BACKGROUND:It is well-established that earlier generations of lipid emulsions based on soybean oil are inferior to later generations based on olive or fish oil. However, evidence directly comparing between later-generation lipid emulsions is limited. This study aims to systematically review existing literature comparing olive versus fish oil based parenteral nutrition formulations within an inpatient setting, and to evaluate clinical outcomes. METHODS:Electronic databases Medline, Embase, CINAHL and Web of Science were searched from earliest to current date. Titles, abstracts and full texts were screened for eligibility. Eligible papers were assessed for risk of bias and relevant data were extracted for a qualitative summary of results. RESULTS:Six papers in total were eligible. Primary outcomes of interest reported across the six papers were related to infection, inflammation and oxidative stress. Overall, the number of studies and significant findings were limited. Based on the current evidence it is not possible to promote either fish or olive oil emulsions as superior to the other in influencing immune function, inflammation, liver function or clinical outcomes. CONCLUSIONS:While previous evidence has shown the clear benefits to reducing soybean oil content, the similar benefits may be obtained by replacing this with either olive or fish oil. More high-quality research is required to further explore olive versus fish oil based parenteral nutrition to guide clinical practice.
BACKGROUND:Cancer cachexia describes the muscle and weight loss, anorexia, and physical impairment common in certain adult cancers. No formal criteria exist to define paediatric cancer cachexia, making its clinical recognition and impact largely unknown. Using established undernutrition guidelines, criteria were developed to identify potential cachexia in children with cancer based on standardised anthropometric measures or diagnostic codes. METHODS:The Surveillance, Epidemiology, and End Results and Optum Electronic Health Records databases were used to estimate prevalence and incidence rates of cancer and cancer cachexia between 2017 and 2021 in patients aged < 20 and < 18 years, respectively. In the absence of a consensus definition for paediatric cachexia, four sets of candidate criteria were developed based on body weight for length/height or body mass index z-scores, or reduced gain or loss of body weight, corresponding to mild or severe undernutrition. A fifth criterion required a potentially cachexia-related ICD-10-CM diagnosis code. RESULTS:This study included 26,855 paediatric patients (aged < 18 years) with cancer; ~90% were aged ≥ 2 years. Epidemiologic estimates for cancer cachexia prevalence and incidence rate varied considerably by age, cancer type and cachexia definition. Estimates were low for most categories, especially in the youngest age groups; however, cachexia was difficult to assess in patients aged < 2 years due to small patient numbers. CONCLUSIONS:We describe one of the first attempts to develop potential paediatric cachexia criteria. These criteria and resulting data provide a framework to inform further research into generating consensus guidelines for the identification of childhood cancer cachexia.
INTRODUCTION:Food policies and standards regulate school meal equity and quality, yet there is a complex system involved in translating and implementing these standards. To catalyze systems-level thinking in school meals, stakeholders across the supply chain were asked to collaborate in examining the role of dairy as representative of broader food system opportunities and challenges in California school meals. METHODS:This descriptive case study applied the What, So What, Now What reflective framework, 19 phone interviews of school nutrition directors and dairy processors, conducted from August to September 2024, logged current practices, infrastructures, supports and insights. Results informed an in-person convening of 40 supply chain stakeholders in January 2025. At the convening, three presentations, four themed small-group dialogues and a strategic planning session sought options for improving student wellness by modifying the school meal system. RESULTS:Interviews focused on the "what," gathering facts about procurement, nutrition and policy compliance challenges. Convening dialogues focused on the "so what," making meaning of the challenges and expanding knowledge on dairy innovation and the future of school meals from different perspectives across the supply chain. The strategic planning session (the "now what") revealed opportunities that were shaped into actionable next steps emphasizing farm-to-cafeteria nutrition education, incorporating a wider cultural variety of dairy foods and activating local food system partnerships and professional development across the food supply chain. DISCUSSION:Collaboration and structured systems thinking identified next steps for dairy that support the supply chain from processors to foodservice professionals to student consumers. Using a systems thinking framework allowed stakeholders to understand the issues more objectively, consider different perspectives and identify actionable solutions. Outcomes also suggest supply chain collaboration can be a replicable blueprint for troubleshooting other institutional food systems.
