Indigenous food sovereignty assessment-A systematic literature review.

AIMS: The aims of this systematic review were to (1) identify assessment approaches of Indigenous food sovereignty using the core domains of community ownership, inclusion of traditional food knowledge, inclusion/promotion of cultural foods and environmental/intervention sustainability, (2) describe Indigenous research methodologies when assessing Indigenous food sovereignty. METHODS: Guided by Indigenous members of the research team, a systematic review across four databases (Medline, Embase, CINAHL and PsycINFO) was performed. Studies in any language from 1996 to 2021, that used one or more of the core domains (identified from a recent scoping review) of community ownership, inclusion of traditional food knowledge, inclusion/promotion of cultural foods and environmental/intervention sustainability were included. RESULTS: From 20 062 records, after exclusion criteria were applied, 34 studies were included. Indigenous food sovereignty assessment approaches were mostly qualitative (n = 17) or mixed methods (n = 16), with interviews the most utilised (n = 29), followed by focus groups and meetings (n = 23) and validated frameworks (n = 7) as assessment tools. Indigenous food sovereignty assessment approaches were mostly around inclusion of traditional food knowledge (n = 21), or environmental/intervention sustainability (n = 15). Community-Based Participatory Research approaches were utilised across many studies (n = 26), with one-third utilising Indigenous methods of inquiry. Acknowledgement of data sovereignty (n = 6) or collaboration with Indigenous researchers (n = 4) was limited. CONCLUSION: This review highlights Indigenous food sovereignty assessment approaches in the literature worldwide. It emphasises the importance of using Indigenous research methodologies in research conducted by or with Indigenous Peoples and acknowledges Indigenous communities should lead future research in this area.

Transformative systemic changes to embed environmental sustainability in foodservices: A grounded theory exploration.

AIMS: Foodservices are a strong contributor to global environmental impact. Systemic change is required to lead the transformation towards environmentally sustainable foodservices. However, guidance to support foodservices to be more environmentally sustainable is lacking. The aim was to explore food-related environmentally sustainable strategies and their transferability to foodservices in a range of settings, to inform a framework for future application and research. METHODS: A constructivist grounded theory study design was used. Semi-structured interviews with foodservice sustainability consultants, who support foodservice organisations to improve environmental sustainability, were conducted. Interviews were recorded, transcribed, and coded line-by-line. Ten consultants were purposively sampled for diversity in location, organisation type, funding model, and services provided. Codes were collapsed into categories, to inform the development of themes and a framework for the implementation of strategies. RESULTS: Four sub-themes were created under an overarching theme of 'Transforming the Foodservice System': embedding leadership, shifting perspective, constructing collaborative networks, and fostering momentum. A range of implementation strategies were captured within the sub-themes. CONCLUSION: These themes informed the development of a practical application framework for implementing sustainable strategies in foodservices that is useful for practice and future research in the area.

The muscle proteome reflects changes in mitochondrial function, cellular stress and proteolysis after 14 days of unilateral lower limb immobilization in active young men.

Skeletal muscle unloading due to joint immobilization induces muscle atrophy, which has primarily been attributed to reductions in protein synthesis in humans. However, no study has evaluated the skeletal muscle proteome response to limb immobilization using SWATH proteomic methods. This study characterized the shifts in individual muscle protein abundance and corresponding gene sets after 3 and 14 d of unilateral lower limb immobilization in otherwise healthy young men. Eighteen male participants (25.4 ±5.5 y, 81.2 ±11.6 kg) underwent 14 d of unilateral knee-brace immobilization with dietary provision and following four-weeks of training to standardise acute training history. Participant phenotype was characterized before and after 14 days of immobilization, and muscle biopsies were obtained from the vastus lateralis at baseline (pre-immobilization) and at 3 and 14 d of immobilization for analysis by SWATH-MS and subsequent gene-set enrichment analysis (GSEA). Immobilization reduced vastus group cross sectional area (-9.6 ±4.6%, P <0.0001), immobilized leg lean mass (-3.3 ±3.9%, P = 0.002), unilateral 3-repetition maximum leg press (-15.6 ±9.2%, P <0.0001), and maximal oxygen uptake (-2.9 ±5.2%, P = 0.044). SWATH analyses consistently identified 2281 proteins. Compared to baseline, two and 99 proteins were differentially expressed (FDR <0.05) after 3 and 14 d of immobilization, respectively. After 14 d of immobilization, 322 biological processes were different to baseline (FDR <0.05, P <0.001). Most (77%) biological processes were positively enriched and characterized by cellular stress, targeted proteolysis, and protein-DNA complex modifications. In contrast, mitochondrial organization and energy metabolism were negatively enriched processes. This study is the first to use data independent proteomics and GSEA to show that unilateral lower limb immobilization evokes mitochondrial dysfunction, cellular stress, and proteolysis. Through GSEA and network mapping, we identify 27 hub proteins as potential protein/gene candidates for further exploration.

