Background L-Leucine (Leu) supplementation may benefit fat-free mass (FFM) per se and glucose metabolism. Objectives To determine whether Leu supplementation during energy restriction blunted the loss of FFM, enhanced the loss of fat mass (FM) and improved glucose tolerance. Design Thirty-seven adults, aged 20–65 years, with increased waist circumference and at least one other metabolic syndrome (MetS) component, were selected. We employed a two-arm parallel, double blind, randomized control trial (RCT) design. Participants were randomly assigned to an intervention group (leucine – 3 g/d) or placebo (lactose - 2.67 g/d), while following an individualised energy restricted diet for an 8-week period. Detailed body composition (DEXA), oral glucose tolerance test (OGTT), insulin and components of MetS were measured before and after the trial. Analysis of covariance (ANCOVA) assessed the effect of Leu on an intention-to-treat (ITT) principle. Bootstrapping method with 1000 bootstrap samples was used to derive parameter estimates, standard errors, p -values, and 95% confidence intervals for all outcomes. Results Adjusted for baseline values and other covariates, FFM ( p = 0.045) and lean tissue mass (LTM) ( p = 0.050) were significantly higher following Leu. These outcomes were modified by a significant treatment x sex interaction that indicated Leu had the greater effect in men. However, on adjustment for body composition changes, there was no difference in insulin sensitivity, oral glucose tolerance, or change in MetS components following Leu. Conclusion Short-term leucine supplementation during energy restriction resulted in a greater preservation of FFM and LTM particularly in men, but did not impact glucose metabolism.

We aimed to compare the dietary intakes of Australian patients with non-alcoholic fatty liver disease (NAFLD) to general Australian population intake data and determine whether the intake of any nutrient or food group was able to predict the degree of steatosis. Dietary data from fifty adult patients with NAFLD were compared to intake data from the Australian Health Survey for energy, macronutrients, fat sub-types, alcohol, iron, folate, sugar, fibre, sodium and caffeine. Linear regression models adjusting for potential confounders (age, sex, physical activity and body mass index) were used to examine predictive relationships between hepatic steatosis (quantified via magnetic resonance spectroscopy) and dietary components. The mean percentage differences between NAFLD and Australian usual intakes were significant for energy, protein, total fat, saturated fat, monounsaturated and polyunsaturated fats (all p < 0.001). The contribution of fat and protein to total energy intake was significantly higher in the NAFLD cohort (p < 0.05). No individual nutrients or food groups were strongly related to hepatic fat in the adjusted models. Higher overall consumption appears to be a major feature of dietary intake in NAFLD when compared to the general population. A whole-diet approach to NAFLD treatment and prevention is likely to be more effective than focusing on single food components.

Abstract Background: Leucine (Leu) supplementation per se could benefit fat-free mass (FFM)/function and improve glucose metabolism. Objectives: To determine whether leucine supplementation during caloric restriction blunted the loss of FFM, increased the loss of fat mass (FM) and impacted glucose tolerance. Design: Thirty-seven adults, aged 20-65 y with increased waist circumference (>80 cm for females and >94 cm for males) and at least another component of metabolic syndrome (MetS) were studied in a parallel, double blind randomized control trial (RCT). Participants were allocated randomly to either an intervention (leucine – 3 g/d) or placebo (lactose - 2.67 g/d) group, while following an individualised calorie-restricted diet over an 8-week period. Body composition (DEXA), oral glucose tolerance test (OGTT), insulin and components of MetS were measured before and after the trial. Analysis of covariance assessed the effect of the leucine intervention on an intention-to-treat (ITT) principle. Bootstrapping method with 1000 bootstrap samples was used to derive parameter estimates, standard errors, p values, and 95% confidence intervals for all outcomes. Results: Adjusted for baseline values and other covariates, FFM (p=0.045) and lean tissue mass (LTM) (p=0.050) were significantly higher following Leu. These outcomes were modified by a significant treatment x gender interaction that indicated Leu had the greater effect in men. Adjusted for body composition changes, there were no differences in insulin sensitivity, oral glucose tolerance, or MetS components. Conclusion: Short-term leucine supplementation resulted in a greater preservation of FFM and LTM particularly in men.