OBJECTIVE:This study aimed to evaluate the validity and reliability of the Turkish version of the Short Questionnaire for the Evaluation of Adherence to the Mediterranean Diet and Nutritional Sustainability (MedQ-Sus), which excludes alcohol consumption and simultaneously assesses adherence to the Mediterranean diet and a sustainable diet, in adults. METHODS:The study included 138 adults, of whom 39.9% were male and 60.1% were female, with a mean age of 34.3 ± 12.7 years. The MedQ-Sus is a brief questionnaire that generates a Mediterranean Diet score and a Sustainable Diet score from the same eight food-group consumption data using different scoring criteria. Dietary intake was assessed using 3-day food records. Validity was evaluated by comparing the MedQ-Sus scores with corresponding food-group and nutrient intakes derived from the food records and by examining construct validity using a modified alternate Mediterranean Diet score (aMED) and the Planetary Health Diet Index (PHDI). Associations and agreement were assessed using Spearman correlation coefficients, Bland-Altman analysis, and intraclass correlation coefficients (ICCs) based on absolute agreement, as appropriate. Test-retest reliability was evaluated in 71 randomly selected participants 4 weeks after the initial administration. RESULTS:Statistically significant and positive correlations were found between the consumption levels of all food groups associated with the Mediterranean Diet score components. The Sustainable Diet score showed positive correlations with all food groups except legumes and fresh fruits (p < 0.05). The strongest relationship for both the Mediterranean Diet score (r = 0.490) and the Sustainable Diet score (r = 0.488) was observed in the consumption of fish and fish products (p < 0.001). Bland-Altman analysis indicated an acceptable level of agreement between the MedQ-Sus scores and the corresponding estimates derived from the food records. As adherence levels measured by the MedQ-Sus increased, intakes of fish, olive oil, dietary fibre, magnesium, zinc, monounsaturated fatty acids, and omega-3 fatty acids increased, whereas polyunsaturated fatty acid intake decreased. In the test-retest analysis, strong positive correlations were observed for the Mediterranean Diet score (r = 0.782) and the Sustainable Diet score (r = 0.813) (both p < 0.001). CONCLUSION:The MedQ-Sus demonstrated good validity and reliability as a practical screening tool for simultaneously assessing adherence to the Mediterranean diet and adherence to a sustainable diet among the adults included in this study, while its exclusion of alcohol consumption may support its use across different adult population groups.
BACKGROUND AND AIM:Ginger (Zingiber officinale L.) contains bioactive compounds with vasodilatory properties that may benefit blood pressure (BP) regulation. However, findings from studies remain inconsistent. This systematic review and meta-analysis aimed to evaluate the effect of ginger supplementation on BP in adults. METHODS:The literature was systematically searched in PubMed, Web of Science, and Scopus from database inception through May 1, 2026, to identify eligible randomized controlled trials (RCTs) evaluating systolic and diastolic blood pressure (SBP, DBP). Pooled effect estimates were calculated as weighted mean differences (WMDs) using a random-effects model. Subgroup and sensitivity analyses, publication bias assessments, and both linear and nonlinear dose-response analyses were conducted. The risk of bias was evaluated using the RoB 2 tool, and the certainty of the evidence was assessed according to the GRADE framework. RESULTS:Twelve unique RCTs contributed 13 effect sizes for SBP and 12 effect sizes for DBP. Ginger supplementation significantly reduced SBP (WMD: -5.03 mmHg, 95% CI: -8.49, -1.57; p = 0.004) and DBP (WMD: -2.03 mmHg, 95% CI: -3.90, -0.15; p = 0.034). Subgroup-specific reductions were observed in trials enrolling participants with elevated baseline BP, using doses ≥ 2000 mg/day, including both sexes, and enrolling participants with obesity. Nonlinear dose-response analyses confirmed a significant inverse association between ginger dose and BP, whereas intervention duration had no meaningful influence. Findings remained robust in sensitivity analyses, and no evidence of publication bias was detected. GRADE assessment rated the certainty of the evidence as low, downgraded only for inconsistency. CONCLUSION:Ginger supplementation was associated with modest reductions in BP, with potentially greater effects in higher-risk populations and at doses ≥ 2000 mg/day. However, substantial heterogeneity, short trial durations, and limited robustness of the DBP findings reduce confidence in these estimates. Further high-quality, long-term RCTs are needed before definitive clinical or dosing recommendations can be made.