Dietary Intake in Law Enforcement Personnel: Occupation Is an Additional Challenge for Changing Behavior.

BACKGROUND: Law enforcement is a dangerous, stressful, and health-threatening occupation. This study investigated the association between demographic factors including sex, age, and types of law enforcement occupation and described self-reported barriers to healthy and enjoyable diets within a cohort of law enforcement personnel. METHODS: This mixed-methods study explored cross-sectional data from the Perceived Barriers to Healthy Eating validated survey. The survey included eight questions obtaining quantitative data and two open ended question obtaining qualitative data. A framework thematic analysis using the theory of planned behavior was undertaken to describe self-reported barriers to a healthy and enjoyable dietary intake. RESULTS: 159 participants (median age = 27 (range 19-60) years; 74% males) were surveyed. In general, demographic factors are not associated with the dietary beliefs and behavior of law enforcement personnel. Self-reported barriers (generated themes) to a healthy and enjoyable diet included individual preferences, social influences, internal drive, capacity to change and occupational influences, which broadly aligned with the theory of planned behavior. CONCLUSIONS: Dietary intake in law enforcement personnel is impacted by occupational considerations, including busy schedules, long working hours, inconsistent meal breaks, tiredness, and shift work. The study provides useful information to support dietary interventions.

Free-Living Dietary Intake in Tactical Personnel and Implications for Nutrition Practice: A Systematic Review.

Tactical personnel (including military, law enforcement, and fire and rescue) are responsible for ensuring national and public safety. Dietary intake is an important consideration to support optimal health and performance. The aims of this systematic review were to: (1) describe the reported free-living dietary intake (energy and macronutrients) of tactical personnel, and (2) describe the practical implications of reported dietary intakes to support the physical and dietary requirements of tactical personnel. A systematic search of databases (MEDLINE, EMBASE, CINAHL and Web of Science) was conducted following the PRISMA guidelines. English and full text research articles were identified and screened against inclusion and exclusion criteria. Demographic and dietary intake data were extracted, tabulated, and synthesized narratively. The quality of the studies was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Twenty-two studies (15 military, 4 law enforcement, and 2 fire and rescue) were eligible to inform this review. The volume of evidence suggested that tactical personnel met dietary protein and exceeded dietary fat recommendations but failed to meet energy and carbohydrate recommendations. Therefore, practical approaches to support optimized energy, fat and carbohydrate intake in tactical personnel is important.

Increased carbohydrate availability effects energy and nutrient periodisation of professional male athletes from the Australian Football League.

This research aimed to explore the effect of increased carbohydrate availability intervention on energy intake and distribution in professional Australian Football athletes. Six 24-h energy and macronutrient intakes were quantified (n = 19 males; age 24 ± 4 y, stature 187 ± 8 cm, mass 87 ± 9 kg) using photographic food diaries and Foodworks analyses. Energy expenditure was estimated for the same period using GeneActiv accelerometers. During 3 control days, athletes had ad libitum access to food, while the 3 intervention days increased carbohydrate availability, through greater prompting and access to carbohydrate foods. Daily energy intake was higher during intervention (185 ± 40 kJ/kg/d) compared with control (172 ± 31 kJ/kg/d; p < 0.05) but remained below estimated expenditure, and carbohydrate intake was also greater with intervention (5.0 ± 0.2 g/kg/d) than control (4.0 ± 0.2 g/kg/d; p < 0.05). Expenditure was highest during the morning, which coincided with lowest intake on all days, while the intervention was associated with greater carbohydrate intake in the morning (0.6 g/kg, p < 0.05) compared with control. Increasing availability of carbohydrate during high-load training generated a modest increase in carbohydrate and energy intake, and the intervention was most effective in improving carbohydrate intake during mornings. Novelty: Increased access and provision of carbohydrate foods increased carbohydrate consumption and energy intake on high training load days. Daily distribution of energy intake can be modified through actively promoting carbohydrate consumption.

