A Mediterranean lifestyle is associated with favourable cardiometabolic markers in people with non-dialysis dependent chronic kidney disease.

Adherence to a Mediterranean lifestyle may be a useful primary and secondary prevention strategy for chronic kidney disease (CKD). This cross-sectional study aimed to explore adherence to a Mediterranean lifestyle and its association with cardiometabolic markers and kidney function in 99 people aged 73⋅2 ± 10⋅5 years with non-dialysis dependant CKD (stages 3-5) at a single Australian centre. Adherence was assessed using an a priori index, the Mediterranean Lifestyle (MEDLIFE) index. Cardiometabolic markers (total cholesterol, LDL-cholesterol, HbA1c and random blood glucose) and kidney function (estimated GFR) were sourced from medical records and blood pressure measured upon recruitment. Overall, adherence to a Mediterranean lifestyle was moderate to low with an average MEDLIFE index score of 11⋅33 ± 3⋅31. Adherence to a Mediterranean lifestyle was associated with employment (r 0⋅30, P = 0⋅004). Mediterranean dietary habits were associated with cardiometabolic markers, such as limiting sugar in beverages was associated with lower diastolic blood pressure (r 0⋅32, P = 0⋅002), eating in moderation with favourable random blood glucose (r 0⋅21, P = 0⋅043), having more than two snack foods per week with HbA1c (r 0⋅29, P = 0⋅037) and LDL-cholesterol (r 0⋅41, P = 0⋅002). Interestingly, eating in company was associated with a lower frequency of depression (χ2 5⋅975, P = 0⋅015). To conclude, Mediterranean dietary habits were favourably associated with cardiometabolic markers and management of some comorbidities in this group of people with non-dialysis dependent CKD.

Factors Influencing Low Sodium Intake in People with Non-Dialysis Dependent Chronic Kidney Disease.

OBJECTIVE: To evaluate dietary sodium intake in people with chronic kidney disease (CKD) and identify contributing factors to low sodium intake by applying the Theory of Planned Behaviour (TPB) framework. DESIGN AND METHODS: Non-dialysed people with CKD completed a 24-hour urinary sodium excretion test and Scored Salt Questionnaire (SSQ). A survey including socio-demographic information, Brief Illness Perception Questionnaire, Short Sodium Knowledge Survey and Dietary Sodium Restriction Questionnaire based on TPB measured the factors contributing to dietary adherence. RESULTS: Sixty-three people [age: 71 (IQR: 64-77); 27% female] participated with 80% having high urinary sodium excretion [median: 134 mmol/day (111; 183)] but only 40% reported high sodium intake [SSQ score = 53 (39; 75)]. Overall sodium knowledge was high in 57% of participants although only 33% had seen a dietitian. There was a positive correlation between attitude towards a low-sodium diet and subjective norm (social expectations), r = 0.44, p < 0.01; urinary sodium and the extent of perceived consequences of CKD (r = 0.26, p < 0.05); and the extent to which willpower was perceived as a barrier to adherence to dietary sodium restriction (r = 0.27, p < 0.05). Multiple regression analysis revealed taste of low-salt foods (ß = 8.9, p < 0.01) explained 26.4% of variance in dietary sodium intake (R2 = 0.264, F(12, 34), p < 0.01). CONCLUSION: TPB successfully identified barriers to follow a low-sodium diet in non-dialysed people with CKD. Taste preferences, willpower, meeting social expectations and disease concern were identified as key contributing factors to adherence.

Online nutrition information seeking among Australian primigravid women.