INTRODUCTION:People with cystic fibrosis (PwCF) have historically been counselled to eat a high-energy, high-fat diet to prevent malnutrition. The widespread availability of novel drug therapy has led to increased weight and body composition changes in this population, necessitating dietary and lifestyle changes to promote optimal health and well-being. The objective of our study was to understand the attitudes, perspectives, and practices related to nutrition issues in the context of elexacaftor-tezacaftor-ivacaftor (ETI) use. METHODS:Semi-structured interviews were conducted with PwCF on topics of body image, perceptions of nutrition status, dietary changes, and CF care team relationships in the context of ETI. Interviews were analysed by two independent coders using inductive thematic analysis. RESULTS:Ten adult PwCF were interviewed. Participants were predominantly white (80%), and half were female. Body mass index ranged from 18.9 to 37.1 kg/m2. Three global themes were identified: finding balance, a new normal, and working together. Participants discussed pre and post-ETI diet experiences, body image changes and perceptions, and interactions with CF care teams and other mechanisms of support. CONCLUSIONS:Perspectives on nutrition status changes on ETI were diverse in our sample and reflect participants' adjustment to a redefined standard of health and nutrition in this new era of CF care. Findings indicate opportunities for partnership strategies with the CF care team, and for providing updated educational resources and personalised nutritional counselling to support the individual needs of PwCF as they navigate dietary and health behaviour changes.
OBJECTIVE:This narrative review evaluates the current evidence on the efficacy of probiotic interventions for Attention Deficit Hyperactivity Disorder (ADHD) symptoms in both medicated and drug-naïve paediatric and adult populations and assesses the implications for clinical dietetic practice. DESIGN:A narrative review synthesizing randomized controlled trials and observational microbiome studies in paediatric and adult populations, specifically distinguishing between probiotic monotherapy and adjunctive protocols. RESULTS:Observational data confirm gut microbiome alterations in ADHD populations, although specific bacterial signatures vary across studies. Evidence from treatment trials demonstrates that the efficacy of probiotics as monotherapy for core ADHD symptoms remains inconclusive. However, specific adjunctive trials combining probiotics with conventional medication have reported preliminary positive findings on symptom reduction, though results remain heterogeneous. Adult evidence is sparse but indicates potential benefits for emotional dysregulation in specific contexts. CONCLUSIONS:This review concludes that current data do not support universal probiotic supplementation or routine clinical recommendation. However, when families inquire about complementary approaches, the existing literature enables evidence informed guidance within a shared decision-making framework that acknowledges the preliminary nature of current findings and sets realistic expectations.
BACKGROUND:This study aimed to examine the changes in orthorexia nervosa (ON) tendencies among dancers at different levels before and during the COVID-19 pandemic. METHODS:This retrospective repeated-measures observational study included 128 professional, semi-professional, and amateur dancers (86 females, 42 males; 19-40 years) from various dance styles. Orthorexia nervosa tendencies before and during COVID-19 were assessed using ORTO-11 and ORTO-15. Physical activity and anthropometric data were collected for both recalled pre-pandemic and pandemic periods, while energy and macronutrient intakes were assessed using a retrospective 24-h dietary recall. Data were analyzed using paired tests, effect sizes (ES), and multivariate linear regression. RESULTS:During the pandemic, dancers reported approximately 50% lower weekly dance frequency and daily dance duration than recalled pre-pandemic values, with large and significant effect sizes. Significant decreases were observed in ORTO-11 and ORTO-15 scores, indicating an increase in orthorexic tendencies. Pandemic-period self-reported body weight was higher than pre-pandemic body weight, whereas BMI did not differ significantly between the recalled pre-pandemic and pandemic-period assessments. In multivariate analyses, female sex remained an independent predictor for both ORTO-11 and ORTO-15 scores. CONCLUSIONS:Compared with recalled pre-pandemic scores, pandemic-period ORTO-11 and ORTO-15 scores were lower, suggesting higher ORTO-measured health-oriented eating tendencies among dancers. Given the retrospective self-report design and the methodological limitations of ORTO-based instruments, these findings should not be interpreted as evidence of clinical ON prevalence or precise longitudinal change. Nevertheless, these ORTO-measured tendencies appeared to differ not only behaviorally but also in relation to nutrient intake patterns. Female sex was associated with pandemic-period ORTO scores, but this finding should be interpreted cautiously because psychological, sociocultural, and clinical variables were not assessed.
