Making hospital shops healthier:evaluating the implementation of a mandatory standard for limiting food products and promotions in hospital retail outlets

Background The range of products stocked and their promotions in food retail outlets in healthcare settings can affect food choices by staff, patients and visitors. The innovative Scottish Healthcare Retail Standard (HRS) is a national mandatory scheme requiring all hospital food retail outlets to change the balance of food products stocked and their promotion to comply with nutritional criteria and promotional restrictions. The aim is to facilitate healthier food choices in healthcare settings. This study examined the implementation of HRS and the impact on foods stocked and promoted. Methods The study aimed to examine implementation process and changes to the retail environment in relation to food promotions and choice. A sample of hospital retail outlets (n=17) including shops and trolley services were surveyed using a mixed methods design comprising: (a) structured observational audits of stock, layout and promotions (with a specific focus on chocolate and fruit product lines, and) (b) face-to-face, semi-structured interviews with the shop manager or nominated members of staff (n=32). Data were collected at Wave 1 (2016), at the beginning and during the early stages of HRS implementation; and Wave 2, 12 months later, after the HRS implementation deadline. Results All outlets, both commercial and not-for-profit, in the sample successfully implemented HRS. Implementation was reported to be more challenging by independent shop managers compared to chain store staff. Retail managers identified areas where more implementation guidance and support could have been provided. The number of chocolate product lines and promotions reduced substantially between Waves 1 and 2, but with no substantial increase in fruit product lines and promotions. Despite initial negative expectations of HRS’s impact, managers identified some opportunities in the scheme and positive changes in the supply chain. Conclusions Positive changes in food retail outlets occurred after hospital shops were required to implement HRS. By creating a consistent approach across hospital shops in Scotland, HRS changed the food retail environment for hospital staff, visitors and patients. HRS provides a regulatory template and implementation learning points for influencing retail environments in other jurisdictions and settings

The Effects of a Carbohydrate Hydrogel System for the Delivery of Bicarbonate Mini-Tablets on Acid–Base Buffering and Gastrointestinal Symptoms in Resting Well-trained Male Cyclists

Background: A new commercially available sodium bicarbonate (SB) supplement claims to limit gastrointestinal (GI) discomfort and increase extracellular buffering capacity. To date, no available data exists to substantiate such claims. Therefore, the aim of this study was to measure blood acid–base balance and GI discomfort responses following the ingestion of SB using the novel “Bicarb System” (M-SB). Twelve well-trained male cyclists completed this randomised crossover designed study. Maximal oxygen consumption was determined in visit one, whilst during visits two and three participants ingested 0.3 g∙kg−1 BM SB using M-SB (Maurten, Sweden) or vegetarian capsules (C-SB) in a randomised order. Finger prick capillary blood samples were measured every 30 min for pH, bicarbonate (HCO3−), and electrolytes (potassium, chloride, calcium, and sodium), for 300 min. Visual analogue scales (VAS) were used to assess GI symptoms using the same time intervals. Results: Peak HCO3− was 0.95 mmol∙L−1 greater following M-SB (p = 0.023, g = 0.61), with time to peak HCO3− achieved 38.2 min earlier (117 ± 37 vs. 156 ± 36 min; p = 0.026, r = 0.67) and remained elevated for longer (p = 0.043, g = 0.51). No differences were observed for any electrolytes between the conditions. Aggregated GI discomfort was reduced by 79 AU following M-SB (p < 0.001, g = 1.11), with M-SB reducing stomach cramps, bowel urgency, diarrhoea, belching, and stomach-ache compared to C-SB. Conclusions: This is the first study to report that M-SB can increase buffering capacity and reduce GI discomfort. This presents a major potential benefit for athletes considering SB as an ergogenic supplement as GI discomfort is almost eliminated. Future research should determine if M-SB is performance enhancing

Development and Implementation of a Nutrition Knowledge Questionnaire for Ultra-Endurance Athletes

The nutritional intake of ultra-endurance athletes is often poorly matched with the requirements of the sport. Nutrition knowledge is a mediating factor to food choice that could correct such imbalances. Therefore, the purpose of this study was to develop and validate a questionnaire to assess the nutrition knowledge of ultra-endurance athletes. Nutritional knowledge was assessed using a modified sports nutrition questionnaire (ULTRA-Q). Four independent assessors with specialist sports nutrition knowledge confirmed the content validity of the ULTRA-Q. Registered Sports Nutritionists, Registered Dietitians, and those without nutrition training completed the ULTRA-Q on two separate occasions. After the first completion, a significant difference in nutrition scores between groups (p = <0.001) provided evidence of construct validity. After the second completion, intra-class correlation coefficients comparing nutrition scores between time points (0.75–0.95) provided evidence of test-retest reliability. Subsequently, experienced ultra-endurance athletes (male n = 74, female n = 27) completed the ULTRA-Q. Athletes also documented their sources of nutrition knowledge for ultra-endurance events. The total nutrition knowledge score for ultra-endurance athletes was 68.3 ± 9.5% and there were no significant differences in knowledge scores between males and females (67.4 ± 9.6% and 70.7 ± 9.3%) or runners and triathletes (69.1 ± 9.7% and 65.1 ± 9.4%). In general, it appeared that ultra-endurance athletes favoured other athletes (73%) over nutrition experts (8%) as a source of nutritional information. The findings of this study indicate that ultra-endurance athletes had a reasonable level of nutrition knowledge, but inter-athlete variability suggests a need for targeted nutrition education