Consumer expectation and responses to environmental sustainability initiatives and their impact in foodservice operations: A systematic review.

BACKGROUND: With increasing pressure on the Earth's finite resources, there is significant demand for environmentally sustainable practices in foodservice. A shift to sustainable foodservice operations can decrease its environmental impact and may align with consumer expectations. This systematic review explored consumer expectations (attitudes pre-intervention) and responses (behaviour, cognitive attitudes and affective attitudes post-intervention) towards environmentally sustainable initiatives of foodservice operations. METHODS: A systematic search following PRISMA guidelines was conducted across MEDLINE, EMABASE, CINAHL and Web of Science databases. English and full-text research articles published up to November 2019 were identified. Consumers' expectations and responses to interventions were extracted. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Thirty-three studies were included and, given the heterogeneity of the studies, the results were synthesised narratively. The main outcomes analysed included changes in behaviour and attitudes (cognitive and affective), including knowledge and satisfaction. Intervention strategies were interpreted and categorised into three groups: food waste reduction, single-use item and packaging waste reduction, and initiatives related to menu, messaging and labelling. Most studies resulted in significant pro-environmental changes towards decreasing food waste, decreasing single use-item and packaging waste, as well as engaging consumers in sustainable eating. CONCLUSIONS: There are a range of successful environmentally sustainable strategies that when implemented by foodservices can have a mostly positive impact on consumer attitudes and responses. However, positive consumer attitudes did not always translate to changes in behaviour. Foodservices should carefully consider implementing interventions that support changes in consumer behaviour.

Comparisons of Daily Energy Intake vs. Expenditure Using the GeneActiv Accelerometer in Elite Australian Football Athletes.

ABSTRACT: Salagaras, BS, Mackenzie-Shalders, KL, Nelson, MJ, Fraysse, F, Wycherley, TP, Slater, GJ, McLellan, C, Kumar, K, and Coffey, VG. Comparisons of daily energy intake vs. expenditure using the GeneActiv accelerometer in elite Australian Football athletes. J Strength Cond Res 35(5): 1273-1278, 2021-To assess validity of the GeneActiv accelerometer for use within an athlete population and compare energy expenditure (EE) with energy and macronutrient intake of elite Australian Football athletes during a competition week. The GeneActiv was first assessed for utility during high-intensity exercise with indirect calorimetry. Thereafter, 14 professional Australian Football athletes (age, 24 ± 4 [SD] y; height, 1.87 ± 0.08 m; body mass, 86 ± 10 kg) wore the accelerometer and had dietary intake assessed via dietitian-led 24-hour recalls throughout a continuous 7 days of competition period (including match day). There was a significant relationship between metabolic equivalents and GeneActiv g·min-1 (SEE 1.77 METs; r2 = 0.64; p < 0.0001). Across the in-season week a significant difference only occurred on days 3 and 4 (day 3: energy intake [EI] EI 137 ± 31 kJ·kg-1·d-1; 11,763 ± 2,646 kJ·d-1 and EE: 186 ± 14 kJ·kg-1·d-1; 16,018 ± 1973 kJ·d-1; p < 0.05; d = -1.4; day 4: EI: 179 ± 44 kJ·kg-1·d-1, 15,413 ± 3,960 kJ·d-1 and EE: 225 ± 42 kJ·kg-1·d-1; 19,313 ± 3,072 kJ·d-1; d = -0.7). Carbohydrate intake (CI) was substantially below current sports nutrition recommendations on 6 of 7 days with deficits ranging from -1 to -7.2 g·kg-1·d-1 (p < 0.05), whereas daily protein and fat intake was adequate. In conclusion, the GeneActiv provides effective estimation of EE during weekly preparation for a professional team sport competition. Australian Footballers attempt to periodize dietary EI to varying daily training loads but fail to match expenditure on higher-training load days. Specific dietary strategies to increase CI may be beneficial to achieve appropriate energy balance and macronutrient distribution, particularly on days where athletes undertake multiple training sessions.