OBJECTIVES:With obesity management medications being used more widely, it is important to understand the role of the dietitian in the obesity care pathway. This study examined primary-care dietitians' perspectives on the various phases of the obesity care pathway, from patients living with obesity (PwO) accessing nutritional services through monitoring and referral. METHODS:In this qualitative study, first-line dietitians in Flanders, Belgium, between March, 2025 and June, 2025, were invited to participate. Participants were interviewed, and data were transcribed and analysed using thematic analysis. The first section of the semi-structured interview guide focused on how PwO typically access nutrition therapy, how dietitians monitor and follow up with PwO, and the criteria they use for referral. Lastly, dietitians were asked about their collaboration with other healthcare professionals involved in the care of PwO. RESULTS:Twelve dietitians were interviewed before data saturation was reached. PwO accessed dietetic care mainly through self-initiative or medical referral, though referrals from general practitioners (GPs) were reported as limited. Monitoring and follow-up varied widely in duration and evaluation tools, while barriers such as limited patient motivation, time constraints, and limited reimbursement for dietetic care hindered continuity of care. Dietitians highlighted the need for referral guidelines, digital tools to support interprofessional communication, educational initiatives on interprofessional collaboration, and a central care coordinator to improve obesity care. CONCLUSION:This qualitative study examined primary-care dietitians' experiences across the obesity care pathway, from patient access to monitoring and referral. Dietitians highlighted limited referrals from GPs as well as variability in the duration and monitoring practices of nutritional therapy. Clear treat-to-target and referral guidelines could reduce reliance on individual clinical judgement, promote coordinated care and prevent delays in effective multidisciplinary care.
INTRODUCTION:Preparing nutrition and dietetics professionals for the complexity of modern food, health, and environmental systems requires educational models that move beyond reductionist training. Systems thinking and transformational learning offer frameworks that support integrative, adaptive, and equity-oriented professional development. This case study describes a systems-based experiential learning pathway designed to cultivate systems literacy, leadership, and cross-sector collaboration among nutrition students. METHODS:A multi-year experiential learning model was implemented within the University of [Minnesota]'s Department of [Food Science & Nutrition]. This case study design included nine sequential activities were co-designed by a student and faculty mentor using systems thinking and transformational learning principles. Activities engaged the student across community, non-profit, regulatory, agricultural, industry, teaching, and leadership contexts. Mentorship meetings, reflective journaling, and iterative feedback loops were used to assess competency development related to systems thinking, ethical decision-making, interdisciplinary collaboration, and adaptive problem-solving. RESULTS:Experiential learning produced outcomes at personal, institutional, and systems levels. Personally, the student developed transdisciplinary collaboration skills, systems thinking competency, reflective practice, and adaptive leadership capacity. Institutionally, the case contributed to new systems-oriented curricular components, student-led organizations, and expanded mentoring structures that embedded systems thinking into departmental culture. At the systems level, partnerships across industry, government, and non-profit organizations strengthened knowledge exchange and demonstrated how systems-trained students can facilitate cross-sector alignment, support community-engaged problem-solving, and contribute to food system innovation. CONCLUSION:This systems-based experiential learning model demonstrates how intentional mentorship, reflective practice, and cross-sector engagement can cultivate the competencies required for nutrition and dietetics professionals to navigate 21st-century food system challenges. Embedding systems thinking into both curricular and co-curricular structures fosters a workforce capable of leading collaborative, evidence-informed, and equity-focused change. The case provides a replicable model for integrating systems thinking into nutrition education to prepare graduates to engage effectively within complex, interconnected food, health, and environmental systems.
