National Nutrition Guidelines Research Articles

Responses to the updated Nutri-Score algorithms in Norway: A qualitative study among food system actors in the NewTools-project.

Nutri-Score is a front-of-pack label grading foods and beverages from A to E indicating nutritional quality based on the foods' favorable and unfavorable components, and a contender in the ongoing debate on the possible implementation of a harmonized mandatory front-of-pack nutrition label in the European Union. NewTools is a research project on scoring systems for foods involving 28 partners representing actors involved in the Norwegian food system. This study aimed to explore views reported by Norwegian food system actors on the advantages and disadvantages with the updated Nutri-Score algorithms for food and beverages (2022-2023). This included Nutri-Score's performance in ranking foods according to the national food-based dietary guidelines and to the nutritional challenges in Norway. A total of 28 project partners and 15 other food system stakeholders following the NewTools-project were invited to provide responses on the Nutri-Score algorithms and their application on foods and beverages in the Norwegian food composition table. Thirteen written responses were received and analyzed with qualitative content analysis. The responses to the updated Nutri-Score varied in content, reflecting mainly concerns. Examples of perceived concerns included excessive penalty of salt content; insufficient differentiation based on fat content in meat, sausages, cheese, and milk; and several unreasonable comparisons across food categories. They also expressed a concern that Nutri-Score may stimulate to increased food processing, and some reported inconsistencies between Nutri-Score's classification of foods and national nutrition guidelines and policies. Several concerns with the updated Nutri-Score algorithms were raised, including the weighting of specific nutrients, unfair outcomes when comparing across food categories, and inconsistencies with established Norwegian nutrition guidelines and policies. The results should be interpreted with caution, as some perspectives from the Norwegian food system may be missing.

What is the dietary intake and nutritional status of defence members: a systematic literature review.

Optimal diet and nutrition is vital for military readiness, performance and recovery. Previous research on military diets has primarily focused on the nutritional composition of field/combat rations and dietary intake during deployment. There is accumulating research exploring the usual free-living dietary intake and nutritional status of defence members in garrison (i.e. military bases on which personnel are stationed). However, no comprehensive review has been conducted to assess the overall dietary quality of defence members internationally. Therefore, this review assessed the diets of military populations against national nutritional guidelines and Military Dietary Reference Intakes (MDRI). A systematic literature review of original research was conducted. CINAHL, Medline (EBSCO), Scopus (Elsevier), PubMed and AMED databases were searched up to the 20/02/2023. A total of thirty-six studies met the inclusion criteria. The overall quality of included studies was high, with a low risk of bias. The diet quality scores indicate poor to fair diet quality among defence members. Defence members display low intakes of fruits, vegetables, wholegrains, seafood, plant protein and nuts and high intakes of added sugars, trans fat and processed meat. Results also indicated suboptimal intake of fibre, essential fatty acids, vitamin A, vitamin E, folate, Mg, Zn and iodine. This may lead to reduced performance, increased risk of chronic diseases and mental health disorders. More research is needed to assess the long-term consequences of poor diet quality in defence members. These results require the attention of policymakers to ensure that military education and food environment is supportive of healthy eating.

Slow violence and the coloniality of carceral foodways in Canadian federal prisons

The disproportionate incarceration of Indigenous peoples continues to be a disturbing trend in Canada, prompting calls to problematize prison as a modern manifestation of settler-colonialism. To address this call, we explore the disconcerting similarities between historical accounts of food insecurity endured by Indigenous children in residential schools and our participants’ shocking food experiences in Canadian federal prisons. Using qualitative data from 57 semi-structured interviews with formerly incarcerated people, we compare participants’ experiences of poor-quality food, chronic hunger, and malnutrition to those of students in residential schools, problematizing the inadequate food provision in Canadian prisons in the present despite government assurances that prison food meets national nutritional guidelines. Ultimately, we contend that settler-colonialism continues to be weaponized against Indigenous people in prison – and incarcerated people, generally – through the slow violence of carceral food provision, perpetuating inequitable health outcomes for communities historically pushed to the margins of Canadian society.