AMEE Consensus Statement: Planetary health and education for sustainable healthcare.

The purpose of this Consensus Statement is to provide a global, collaborative, representative and inclusive vision for educating an interprofessional healthcare workforce that can deliver sustainable healthcare and promote planetary health. It is intended to inform national and global accreditation standards, planning and action at the institutional level as well as highlight the role of individuals in transforming health professions education. Many countries have agreed to 'rapid, far-reaching and unprecedented changes' to reduce greenhouse gas emissions by 45% within 10 years and achieve carbon neutrality by 2050, including in healthcare. Currently, however, health professions graduates are not prepared for their roles in achieving these changes. Thus, to reduce emissions and meet the 2030 Sustainable Development Goals (SDGs), health professions education must equip undergraduates, and those already qualified, with the knowledge, skills, values, competence and confidence they need to sustainably promote the health, human rights and well-being of current and future generations, while protecting the health of the planet.The current imperative for action on environmental issues such as climate change requires health professionals to mobilize politically as they have before, becoming strong advocates for major environmental, social and economic change. A truly ethical relationship with people and the planet that we inhabit so precariously, and to guarantee a future for the generations which follow, demands nothing less of all health professionals.This Consensus Statement outlines the changes required in health professions education, approaches to achieve these changes and a timeline for action linked to the internationally agreed SDGs. It represents the collective vision of health professionals, educators and students from various health professions, geographic locations and cultures. 'Consensus' implies broad agreement amongst all individuals engaged in discussion on a specific issue, which in this instance, is agreement by all signatories of this Statement developed under the auspices of the Association for Medical Education in Europe (AMEE).To ensure a shared understanding and to accurately convey information, we outline key terms in a glossary which accompanies this Consensus Statement (Supplementary Appendix 1). We acknowledge, however, that terms evolve and that different terms resonate variably depending on factors such as setting and audience. We define education for sustainable healthcare as the process of equipping current and future health professionals with the knowledge, values, confidence and capacity to provide environmentally sustainable services through health professions education. We define a health professional as a person who has gained a professional qualification for work in the health system, whether in healthcare delivery, public health or a management or supporting role and education as 'the system comprising structures, curricula, faculty and activities contributing to a learning process'. This Statement is relevant to the full continuum of training - from undergraduate to postgraduate and continuing professional development.

Disordered eating measures validated in pregnancy samples: a systematic review.

Although disordered eating in pregnancy has been linked to numerous negative consequences, there is currently no published instrument specifically devised to identify or measure such symptoms in pregnancy. As such, this study systematically reviewed the literature to evaluate the performance of general measures of disordered eating in pregnancy samples. A systematic search of the following electronic databases was undertaken from inception to April 2019: Scopus, Medline, PsycINFO, Embase, ProQuest Dissertations and Theses, and the Cumulative Index to Nursing and Allied Health Literature. From 1724 citations, eight publications met the inclusion criteria and were included in the review. Most of the included studies (6/8) were of reasonable quality. Overall, three self-report inventories (EDE-Q, EDI-2, and DEBS) and one semi-structured clinical interview (EDE) had some form of psychometric information available. Most studies reported reliability, with only two reporting validity. No studies assessed screening accuracy. Other than the EDE-Q, which had preliminary evidence to suggest possible utility in pregnancy, the findings of this review revealed little to no evidence to support the use of general measures of disordered eating in pregnancy. A strong need for research exploring the validity of existing measures in pregnancy samples, including the EDE-Q, was also evident.

Workplace programmes for supporting breast-feeding: a systematic review and meta-analysis.