Clinical practice guidelines (CPGs) are essential tools to support evidence-based nutritional care in critically ill patients; however, the methodological quality and credibility of recommendations for nutritional risk screening remain unclear. This study aimed to evaluate the methodological quality of CPGs addressing nutritional risk screening in critically ill adults and to critically appraise the evidence supporting these recommendations. A systematic search was conducted between January and April 2026 in Embase, PubMed, SciELO, Scopus, LILACS, Google Scholar, and guideline repositories. CPGs, consensus statements, and position papers, including nutritional risk screening recommendations for critically ill adults were eligible. Guideline quality was assessed using the AGREE II and AGREE-REX instruments. Original studies and systematic reviews supporting nutritional risk screening recommendations were critically appraised using ROBINS-E and AMSTAR 2, respectively. Four CPGs were included. AGREE II assessment demonstrated satisfactory methodological quality overall, particularly in Scope and Purpose (84.4%) and Clarity of Presentation (92.0%), whereas Applicability showed the lowest performance (50.0%). AGREE-REX evaluation demonstrated moderate overall recommendation quality (64.8%), with the Chinese Society of Critical Care Medicine guideline presenting the highest score (77.8%). Most original studies supporting recommendations were classified as having high or very high risk of bias, and one systematic review was classified as critically low confidence. Although the included guidelines demonstrated satisfactory methodological quality, important limitations were identified regarding recommendation credibility, applicability, and evidence quality. These findings highlight the need for higher-quality evidence synthesis, transparent risk-of-bias assessment, and improved implementation strategies in future guideline development.
BACKGROUND:The delivery of artificial nutrition support during acute illness in patients who are pregnant is complex with considerations for both maternal and foetal health outcomes. However, there is little known about the research available to guide the artificial nutrition support during pregnancy. This scoping review aims to examine the literature related to artificial nutrition support practices during acute illness in pregnancy, to understand current research, identify gaps and inform directions for future research. METHODS:The review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. A systematic search of five databases (MEDLINE, Embase, CINAHL, Web of Science and the Maternal and Infant Care Database (MIDIRS)) was conducted. Eligible studies involved adult pregnant patients aged 18 or over, hospitalised across a variety of care settings, and receiving artificial nutrition in the form of enteral nutrition or parenteral nutrition. Studies not written in English Language were excluded. Data were extracted on weight, gestation period, type and route of feeding, indication for artificial feeding, energy target and provision, protein target and provision, duration of intervention, micronutrient delivery and supplementation, method of delivery, foetal birthweight and maternal and foetal outcomes. RESULTS:A total of 24 studies were included of which the majority were case reports (n = 12 studies), followed by case series (n = 7), and only one randomised controlled trial (early enteral feeding vs standard care). The most common indication for artificial nutrition support was hyperemesis gravidarum (n = 14 studies) and the most common method was parenteral nutrition (n = 14). There was considerable heterogeneity in reporting of energy and protein targets and delivery, micronutrient supplementation, weight change over pregnancy and maternal and foetal outcomes. CONCLUSIONS:This scoping review highlighted the very limited number of studies regarding artificial nutrition support during pregnancy. Hugh quality research is urgently required to inform guidelines and standardise and optimise management strategies and improve outcomes in this complex patient cohort.
BACKGROUND:The quality of food environments in secondary schools in the Republic of Ireland (ROI) varies depending on local practices. Funding for free hot school meals recently increased significantly with phased implementation and priority for universal access in primary schools and among 'disadvantaged' status schools at the secondary level. Engagement with students, in the context of rapidly changing school food policies, is lacking. This study explored students' views about the food environment in secondary schools using a system-based approach and identified student priorities for actions and policies to support school food environments that are healthy for people and planet. METHODS:A cross-sectional qualitative study design using participatory methods was used. Public secondary schools were recruited in 2023 and 2024. Fourth year students volunteered to participate in one CO-CREATE Dialogue Forum per school on the idea: How to make our school food environment better for our health and the planet? Data were analysed using content analysis. The systems-based action scales model was applied to categorise students' recommendations for a desired system. RESULTS:Sixty-two students (55% female) aged 15-17 years in eight schools (including four schools designated 'disadvantaged' status) participated in dialogue forums. Issues with time, space and mealtime infrastructure were reported by students. Dissatisfaction with food quality and lack of variety were reported by some. Practices that identify students accessing free school meals risk perpetuating stigma. Food and packaging waste and catering for diverse food cultures and health needs were students' primary concerns from a planetary health perspective, with a small minority suggesting more plant-based food options. Limited opportunities to influence school food were reported. In the desired system, food choice, taste and quality, food and packaging waste, adequate spaces to eat and socialise, improved break-time logistics (e.g., food ordering system, time available, queue systems), and structures for participation and influence were priorities for students. CONCLUSION:The CO-CREATE Dialogue Forum was an effective method for exploring school food, with students demonstrating systems thinking ability in considering a range of factors shaping their environments. Their ideas and solutions are important to inform policy and practice at local school, public health and government levels.
