Nutrition-related Problems Research Articles

Nutrition‐related hospital presentations and admissions among radiotherapy outpatients: a systematic literature review

Unplanned presentations and admissions to hospital among outpatients with cancer are a key indicator of quality care in cancer services. Nutritional issues including malnutrition and dehydration, which fall under the dietitian's scope of practice, can result in unplanned contacts. The present review focused on cancer outpatients undergoing radiotherapy as a particular at risk group and aimed to provide a comprehensive overview of the range and prevalence of nutrition-related unplanned contacts and the associated factors, including the role of dietetic intervention. A systematic review analysed studies published between 1990 and August 2016 from five databases. Eligible studies reported rates of nutrition-related unplanned contacts among adult nonhaematological cancer outpatients, treated with nonpalliative radiotherapy. Studies were screened for eligibility, extracted, descriptively analysed and synthesised. Fifteen studies were included. Common causes of nutrition-related unplanned contacts included dehydration and enteral feeding commencement and complications. Factors that influenced nutrition-related unplanned contacts included tumour location and stage, treatment modality and the presence of a feeding tube. There were issues in determining the prevalence and identifying dietetic interventions partly as a result of the heterogeneity in reported study designs and varying definitions of nutrition-related unplanned contacts. Nutrition-related problems appear to be associated with unplanned contacts in cancer outpatients undergoing radiotherapy. Hence, there is a strategic need for dietetic involvement aiming to reduce these. Further research is required to define the role of the dietitian in managing nutrition-related unplanned contacts, particularly for dehydration. This may help to define the full scope of practice for dietitians caring for these nutritionally vulnerable and complex outpatients.

Mechanisms Affecting the Gut of Preterm Infants in Enteral Feeding Trials.

Large randomized controlled trials (RCTs) in preterm infants offer unique opportunities for mechanistic evaluation of the risk factors leading to serious diseases, as well as the actions of interventions designed to prevent them. Necrotizing enterocolitis (NEC) a serious inflammatory gut condition and late-onset sepsis (LOS) are common feeding and nutrition-related problems that may cause death or serious long-term morbidity and are key outcomes in two current UK National Institutes for Health Research (NIHR) trials. Speed of increasing milk feeds trial (SIFT) randomized preterm infants to different rates of increases in milk feeds with a primary outcome of survival without disability at 2 years corrected age. Enteral lactoferrin in neonates (ELFIN) randomizes infants to supplemental enteral lactoferrin or placebo with a primary outcome of LOS. This is a protocol for the mechanisms affecting the gut of preterm infants in enteral feeding trials (MAGPIE) study and is funded by the UK NIHR Efficacy and Mechanistic Evaluation programme. MAGPIE will recruit ~480 preterm infants who were enrolled in SIFT or ELFIN. Participation in MAGPIE does not change the main trial protocols and uses non-invasive sampling of stool and urine, along with any residual resected gut tissue if infants required surgery. Trial interventions may involve effects on gut microbes, metabolites (e.g., short-chain fatty acids), and aspects of host immune function. Current hypotheses suggest that NEC and/or LOS are due to a dysregulated immune system in the context of gut dysbiosis, but mechanisms have not been systematically studied within large RCTs. Microbiomic analysis will use next-generation sequencing, and metabolites will be assessed by mass spectrometry to detect volatile organic and other compounds produced by microbes or the host. We will explore differences between disease cases and controls, as well as exploring the actions of trial interventions. Impacts of this research are multiple: translation of knowledge of mechanisms promoting gut health may explain outcomes or suggest alternate strategies to improve health. Results may identify new non-invasive diagnostic or monitoring techniques, preventative or treatment strategies for NEC or LOS, or provide data useful for risk stratification in future studies. Mechanistic evaluation might be especially informative where there are not clear effects on the primary outcome (ISRCTN 12554594).

