Exploring the adoption of concept-based curricula: insights from educators and implications for change.

Concept-based approaches to curriculum design have been proposed to solve content and curricula overload and promote conceptual learning. Few health professions have adopted this approach and little is known about how to support this educational change. We aimed to understand how nutrition and dietetics educators may navigate proposed education change towards concept-based curricula. We employed an interpretivist approach and in-depth interviews that explored the views of nutrition and dietetic educators towards using a concept-based approach to curriculum. Employing deductive thematic analysis based on the diffusion of innovation theory, data from twenty experienced dietetics educators were analysed. Three main themes were identified; the need for change champions, concerns about change, and the complexity of the education system. Diffusion of innovation theory highlighted that to enact change, the relative advantage and compatibility of the approach with current structures and systems, with evidence from trialling and observing the new approach in action, were needed. Developing education leaders and infiltrating the social system of education through existing communities of practice is critical to enacting educational change.

Study protocol - assessing parkrun for walking rehabilitation for people living with, and beyond, cancer: acceptability, adherence, social support and physical function.

INTRODUCTION: Due to a variety of barriers, the majority of cancer survivors do not do enough physical activity to meet current recommendations. This study will assess the feasibility of participation in parkrun walk-run events as a novel mode of community rehabilitation exercise. METHODS: This protocol describes a single-arm intervention study with participants acting as their own controls. The study accepts adults diagnosed with any type of cancer, undergoing treatment or in remission. Participants must be able to walk and have medical clearance to exercise. A sample of 100 participants will be recruited across the Sunshine Coast over two years. Data will be collected over 9-months at 4 time points: Baseline (T1); after 4-weeks of usual daily activities and cancer management prior to parkrun participation(T2); after a 6-month parkrun intervention (T3); at 2-month follow-up (T4). The primary objectives are to assess the acceptability of, and adherence to, parkrun as rehabilitation exercise. Secondary outcomes include wellness, health-related quality of life, anxiety, depression, mood, physical function, parkrun metrics, dietary intake, and diet and exercise behaviour. CONCLUSION: This study will be the first to examine the long-term effects of parkrun as a cancer rehabilitation modality with regard to physical function, psychosocial outcomes and dietary intake. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12623000473662 registered 09/05/2023.Approved by UniSC Human Research Ethics Committee (A221828) and the UK parkrun Research Board. Original protocol. Authors SB, RB, HHW, MM, YK.

The effect of dietary interventions or patterns on the cardiometabolic health of individuals treated with androgen deprivation therapy for prostate cancer: A systematic review.

Prostate cancer survivors treated with androgen deprivation therapy may be at increased risk of cardiovascular disease. Dietary recommendations for the prevention and/or management of cardiovascular disease for these individuals are lacking. This review synthesizes the evidence on the effect of dietary interventions on cardiometabolic biomarkers and cardiovascular disease risk in prostate cancer survivors receiving androgen deprivation therapy. A systematic review was conducted across PubMed, CINAHL, Embase, and Cochrane CENTRAL. Intervention or observational cohort studies evaluating diets, nutrients, or nutraceuticals with or without concurrent exercise interventions on cardiovascular disease, cardiovascular events, or cardiovascular disease biomarkers in those treated with androgen deprivation therapy were included. Confidence in the body of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluations. Twelve studies reported across fifteen papers were included. Interventions were heterogenous, with most studies including an exercise co-intervention (n = 8). Few significant findings for the effects of diet on cardiometabolic markers were likely due to weak methodology and sample sizes. Strongest evidence was for the effect of a healthy Western dietary pattern with exercise on improved blood pressure (Confidence: moderate). The healthy Western dietary pattern with exercise may improve high-density lipoprotein cholesterol (Confidence: Low) and flow-mediated dilation. Soy may improve total cholesterol (Confidence: Very low). A low-carbohydrate diet with physical activity may improve high-density lipoprotein cholesterol, incidence of metabolic syndrome, and Framingham cardiovascular disease risk score. Evidence of the effect of dietary interventions on cardiometabolic biomarkers and cardiovascular disease risk of prostate cancer survivors receiving androgen deprivation therapy is insufficient to inform practice. Well-designed dietary interventions aimed at improving cardiometabolic outcomes of this population are warranted to inform future dietary recommendations.