BACKGROUND:Dietary management of hyperkalaemia in chronic kidney disease has traditionally focused on potassium restriction. However, contemporary renal nutrition practice increasingly requires dietitians to balance biochemical safety with nutritional adequacy, dietary quality, treatment burden, and patient wellbeing. Limited empirical evidence has examined how renal dietitians reason through these competing priorities in routine practice. OBJECTIVE:To explore how renal dietitians approach dietary hyperkalaemia management in chronic kidney disease and to examine the professional reasoning underpinning dietary decision-making. METHODS:This qualitative study integrated free-text responses from an international online survey of renal dietitians with semi-structured interviews. Survey free-text responses provided breadth across practice settings, while interviews enabled more detailed exploration of clinical reasoning. Data from 203 survey respondents and eight interview participants were analysed consequently using reflexive thematic analysis to examine how dietitians prioritised, sequenced, and adapted dietary interventions. RESULTS:Dietitians described dietary hyperkalaemia management as a staged but flexible process of professional reasoning. Four interrelated themes were identified: consideration of non-dietary contributors before dietary restriction; prioritisation of potassium additives and highly processed foods; preservation of nutritional adequacy as a central boundary condition; and selective restriction of potassium-rich whole foods only when clinically indicated. Dietary restriction was not described as an automatic response to elevated serum potassium, but as one possible component of a broader reasoning process shaped by biochemical trends, nutritional status, clinical urgency, patient preferences, and psychosocial context. These findings informed development of the Prioritisation and Reasoning in the Management of Elevated Potassium in Chronic Kidney Disease model, known as PRIME-K. CONCLUSIONS:Renal dietitians reported using flexible professional judgement to manage hyperkalaemia while minimising unnecessary dietary burden and protecting nutritional adequacy. The PRIME-K model offers a practice-informed representation of professional reasoning in dietary hyperkalaemia management and may support dietetic education, reflective practice, and the development of more context-sensitive approaches to dietary care in chronic kidney disease.
INTRODUCTION:Nutrition is not currently integrated into standard care provision in sickle cell disease (SCD) impacting patients experience, access and outcomes of nutrition. The lack of understanding of the nutritional needs in SCD and its impact on patient outcomes requires exploration to integrate nutrition into clinical practice. However, there is a paucity of qualitative studies conducted with sickle cell service users/carers to explore their views, knowledge and experiences of nutritional care and the influencing factors affecting nutrition integration in SCD care. METHODS:An independent focus group involving SCD service users and carers formed part of a larger four phased participatory sequential Learning Alliance study conducted between March and December of 2020. Purposive sampling was used to recruit suitable adult sickle cell service users/carers (n = 11) to participate in this UK based study. RESULTS:Four main themes were generated including 1) The invisibility of SCD, 2) Under -recognised importance of nutrition, 3) Lack of priority to nutrition and 4) Multi-level factors affecting nutrition and service provision that underscore key knowledge and care gaps in addition to an array of influencing factors affecting nutrition integration in SCD. Moreover, these themes reflect the complexity of sickle cell nutrition and the impact of the lack of nutrition integration on SCD patients access and outcomes of nutrition. CONCLUSION:The main findings provide evidence of the nutrition knowledge and care gaps in SCD and the need to address the under-recognition and lack of priority to nutrition, driving the lack of nutrition integration and poor patient outcomes in SCD.