Nacking Behaviours by Obese and Normal-Weight Male Teenagers in Shah Alam, Selangor

The well-being and health of Malaysian teenagers are significantly influenced by their dietary choices. To promote healthier eating habits, implementing school nutrition guidelines that address the food environment is a crucial step. However, complementing this effort with insights into snack preferences could further enhance this initiative. This study aims to investigate the snacking behaviours among male teenagers in public schools in Shah Alam, Selangor. The respondents, who are male teenagers aged between 13 to 19 years old (n=476), have undergone a BMI test to determine their level of obesity. A chi-square analysis has been utilised to assess the significance of snacking frequency among these male teenagers. The results have indicated that snacking frequency, preferred snack time, and types of snacks are significant factors associated with obesity among the respondents. The respondents have shown a preference for consuming chips, crisps, or crackers, which is largely influenced by media advertising and peer pressure to consume more than necessary. Understanding the snack preferences of obese male teenagers can potentially enhance the adoption of healthier dietary patterns within educational institutions. This has implications for stakeholders responsible for implementing and adhering to national school nutrition guidelines.

Food neophobia scores at 8 Years and associations with nutrition-related behaviors at home in early life: Findings from a New Zealand contemporary birth cohort

Food neophobia (FN) reduces nutritional adequacy and variety which poses a significant concern for children's health and well-being We described the FN scores among 8-year-olds and examined its associations with nutrition-related behaviors at 45 months within the Growing Up in New Zealand cohort (n = 4621). FN was estimated using the Food Neophobia Scale (FNS). Mean FNS scores between variable categories were compared using t-tests for independent samples and ANOVA. Associations between FNS scores at 8 years and nutrition-related behaviors at 45-months were examined using multivariate linear regression. The mean (standard deviation) FN score was 46.2 (15.2) with statistically significant differences by sex (boys = 47.6 (15.7), girls = 43.8 (14.2), p=<0.001). For all children, in models adjusted by breastfeeding duration and sociodemographic characteristics: children who sometimes and never/almost never ate the same foods as their parents, scored, on average, 5.8 and 11 points higher in the FNS (versus those who did always/almost always); children who occasionally/never found mealtimes enjoyable scored on average 3.6 points lower in the FNS (versus mostly/quite often); children who always/almost always had the television on during mealtimes scored on average 2.7 higher in the FNS (versus never/almost never). In comparison to children who mostly/quite often had time to talk to others during mealtimes, those who never/occasionally did it scored on average higher points in the FNS overall (1.46 points higher) and within girls (1.73 points higher). These findings support the eating behavior statements in the National Children's Food and Nutrition Guidelines, which emphasize early exposure to food variety, limiting mealtime distractions, and acknowledge that parental role modeling shapes children's nutrition-related behaviors. Early adoption of preventative interventions for reducing FN in early and middle childhood are needed.

Dietary assessment and prevention of hypertension in Nigeria: Protocol for a retrospective cross-sectional study for the development and validation of a food frequency questionnaire for clinical use.

Contrary to North America and Europe, the prevalence of hypertension is rising in West Africa. With a transition from whole foods to processed foods in Nigeria, diet plays a key driver of hypertension. To combat this, the national nutritional guidelines in Nigeria were implemented, but their translation into actionable tools for clinicians remains a challenge. Currently, there are no simple dietary assessment tools that are concise and suitable to be incorporated into clinical care without requiring extensive data analysis while still providing personalised dietary support to their patients. This study aims to deliver a clinically tested and validated short dietary assessment tool for clinicians, patients, and researchers across Nigeria to provide personalised dietary advice for patients with hypertension. The study will be conducted in two phases: Phase 1 (n = 75) will investigate the feasibility of the short FFQ and its agreement with 24-hour dietary recalls (3x) in a clinical setting in Nigeria. During the analysis of Phase 1 data, a scoring system will be developed based on the associations between individual food items in the FFQ and measures of hypertension. Phase 2 (n = 50) will assess the acceptability of the FFQ and validate the association between the FFQ score and hypertension. Expected outcomes: The development of a clinically tested and validated short food frequency questionnaire that will be ready to use by clinicians, patients, and researchers across Nigeria to support the prevention and management of hypertension. This study will contribute to knowledge on dietary assessment and hypertension prevention by developing a validated and acceptable FFQ, which will be valuable for clinicians and researchers for personalised dietary recommendations to combat hypertension in Nigeria.