The DASH Pilot Project: Developing Community-Based Nutrition Education for Older Adults

ABSTRACTNutrition-related chronic health conditions among older adults are a growing concern. In this study, nutrition education materials were created for use in senior centers by graduate nutrition students. After the materials were presented, focus groups were conducted with participants (n = 62) to obtain feedback on the content and presentation. Findings related to the participant’s knowledge of nutrition-related information, strategies to improve future class sessions, and participant recruitment will be discussed. These findings will be useful to program administrators as they develop nutrition programs for older adults who are vulnerable to nutrition-related health problems.

The Emerging Nutritional Problems of School Adolescents: Overweight/Obesity and Associated Factors in Jimma Town, Ethiopia

BackgroundGlobally, overweight is rapidly becoming one of the most important medical and public health problems. Adolescent obesity is a multisystem disease with potentially devastating consequences that persist into adulthood. However, there is a paucity of available information regarding the adolescent overweight and obesity in Ethiopia, particularly in the study area. MethodsA school-based cross-sectional study was conducted from March to April/2015 among 546 adolescents. Study participants were selected using a multi-stage, stratified random sampling method. An interviewer administered questionnaire was used to collect data. Multivariable logistic regression analysis was used to identify independent predictors of overweight and obesity at 95% confidence intervals. ResultsThe mean dietary diversity score of school adolescents was 6.97±1.15. Cereal based diets (99.6%) and vegetables (73.9%) are the two common foods of adolescents. The prevalence of overweight/obesity was 13.3%. Overweight/Obesity was significantly associated with being a female (AOR=3.57 [95% CI:1.28–9.9]), attending private schools (AOR=7.53 [2.51–22.3]), lack of paternal education (AOR=5.57 [95% CI:1.53–20.26]), wealthy households (AOR=3 [95% CI:1.09–8.26]) and not being a vegetarian (AOR=9.23 [95% CI:1.68–50.8]). Adolescents who are physically inactive (AOR=3.7 [95% CI:1.06–13.02]) and those with sedentary lifestyles (AOR=3.64 [95% CI:1.39–9.5]) were more obese compared to their counter peers. ConclusionsThe proportion of overweight/obesity among school adolescent was considerably high. Being a female, learning in private school, high household economic status, not being a vegetarian and having a sedentary life were significantly associated with overweight/obesity. Practice implicationsFindings of this study can be used to guide the development of programs aimed at preventing overweight/obesity in Ethiopia by informing policymakers and other stakeholders about this emerging nutrition-related problem among school adolescents.

Toward Harmonization of the Nutrition Care Process Terminology and the International Classification of Functioning, Disability and Health−Dietetics: Results of a Mapping Exercise and Implications for Nutrition and Dietetics Practice and Research

Toward Harmonization of the Nutrition Care Process Terminology and the International Classification of Functioning, Disability and Health−Dietetics: Results of a Mapping Exercise and Implications for Nutrition and Dietetics Practice and Research

Using the Nutrition Care Process to Identify Common Food and Nutrition-Related Problems of Parents Enrolled in a Childhood Obesity Prevention Intervention

Using the Nutrition Care Process to Identify Common Food and Nutrition-Related Problems of Parents Enrolled in a Childhood Obesity Prevention Intervention

Nutritional care of cancer patients: a survey on patients' needs and medical care in reality.

Cancer patients represent a patient group with a wide-range of nutrition related problems which are often under-recognized and undertreated. In order to assess the status quo of nutritional care in Germany, we conducted a survey among patients with different types of cancer. A standardized questionnaire was distributed online by two national umbrella organizations for self-help groups. 1335 participants completed the questionnaire. 69% of the participants reported having received information on nutrition and/or specific nutrition-related symptoms. Most often this information was derived from print media (68.5%) or from within self-help groups (58.7%). 57.0% of participants reported having had questions concerning nutrition and/or problems with food intake. most frequently named topics of interest were "healthy diet" (35.0%) weakness/fatigue (24.3%), dietary supplements (21.3%) and taste changes (19.8%). Nutrition information was most often provided by dietitians (38.7%) followed by physicians (9.8%). Women reported receiving nutrition counseling in the hospital nearly twice as often as men (12.5% versus 5.7%; p<0.001). A quarter of the patients (24.1%) reported using dietary supplements and patients who had received some sort of nutrition information more often reported using supplements (p<0.001). Nutrition is an essential element in cancer care and patients report a high interest and need: Yet, many patients do not have access to high quality nutrition therapy during and after cancer therapy. With respect to survival and quality of life, increasing the availability and resources for provision of evidence based nutrition information seems mandatory.