BACKGROUND:Nutrition is a significant modifiable risk factor for many illnesses. One often-cited barrier to diet change is the perceived cost of healthy food. While many diet diary templates exist, none have been developed to capture the data needed for calculating the cost of a diet consumed during a diet intervention study. METHODS:The objective of the present project was to develop and pilot test (1) a tailored diet diary template with instructions, and (2) alternative approaches for calculating diet cost. We created a draft diet diary and instructions which were used by participants. We used those data to test the feasibility of calculating weekly diet cost. Two methods were used: calculation of the cost of the actual price of the items purchased, and standardised prices. Acceptability was assessed by conducting participant interviews and the feedback that was provided was used to revise them. The methods to calculate costs were compared in terms of feasibility and researcher time needed. RESULTS:Of the 15 participants enrolled, 14 completed the interview. All participants reported that the process was acceptable or highly acceptable. Participant feedback was used to guide changes to the diet diary and instructions. Costs were calculated for 85.3% to 96.3% of food items. The researcher time needed to complete each method per participant, per week was 5 to 6.5 h. Participants who gave feedback confirmed that the edits addressed their previous concerns. CONCLUSIONS:Overall, the diet diary and instructions were acceptable to participants who are women and feasible for the collection and costing of diet data in Canada.
INTRODUCTION:Dietitians are increasingly called upon to address complex food systems challenges, including the transition to circular economies that support both human and planetary health. This reflexive perspective draws on a structured reflective process undertaken by the research team to explore how dietitians can apply their core competencies, such as critical thinking, evidence-based practice, and communication, to lead and facilitate food systems transformation. MATERIALS AND METHODS:Drawing on a case study from the Bega Valley region of Australia, known for its unique focus on circularity, researchers from the University of Wollongong conducted interviews with small-scale agrifood producers to identify barriers and enablers to circular supply chains. Findings from this prior qualitative study subsequently informed a structured reflection process undertaken by the inter-disciplinary research team which included dietitians. Using Borton's Reflective Model ('What? So What? Now What?' framework), researchers reflected on the role of dietitians in advancing food systems transformation. Reflexive thematic analysis was applied to the written reflections to identify key themes across each stage of the framework. RESULTS:Of the 10 original research team members, seven completed the reflection process, comprising three dietitians, two engineers with an interest in circular economy, one supply chain expert, and one food systems doctoral researcher. The collective reflections showed: What? We engaged in research exploring perspectives of small-scale producers towards circularity to understand the barriers and enablers towards implementing more circular supply chains. So What? The reflection highlighted dietitians' capacity to engage diverse stakeholders and navigate complexity, with potential to broaden their scope in transitioning the food system. Now What? Researchers proposed actionable pathways to increase dietitians' competencies in systems transformation. Professional advocacy is required to position dietitians for future food system and policy roles. CONCLUSION:Reflections from this study suggest that dietitians are well-positioned to act as connectors and brokers within food systems when equipped with systems thinking tools and opportunities for cross-sector engagement.
OBJECTIVE:To identify the key behavioural determinants that influence dietary self-management among adults with CKD, using the Theoretical Domains Framework and Behaviour Change Wheel to guide development of practical dietary interventions for clinical practice and research trials. METHODS:A theory-informed secondary analysis of a published qualitative meta-synthesis that included 92 studies and 2924 adults with CKD from 23 countries. Themes from the meta-synthesis were mapped to Theoretical Domains Framework (v2) and linked to Behaviour Change Wheel intervention functions and behaviour change techniques. Potential behaviour change intervention strategies were then evaluated using the APEASE criteria (Affordability, Practicability, Effectiveness/Cost-effectiveness, Acceptability, Side-effects/Safety, Equity). RESULTS:Twelve of the 14 Theoretical Domains Framework (v2) domains were identified, indicating that dietary self-management in CKD is influenced by a broad range of cognitive, emotional, social, and environmental factors. Key barriers included inconsistent or conflicting dietary advice (Knowledge; Environmental Context and Resources), limited practical guidance (Skills; Behavioural Regulation), and emotional distress and social disruption associated with dietary change (Emotion; Social Influences). Trust in healthcare professionals and experiential learning also shaped adherence (Beliefs about Capabilities and Consequences). Optimism and Intentions domains were not evident. Mapping to the Behaviour Change Wheel identified Education, Enablement, Environmental Restructuring, Training, Persuasion, Incentivisation, and Modelling as relevant intervention functions. APEASE assessment suggested that Education and Enablement were the most feasible, acceptable, and scalable approaches for clinical implementation, while more complex components requiring additional resources or coordination (e.g., training and system-level changes) were comparatively less practical. CONCLUSIONS:Dietary self-management in CKD is influenced by multiple behavioural determinants beyond knowledge alone. Interventions should therefore integrate education with skills training, confidence building, social support, and environmental adaptation. Embedding these multi-component strategies within clinical nutrition practice and research may enhance self-management and improve patient engagement across the CKD care pathway.