Children`s dietary patterns and their maternal determinants during the first 5 years of life: Information from the Growing Up in New Zealand cohort

Monitoring indicators of children`s diet quality at the national level is imperative to examine if a country is on track to achieving children`s global nutrition targets and fulfilling the related Sustainable Development Goals. Despite the importance of diet quality in early life and its impact in health and wellbeing throughout the life course, Aotearoa New Zealand has limited information that is nationally representative or generalizable on children`s diet quality, especially among children under 5 years old. The only national child nutrition survey conducted to date took place two decades ago and involved children 5 years of age and older. We have previously used data collected by the Growing in Up in New Zealand cohort study, which is nationally generalizable, to partially fill historic gaps in knowledge of children`s diet and feeding practices in the first five years of life. Information on breastfeeding initiation, duration and exclusivity, timing of food introduction and whole-of-diet adherence to National Food and Nutrition Guidelines have been previously published 1–3. This work intends to complement information on NZ children`s diet quality by examining the cohort`s dietary patterns (DPs) at 9- (n = 6,259), 24- (n = 6,292), and 54-months (n = 6,131) and their maternal sociodemographic and health behaviour determinants. At all time-points, children`s DPs were identified using principal components analyses. Multivariate linear regressions were performed to examine the associations between each DP and the maternal variables. At 9-, 24- and 54-months two distinct DPs were identified, explaining, 36.4%, 35.3% and 33.6% of children`s intake variability, respectively. The Refined high in sugar and salt DP, at all time-points, was characterised by high positive loadings in white/refined breads and cereals and items with high content of sugar, sodium, and fat. At 24-months, the Refined high in sugar and salt DP also had high positive loading in the protein group. The Fruit/Vegetables DP, at all time-points, had high positive loadings for fruits and vegetables (with type varying across time-points). The Fruit/Vegetables DP had high loading in whole grain options of breads and cereals at 24-months and positive loading in the protein group at 9- and 54-months. High scores on the Refined high in sugar and salt DP at the three time-points were associated with maternal smoking habits, maternal education level, ethnicity, and maternal scores in the “Junk” and “Traditional/White bread” DPs (obtained at the antenatal maternal interview). High children’s scores on the Fruit/Vegetables DP, at all time-points, were associated with the maternal antenatal score in the “Health Conscious” DP. Findings support that policies and interventions aiming to improve early life diets in NZ should be culturally safe and support mothers’ access to formal education, healthy diets, and smoking cessation.

Effect of nutritional guidance on employee work ability, work well-being and quality of life (RAVI trial): Study protocol for a randomized controlled trial

BackgroundThe minority of working-age Finns eat according to the national and Nordic nutritional guidelines and increasing numbers of health problems affect the Finnish workforce. Coincidently recruiting new workers in the more rural areas of Finland, such as Satakunta, has been problematic. To optimize the use of the existing workforce, health promotion interventions focusing on nutrition have been suggested to improve the health and well-being of the current working age Finns. Methods and analysisThe aim of this RCT study is to assess the effectiveness of a 12-month multifactorial nutritional guidance intervention to improve work ability (performance), work well-being, health-related quality of life, work productivity, sickness absence, dietary intake and eating habits. In total, six small or medium-sized companies and their employees (n = 170) from the Satakunta region will be recruited. Companies will be randomized 1:1 to a 12-month multifactorial nutritional guidance intervention group (INT) or a control group (CG). Comprehensive measurements are taken before randomization (baseline) and at the end of the 12-month study period. Primary outcomes (work ability, work well-being and health-related quality of life) are measured with Work Ability Index, Utrecht Work Engagement Scale short questionnaire and EQ-5D. Dietary intake and eating habits are measured with 3-day food records and Food Frequency Questionnaire (FFQ). DiscussionThis study will provide nationally important data on how workplace nutrition guidance affects work-related outcomes, quality of life, and nutritional and overall health status among working age Finns.

Feeding Mothers, Making Citizens: Japanese Maternity Clinic Meals as Treatment, Care, and Identity

Abstract: Postpartum Japanese mothers and neonates typically spend 5-6 days in a hospital or clinic. Therefore, institution-prepared meals are an important part of the immediate postpartum experience. Drawing from ethnographic research conducted at a 17-bed maternity clinic in central Japan, I discuss how 1) nutrients are calculated to ensure adherence to national nutrition guidelines, and meals are individualized to fit specific patients, 2) staff incorporate local ingredients and specialties that support local identity, and 3) non-Japanese foods are used both as entertainment and vehicles through which Japanese mothers consume regional, national, and non-Japanese cultures. With attention to the emic terms tanoshimi , shigoto , and ikigai , I demonstrate that meals here go beyond prescription and care: they are sites of the production and consumption of regional, national, and global citizenship ideals and constitute what Takeda calls “biopolitical governing” (2008).