Background: While a number of studies have examined associations between dietary factors and risk of multiple sclerosis (MS), little is known about intakes of inflammation-modulating foods and nutrients and risk of MS. Objectives: To test associations between the Dietary Inflammatory Index (DII (R)) and risk of a first clinical diagnosis of central nervous system (CNS) demyelination (FCD) (267 cases, 507 controls) using data from the Ausimmune Study. Methods: The 2003-2006 Ausimmune Study was a multicentre, matched, case-control study examining environmental risk factors for an FCD, a common precursor to MS. The DII is a well-recognised tool that categorises individuals' diets on a continuum from maximally anti-inflammatory to maximally pro-inflammatory. The DII score was calculated from dietary intake data collected using a food frequency questionnaire. Conditional logistic regression models were used to estimate the association between DII and FCD separately for men and women. Results: In women, a higher DII score was associated with increased likelihood of FCD, with a 17% increase in likelihood of FCD per one-unit increase in DII score (adjusted odds ratio 1.17, 95% confidence interval 1.04-1.33). There was no association between DII and FCD in men (adjusted odds ratio 0.88, 95% confidence interval 0.73-1.07). Conclusions: These findings suggest that a pro-inflammatory diet is associated with an increased likelihood of FCD in women.

Higher intakes of omega-3 polyunsaturated fatty acids (n3PUFAs) have been associated with lower MS risk. We aimed to test associations between the Omega-3 Index, blood levels of n3PUFAs, fish oil supplement use, and fish consumption with a first clinical diagnosis of CNS demyelination (FCD). Cases (n = 250) had a higher Omega-3 Index compared with a matched group of controls (n = 471) (average treatment effect (ATE)=0.31, p = 0.047, based on augmented inverse probability weighting). A higher percentage of cases than controls used fish oil supplements (cases=17% vs. controls=10%). We found that Omega-3 Index increased as time between FCD and study interview increased (e.g., at or below median (112 days), based on ATE, mean=5.30, 95% CI 5.08, 5.53; above median, mean=5.90, 95% CI 5.51, 6.30). Fish oil supplement use increased in a similar manner (at or below median (112 days), based on ATE, proportion=0.12, 95% CI 0.06, 0.18; above the median, proportion=0.21, 95% CI 0.14, 0.28). Our results suggest a behaviour change post FCD with increased use of fish oil supplements.

Despite the crucial role of thiamine in glucose and energy metabolism pathways, there has been no published study examining the impact of thiamine on energy metabolism in humans. To assess the effects of thiamine supplementation on resting energy expenditure (REE) in individuals with hyperglycemia. Twelve hyperglycemic patients completed this double-blind, randomized trial, where all participants received both thiamine (300 mg/day) and matched placebo for 6 weeks in a cross-over manner. REE was assessed by indirect calorimetry. Anthropometric measurements, fasting and 2-h plasma glucose, and glucose-induced thermogenesis were also assessed at the beginning and on the completion of each six-week phase. Participants consuming thiamine supplements experienced a significant decrease in the REE assessed at week six compared to the baseline [mean (SE): 1478.93 (73.62) vs.1526.40 (73.46) kcal/d, p = 0.02], and the placebo arm (p = 0.002). These results did not change significantly after adjusting for the participants’ body weight and physical activity as potential confounders. Six-week intervention had no significant effect on the participants’ body weight or waist circumference, in either supplement or placebo arms (all p values>0.05). However, correlation analysis highlighted significant positive relationships between the changes in REE, and those in fasting (rs = 0.497, p = 0.019) and 2-h plasma glucose (rs = 0.498, p = 0.018) during the six-week intervention period. Supplementation with high-dose thiamine may attenuate REE in patients with impaired glucose regulation. Our findings suggest that the impact of thiamine on REE may in part be explained by improved glycemic control. Australian New Zealand Clinical Trials Registry ACTRN12611000051943. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000051943

The evidence for diet as a risk factor for multiple sclerosis (MS) is inconclusive. We examined the associations between fish consumption and risk of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. The 2003–2006 Ausimmune Study was a case-control study examining environmental risk factors for FCD, with participants recruited from four regions of Australia and matched on age, sex, and study region. Dietary intake data were collected using a food frequency questionnaire. We used conditional logistic regression models to test associations between fish consumption (total, tinned, grilled, and fried) and risk of FCD (249 cases and 438 controls), adjusting for history of infectious mononucleosis, smoking, serum 25-hydroxyvitamin D concentrations, socio-economic status, omega-3 supplement use, dietary under-reporting, and total energy intake. Higher total fish consumption (per 30 g/day, equivalent to two serves/week) was associated with an 18% reduced risk of FCD (AOR 0.82; 95% CI 0.70, 0.97). While we found no statistically significant associations between grilled and fried fish consumption and risk of FCD, higher tinned fish consumption (per 30 g/day) was associated with a 41% reduced risk of FCD (AOR 0.59; 95% CI 0.39, 0.89). Tinned fish is predominantly oily, whereas grilled and fried fish are likely to be a combination of oily and white types. Oily fish is high in vitamin D and very long chain polyunsaturated omega-3 fatty acids, both of which may be beneficial in relation to MS.

