AIMS:Healthcare systems contribute significantly to the global environmental footprint, and hospital food services have been identified as having a significant impact. However, existing sustainability studies auditing the food supply chain in the hospital setting have excluded nutrition support. This study aims to quantify the waste associated with oral, enteral, and parenteral nutrition support in a major tertiary-referral hospital and to identify ways to improve waste management. METHODS:This observational audit investigated the types of waste and waste disposal methods associated with nutrition support, to quantify the amount of waste and the cost of waste disposal and associated emissions, and to identify barriers to improved waste management practices. A draft audit checklist was developed as a tool to assist hospitals in nutrition support waste management quality improvement. Calculations and descriptive statistics were used to identify total waste weights, disposal costs and carbon dioxide equivalent emissions for nutrition support products used on the audit day. RESULTS:Nutrition support generated 45.89 kg of waste per day or median 0.19 kg per patient, approximately half of which was discarded formula. Other than the cardboard cartons, a negligible proportion of the waste was recycled; the cost of disposal was approximately $7400 per year. Improving waste management could save $900 per year and reduce total hospital emissions by 7 tonnes of carbon dioxide equivalents. CONCLUSION:Patients receiving nutrition support in hospital generate waste from packaging, containers and discarded formula and this is commonly sent to landfill. Improvements in waste management could benefit environmental sustainability and reduce costs in the healthcare system.
AIM:The lack of research and guidelines on transgender and gender diverse health, including nutrition considerations, contributes to negative health outcomes for transgender and gender diverse people. This study sought to examine dietitians' perspectives, knowledge, and experiences regarding transgender and gender diverse health dietetic practice. METHODS:This critical inquiry study recruited dietitians globally. Data collection involved online surveys and interviews. At survey completion, consenting dietitians were invited to participate in an individual interview or focus group. Quantitative data were analysed using descriptive statistics. Qualitative analysis was conducted through reflexive, team-based thematic analysis. RESULTS:Seventy-eight participants across seven countries completed the survey. Twenty-three dietitians participated in interviews. There was diversity in dietitians' gender, sexuality, disability, chronic illness, and neurodivergence. Many (74%) of dietitians had experience working with transgender and gender diverse people, and 79% reported their comfort to engage with transgender and gender diverse people as high or very high. Six themes were conceptualised: (1) diversity and intersectionality of dietitians; (2) disappointment in the profession; (3) recognition and support for transgender and gender diverse people in dietetic practice; (4) fostering safe, respectful, and inclusive dietetic practice; (5) desire to change; and (6) dissonance and tensions in the transgender and gender diverse space. CONCLUSIONS:Study findings suggest that most dietitians are prepared to support transgender and gender diverse people. The data indicate that some dietitians are disappointed in dietetics as a profession and desire radical change regarding transgender and gender diverse health, with concerns about current practices harming transgender and gender diverse people.
AIMS:This study aimed to explore the experiences of Māori dietitians and students in Aotearoa New Zealand, with a focus on how racism, marginalism and tokenism affect their training, workplaces and wellbeing. METHODS:A kaupapa Māori community research approach was undertaken in partnership with Te Kāhui Manukura o Kai Ora (Māori Dietitians Association). A focus group was held with Māori dietitians and students in March 2024. Data were analysed using reflexive thematic analysis, guided by kaupapa Māori research principles. Candidate themes were then shared with participants in March 2025, and a dissemination strategy was co-designed to protect anonymity. Composite narratives were then developed to illustrate how individual experiences connect to systemic issues. RESULTS:Three composite narratives were developed to highlight shared experiences of racism, tokenism and marginalism across the dietetic journey. Participants described culturally unsafe training environments where deficit stereotypes and staff silence placed additional burdens on Māori students. In workplaces, participants observed Māori patients being subject to inequitable care shaped by racialised assumptions, while Māori dietitians often carried the cultural load of being positioned as 'the Māori voice' without adequate support. These pressures contributed to isolation, burnout and challenges to professional identity, belonging and wellbeing. CONCLUSION:Systemic racism underpins these experiences, creating culturally unsafe environments and unsustainable cultural loading for Māori dietitians and students. Addressing these issues requires profession-wide action to strengthen cultural safety, support the retention and wellbeing of Māori within dietetics.