OBJECTIVE: To critically review the literature regarding workplace breast-feeding interventions and to assess their impact on breast-feeding indicators. DESIGN: A systematic review and meta-analysis was conducted. Electronic searches for workplace intervention studies to support breast-feeding, without restriction on language or study design, were performed in PubMed, CENTRAL, CINAHL, Embase, Web of Science, Business Source Complete, ProQuest-Sociology and ProQuest-Social Science to 13 April 2020. A meta-analysis of the pooled effect of the programmes on breast-feeding indicators was conducted. RESULTS: The search identified 10 215 articles; fourteen studies across eighteen publications met eligibility criteria. Programmes were delivered in the USA (n 10), Turkey (n 2), Thailand (n 1) or Taiwan (n 1). There were no randomised controlled trials. The pooled OR for exclusive breast-feeding at 3 or 6 months for participants v. non-participants of three non-randomised controlled studies was 3·21 (95 % CI 1·70, 6·06, I2 = 22 %). Despite high heterogeneity, other pooled outcomes were consistently in a positive direction with acceptable CI. Pooled mean duration of breast-feeding for five single-arm studies was 9·16 months (95 % CI 8·25, 10·07). Pooled proportion of breast-feeding at 6 months for six single-arm studies was 0·76 (95 % CI 0·66, 0·84) and breast-feeding at 12 months for three single-arm studies was 0·41 (95 % CI 0·22, 0·62). Most programmes were targeted at mothers; two were targeted at expectant fathers. CONCLUSIONS: Workplace programmes may be effective in promoting breast-feeding among employed mothers and partners of employed fathers. However, no randomised controlled trials were identified, and better-quality research on workplace interventions to improve breast-feeding is needed.

Law enforcement personnel are willing to change, but report influencing beliefs and barriers to optimised dietary intake.

BACMROUND: Law enforcement personnel have been recognized as having a high risk for several lifestyle-related health conditions which, in combination with the nature of their work (sedentary roles interspersed with intermittent high-intensity activity, shift work, and a high stress-load), can have a negative impact on their health. The aim of this study was to investigate the dietary habits and factors or barriers influencing these habits within a cohort of law enforcement personnel in the United States of America. METHOD: Cross-sectional data were obtained via validated paper-based surveys being the Perceived Barriers to Healthy Eating, Food Choice Questionnaire and Rapid Eating Assessment for Participants, Short Version. RESULTS: A total of 159 participants (median age = 27 [range 19-60] years; 74% males) participated. Barriers to healthy eating included being busy and irregular working hours. Overall, 91% (n = 143) placed high importance on consuming nutritious food and 80% (n = 126) on food high in vitamins and minerals. A further 80% (n = 127) emphasized high protein content and 41% (n = 62) followed a high protein diet. Barriers to healthy eating included busy lifestyle (60%, n = 94), and irregular working hours (41%, n = 64). Overall, 80% (n = 127) were very willing to make changes in eating habits to be healthier. CONCLUSION: Law enforcement officers know what they should eat and report convenience and health the most important factors guiding their food choices. Knowing this, officers find challenges putting good dietary practices into practice due to factors like a busy lifestyle and irregular work hours. Reportedly "very willing" to make changes in their eating habits to be healthier, future interventions should focus on how to effect changes to their eating habits as opposed to focussing on what to eat.

The effect of exercise interventions on resting metabolic rate: A systematic review and meta-analysis.

The systematic review and meta-analysis evaluated the effect of aerobic, resistance and combined exercise on RMR (kCal·day-1) and performed a methodological assessment of indirect calorimetry protocols within the included studies. Subgroup analyses included energy/diet restriction and body composition changes. Randomized control trials (RCTs), quasi - RCTs and cohort trials featuring a physical activity intervention of any form and duration excluding single exercise bouts were included. Participant exclusions included medical conditions impacting upon RMR, the elderly (≥65 years of age) or pregnant, lactating or post-menopausal women. The review was registered in the International Prospective Register of Systematic Reviews (CRD 42,017,058,503). 1669 articles were identified; 22 were included in the qualitative analysis and 18 were meta-analysed. Exercise interventions (aerobic and resistance exercise combined) did not increase resting metabolic rate (mean difference (MD): 74.6 kCal·day-1[95% CI: -13.01, 161.33], P = 0.10). While there was no effect of aerobic exercise on RMR (MD: 81.65 kCal·day-1[95% CI: -57.81, 221.10], P = 0.25), resistance exercise increased RMR compared to controls (MD: 96.17 kCal·day-1[95% CI: 45.17, 147.16], P = 0.0002). This systematic review effectively synthesises the effect of exercise interventions on RMR in comparison to controls; despite heterogenous methodologies and high risk of bias within included studies.