Research in dietetic practice and education: Insights from the sociological perspective

Research in dietetic practice and education: Insights from the sociological perspective

Factors affecting poor nutritional status after small bowel resection in patients with Crohn disease.

In Crohn disease, bowel-preserving surgery is necessary to prevent short bowel syndrome due to repeated operations. This study aimed to determine the remnant small bowel length cut-off and to evaluate the clinical factors related to nutritional status after small bowel resection in Crohn disease.We included 394 patients (69.3% male) who underwent small bowel resection for Crohn disease between 1991 and 2012. Patients who were classified as underweight (body mass index < 17.5) or at high risk of nutrition-related problems (modified nutritional risk index < 83.5) were regarded as having a poor nutritional status. Preliminary remnant small bowel length cut-offs were determined using receiver operating characteristic curves. Variables associated with poor nutritional status were assessed retrospectively using Student t tests, chi-squared tests, Fisher exact tests, and logistic regression analyses.The mean follow-up period was 52.9 months and the mean patient ages at the time of the last bowel surgery and last follow-up were 31.2 and 35.7 years, respectively. The mean remnant small bowel length was 331.8 cm. Forty-three patients (10.9%) underwent ileostomy, 309 (78.4%) underwent combined small bowel and colon resection, 111 (28.2%) had currently active disease, and 105 (26.6%) underwent at least 2 operations for recurrent disease. The mean body mass index and modified nutritional risk index were 20.6 and 100.8, respectively. The independent factors affecting underweight status were remnant small bowel length ≤240 cm (odds ratio: 4.84, P < 0.001), ileostomy (odds ratio: 4.70, P < 0.001), and currently active disease (odds ratio: 4.16, P < 0.001). The independent factors affecting high nutritional risk were remnant small bowel length ≤230 cm (odds ratio: 2.84, P = 0.012), presence of ileostomy (odds ratio: 3.36, P = 0.025), and currently active disease (odds ratio: 4.90, P < 0.001).Currently active disease, ileostomy, and remnant small bowel length ≤230 cm are risk factors affecting the poor nutritional status of patients with Crohn disease after small bowel resection.

PTH-132 Medical Students’ Perception of Nutrition Education at An Undergraduate Level and The Role of The Clinicians They Shadow