AIMS:To seek input on the development of a tool for measuring treatment burden in Home Enteral Tube Feeding by healthcare professional consultation. METHODS:A modified two-round online Delphi study recruited experts via an open call to professional organisations and snowball sampling. Experts were healthcare professionals involved in the provision, coordination, or management of care for adults receiving Home Enteral Tube Feeding. In Round 1, participants rated 14 topics grouped under three themes derived from prior qualitative research with Australian Home Enteral Tube Feeding patients and a literature review. Agreement was defined as the proportion of the top two ratings on a five-point Likert scale. Ratings and free-text comments were summarised and presented in Round 2, where topics and themes were re-rated and ranked for usefulness to clinical practice and service management. RESULTS:Forty-five dietitians and nurses completed Round 1 and 32 self-nominated for Round 2, which was completed by 18 respondents. In Round 1, agreement for importance (n = 33-41, 75%-98%) and relevance (n = 28-40, 72%-95%) was high across all topics. In Round 2, agreement for usefulness to practice was 88%-100% (n = 14-18) and for management, 60%-100% (n = 3-5). When prioritised, the theme 'Essential Treatment Work' ranked highest (n = 9, 60%), with three of its six topics placed in the top tertile by at least half of respondents. CONCLUSION:Clinicians perceived measurement of the topics patients previously described as contributing to Home Enteral Tube Feeding burden as important for improving clinical care. Findings support use of these topics to develop a targeted, patient-reported measure that produces clinically meaningful data.
AIMS:The aim of this scoping review was to synthesise how supermarkets shape health behaviours and nutrition-related outcomes of vulnerable populations in Australia. METHODS:Five databases were searched and studies were included if they discussed Australia's major supermarket chains, their relationship with vulnerable populations, and outcomes linked to nutrition behaviour or health. Findings were synthesised narratively and reported using the food systems approach interdisciplinary conceptual framework. RESULTS:Twenty-eight studies met the inclusion criteria. Twenty-seven studies investigated food access, six studies examined health behaviours, and four studies focused on nutrition-related health outcomes. Socioeconomic disadvantage was the only vulnerability explored across all studies. Large supermarket chains provided greater access and availability to foods of higher nutritional quality at lower prices than other types of stores; however, areas of lower socio-economic status experienced poorer proximity to supermarkets. Supermarket food prices were less affordable for low-income households in all locations. Individuals living in lower socio-economic areas had a higher risk of greater body size. CONCLUSION:Supermarkets play a structural role in the health of socioeconomically vulnerable populations in Australia. Supermarkets are important for the provision of higher nutritional quality foods but can also have negative effects through the stocking and marketing of discretionary foods. Future research is required to understand the relationship between supermarkets and other populations experiencing disadvantage and/or vulnerability, such as those with physical disabilities, older adults, youth, and other cultural backgrounds. The extent of alternative food systems and community-based initiatives that provide food for these groups requires further investigation.
AIMS:This study explores the maintenance of dietetic full time equivalent staffing alongside malnutrition rate in a metropolitan renal dialysis service in Victoria, Australia. Objectives were to: (1) describe changes in dietitian staff-to-patient ratios over time; (2) evaluate dietetic service delivery against best practice guidelines and (3) report malnutrition prevalence over a 10-year period. METHODS:Data were collated from nine retrospective point prevalence audits conducted between 2009 and 2024 across satellite, home haemodialysis and peritoneal dialysis modalities. Nutritional status was primarily assessed using the Subjective Global Assessment, with the Mini Nutritional Assessment and Global Leadership Initiative on Malnutrition criteria introduced in 2024. Malnutrition prevalence was analysed across gender, age and dialysis vintage. Staffing levels were mapped against patient growth, with a target of 1 full time equivalent dietitian per 143 patients (1:143). A decade of renal dietetic staffing and malnutrition prevalence in dialysis patients: An observational study in a large dialysis population RESULTS: Between 2014 and 2024, dietitian staffing levels increased proportionally with patient numbers, maintaining dietitian staff-to-patient ratios between 1:126 and 1:157. Nutritional assessments completed in the home haemodialysis population rose from 25% to 96%. Malnutrition prevalence declined from 25% to 18% in the haemodialysis and from 22% to 11% in the home haemodialysis populations. These improvements were sustained over time. Malnutrition prevalence was higher in older adults, females and individuals on dialysis for less than 1 year. CONCLUSION:This audit observed that maintaining dietetics staffing in line with recommendations aligned with sustained reductions in malnutrition prevalence. These findings support the integral role of renal dietitians in multidisciplinary renal care.
