such as oils, nuts, oily fish and soy were included. The food groupings proved appropriate for dietary advice for diabetes

Development of a matching file of Australian food composition databases (AUSNUT 2007 to 2011-13)

Changes to the food supply and analytical methods necessitate updating food composition databases over time. In Australia, survey-specific databases include AUSNUT 1999, 2007, and 2011-13. There is no standardized method to match AUSNUT 2007 foods to 2011-13 counterparts. This study aimed to develop an AUSNUT 2007 to 2011-13 matching file, and demonstrate its use in the clinical trial context. Food items aligned with AUSNUT 2007 were back-matched to 1999 and then forward to 2011-13 using food identification codes and existing matching files. Any unmatched AUSNUT 2007 foods were manually matched to appropriate 2011-13 foods based on conceptual and nutritional similarities. The file was then applied to clinical trial data originally collected using AUSNUT 2007. Of the n = 3874 products in AUSNUT 2007, n = 1270 were initially matched to 2011-13 equivalents using existing matching files. Of these foods, n = 1070 were deemed to have an acceptable one-to-one match. A total of n = 2804 AUSNUT 2007 foods required manual matching. Application to clinical trial data found small differences in nutrient intake between original and converted data. The AUSNUT 2007 to 2011-13 matching file will facilitate conversion of dietary data originally collected using AUSNUT 2007 into 2011-13 foods and groups, and to allow re-coding of intake data

The clinical utility of the AUSDRISK tool in assessing change in type 2 diabetes risk in overweight/obese volunteers undertaking a healthy lifestyle intervention

The objective of this study was to assess the clinical utility of the AUSDRISK tool for determining risk of Type 2 diabetes mellitus (T2DM). In this secondary analysis from the HealthTrack study, the AUSDRISK tool was applied to data from overweight/obese volunteers completing a lifestyle intervention trial. Participants were volunteer residents of the Illawarra region recruited in 2014-2015. From 377 trial participants (BMI 25-40 kg/m2, 25-54 yr), 161 provided data required for measurement of AUSDRISK, collected at 0 and 12 months. They had been randomised to one of two lifestyle interventions (±a healthy food sample, 30 g walnuts/day, I and IW) delivered by dietitians, or a control intervention (C) delivered by nurse practitioners. HbA1c measures were considered for comparison. At baseline the AUSDRISK score indicated n = 83 (51.5%) were at high risk of T2DM within 5 years (≥12 points). After 12 months the proportion scored as high risk significantly decreased in the IW group (51.5% vs 33.3%; p = 0.005), but not I (51.2% vs 39.0%; p = 0.063) or C group (51.9% vs 38.9%; p = 0.065). By comparison, HbA1c measures indicated high risk in n = 24 (17%) of 139 participants at baseline and borderline non-significant changes over time in the randomised groups. In conclusion, the AUSDRISK tool has reasonable clinical utility in identifying T2DM risk in clinical samples of overweight/obese individuals

Relationships between patient age and BMI and use of a self-administered computerised dietary assessment in a primary healthcare setting

The objective of this paper was to determine relationships between patient age and BMI and use of a self-administered dietary assessment website in the primary healthcare setting. Chi- square and ordinal regression models were used to determine the relationships between age and BMI and computer experience, ownership, and usage from 188 patients using a self-administered dietary assessment website over 12 months. One hundred and twenty-five (66.5%) female and 63 (33.5%) male patients used the website. A total of 72.9% were overweight (BMI425 kg/m2). Advanced/intermediate computer users were 17.1 times more likely to own a computer than beginners or patients who had never used a computer. Patients with a higher BMI were 1.9 times (P ¼ 0.04) more likely to use the computer at home than in the GP practice, and patients aged o35 years and using the computer at home were 16.8 times more likely to be advanced computer users than patients aged 456 years using the computer in the GP practice. Finding innovative ways for overweight patients in the primary healthcare setting to report intakes may include the use of computers. Overweight patients may feel greater comfort having their diet assessed in their own home and any social desirability bias related to food and/or the interviewer may be decreased due to the limited face-to-face contact required

What do stakeholders consider the key issues affecting the quality of foodservice provision for long-stay patients

This study aimed to elicit concerns of key stakeholders regarding food service provision to long stay hospital patients. Seventeen focus groups and four individual interviews were conducted involving six stakeholder groups: dietitians, nutrition assistants, patients, nurses, food service assistants and food service managers. Ninety-eight participants (20 male; 78 female) were recruited from public and private hospitals in New South Wales, Australia. Each of the focus groups and individual interviews was conducted in the hospital setting where free and open discussions could be digitally recorded. Transcripts were prepared from the digital recordings and QSR Nvivo 2.0™ qualitative analysis software was used to code the transcripts prior to content and thematic analysis. Themes were identified by relative frequency in the discussion, number of issues raised within each theme and the importance placed on the issues raised. Five major themes emerged from thirty seven discussion topics: the food service system, menu variety, preparation to eat/feeding assistance, packaging and portion size. Participants were particularly concerned about the increased packaging of food products, perceived lack of meal set up and feeding assistance, limited menu variety especially when considering longer stay hospital inpatients, and the increased use of cook-chill operations. These findings lend themselves well to testing in a wider sphere via quantitative means in a proposed national survey. The results of this survey may produce a position on the main barriers to effective food service provision to long stay patients in the Australian context, and enable identification of practical solutions

Does a standardised dinner meal consumed the evening prior to testing add methodological integrity to an acute meal test study design?

Abstract of an oral paper that was presented at the Dietitians Association of Australia 31st National Conference. Incorporating: 2nd World Forum on Nutrition Research - Translating the Principles of the Mediterranean Diet, 15-17 May 2014, Brisbane Convention and Exhibition Centre, Brisbane, Queensland, Australia

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