Türkiye’de Yaşayan Vegan - Vejetaryen Bireylerin Beslenme Durumlarının Kıyaslanması Üzerine Pilot Bir Çalışma

Aim: Vegan and vegetarian diets are in an increasing trend worldwide in recent years. Vegan/vegetarian diets, which are known to have positive effects on health, may result in nutrient deficiencies if they are not balanced. It is important to determine the nutritional status of vegan and vegetarian individuals, whose number is increasing in Turkey, in order to build national recommendations. This study was conducted as a pilot study to determine the energy and nutrient intake of vegan/vegetarian individuals living in Turkey. Subjects and Method: A total of 285 volunteered vegan/vegetarian individuals aged 19-64 years participated in the study. The general information and vegan/vegetarian status of the participants were questioned with an online survey. After answering the survey, 38 volunteered participants kept a consecutive three-day “24-h food record” and shared it with the researchers. The energy and nutrient intakes of the individuals and the rates of meeting their requirements were calculated. Chi-square test of independence was used to compare individuals’ vegan/vegetarian status by gender and general knowledge by vegan/vegetarian status; independent sample t-test and Mann-Whitney U test were used for age, energy and nutrient comparisons between groups. Results: The majority of the participants were female (79.3%), holding at least a bachelor’s degree (89.5%), and had a normal BMI value (72.6%). Rate of vegan and vegetarian participants that were not able to meet their energy and nutrient requirements were as follows respectively: 76.5%, 85.7% for energy (kcal); 52.9%, 95.2% for carbohydrate (%); 100%, 52.4% for vitamin B12; 64.7% 61.9% for folate; 94.1%, 76.2% for calcium; 64.7%, 76.2% for iron; and 88.2%, 71.4% for zinc. Conclusion: It has been observed that vegan and vegetarian individuals living in Turkey are at risk of several nutrient deficiencies. Considering the increasing trend of vegan and vegetarian diets, it is necessary to determine the nutritional status of individuals on a large scale and to raise awareness of individuals. It is important that the recommendations specific to vegan/vegetarian individuals in national nutrition guidelines are implemented by vegan/vegetarian individuals, health professionals and food service providers.

Nutritional Intake of Children in Kebon Pala East Jakarta

Background: A mother is the main nutrition provider of an Indonesian family. Their own health profiles and situations may affect their abilities to provide proper nutrition. In this research, we try to find mothers in Kebon Pala profile, and the nutrition taken by their children; Method: This quantitative descriptive study was conducted by using a self-administered questionnaire which has been responded to by 94 mothers in Kebon Pala. This research was conducted from October 2021-April 2022. Results: 61.54% child takes 3 times carb intake a day, but unlike the national nutritional guidelines, only 20% take anima-based protein 3 times a day, only 34.83% take plant-based protein 3 times a day, and only 33.33% take vegetable 3 times a day. This minimal variation of plate filling happened, even though 49.44% child never complained about the food available and 55.56% child never complained about vegetables/fruit on their plate. Conclusion: Children in Kebon Pala did not eat balanced nutrition meals, and most of them have eating difficulties (fussy eaters).

A Qualitative Study Investigating the Current Practices, Obstacles, and Needs of Enteral Nutrition Support among Registered Dietitians Managing Non-Critically Ill Hospitalized Patients in Riyadh, Saudi Arabia

Introduction: Despite the wide availability of international guidelines that direct enteral nutrition practices, no recommendations or guidelines are tailored specifically for the unique healthcare environment in Saudi Arabia. Specifically tailored national guidelines are considered essential evidence that should be developed and followed. However, understanding the current practices, local needs, and gaps is important to facilitate the process of developing a practical national guideline. Methodology: In this qualitative study, focus groups using a structured interview technique were conducted to gain an in-depth understanding of the current enteral nutrition practices and related needs/obstacles from 24 registered dietitians handling non-critically ill patients. The recorded sessions were transcribed, and then themes were identified via coding analysis. In addition, the inter-rater agreement of the data’s themes was evaluated. Results: Five focus group sessions that consisted of 24 participants (3 males and 21 females) working in private and governmental hospitals (18 governmental and 6 private) in Riyadh city were conducted. Ten enteral nutrition practice-related themes for non-critically ill patients were identified via coding analysis, in addition to four obstacle-related themes and four need-related themes. Conclusion: Non-critically ill patients represent the most significant majority of hospitalized patients. Therefore, it is recommended for the relevant regulatory authorities to develop national enteral nutrition guidelines and policies that guarantee consistent and sustainable care, along with improving the health outcomes for this population.