Introduction Medical schools have neglected nutrition training in undergraduate courses, resulting in medical students being unsure of its importance1 and doctors not confident in managing nutrition-related problems.2 The aim of this study was to explore medical students’ views and experiences of nutrition training at different stages of their training and to evaluate the impact of the views of the clinicians they shadowed. Methods A cross-sectional email survey of all medical students in the first (T) and final (F) clinical years at St. George’s University of London was conducted. Clinicians at St. George’s hospital were surveyed with a 10 item questionnaire. Data were analysed using SPSS version 21.0 and the significance determined using a 2 tailed Fischer’s exact test. Results The overall student response rate was 106/549 (19.3%) with no significant difference between the 2 year groups. 86/~500 clinicians responded. 75% of students agreed that ‘having a strong understanding of nutrition is an important aspect of a doctor’s job’. Of those that disagreed, 57% cited as a reason that ‘other members of the healthcare team deal with nutrition problems’. 71% of students agreed that ‘nutrition should be included in the undergraduate medical curriculum’. The only students to disagree were from F year (12% vs 0%, p = 0.016) and 36% of them cited as a reason that their ‘medical school timetable is too full’. Only 11% of students had had the importance of nutrition highlighted to them by a senior clinician ‘regularly’. This group were more likely to ‘strongly agree’ with the statements above than those who had not (24% vs 3%, P = 0.02 and 21% vs 6%, P = 0.039). However, only 17% of clinicians frequently emphasised the importance of nutrition problems and only 7% frequently emphasised the importance of nutrition screening tools to students. The most commonly cited reason for clinicians not emphasising these was ‘it does not occur to me’ Only 50% of clinicians said they were confident managing nutrition related problems and for the majority (63.4%) of confident clinicians, it took greater than one year as a doctor to achieve this confidence. Conclusion It appears that whilst senior clinicians do have an impact on how students perceive the importance of nutrition, they do not emphasise it enough and; this may be due to themselves viewing it as a low priority or a lack of confidence. The greater likelihood of F year students disagreeing with nutrition’s inclusion in the curriculum may result from increased time spent on clinical placements compared with T year students, allowing their perception of nutrition to be negatively influenced by the clinicians they shadowed. References 1 Tripisciano F, Neild P. Proceedings of the Nutrition Society. 2010;69(0CE2). 2 Nightingale JM, et al. Clin Nutr. 1999;18(1):23–27. Disclosure of Interest None Declared

A STUDY OF THE STATE OF KNOWING THE NUTRITIONAL LITERACY CONCEPT IN TURKEY

INTRODUCTION:Diet and are important factors in the promotion and maintenance of good health (WHO, 2002). Their role as determinants of chronic noncommunicable disease (obesity, type 2 diabetes, hypertension, dyslipidemia, Coronary Heart Disease (CHD) and stroke) is well established (WHO, 2015). Turkey faces two kinds of nutrition-related problems, undernutrition and micronutrient deficiencies on the one hand and diet -related chronic diseases on the other hand.In general, malnutrition is more prevalent in rural areas, while obesity and cardiovascular diseases are more prevalent in urban areas (Pekcan, 2009).The most important parameters influencing food consumption patterns in Turkey are income level and lack of knowledge (Pekcan & Karaagaoglu, 2000; FAO, 2001). In the studies investigating the nutritional habits and status of university students in Turkey, it was reported that undernutrition, malnutrition and eating disorders problems are caused by reasons such as separation from family for university education, living in dorms, economic status, and lack of knowledge on adequate nutrition; in addition, students do not pay attention to consume regular meal time and eating pattern, and skips meals especially the breakfast with fast-food (Sanlier et al. 2008; Gulec et al. 2008; Ozdogan et al. 2010; Yardimci et al. 2012; Ozkok, 2015).The college years are the period of significant changes in the lifestyles of young adults. Food patterns established during college ar e likely to be maintained for the rest of life and may have long -lasting influences on future health (Brown et al. 2005).It is well documented that college students have unhealthy eating behaviors, including skipping meals, (Huang et al. 1994) frequent snacking on energy-dense food, (Nuru & Mamang, 2015) and engaging in unhealthy weight-loss methods (Story et al. 1998; Liebman et al. 2001).Many factors can contribute to understanding of and healthy eating habits (Boehl, 2007).Economic and household tasks related to food production, processing, provisioning (meal planning, shopping, etc.), cooking and consumption are becoming increasingly complex and are linked to literacy and language proficiency (Arrom, 2011). The term nutrition literacy' has emerged as a distinct form of health literacy, yet scholars continue to reflect on constituent skills and capabilities in light of discussions regarding what it means to be food literate and health literate (Velardo, 2015). Food and literacy term is defined as taking into account, different aspects like social, health, sustainability, food systems, knowledge, skill, attitude, food choice and food consumption by previous researchers. These definitions are used for food literacy or literacy in many studies (Cimbaro, 2008; Zoellner et al. 2009; Vidgen & Gallegos, 2014). Several authors conceptualize literacy as a specific health literacy domain that reflects the ability to access, interpret, and use information (Silk et al. 2008; Carbone & Zoellner, 2012; Watson et al. 2012). Similarly, tohealth literacy, literacy can be defined as the degree of individuals where they can obtain, process, and understand the basic health (nutrition) information and services they need to make appropriate health (nutrition) decisions (IOM, 2004).Nutrition literacy is about using language for creating, understanding and knowledge about food systems. Ecological relationship with biological, social and environmental systems and introducing this understanding and knowledge to individuals and communities (Cimbaro, 2008). Increasing the population's food literacy will allow and empower people to engage in society and influence their local food systems. Food literacy and health literacy can work in conjunction to enable individuals to take ownership over their health and well-being (Cullen et al. 2015).There are many studies implemented in Turkey about the eating habits and knowledge level of university students. …