The evidence associating red meat consumption and risk of multiple sclerosis is inconclusive. We tested associations between red meat consumption and risk of a first clinical diagnosis of central nervous system demyelination (FCD), often presaging a diagnosis of multiple sclerosis. We used food frequency questionnaire data from the 2003–2006 Ausimmune Study, an incident, matched, case-control study examining environmental risk factors for FCD. We calculated non-processed and processed red meat density (g/1,000 kcal/day). Conditional logistic regression models (with participants matched on age, sex, and study region) were used to estimate odds ratios (ORs), 95% confidence intervals (95% CI) and p-values for associations between non-processed (n = 689, 250 cases, 439 controls) and processed (n = 683, 248 cases, 435 controls) red meat density and risk of FCD. Models were adjusted for history of infectious mononucleosis, serum 25-hydroxyvitamin D concentrations, smoking, race, education, body mass index and dietary misreporting. A one standard deviation increase in non-processed red meat density (22 g/1,000 kcal/day) was associated with a 19% reduced risk of FCD (AOR = 0.81; 95%CI 0.68, 0.97; p = 0.02). When stratified by sex, higher non-processed red meat density (per 22 g/1,000 kcal/day) was associated with a 26% reduced risk of FCD in females (n = 519; AOR = 0.74; 95%CI 0.60, 0.92; p = 0.01). There was no statistically significant association between non-processed red meat density and risk of FCD in males (n = 170). We found no statistically significant association between processed red meat density and risk of FCD. Further investigation is warranted to understand the important components of a diet that includes non-processed red meat for lower FCD risk.

Vitamin D deficiency is recognised as a public health problem globally, and a high prevalence of deficiency has previously been reported in Australia. This study details the prevalence of vitamin D deficiency in a nationally representative sample of Australian adults aged >= 25 years, using an internationally standardised method to measure serum 25-hydroxyvitamin D (25(OH)D) concentrations and identifies demographic and lifestyle factors associated with vitamin D deficiency. We used data from the 2011-2013 Australian Health Survey (n 5034 with complete information on potential predictors and serum 25(OH)D concentrations). Serum 25(OH)D concentrations were measured by a liquid chromatography-tandem MS that is certified to the reference measurement procedures developed by the National Institute of Standards and Technology, Ghent University and the US Centers for Disease Control and Prevention. Vitamin D deficiency and insufficiency were defined as serum 25(OH)D concentrations <50 nmol/l and 50 to <75 nmol/l, respectively. Overall, 20% of participants (19% men; 21% women) were classified as vitamin D deficient, with a further 43% classified as insufficient (45% men; 42% women). Independent predictors of vitamin D deficiency included being born in a country other than Australia or the main English-speaking countries, residing in southern (higher latitude) states of Australia, being assessed during winter or spring, being obese, smoking (women only), having low physical activity levels and not taking vitamin D or Ca supplements. Given our increasingly indoor lifestyles, there is a need to develop and promote strategies to maintain adequate vitamin D status through safe sun exposure and dietary approaches.

AIMS The Australian Health Survey 2011 to 2013 indicated that Western Australian women had good iodine status, suggesting adequate consumption of iodine from food, however, little is known about pregnant women in this state. The aim was to investigate the iodine-containing food practices of Western Australian pregnant women. METHODS Pregnant women attending antenatal clinics at a public tertiary hospital in Perth, Western Australia, were invited to complete a questionnaire investigating consumption of key iodine food sources and knowledge of iodine-containing foods. Food frequency data were entered into FoodWorks based on the Australian Food and Nutrition Database 2007. RESULTS A total of 425 women took part in the study with a mean (SD) age of 29.4 (5.5) years. Sixty percent of women reported consuming bread at least daily. Only 37.6% of women used iodised salt, but the median (25, 75 percentile) iodine intake of these women was 183 (142, 267) μg/day compared to 148 (100, 228) μg/day of iodine from food only. Ethnicity was associated with iodised salt use: 76% of Asian women compared with 33% of Caucasian women. Three quarters of the women did not know if any foods are required to be fortified with iodine. CONCLUSION The iodine-containing food practices of pregnant women in this state suggest a risk of insufficiency. The present study is limited by the use of a semi-quantitative and non-validated food frequency questionnaire, thus assessment of the iodine intake and status of pregnant women representative of the ethnic mix of Western Australia is recommended.