Environmental impacts and diet quality of popular diet models compared to Turkey's national nutrition guidelines.

This study aimed to compare the environmental impacts and diet qualities of popular diet models with the recommendations of the Turkish national dietary guidelines. Seven-day isocaloric (8368 kJ) diet models were created taking into account the Mediterranean, Atkins (20/40/100), Ornish, Zone diets, and Turkey Dietary Guidelines-2015 recommendations with different food and nutrient contents. Water footprints were evaluated using the global water footprint standards. Greenhouse gas emissions were evaluated using carbon footprint factors compiled as a result of meta-analyses of life cycle analysis studies in the literature. In addition, the quality of diets was evaluated with the Diet Quality Index-International. Atkins20 diet model had the most harmful environmental impact (greenhouse gas emissions 8.74 kg CO2 -eq/per/day and total water footprint 7731 L/per/day), whereas Ornish and Mediterranean diet models (greenhouse gas emissions 2.2/3.07 kg CO2 -eq/per/day and total water footprints 3184/3675 L/per/day, respectively) had less harmful environmental impact. The highest Diet Quality Index-International score was in the Ornish diet model while the lowest Diet Quality Index-International was in the Atkins20 diet model. Ornish and Mediterranean diet models had less harmful environmental impacts, which contributed to sustainable nutrition. The importance of diet quality and environmental impacts should be kept in mind when evaluating diet models to ensure sustainable nutrition.

Child feeding indexes measuring adherence to New Zealand nutrition guidelines: Development and assessment.

New Zealand (NZ) lacks nationally representative or generalisable information on the dietary intakes of pre‐schoolers. We used Growing Up in New Zealand cohort data to i) develop child feeding indexes (CFIs) based on National Food and Nutrition Guidelines for 2‐ and 4.5‐year‐olds; ii) describe the cohort adherence to the guidelines at 2 (n = 6046) and 4.5 years (n = 5889) and; iii) assess the CFIs’ convergent construct validity, by exploring associations with maternal sociodemographic and health behaviours and with child body mass index for age (BMI/age) and the waist‐to‐height ratio at 4.5 years. The CFIs scores ranged from 0 to 11, with 11 representing full adherence to the guidelines. Associations were tested using multiple linear regressions and Poisson regressions with robust variance (risk ratios [RR], 95% confidence intervals, 95% CI). The CFIs mean scores (SD) at 2 and 4.5 years were, respectively, 6.13 (1.21) and 6.22 (1.26) points. Maternal characteristics explained, respectively, 27.2% and 31.9% of the variation in the CFIs scores at 2 and 4.5 years. In the adjusted model at the 4.5‐year interview, in relation to girls ranked in the 5th quintile, those in the 2nd (RR, 95% CI: 1.48; 1.03; 1.24) and 4th (1.53; 1.05; 2.23) quintiles of the CFI were more likely to have BMI/age > +2z (World Health Organization growth standards) at 4.5 years. At 2 and 4.5 years, most children fell short of meeting national guidelines. The associations between the CFIs scores at both time points with maternal characteristics and with children's body size at 4.5 years were in the expected directions, confirming the CFIs’ convergent construct validity among NZ pre‐schoolers.

Dietary Behavior and Compliance to Bulgarian National Nutrition Guidelines in Patients With Type 1 Diabetes With Longstanding Disease.