Iron deficiency as a risk factor for febrile seizures

Introduction: Febrile seizures (FS) are a form of acute symptomatic seizures. Iron deficiency Anaemia (IDA) is one of the most common nutrition related problems in the world. Iron is important for neurological functions and development of brain. Methods: A case control study was done among 100 children at the Pediatric department, NRI Medical College & Hospital. Total of 100 children between age group of 6 months – 6 years with fever were included, out of which 50 children with first febrile seizure were enrolled as cases. 50 children with fever without seizure were enrolled as control group. A pre designed proforma was used to collect the relevant information. Blood samples collected from all cases and control groups and estimated for hematological parameters. Results: The mean age in months was 22.4 among cases and 26.7 months in controls. Nine cases had a positive family history of febrile seizures. Respiratory tract infections were most common underlying cause of illness. The mean and standard deviation values of all the hematological parameters (HB, PCV, MCV, MCH, MCHC & serum Ferritin) showed that measurements were lower among cases compared to control and it was statistically significant. Conclusions: IDA was more frequent among children with FS than those with febrile illness alone. The result suggests that IDA may be a risk factor for FS. Screening for IDA should be considered in children with First Febrile Seizures (FFS).

Abstracts from the 2015 BDA Research Symposium, 2 December 2015, Birmingham, UK.

Jane McClinchy, Rebekah Lindhop, ‘An exploration of the language used alongside the Process for Nutrition and Dietetic Practice (PNDP) to describe nutrition-related problems’, poster presented at the British Dietetic Association Research Symposium, Birmingham, UK, 2 December, 2015.

Manipulation of Carotenoid Content in Plants to Improve Human Health.

Carotenoids are essential components for human nutrition and health, mainly due to their antioxidant and pro-vitamin A activity. Foods with enhanced carotenoid content and composition are essential to ensure carotenoid feasibility in malnourished population of many countries around the world, which is critical to alleviate vitamin A deficiency and other health-related disorders. The pathway of carotenoid biosynthesis is currently well understood, key steps of the pathways in different plant species have been characterized and the corresponding genes identified, as well as other regulatory elements. This enables the manipulation and improvement of carotenoid content and composition in order to control the nutritional value of a number of agronomical important staple crops. Biotechnological and genetic engineering-based strategies to manipulate carotenoid metabolism have been successfully implemented in many crops, with Golden rice as the most relevant example of β-carotene improvement in one of the more widely consumed foods. Conventional breeding strategies have been also adopted in the bio-fortification of carotenoid in staple foods that are highly consumed in developing countries, including maize, cassava and sweet potatoes, to alleviate nutrition-related problems. The objective of the chapter is to summarize major breakthroughs and advances in the enhancement of carotenoid content and composition in agronomical and nutritional important crops, with special emphasis to their potential impact and benefits in human nutrition and health.

Building systemic capacity for nutrition: training towards a professionalised workforce for Africa.