AIMS:Food insecurity has increasingly been recognised as a significant challenge among university student populations in Australia. This systematic review aimed to synthesise existing evidence on the prevalence, predictors, and outcomes of food insecurity among university students in Australia. METHODS:A comprehensive search was conducted (May 2025), following PRISMA guidelines, across eight databases (Scopus, Web of Science, Google Scholar, ERIC, MEDLINE, CINAHL, Informit, and PsycINFO). Studies were included if peer reviewed, published in English since 2000, and food insecurity was assessed among students attending tertiary institutions in Australia. Two authors independently screened search results against the inclusion criteria. RESULTS:From 1450 records, 23 met the inclusion criteria: 20 quantitative (n = 105-3077) and 3 qualitative or mixed methods (n = 14-64). 17 studies assessed the prevalence of food insecurity, reporting rates between 9.0% and 77.9%. Fifteen studies examined predictors of food insecurity. Key risk factors included being an international student (n = 2), low income/limited financial resources (n = 3), unstable employment (n = 3), younger age (n = 5), and living alone (n = 9). 6 studies found associations between food insecurity and poor dietary patterns; 5 studies reported associations with poorer physical health. 6 studies identified associations with increased anxiety, depression, and stress, and 2 of 4 studies reported associations with poorer academic performance. Qualitative findings suggested that food insecurity exacerbated existing health conditions and weight management. Studies evaluating interventions to improve student food insecurity were not identified. CONCLUSION:Food insecurity is highly prevalent among Australian university students and was associated with poorer diet and health, and to reduced academic performance. Despite evidence of widespread impact, no evaluated interventions were identified, underscoring the need for coordinated research and policy action in higher education.
AIM:Ultra-processed foods have been associated with a range of adverse health and environmental impacts, yet their supply in health-promoting settings like hospitals remains largely unexamined. This study aimed to assess and quantify the proportion of ultra-processed foods utilised in a sample of Australian hospitals using cook fresh foodservice systems (i.e., most menu items are prepared/cooked just prior to service), and to determine types of ultra-processed foods available in each of the menu categories. METHODS:Cross-sectional data on the foods and drinks available to inpatients in Australian hospitals were collected in October and November 2023. Trained hospital dietitians recorded the standard inpatient menu (Full ward diet), short-order menu items, and oral nutrition support products for paediatric and adult patients over seven consecutive days. Australian food composition databases were used to estimate the energy content of each item. The number of items and energy contribution of ultra-processed foods was estimated by meal (e.g., breakfast, lunch, dinner) and food category (e.g., cereals, spreads, dairy). RESULTS:Six hospitals using predominantly or cook fresh only foodservice systems were included, offering 100-1200 meals per day. Ultra-processed foods contributed 51% of total energy provided, with the highest proportions observed at breakfast and afternoon tea. Bread, dessert, snack, spread/sauce, and drinks had over two-thirds of items classified as UPFs. CONCLUSIONS:Findings suggest a concerning large contribution of ultra-processed foods in Australian hospital cook fresh foodservice systems. These findings have implications for interventions aimed at promoting both public and planetary health in institutional settings.