INTRODUCTION:Emerging adult college students often experience poor diet quality (DQ) and rely heavily on ultra-processed foods (UPFs), such as sugary beverages, salty snacks, sweet snacks, and other calorie-dense, convenience foods. Meal kits, which provide pre-portioned ingredients and simple recipes, may offer a practical strategy to support healthier eating among emerging adults, yet their relevance and feasibility in college settings remain poorly understood. This study aims to assess the health behaviors, needs, and preferences of the target college student population to inform the development and feasibility of a pilot meal kit program. METHODS:This exploratory, community-informed research used a multi-method approach implemented in two phases: (1) an electronic survey of undergraduate students assessing sociodemographics, eating patterns, and meal preparation habits, and (2) virtual focus groups exploring protein intake, cooking behaviors, and desired meal-kit features. Quantitative data were analyzed using descriptive statistics, Pearson correlations, and logistic regression models. Qualitative data were coded using inductive thematic analysis. RESULTS:Students (N = 501) demonstrated low DQ (sHEI = 47.7 ± 10.0/100), and 33.7% reported low or very low food security. Higher UPF intake (OR = 1.14, 95% CI [1.02, 1.25], p = 0.015), more frequent cooking (OR = 1.31, 95% CI [1.02, 1.70], p = 0.037), and greater food insecurity (OR = 1.08, 95% CI [1.003, 1.16], p = 0.042) significantly predicted interest in meal kits, although effect sizes were small (Nagelkerke R2 = 0.015-0.023). Qualitative findings identified key barriers to healthy meal preparation, including limited time, inadequate kitchen access and equipment, financial constraints, and dissatisfaction with campus dining protein options. Students perceived meal kits as convenient and customizable but expressed concerns about affordability. CONCLUSION:Emerging adult college students face numerous barriers to healthy eating. Many view meal kits as a practical way to access convenient, nutritious meals. Affordable, culturally and economically tailored programs may help improve DQ and reduce reliance on UPFs. Findings support pilot testing a campus-based meal-kit program.
Hospital malnutrition remains highly prevalent in Australia and contributes to poorer clinical outcomes and increased healthcare costs. Hospital nutrition standards play a critical role in ensuring nutritionally adequate menus and supporting patient intake. While Australian jurisdictions have developed hospital nutrition standards, the extent of their consistency and alignment with national and international evidence-based guidelines has not been systematically examined. This scoping review aimed to identify and compare existing hospital nutrition standards across Australia and assess their alignment with the Australian Dietary Guidelines (ADG) and European Society for Clinical Nutrition and Metabolism (ESPEN) hospital nutrition guidelines. Guided by JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, grey literature searches were conducted across government websites, national repositories, and targeted Google searches. Twelve documents met inclusion criteria, including six nutrition standards and six supporting documents. Directed content analysis guided by ADG and ESPEN deductive frameworks was used to extract and compare data across jurisdictions. Findings showed strong alignment with the ADG, particularly in five food group provision and macronutrient targets. Alignment with ESPEN guidelines was more variable. All jurisdictions met minimum energy and protein targets and offered patient menu choices; however, inconsistencies were observed in therapeutic diet provisions, macronutrient distribution, food service considerations, adaptations for diverse patient groups and monitoring practices. Hospital nutrition standards in Australia are fragmented. Developing a unified evidence-based standard integrating ADG principles with ESPEN hospital nutrition recommendations could enhance consistency, quality, and equity in hospital nutrition care.