Dietary Inflammatory Index and Associations with Sarcopenia Symptomology in Community-Dwelling Older Adults.

Low-grade systemic inflammation is a key driver of muscle degeneration in older adults, and diets with pro-inflammatory properties may further contribute to loss of muscle mass, strength and function. Therefore, this research aimed to explore the associations between the inflammatory potential of the diet and measures of sarcopenia symptomology in community-dwelling older adults. Upper (handgrip strength, HGS) and lower extremity (sit-to-stand) muscle strength, physical performance (timed-up-and-go, TUG) and appendicular skeletal muscle mass (ASM) was assessed according to the European Working Group on Sarcopenia in Older People version 2 (EWGSOP2) criteria. Multiple 24-hr dietary recalls were used to calculate the Dietary Inflammatory Index (DII), which was then used to group participants into anti- and pro-inflammatory dietary groups. Multiple linear regression investigated associations between DII, muscle strength, physical performance, and muscle quantity adjusted for age, gender, comorbidities, waist circumference and physical activity. Adults 65-85 years (n = 110, 72.1 ± 4.7 years, 76.4% female) were recruited. One participant was identified with sarcopenia, 35.2% were pre-frail, or frail. More participants with a pro-inflammatory DII score had low muscle quantity than those with anti-inflammatory DII (3.4% vs. 6.4%, x2 = 4.537, p = 0.043) and DII was negatively associated with HGS (ß = -0.157, p = 0.016) and ASM (ß = -0.176, p = 0.002) which remained significant after adjusting for covariates. In this population, DII was associated with less favorable muscle strength, physical performance, and muscle quantity.

Perceptions of Older Adults with Hematological Cancer on Diet and Exercise Behavior and Its Role in Navigating Daily Tasks.

Diet and exercise are associated with the maintenance of physical function, independence and better health-related quality of life in cancer survivors. Adherence to healthy diet and exercise guidelines, however, remains low. The aim of this study was to explore the perceptions of hematological cancer survivors (HCS, ≥50 years) on the role of diet and exercise in navigating daily tasks using a qualitative descriptive research method. Eligible HCS completed an online survey gathering demographic information including physical functioning, exercise frequency, malnutrition and frailty risk. Following a semi-structured telephone interview, thematic analysis was used. Nine HCS (67 ± 2 years) were included in the final analysis, with 55.5% sufficiently active, three at risk of malnutrition and five of frailty. Three primary themes reflected the survivors' perceptions: (1) beliefs about the impact of diet and exercise on physical and mental wellbeing, (2) the ability to overcome barriers to adhere to healthy diet and exercise behavior, and (3) diet and exercise empowered and gave hope. Participants had a more nuanced understanding of the role of exercise in physical function but lacked insight into the role of a healthy diet. Knowledge, support and instruction were key enablers of diet and exercise behavior, with community connection a unique enabler identified in this group.

Dietary strategies for chemotherapy-induced nausea and vomiting: A systematic review.

BACKGROUND & AIMS: Chemotherapy-induced nausea and vomiting (CINV) is one of the most distressing cancer treatment side effects, affecting 20-70% of patients despite routine antiemetic prescription. Although dietary modifications are routinely recommended in clinical practice, there is lack of data synthesis to determine which dietary strategies for managing CINV are supported by quality evidence. This systematic review was conducted to examine the effect of dietary strategies on incidence and severity of CINV in adults compared with no intervention, usual care, or alternative strategies. METHODS: Five electronic databases were searched from inception to 15th July 2021 for original research studies of interventional or observational design assessing dietary strategies for CINV. The quality of evidence was appraised, data were synthesized narratively, and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment of the certainty of the evidence was applied. RESULTS: Twenty-one studies were included, 10 (48%) interventional studies and 11 (52%) observational studies. Most interventional and observational studies had a high or neutral risk of bias (70% and 72%, respectively). Of the interventions studied, strongest evidence with highest certainty was found for the very large positive effect of CINV-specific education and support with a personalized meal plan from a dietician, implemented in person or in writing, for reducing the severity of nausea and overall CINV (effect size: very large; GRADE: high). A statistically significant very large positive effect of ginger tea consumption was also found on overall CINV severity; however, certainty in this effect was very low. Although confidence in the findings from observational studies was very low to low, a statistically significant positive association was also found between a moderate intake of alcohol and incidence of nausea, vomiting, or overall CINV as well as nausea severity; the Mediterranean diet and nausea incidence and severity; and adequate intake of energy, protein, fat, or carbohydrate and nausea or vomiting incidence. CONCLUSION: Improved CINV was associated with CINV-specific nutrition education and support from health professionals. Non-restrictive dietary patterns that include adequate energy and macronutrient intakes, particularly protein, and include ginger, and Mediterranean diet concepts may benefit CINV; however, the confidence in the body of evidence to inform these conclusions is mostly very low to moderate. Future rigorous trials with adequate sample sizes, clearly defined dietary strategies, and valid outcome measures are warranted prior to dietary strategies being routinely prescribed alongside antiemetic regimens.