AIMS:Trust plays a critical role in the decision-making and responsible use of artificial intelligence within professional contexts in health science. This study aimed to develop and validate a novel scale to assess dietitians' perceived trust in dialogue-based artificial intelligence systems within professional practice. METHODS:A three-phase approach was employed to develop and validate the Dietitians' Perceived Trust in Artificial Intelligence for Professional Practice Scale. Phase I involved generating 53 items from a literature review, which were reduced to 33 items by 10 experts via the Davis technique. In Phase II, exploratory factor analysis was conducted on data from 92 participants, resulting in a 12-item, four-factor structure: Data Security, Professional Competence, Scientific Accuracy, and Usability. In Phase III, the psychometric properties were evaluated, and its relationship with the Artificial Intelligence Literacy Scale was examined in a sample of 190 dietitians. RESULTS:Confirmatory factor analysis confirmed model fit with all standardised loadings ranging from 0.69 to 0.89. Internal consistency was high (Cronbach's alpha = 0.89), and reliability values ranged from 0.84 to 0.94 across the factors. Test-retest reliability was supported by intraclass correlation coefficients ranging from 0.66 to 0.86. A significant correlation was observed between the total scores of the Dietitians' Perceived Trust in Artificial Intelligence for Professional Practice Scale and the Artificial Intelligence Literacy Scale (rs = 0.256, p < 0.001). CONCLUSIONS:The Dietitians' Perceived Trust in Artificial Intelligence for Professional Practice Scale is a valid and reliable instrument capturing multidimensional aspects of trust in artificial intelligence tools among dietitians.
AIM:This scoping review aims to explore the literature on social influences on firefighters' occupational dietary behaviour. METHODS:Academic databases (PsycINFO, Web of Science Core Collection, Scopus, PubMed, Embase, ProQuest Dissertations & Theses) were searched from inception to 29 August 2025, for published articles and theses meeting the inclusion criteria: English language, primary research studies reporting on social influences on workplace dietary behaviour in international firefighters aged 18-65 years. RESULTS:Of 2576 identified works, 24 met the eligibility criteria; 20 peer-reviewed studies and four PhD dissertations. Ten qualitative, nine quantitative, and five mixed-methods studies were included. Twenty-one studies were conducted in North America, with the remainder conducted in Australia, Canada, and the United Kingdom. Sample populations included career, volunteer, and wildlands firefighters (n = 14-599), who were predominantly Caucasian males with a median age between 39 and 51 years. The volume of evidence suggests the social influence of colleagues significantly shapes firefighters' dietary behaviour. This influence can be negative (promoting less healthy eating patterns) or positive (promoting healthier eating patterns). Firefighters who exert social influence and those most susceptible to influence tend to exhibit different characteristics. Social influence also plays a key role in communicating normative behaviour, contributing to a distinct culture in firefighting workplaces. CONCLUSIONS:The social influences on firefighters' occupational dietary behaviour warrant further investigation as a potential barrier or facilitator to dietary change. Given diet is a modifiable risk factor for health conditions disproportionately affecting firefighters, understanding these influences is critical to informing effective interventions.
AIM:Malnutrition is prevalent among aged care residents and is exacerbated by inadequate provision and intake of protein. High rates of malnutrition and inadequate provision of protein were two issues raised by the Royal Commission into Aged Care Quality and Safety that prompted the Federal government to provide financial support to the sector to improve nutrition in residents. We aimed to determine if protein provision to, and intake in, residents has improved and meets requirements following the Royal Commission. METHODS:Protein intakes from 12 Pre-Royal Commission studies were identified from a literature search (n = 2378 residents, 85.9 years, 72.3% female). Post-Royal Commission intakes of 78 residents (84.3 years, 84.6% female) were documented. Protein intakes were measured using weighed intake or visual plate waste assessment over 1-3 days. Intakes (±95% confidence interval) for protein (g), relative protein (g/kg body weight), high-protein foods and energy (kJ/kg body weight) were calculated. Differences occurred if the 95% confidence interval between Pre- and Post-Royal Commission intakes did not overlap. RESULTS:Mean relative protein (0.9 g/kg body weight; 95% confidence interval: 0.8-0.9) and energy (98 kJ/kg body weight; 95% confidence interval: 97-100) intakes of residents pre-Royal Commission did not differ to post-Royal Commission residents (protein: 0.9 g/kg body weight; 95% confidence interval: 0.8-1.0, energy: 96 kJ/kg body weight; 95% confidence interval: 88-104). Provision and intakes of high-protein foods remained below recommended levels. CONCLUSIONS:Protein intake of residents and provision of high-protein foods were inadequate prior to and remain below recommendations since the Royal Commission. Regulatory changes such as minimal national nutritional standards for food provision are required to ensure nutritional adequacy of aged care residents.