IntroductionNutrition education attempts to maintain and enhance good eating habits to achieve optimal metabolic control in people with type 1 diabetes (T1D). Recommendations for patients with T1D are comparable to those of the general population.This Study AimedTo investigate dietary habits and adherence to nutritional recommendations of patients with T1D as compared with age, gender, and BMI matched people in Bulgaria.MethodsA case-control study included 124 patients with T1D with long disease duration (mean duration 25.3 ± 8.2 years) followed up at a diabetes clinic in Varna, Bulgaria for 2 years (2017–2019) and 59 controls matched for gender, age and BMI. A 24-h dietary recall method was used to assess the nutrition of both groups. A standardized questionnaire was applied to assess the frequency of food consumption (Feel4Diabtes). Height and weight were standardly measured, and BMI was calculated. Findings were compared with Bulgarian recommendations and reference values for energy and nutrient intake for healthy adults. The data were analyzed with the statistical package SPSSv21.0 and Jamovi v.22.5.ResultsThe nutritional characteristics of T1D men and women differ. Men with T1D had a higher intake of total carbohydrates (CHO) (p = 0.009), a lower intake of total fats (p = 0.007), and monounsaturated fatty acids (p = 0.029) as a percentage of total daily energy compared with the controls. Women with T1D had a different distribution of energy intake per meal compared to controls: they consumed more energy (p = 0.001) and a corresponding share of CHO for lunch, less for dinner (p = 0.015) and had a higher overall healthy diet score when compared to controls (p = 0.02). Adherence to dietary recommendations (e.g., CHO, total fats, saturated fat, fibers) was low in both genders, but lower in the general population compared to people with T1D.ConclusionOur data demonstrate that people with T1D consume a healthier diet than the general population, which could be attributed to healthier diet awareness, still far from the recommendations. Introduction of annual consultations with a dietitian may improve long-term outcomes.

The Burden of Malnutrition in Childhood Cancer in Malawi – Risk Regardless of Age

Malnutrion among children with childhood cancer in low and middle income countries (LMICs) is prevelant. While national nutrition programs focus on children under 5 years, childhood cancer can occur regardless of their age. Through a single-center retrospective cohort in Lilongwe, Malawi, we aim to characterize the burden of age-related malnutrition among children diagnosed with cancer in Lilongwe, Malawi, and evaluate them for any associations with mortality. Four hundred and sixty-three children (63.5% ≥5 years and 58.3% males) were identified.The majority of children (63.3%) were malnourished; 23.1% had moderate acute malnutrition (MAM) and 40.2% had severe acute malnutrition (SAM). Malnutrition was more common in children ≥5 years (70.0%) compared to children <5 years (51.8%); p < 0.0001. Age <5 years (HR 1.6; 95%CI 1.1-2.3, p = 0.016) and presence of sever acute malnutrition (HR 1.6, 95%CI 1.1-2.3, p = 0.012) were both associated with increased mortality risk. Acute malnutrition was highly prevalent among children with cancer above 5 years of age. This age group is not prioritized among malnutrition programs in LMICs, hence there is a direct need to include children with cancer regardless of age in national nutrition guidelines in LMICs to give them acces to adequate nutritional support.

Longitudinal Nutritional Intakes in Italian Pregnant Women in Comparison with National Nutritional Guidelines.

Background: Nutritional quality during pregnancy is crucial for mother and child health and their short/long-term outcomes. The aim of this study is to evaluate the adherence to nutritional recommendations in Italy during the three pregnancy trimesters in Normal Weight (NW) and Over Weight (OW) women. Methods: Data from a multicenter randomized controlled trial included 176 women (NW = 133; OW = 43) with healthy singleton pregnancies enrolled within 13 + 6 weeks of gestation. Dietary intake was assessed every trimester by a Food Frequency Questionnaire. Results: OW and NW had similar gestational weight gain. However, as Institute of Medicine (IOM) recommend lower gestational weight gain (GWG) for OW, they exceeded the suggested range. In both groups, caloric intake during the three trimesters never met recommendations. Protein intake in first and second trimester was higher than recommendations, as was sugars percentage. Dietary fiber intake was lower in OW. Polyunsaturated fatty acids, calcium, iron and folic acid requirements were never satisfied, while sodium intake exceeded recommendations. Conclusions: NW and OW women in Italy do not adhere to nutritional recommendations during pregnancy, with lower caloric intake, protein and sugars excess and inadequacies in micronutrients intake. Pregnant women in Italy should be provided with an adequate counseling and educational intervention as well as supplementation when indicated.

Preparedness to implement national enteral nutritional therapy practice guidelines: An observational study of primary health care institutions in South Africa.