Iodine requirements increase during pregnancy and although national recommendations for daily iodine supplementation (150 µg) exist, there is no research related to the uptake of these recommendations by pregnant women in Western Australia.

Background/objectives: Although the current evidence is insufficient to recommend a special diet for people with multiple sclerosis (MS), dietary advice for people with MS is prolific online and in the media. This study aimed to describe dietary changes made in the year following a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. Subjects/methods: We used follow-up data from the Ausimmune Study, a multicentre matched case-control study examining the environmental risk factors for a FCD. A total of 244 cases (60 male, 184 female) completed a 1-year follow-up interview, which included a question about dietary changes. We described the number and proportion (%) of participants who reported making dietary changes and the type of change made. We investigated independent predictors of making a dietary change using a multivariable logistic regression model. Results: A total of 38% (n = 92) of participants at the 1-year follow-up reported making at least one dietary change over the last year. There were no statistically significant independent associations between any participant characteristic and odds of making a dietary change. Of those who made at least one dietary change, the most common changes were increasing fruit and/or vegetable intake (27%, n = 25) and following a low-fat diet (25%, n = 23). Conclusion: A considerable proportion of the study population reported making at least one dietary change in the year following a FCD, with the majority of changes being toward a healthier diet. Further research is warranted to investigate the reasons behind any dietary changes adopted by people with a FCD or with MS, and whether making a dietary change has benefits for the progression of demyelinating diseases, e.g., to a diagnosis of MS, as well as for general health and well-being.

Nutrition & DieteticsVolume 76, Issue 1 p. 119-120 Letter to the Editor Current enteral feeding practices in paediatric intensive care units in Australia and New Zealand: Results from a survey of dietitians Belinda Martin GradDipDiet, APD, Belinda Martin GradDipDiet, APD Lecturer Nutrition and Dietetics, School of Public Health, Curtin University, Perth, Western Australia, AustraliaSearch for more papers by this authorGeoff Knight MBBS, FRACP, Geoff Knight MBBS, FRACP Paediatrician Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, AustraliaSearch for more papers by this authorJill Sherriff PhD, Corresponding Author Jill Sherriff PhD Associate Professor j.sherriff@curtin.edu.au orcid.org/0000-0002-4283-958X Nutrition and Dietetics, School of Public Health, Curtin University, Perth, Western Australia, Australia Correspondence: J. Sherriff, School of Public Health, Curtin University, Hayman Road, Bentley, Perth, WA 6102, Australia. Tel: +61 89266 7948; fax: + 61 89266 2358. Email: j.sherriff@curtin.edu.auSearch for more papers by this author Belinda Martin GradDipDiet, APD, Belinda Martin GradDipDiet, APD Lecturer Nutrition and Dietetics, School of Public Health, Curtin University, Perth, Western Australia, AustraliaSearch for more papers by this authorGeoff Knight MBBS, FRACP, Geoff Knight MBBS, FRACP Paediatrician Paediatric Intensive Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, AustraliaSearch for more papers by this authorJill Sherriff PhD, Corresponding Author Jill Sherriff PhD Associate Professor j.sherriff@curtin.edu.au orcid.org/0000-0002-4283-958X Nutrition and Dietetics, School of Public Health, Curtin University, Perth, Western Australia, Australia Correspondence: J. Sherriff, School of Public Health, Curtin University, Hayman Road, Bentley, Perth, WA 6102, Australia. Tel: +61 89266 7948; fax: + 61 89266 2358. Email: j.sherriff@curtin.edu.auSearch for more papers by this author First published: 26 September 2018 https://doi.org/10.1111/1747-0080.12476 Present address: G. Knight, Perth Children's Hospital, Perth, WA, Australia. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume76, Issue1February 2019Pages 119-120 RelatedInformation