The fundamental role played by good nutrition in enabling personal, social and economic development is now widely recognised as presenting a fundamental global challenge that has to be addressed if major national and international problems are to be resolved in the coming decades. The recent focus provided by the Millennium Development Goals and the Scaling-Up-Nutrition (SUN) movement has been towards reducing the extent of nutrition-related malnutrition in high-burden countries. This has served to emphasise that there is a problem of inadequate professional capacity in nutrition that is sufficiently widespread to severely limit all attempts at the effective delivery and sustainability of nutrition-related and nutrition-enabling interventions that have impact at scale. Many high-burden countries are in sub-Saharan Africa where there is a high dependency on external technical support to address nutrition-related problems. We have sought to explore the nature and magnitude of the capacity needs with a particular focus on achieving levels of competency within standardised professional pre-service training which is fit-for-purpose to meet the objectives within the SUN movement in Africa. We review our experience of engaging with stakeholders through workshops, a gap analysis of the extent of the problem to be addressed, and a review of current efforts in Africa to move the agenda forward. We conclude that there are high aspirations but severely limited human resource and capacity for training that is fit-for-purpose at all skill levels in nutrition-related subjects in Africa. There are no structured or collaborative plans within professional groups to address the wide gap between what is currently available, the ongoing needs and the future expectations for meeting local technical and professional capability. Programmatic initiatives encouraged by agencies and other external players, will need to be matched by improved local capabilities to address the serious efforts required to meet the needs for sustained improvements related to SUN in high-burden countries. Importantly, there are pockets of effort which need to be encouraged within a context in which experience can be shared and mutual support provided.

PTH-148 Artificial nutrition support (ANS) after oesophagectomy for cancer – a review of practice: Abstract PTH-148 Table 1

Introduction ANS is required after Oesophagectomy until resumption of oral intake. Jejunostomy tube (JT) feeding is associated with less post operative complications and shorter hospital length of stay LOS over Parenteral nutrition (PN). However, JT feeding comes with a risk of major complications including volvulus, bowel obstruction, bowel necrosis and mortality. It was routine at GSTFT to place a JT at Oesophagectomy. However, following the death of a patient due to small bowel volvulus/ischaemia this practice was suspended. Patients now receive PN. Method A retrospective observational study was carried out looking at post Oesophagectomy ANS practices at GSTFT in 2014. Data on feeding method used, postoperative LOS, readmissions, mortality, and use of JT after discharge was collated. Results Sixty three patients underwent an Oesophagectomy between January–December 2014; 31 received post operative feeding via a JT and 32 patients received PN. [Table 1][1]presents the demographics and descriptive statistics (using Microsoft Xcel) of results for both groups. Median LOS was shorter in the PN group, which is at odds with the literature. The introduction of enhanced recovery and increased dietetic personnel may have contributed this difference. Nine out of the 11 readmissions were for nutrition related problems and patients went home on JT or Nasojejunal tube feeding. One third of patients who had a JT insitu after discharge, did not use their tube again before removal. Conclusion The results of this study demonstrate the high requirements for ANS in patients following Oesophagectomy. ANS was key in the management of most readmissions. The advantage of JTs over PN is the potential for longterm use. However, given that a third of patients did not need to use their JT after discharge, is the risk of major complications too great that it outweighs the benefits? Prospective randomised studies are required to elucidate this. Better patient selection for JT insertion would prevent some patients undergoing an unnecessary additional risk at surgery. Disclosure of interest None Declared. View this table: Abstract PTH-148 Table 1 [1]: #T1

Analysis of Factors Affecting the Dairy Cattle Holding in Drought Prone Areas: A Study of Raichur District of Karnataka