Impact of electronic bedside meal ordering systems on dietary intake, patient satisfaction, plate waste and costs: A systematic literature review.

AIM: Hospital foodservices provide an important opportunity to deliver valuable dietary support to patients, address hospital-acquired malnutrition risk and enhance patient satisfaction. Modifying the meal ordering process through the adoption of technology may actively engage patients in the process and provide an opportunity to influence patient and organisational outcomes. This systematic review was undertaken to evaluate the impact of electronic bedside meal ordering systems in hospitals on patient dietary intake, patient satisfaction, plate waste and costs. METHODS: A systematic search following PRISMA guidelines was conducted across MEDLINE, CINAHL, EMBASE and Web of Science for randomised controlled trials and observational studies comparing the effect of electronic bedside meal ordering systems with traditional menus on dietary intake, patient satisfaction, plate waste and cost. The quality of included studies was assessed using the Quality Criteria Checklist for Primary Research tool. RESULTS: Five studies involving 720 patients were included. Given the heterogeneity of the included studies, the results were narratively synthesised. Electronic bedside meal ordering systems positively impacted patient dietary intake, patient satisfaction, plate waste and costs compared with traditional menus. CONCLUSIONS: Despite the increase in healthcare foodservices adopting digital health solutions, there is limited research specifically measuring the impact of electronic bedside meal ordering systems on patient and organisational outcomes. This study highlights potential benefits of electronic bedside meal ordering systems for hospitals using traditional paper menu systems, while also identifying the need for continued research to generate evidence to understand the impact of this change and inform future successful innovations.

Are increases in skeletal muscle mass accompanied by changes to resting metabolic rate in rugby athletes over a pre-season training period?

Optimising dietary energy intake is essential for effective sports nutrition practice in rugby athletes. Effective dietary energy prescription requires careful consideration of athletes' daily energy expenditure with the accurate prediction of resting metabolic rate (RMR) important due to its influence on total energy expenditure and in turn, energy balance. This study aimed to (a) measure rugby athletes RMR and (b) report the change in RMR in developing elite rugby players over a rugby preseason subsequent to changes in body composition and (c) explore the accurate prediction of RMR in rugby athletes. Eighteen developing elite rugby union athletes (age 20.2 ± 1.7 years, body mass 101.2 ± 14.5 kg, stature 184.0 ± 8.4 cm) had RMR (indirect calorimetry) and body composition (dual energy x-ray absorptiometry) measured at the start and end of a rugby preseason ∼14 weeks later. There was no statistically significant difference in RMR over the preseason period (baseline 2389 ± 263 kcal·day-1 post 2373 ± 270 kcal·day-1) despite a significant increase in lean mass of +2.0 ± 1.6 kg (P < 0.01) and non-significant loss of fat mass. The change in RMR was non-significant and non-meaningful; thus, this study contradicts the commonly held anecdotal perception that an increase in skeletal muscle mass will result in a significant increase in metabolic rate and daily energy needs. Conventional prediction equations generally under-estimated rugby athletes' measured RMR, and may be problematic for identifying low energy availability, and thus updated population-specific prediction equations may be warranted to inform practice.

Signs and symptoms of disordered eating in pregnancy: a Delphi consensus study.

BACKGROUND: This study aimed to establish consensus on the expression and distinction of disordered eating in pregnancy to improve awareness across various health professions and inform the development of a pregnancy-specific assessment instrument. METHODS: A three-round modified Delphi method was used with two independent panels. International clinicians and researchers with extensive knowledge on and/or clinical experience with eating disorders formed the first panel and were recruited using structured selection criteria. Women who identified with a lived experience of disordered eating in pregnancy formed the second panel and were recruited via expressions of interest from study advertising on pregnancy forums and social media platforms. A systematic search of academic and grey literature produced 200 sources which were used to pre-populate the Round I questionnaire. Additional items were included in Round II based on panel feedback in Round I. Consensus was defined as 75% agreement on an item. RESULTS: Of the 102 items presented to the 26 professional panel members and 15 consumer panel members, 75 reached consensus across both panels. Both panels clearly identified signs and symptoms of disordered eating in pregnancy and endorsed a number of clinical features practitioners should consider when delineating disordered eating symptomatically from normative pregnancy experiences. CONCLUSION: A list of signs and symptoms in consensus was identified. The areas of collective agreement may be used to guide clinicians in clinical practice, aid the development of psychometric tools to detect/assess pregnancy-specific disordered eating, in addition to serving as starting point for the development of a core outcome set to measure disordered eating in pregnancy.