BACKGROUND/OBJECTIVES:Multiple sclerosis (MS) is an immune-mediated disease with no known cure and insufficient evidence to support a special therapeutic diet to alter symptom management or disease progression. Several studies have reported dietary changes made by people with MS, but there has been limited investigation into experiences surrounding diet in those recently diagnosed. This study explored responses to diet after a recent diagnosis of MS in people living in Western Australia.SUBJECTS/METHODS:Eleven adults with MS (mean time since diagnosis 8 months) participated in semi-structured interviews focusing on responses to diet since MS diagnosis. Interviews were transcribed, coded and analysed using grounded theory principles.RESULTS:Three theme responses emerged; (1) the perceived incompatibility of lack of/or generalised dietary advice with disease seriousness at the time of diagnosis; (2) extensive personal research and information seeking with difficulty judging credibility, and (3) self-experimentation with diet to either control MS symptoms or to cure MS.CONCLUSIONS:Given the seriousness of the disease, there is a perceived gap in dietary information provided at the time of diagnosis. Healthcare professionals should address concerns with alternative therapeutic diets advertised to treat or cure MS, and clearly convey the reasoning for the general healthy dietary recommendations. This would better align advice with the perceptions about the role of diet in MS, assist people with MS in need of information and minimise dietary self-experimentation. Future research should explore the importance of diet for those who have had MS for a longer period of time.

Background: Community pharmacists play a significant role in the provision of non-prescription medicines. There is evidence that women self-medicate and use non-prescription medicines whilst breastfeeding. Studies have demonstrated that breastfeeding women are likely to seek advice from pharmacists, presenting a unique opportunity for pharmacists to provide on-going support of these women especially in relation to the appropriate use of non-prescription medicines. Objectives: This study aimed to explore community pharmacists' attitudes and perspectives towards the use of non-prescription medicines during breastfeeding. Methods: This exploratory study was conducted through semi-structured interviews with 30 community pharmacists in Western Australia, between July and September 2013. Transcribed data were analysed using descriptive and qualitative approaches. NVivo (R) Version 10.0 was used to organise qualitative data and quotations to facilitate thematic analysis. Results: Four major themes emerged. Despite the positive attitudes and favourable perceived knowledge level, participants often found themselves in a dilemma when required to make clinical recommendations especially in situations where there was a therapeutic need for treatment but clear guidelines or evidence to suggest safety of the medicines or treatment in lactation was absent. Despite the popularity of complementary medicines, participants felt more confident in providing advice in relation to conventional over complementary medicines. Whilst medication safety is within the field of expertise of pharmacists, the absence of information and safety data was seen as a major challenge and barrier to enable pharmacists to confidently provide evidence-based recommendations. Conclusions: This study has enhanced our understanding of the attitudes and perspectives of community pharmacists towards the use of non-prescription, including complementary medicines, during breastfeeding. Future studies are warranted to confirm the safety of commonly used or requested medicines in breastfeeding. University training and continuing education for pharmacists should include the latest information available regarding the use of both conventional and complementary medicines throughout lactation. (c) 2017 Elsevier Inc. All rights reserved.

Background and Objectives: Malnutrition is prevalent amongst people with head and neck cancer treated with radiotherapy and can result in reduced tolerance to treatment and increased hospital admissions. Current best-practice guidelines recommend weekly dietetic review during radiotherapy and fortnightly review for six weeks following radiotherapy to minimize weight loss. The primary aim of this study was to compare percent weight loss during radiotherapy before and after the implementation of weekly dietetic review. In the post-guideline implementation group we aimed to investigate factors associated with greater weight loss and describe weight changes 4-8 weeks post radiotherapy. Methods and Study Design: Adults with head and neck cancer who received dietetic input and curative intent radiotherapy were included. Data were collected via retrospective chart audit of records from the Nutrition and Dietetics department. Results: The analysis involved 142 people, 66% (n=94) of whom received dietetic input in the post-guideline implementation period. Mean weight loss was not different between the pre-and post-guideline implementation groups (-5.9 +/- 6.34% vs -6.6 +/- 5.29%; p=0.477). In the post-guideline implementation group, advanced tumor stage and concurrent chemoradiation were associated with greater percent weight loss (p=0.006 and p<0.001, respectively). Mean weight loss increased by 1.9 +/- 4.96%, 4-8 weeks after radiotherapy (p=0.004). Conclusions: Percent weight loss during radiotherapy was not reduced following the implementation of weekly dietetic review. In the 4-8 weeks following radiotherapy, weight loss increased significantly over that between baseline and end of radiotherapy. Future research should explore and address the reasons why critical weight loss occurs despite improved access to dietetic care.