AIM:Patients receiving home enteral tube feeding have a high risk of complications and readmission to hospital. Enteral nutrition training for health professionals is essential but often not included in basic training curricula. This paper aims to (i) outline the development of a state-wide gastrostomy training program and (ii) undertake a 7-year evaluation of the program. METHODS:A state-wide gastrostomy education and training program was developed and implemented using a spiral learning model, stakeholder engagement, review of the literature, and consumer involvement. Medico-legal consideration was given to credentialing, competencies, and extended scope of practice. Direct outcomes were evaluated using a RE-AIM framework. RESULTS:In the 7 years since starting the program 819 clinicians have completed all online modules including the evaluation, and 178 and 42 clinicians have participated in workshop 1 (gastrostomy care and management) and workshop 2 (gastrostomy removal and replacement), respectively. Additionally, 85 extended care paramedic trainees have participated in the program. Average pre-post measures of knowledge and confidence improved 11% and 23%, respectively, across all aspects of the program. CONCLUSION:The development of a state-wide gastrostomy education and training program allowed health professionals to gain expertise in the specialty area of gastrostomy care to support consistent safe practice. Over the 7 years the program has been functional it has expanded to include regional and ambulance services. There have also been limitations and learnings along the way. The model used for this program may allow others insight into the developing future programs.
AIM:To describe the burden of malnutrition in an at-risk population and validate a screening tool. METHODS:A 10-year cross-sectional study was conducted in a remote hospital. Dietitians screened participants using the Malnutrition Screening Tool or the Adult Nutrition Tool. Participants scoring ≥2 utilising the Malnutrition Screening Tool or ≥4 utilising the Adult Nutrition Tool, or already under the care of a dietitian, were assessed for malnutrition using a Subjective Global Assessment. The validity of the Adult Nutrition Tool was compared to the Malnutrition Screening Tool in participants undergoing a Subjective Global Assessment. RESULTS:Of 980 study participants, 70.1% identified as Aboriginal Australian and 42.6% were at risk of malnutrition. Three-hundred and seventy-four (58.8%) participants were malnourished. The Adult Nutrition Tool showed superior area under the curve (0.74, 95% confidence interval [0.67, 0.81], p < 0.001) than the Malnutrition Screening Tool (0.64, 95% confidence interval [0.56-0.73], p 0.001). An Adult Nutrition Tool score ≥2 demonstrated superior sensitivity (98.2%) and specificity (16.7%) compared to a Malnutrition Screening Tool score ≥2 (sensitivity 97.2% and specificity 14.3%). An Adult Nutrition Tool score of ≥3 demonstrated reduced sensitivity (92.0%) but superior specificity (20.2%) than screening scores ≥2 for both tools. CONCLUSION:Malnutrition risk is high in a remote Australian hospital. This study confirms the Adult Nutrition Tool and the Malnutrition Screening Tool are valid tools to predict malnutrition in a unique remote hospital, recommending an 'at-risk' threshold of ≥2 for the Adult Nutrition Tool to aid in the early detection of malnutrition.
AIM:This study analyses the Hollywood body horror film The Substance to explore how Western beauty culture regulates emotions and bodies. It aims to explore compassion within dominant body image discourses and considers how this impacts dietetic care. METHODS:Using Foucauldian discourse analysis informed by affect theory, the film was analysed through repeated viewings and close readings of the screenplay. This approach enabled attention to both visual and textual elements. The analysis focused on how subjectivity, bodily regulation, and the possibility for compassion are shaped. RESULTS:Three key discursive and affective formations were identified: (1) surveillance and affective discipline as mechanisms enforcing normative appearance ideals; (2) the denial of compassion to bodies deemed unworthy; and (3) the inescapability of disciplinary beauty systems, even for idealised bodies. CONCLUSIONS:The film shows how Western media circulates power by shaping what is known and felt about bodies, often denying compassion to those who do not fit dominant beauty ideals. This underscores the need for dietitians to reflect on how professional practices may unintentionally reinforce harmful norms. Compassion, understood as an affective and discursive counter-practice, can disrupt these norms and create space for more inclusive, caring approaches to bodies in dietetic care.