BACKGROUND: optimal nutrition in pregnancy is crucial for short and long term health in both mother and child. While a large proportion of pregnant women utilise the internet for informational support during pregnancy, little is known about online practices relating to food and nutrition in pregnancy. METHODS: a qualitative study; Semi-structured interviews were undertaken with 16 primigravid women to explore their approaches and preferences when accessing and engaging with pregnancy-related nutrition information online. Women who had accessed the Internet for pregnancy related nutrition and food information were recruited via snowball sampling from South East Queensland, Australia. Data were analysed in accordance with descriptive phenomenology. FINDINGS: food and nutrition information-seeking practices were highly varied but followed a similar overall pathway. Six broad themes were identified "triggers", "access and navigation", "appraisal", "changes in searching frequency", "preferred features" and "engagement with communication approaches". Women preferred online sources that were easy to navigate and presented information clearly. Experience as well as fact based communication appeared to satisfy different informational needs. KEY CONCLUSIONS AND IMPLICATIONS: women search for food and nutrition information online in similar ways to other pregnancy issues. Opportunity for engaging with women online regarding a range of food and nutrition topics may be limited to early in pregnancy unless prompted to via conversations with antenatal service providers. Health practitioners have a role to play in helping women source evidence-based web sites. There is opportunity for organisations with mandates to support women to optimise diet quality during pregnancy, to improve user experience building on key preferences identified in this study to increase appeal and engagement by pregnant women.

Online nutrition information for pregnant women: a content analysis.

Pregnant women actively seek health information online, including nutrition and food-related topics. However, the accuracy and readability of this information have not been evaluated. The aim of this study was to describe and evaluate pregnancy-related food and nutrition information available online. Four search engines were used to search for pregnancy-related nutrition web pages. Content analysis of web pages was performed. Web pages were assessed against the 2013 Australian Dietary Guidelines to assess accuracy. Flesch-Kincaid (F-K), Simple Measure of Gobbledygook (SMOG), Gunning Fog Index (FOG) and Flesch reading ease (FRE) formulas were used to assess readability. Data was analysed descriptively. Spearman's correlation was used to assess the relationship between web page characteristics. Kruskal-Wallis test was used to check for differences among readability and other web page characteristics. A total of 693 web pages were included. Web page types included commercial (n = 340), not-for-profit (n = 113), blogs (n = 112), government (n = 89), personal (n = 36) and educational (n = 3). The accuracy of online nutrition information varied with 39.7% of web pages containing accurate information, 22.8% containing mixed information and 37.5% containing inaccurate information. The average reading grade of all pages analysed measured by F-K, SMOG and FOG was 11.8. The mean FRE was 51.6, a 'fairly difficult to read' score. Only 0.5% of web pages were written at or below grade 6 according to F-K, SMOG and FOG. The findings suggest that accuracy of pregnancy-related nutrition information is a problem on the internet. Web page readability is generally difficult and means that the information may not be accessible to those who cannot read at a sophisticated level. © 2016 John Wiley & Sons Ltd.

Practitioner consensus on the determinants of capacity building practice in high-income countries.

OBJECTIVE: To assess and develop consensus among experienced public health nutrition practitioners from high-income countries regarding conceptualisation of capacity building in practice, and to test the content validity of a previously published conceptual framework for capacity building in public health nutrition practice. DESIGN: A Delphi study involving three iterations of email-delivered questionnaires testing a range of capacity determinants derived from the literature. Consensus was set at >50% of panellists ranking items as 'very important' on a five-point Likert scale across three survey rounds. SETTING: Public health nutrition practice in Australia, the UK, Canada and the USA. SUBJECTS: Public health nutrition practitioners and academics. Result A total of thirty expert panellists (68% of an initial panel of forty-four participants) completed all three rounds of Delphi questionnaires. Consensus identified determinants of capacity building in practice including partnerships, resourcing, community development, leadership, workforce development, intelligence and quality of project management. CONCLUSIONS: The findings from the study suggest there is broad agreement among public health nutritionists from high-income countries about how they conceptualise capacity building in public health nutrition practice. This agreement suggests considerable content validity for a capacity building conceptual framework proposed by Baillie et al. (Public Health Nutr 12, 1031-1038). More research is needed to apply the conceptual framework to the implementation and evaluation of strategies that enhance the practice of capacity building approaches by public health nutrition professionals.