Although diet‐induced weight loss is first‐line treatment for patients with nonalcoholic fatty liver disease (NAFLD), long‐term maintenance is difficult. The optimal diet for improvement in either NAFLD or associated cardiometabolic risk factors, regardless of weight loss, is unknown. We examined the effect of two ad libitum isocaloric diets (Mediterranean [MD] or low fat [LF]) on hepatic steatosis (HS) and cardiometabolic risk factors. Subjects with NAFLD were randomized to a 12‐week blinded dietary intervention (MD vs. LF). HS was determined by magnetic resonance spectroscopy (MRS). From a total of 56 subjects enrolled, 49 completed the intervention and 48 were included for analysis. During the intervention, subjects on the MD had significantly higher total and monounsaturated fat, but lower carbohydrate and sodium, intakes compared to LF subjects ( P < 0.01). At week 12, HS had reduced significantly in both groups ( P < 0.01), and there was no difference in liver fat reduction between groups ( P = 0.32), with mean (SD) relative reductions of 25.0% (±25.3%) in LF and 32.4% (±25.5%) in MD. Liver enzymes also improved significantly in both groups. Weight loss was minimal and not different between groups (–1.6 [±2.1] kg in LF vs –2.1 [±2.5] kg in MD; P = 0.52). Within‐group improvements in Framingham Risk Score (FRS), total cholesterol, serum triglyceride (TG), and glycated hemoglobin (HbA1c) were observed in the MD (all P < 0.05), but not with the LF diet. Adherence was higher for the MD compared to LF (88% vs. 64%; P = 0.048). Conclusion: Ad libitum low‐fat and Mediterranean diets both improve HS to a similar degree.

Vitamin D has previously been quantified in some plants and algae, particularly in leaves of the Solanaceae family. We measured the vitamin D content of Australian native food plants and Australian-grown edible seaweed. Using liquid chromatography with triple quadrupole mass spectrometry, 13 samples (including leaf, fruit, and seed) were analyzed in duplicate for vitamin D2, vitamin D3, 25-hydroxyvitamin D2, and 25-hydroxyvitamin D3. Five samples contained vitamin D2: raw wattleseed (Acacia victoriae) (0.03 µg/100 g dry weight (DW)); fresh and dried lemon myrtle (Backhousia citriodora) leaves (0.03 and 0.24 µg/100 g DW, respectively); and dried leaves and berries of Tasmanian mountain pepper (Tasmannia lanceolata) (0.67 and 0.05 µg/100 g DW, respectively). Fresh kombu (Lessonia corrugata) contained vitamin D3 (0.01 µg/100 g DW). Detected amounts were low; however, it is possible that exposure to ultraviolet radiation may increase the vitamin D content of plants and algae if vitamin D precursors are present.

BackgroundPre-operative immunonutrition for upper gastrointestinal cancer patients is provided in a number of Australian tertiary hospitals. However, previous studies yielded inconsistent results; limited information on patient acceptance of pre-operative supplementation is likely to be an as yet unexplored contributing factor.AimsTo determine patient acceptance of a pre-operative immunonutrition supplement protocol and to compare post-operative outcomes pre- and post-implementation of the protocol.MethodsA retrospective review of medical records was undertaken for upper gastrointestinal cancer surgery patients pre- and post-implementation of a pre-operative immunonutrition protocol. Endpoints noted were surgery type, timing of attendance at the pre-admission clinic, post-operative complications, intensive care unit admissions, diet progression and length of stay. Patient feedback on the immunonutrition protocol and supplement acceptability was obtained via interview.ResultsThe audit identified 74 patients as having undergone upper gastrointestinal cancer surgery (36 patients pre- and 38 patients post-implementation). Less than half of the post-implementation patients attended the pre-admission clinic as per protocol. Infectious and non-infectious complication rates were similar between the two groups. Number of days until patients received full diets post-operatively were 0.80 days shorter post-implementation, but not statistically significant. Patients in the post-implementation group with infective complications spent significantly longer time nil by mouth than those who did not incur complications (26.15 vs 17.13 days, p=0.024). Length of stay was 1.5 days shorter in the post-implementation group but not statistically different.ConclusionWe found no difference in post-operative outcomes; however, the pre- and post-implementation comparison was limited by poor adherence to the protocol as a consequence of late attendance at pre-admission clinic. Of those who did attend as planned, patient acceptance was high. Future studies incorporating prospective, quantitative pre-operative immunonutrition intake are needed.