AIMS:The opening of a new digital metropolitan hospital with surgical and subacute cohorts required a flexible food service model to meet diverse patient needs. This project aimed to design, implement and evaluate such a system, optimising service efficiencies and patient experience. METHODS:A flexible, mixed-model food service was designed by reviewing research, consulting experts, and gathering consumer feedback. The Knowledge-To-Action framework guided the model's development and implementation. Key features included an on-demand meal ordering system on the surgical ward; efficient and safe communal dining and snack services for long-stay patients; routine patient food intake hospital-wide to proactively identify at-risk patients; innovative waste and cost recovery strategies. Evaluation was based on the quadruple aims of healthcare measuring patient satisfaction, malnutrition prevalence, mealtime assistance, food waste and cost, and staff satisfaction. The success of targeted implementation strategies was also monitored. RESULTS:Patients were highly satisfied with the food service model (4.6/5, n = 1284). High rates of mealtime assistance (>90% over 3 years) were achieved, and malnutrition prevalence was 21% (82/369) over the 3 years. Low plate waste (3-year average 16.5%) and an average food cost per meal of $4.73 were reported. Staff satisfaction was high, with a culture of success noted. CONCLUSIONS:This flexible, mixed model food service met the needs of different patient cohorts across surgical, subacute and outpatient services, optimising service efficiencies, patient outcomes and staff satisfaction. This project serves as a guide for creating food service models that address diverse patient needs in hospital settings, translating contemporary evidence into practice.
AIMS:Nutrition content claims and health claims are commonly displayed on food packaging and are known to influence consumer preferences and purchasing of labelled foods. This study aimed to assess the prevalence of content and health claims found on ready meals in the Australian food supply and examine their alignment with the Nutrient Profiling Scoring Criterion and Standard 1.2.7 of the Food Standards Code. METHODS:In a cross-sectional analysis, ready meal products were identified from the Australian FoodSwitch 2023 database to record serving size, nutrition information, Health Star Rating and claims for each product. The Nutrient Profiling Score was calculated for each product and claim compliance was assessed against Standard 1.2.7. Descriptive statistics were conducted to explore the data for prevalence of content and health claims, and alignment with the relevant standard. RESULTS:A total of n = 777 ready meals were identified in the database. Eighty-eight percent of products met threshold criteria for eligibility to carry a health claim. In total, 2051 claims were identified, with nutrition content claims the most common (93% of all claims). In total, 92% of nutrition content claims and 39% of general-level health claims complied with all provisions of Standard 1.2.7. CONCLUSIONS:This study highlights the widespread use of claims, particularly nutrition content claims, on ready meal products sold in Australia. Strengthened guidelines and stricter enforcement of claim compliance are essential to prevent misleading claims in the Australian food supply.
AIMS:Transition to employment is considered a vulnerable period for health professional graduates. This study aimed to follow the transition to employment for graduates from a single dietetics program, at several timepoints over 24 months to assess dietetic employment outcomes. METHODS:Griffith University dietetics graduates from 2017 to 2019 were invited to participate in the longitudinal Griffith Dietetics Graduate Outcomes Study comprising four online surveys on employment preferences and outcomes: Survey 1 (graduation), Survey 2 (6-months), Survey 3 (12-months), and Survey 4 (24-months). Quantitative data were analysed using descriptive statistics, for cross-sectional findings (Surveys 3 and 4) and longitudinal analyses (Surveys 1-4). RESULTS:Of the 150 eligible graduates, 91.3%, 73.3%, 59.3% and 51.3% responded to Surveys 1-4 respectively. At Survey 3, 84.3% of respondents were employed as a dietitian, 60.0% working more than 32 h/week and 25.3% in permanent positions. At Survey 4, 85.7% worked as a dietitian, 69.7% more than 32 h/week, predominantly in hospitals (45.5%) and private practice (37.9%). Longitudinal analyses showed that of 44/62 (70.1%) respondents who preferred a hospital role at graduation, 25 (56.8%) worked in a hospital at 24 months. All but one of the 16/62 (25.8%) who preferred private practice at graduation worked there at 6 months (93.8%), 12 of whom remained in private practice at 24 months (75%). CONCLUSION:Universities need to prepare graduates for the challenging transition to full-time employment within their preferred sector. For dietitians within this study, the most vulnerable period was the 12 months post-graduation. National, longitudinal studies to at least 24 months are needed to investigate graduate employment outcomes for all dietetics programs.