Consensus on the assessment of disordered eating in pregnancy: an international Delphi study.

This study aimed to assess and develop consensus on the assessment of disordered eating in pregnancy. A three-round modified Delphi approach was used. Participants were international clinicians and researchers (N = 26) with extensive knowledge on and/or clinical experience with eating disorders, particularly in relation to pregnancy and/or women's health. Clear consensus among the panel, defined as 75% agreement, was reached regarding the assessment of disordered eating in pregnancy, in addition to potential assessment methods. Antenatal assessment of disordered eating was perceived to be crucial and ideally occur in a routine manner. Despite agreement that various assessment methods would be relevant in assessing disordered eating in pregnancy, psychometrically sound brief screening instruments were perceived to be most feasible for practitioners and women accessing antenatal care; however, these instruments must be pregnancy-specific and delivered in an authentic and caring manner to be beneficial.

Room Service Improves Nutritional Intake and Increases Patient Satisfaction While Decreasing Food Waste and Cost.

BACKGROUND: Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs. OBJECTIVE: The aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model. DESIGN: A retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre-post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation. PARTICIPANTS: Audit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015. MAIN OUTCOME MEASURES: The primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs. STATISTICAL ANALYSES PERFORMED: Independent samples t-tests and χ2 analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ2 analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ2 used for the plate waste analysis. Significance was assessed at P<0.05. RESULTS: This study reported an increased nutritional intake, improved patient satisfaction, and reduced plate waste and patient meal costs with room service compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0.005) and protein (52 g/day vs 66 g/day, P=0.003) intake, as well as energy and protein intake as a percentage of requirements (63% vs 75%; P=0.024 and 65% vs 85%; P=0.011, respectively). Total mean plate waste decreased from 29% (traditional foodservice model) to 12% (room service) (P<0.001). Patient satisfaction ratings indicated improvement with room service across all Press Ganey meal scores: 68th to 86th percentile overall; 64th to 95th percentile for "quality of food"; and 60th to 99th percentile for "flavor of food." Evaluated during comparable times of the year, patient meal costs decreased by 15% with room service. CONCLUSIONS: A patient-centered foodservice model, such as room service, can improve patient nutritional intake and enhance patient satisfaction in a budget constrained health care environment.

Increasing Protein Distribution Has No Effect on Changes in Lean Mass During a Rugby Preseason.

Increasing the frequency of protein consumption is recommended to stimulate muscle hypertrophy with resistance exercise. This study manipulated dietary protein distribution to assess the effect on gains in lean mass during a rugby preseason. Twenty-four developing elite rugby athletes (age 20.1 ± 1.4 years, mass 101.6 ± 12.0 kg; M ± SD) were instructed to consume high biological value (HBV) protein at their main meals and immediately after resistance exercise while limiting protein intake between meals. To manipulate protein intake frequency, the athletes consumed 3 HBV liquid protein supplements (22 g protein) either with main meals (bolus condition) or between meals (frequent condition) for 6 weeks in a 2 × 2 crossover design. Dietary intake and change in lean mass values were compared between conditions by analysis of covariance and correlational analysis. The dietary manipulation successfully altered the protein distribution score (average number of eating occasions containing > 20 g of protein) to 4.0 ± 0.8 and 5.9 ± 0.7 (p < .01) for the bolus and frequent conditions, respectively. There was no difference in gains in lean mass between the bolus (1.4 ± 1.5 kg) and frequent (1.5 ± 1.4 kg) conditions (p = .91). There was no clear effect of increasing protein distribution from approximately 4-6 eating occasions on changes in lean mass during a rugby preseason. However, other dietary factors may have augmented adaptation.