BackgroundDespite the long-term consequences of malnutrition in hospitalised patients, nutritional practice guidelines for adults, particularly in the recovery phase are rarely implemented in community based primary health care settings.AimThis study aimed at assessing the current practice to establish preparedness for effective implementation of the 2016 South African Enteral Nutrition Practice Guidelines for Adults.SettingThis study was conducted in a district hospital in KwaZulu-Natal, a community health centre, two primary health care (PHC) clinics and one household.MethodsNon-participant observations were conducted to observe 10 purposefully selected health care professionals involved in nutritional therapy provision to adults, a patient on home enteral nutrition (HEN) and a family caregiver. Content analysis helped identify predominant themes that emerged in the study.ResultsObservation results showed that the national enteral nutritional (EN) therapy practice guidelines were not available in all health care institutions. Health care professionals were not aware of them and the care users confirmed that they attended HEN related follow-up care at institutions that prescribed and inserted their feeding tubes. Two major themes that emerged in this study include positive factors and negative factors that influence implementation of the guideline.ConclusionThe study identified factors that can have significant influence on the implementation of the national enteral nutritional therapy practice guidelines, a necessary step for changing clinical practice and thus clinical outcomes of patients. The EN/HEN training and the provision of necessary resources are needed to improve the situation. More research on the strategies for the dissemination of guidelines is essential to improve awareness and thus adoption and implementation.

Preparedness to implement national enteral nutritional therapy practice guidelines: An observational study of primary health care institutions in South Africa

Background: Despite the long-term consequences of malnutrition in hospitalised patients, nutritional practice guidelines for adults, particularly in the recovery phase are rarely implemented in community based primary health care settings. Aim: This study aimed at assessing the current practice to establish preparedness for effective implementation of the 2016 South African Enteral Nutrition Practice Guidelines for Adults. Setting: This study was conducted in a district hospital in KwaZulu-Natal, a community health centre, two primary health care (PHC) clinics and one household. Methods: Non-participant observations were conducted to observe 10 purposefully selected health care professionals involved in nutritional therapy provision to adults, a patient on home enteral nutrition (HEN) and a family caregiver. Content analysis helped identify predominant themes that emerged in the study. Results: Observation results showed that the national enteral nutritional (EN) therapy practice guidelines were not available in all health care institutions. Health care professionals were not aware of them and the care users confirmed that they attended HEN related follow-up care at institutions that prescribed and inserted their feeding tubes. Two major themes that emerged in this study include positive factors and negative factors that influence implementation of the guideline. Conclusion: The study identified factors that can have significant influence on the implementation of the national enteral nutritional therapy practice guidelines, a necessary step for changing clinical practice and thus clinical outcomes of patients. The EN/HEN training and the provision of necessary resources are needed to improve the situation. More research on the strategies for the dissemination of guidelines is essential to improve awareness and thus adoption and implementation.

Identifying Nutrient Patterns in South African Foods to Support National Nutrition Guidelines and Policies.

Food composition databases (FCDBs) provide the nutritional content of foods and are essential for developing nutrition guidance and effective intervention programs to improve nutrition of a population. In public and nutritional health research studies, FCDBs are used in the estimation of nutrient intake profiles at the population levels. However, such studies investigating nutrient co-occurrence and profile patterns within the African context are very rare. This study aimed to identify nutrient co-occurrence patterns within the South African FCDB (SAFCDB). A principal component analysis (PCA) was applied to 28 nutrients and 971 foods in the South African FCDB to determine compositionally similar food items. A second principal component analysis was applied to the food items for validation. Eight nutrient patterns (NPs) explaining 73.4% of the nutrient variation among foods were identified: (1) high magnesium and manganese; (2) high copper and vitamin B12; (3) high animal protein, niacin, and vitamin B6; (4) high fatty acids and vitamin E; (5) high calcium, phosphorous and sodium; (6) low moisture and high available carbohydrate; (7) high cholesterol and vitamin D; and (8) low zinc and high vitamin C. Similar food patterns (FPs) were identified from a PCA on food items, yielding subgroups such as dark-green, leafy vegetables and, orange-coloured fruit and vegetables. One food pattern was associated with high sodium levels and contained bread, processed meat and seafood, canned vegetables, and sauces. The data-driven nutrient and food patterns found in this study were consistent with and support the South African food-based dietary guidelines and the national salt regulations.