The dairy farming system enhances sustainable livelihood of farmers in drought prone area as it has been known as one of the activities aimed at alleviating poverty, unemployment, and nutritional related problems especially in rural areas of drought prone area. Karnataka stands next only to Rajasthan in India in terms of total geographical area prone to drought and Raichur district comes under severely affected category. Therefore, it becomes imperative to study the factors influencing holding of dairy animals in a drought prone area like Raichur district. A total of 100 dairy farmers were selected and in that 40 from unirrigated and 60 from irrigated area in the study area. Data were analysed using descriptive statistics and multiple regression analysis. The study revealed that the relationship between cropped area and rearing of dairy animals was positive and significant in irrigated area which indicated that existence of strong crop - livestock interaction. The qualitative and quantitative improvement of crop residues assures further improvement of dairy farming. The government should lay special emphasis on supply of dry fodder particularly in unirrigated areas to ensure round the year availability at cheap rates. As off-farm income plays important role in inducing the farmers to hold dairy animals it signifies the importance of successful implementation of welfare schemes like MGNREGA which have spill-over effects like rearing of dairy animals.

Action-Oriented Population Nutrition Research: High Demand but Limited Supply.

The relatively rapid ascendancy of nutrition and health on policy agendas, along with greater emphasis on accountability and results, has stimulated interest in new forms of research to guide the development and implementation of effective policies, programs, and interventions-what we refer to as action-oriented research. To date, action-oriented research in the nutrition field is thought to be the exception rather than the rule, but empirical evidence to support this claim is lacking. We conducted a survey of selected journals in nutrition and public health to assess the extent and nature of population nutrition research published in 2012 that embodied 5 defined characteristics of action-oriented research in relation to: (1) topic(s) of study, (2) processes/influences, (3) actors, (4) methods, and (5) approaches. We identified 762 articles from the 6 selected nutrition journals and 77 nutrition-related articles from the 4 selected public health journals that met our search criteria. Only 7% of the 762 papers in nutrition journals had at least 1 of the 5 action-oriented research characteristics, compared with 36% of the 77 nutrition-related papers in the public health journals. Of all 80 articles that had at least 1 action-oriented research characteristic, only 5 articles (6.25%) embodied all 5 characteristics. Articles with action-oriented research covered a broad range of topics and processes/influences, including policy, workforce development, and schools, as well as actors, such as program staff, store owners, parents, and school staff. In addition, various research methods were used, such as stakeholder analysis, ethnographic narrative, iterative action research, and decision tree modeling, as well as different approaches, including participant-observer and community-based participatory research. Action-oriented research represents a small fraction of articles published in nutrition journals, especially compared with public health journals. This reinforces recent calls to expand population nutrition research agendas to more effectively inform and guide the initiation, development, implementation, and governance of policies, programs, and interventions to address the varied forms of nutrition-related problems. With heightened attention to the magnitude and importance of nutrition problems worldwide, there are substantial reasons and opportunities to incentivize and support such expansion.

Bearded Dragons: common husbandry and nutrition-related problems

ABSTRACTBearded Dragons are one of the most popular reptiles kept as pets. They are regarded as low maintenance, friendly and inquisitive animals and, because of this, are highly desired. However, they are often presented for a variety of illnesses which, with the correct understanding of this species, could have been prevented. This article aims to inform the veterinary nurse about the common problems associated with keeping Bearded Dragons and about simple husbandry and dietary advice that they can give to owners to promote a healthier lifestyle.

Social marketing and healthy eating: findings from young people in Greece

Greece has high rates of obesity and non-communicable diseases owing to poor dietary choices. This research provides lessons for social marketing to tackle the severe nutrition-related problems in this country by obtaining insight into the eating behaviour of young adults aged 18–23. Also, the main behavioural theories used to inform the research are critically discussed. The research was conducted in Athens. Nine focus groups with young adults from eight educational institutions were conducted and fifty-nine participants’ views towards eating habits, healthy eating and the factors that affect their food choices were explored. The study found that the participants adopted unhealthier nutritional habits after enrolment. Motivations for healthy eating were good health, appearance and psychological consequences, while barriers included lack of time, fast-food availability and taste, peer pressure, lack of knowledge and lack of family support. Participants reported lack of supportive environments when deciding on food choices. Based on the findings, recommendations about the development of the basic 4Ps of the marketing mix, as well as of a fifth P, for Policy are proposed.