Assessment of communication skills using telehealth: considerations for educators.

Objective: The main aim of this study was to explore the views and perceptions of dietetic educators on their ability to assess communication skills of undergraduate student dietitians in a telehealth setting. A secondary aim was to provide recommendations to educators when assessing these skills using telehealth. Methods: A descriptive qualitative study design was used. Australian and New-Zealand dietetic educators used a validated global communication rating scale to evaluate three pre-recorded telehealth encounters. Educators then answered a series of open-ended questions on their ability to assessed communication skills in the telehealth environment. Analysis: Inductive analysis allowed the emergence of themes and sub-themes independent of a specific framework or theory. Peer debriefing and triangulation increased research rigor. Results: Twenty-four educators were included in this study with the majority (87.5%) having > 10 years experience as a dietetic educator, and 41.6% (n = 10) with experience in assessing dietetics student using telehealth. Most (76%) educators reported the assessment of non-verbal communication skills were challenging in the telehealth environment. Five themes and 15 subthemes emerged relating to advice for students and educators when assessing communication skills and a checklist was developed from recommendations that students and educators can use when preparing, planning, implementing, and assessing telehealth consultations. Conclusion: Assessing student communication skills via telehealth provides a useful opportunity with the growing use of the online environment, however, it also presents challenges that must be taken into consideration. While verbal communication skills are easier to assess than non-verbal, both need to be adapted for the telehealth setting.

Correction: Identification of a variant in NDP associated with X-linked retinal dysplasia in the English cocker spaniel dog.

[This corrects the article DOI: 10.1371/journal.pone.0251071.].

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.

Identification of a variant in NDP associated with X-linked retinal dysplasia in the English cocker spaniel dog.

PURPOSE: Three related male English Cocker Spaniels (ECS) were reported to be congenitally blind. Examination of one of these revealed complete retinal detachment. A presumptive diagnosis of retinal dysplasia (RD) was provided and pedigree analysis was suggestive of an X-linked mode of inheritance. We sought to investigate the genetic basis of RD in this family of ECS. METHODS: Following whole genome sequencing (WGS) of the one remaining male RD-affected ECS, two distinct investigative approaches were employed: a candidate gene approach and a whole genome approach. In the candidate gene approach, COL9A2, COL9A3, NHEJ1, RS1 and NDP genes were investigated based on their known associations with RD and retinal detachment in dogs and humans. In the whole genome approach, affected WGS was compared with 814 unaffected canids to identify candidate variants, which were filtered based on appropriate segregation and predicted pathogenic effects followed by subsequent investigation of gene function. Candidate variants were tested for appropriate segregation in the ECS family and association with disease was assessed using samples from a total of 180 ECS. RESULTS: The same variant in NDP (c.653_654insC, p.Met114Hisfs*16) that was predicted to result in 15 aberrant amino acids before a premature stop in norrin protein, was identified independently by both approaches and was shown to segregate appropriately within the ECS family. Association of this variant with X-linked RD was significant (P = 0.0056). CONCLUSIONS: For the first time, we report a variant associated with canine X-linked RD. NDP variants are already known to cause X-linked RD, along with other abnormalities, in human Norrie disease. Thus, the dog may serve as a useful large animal model for research.

Lower body extremity function is associated with health-related quality of life: a cross-sectional analysis of overweight and obese older adults with and without type 2 diabetes mellitus.

PURPOSE: We aimed to explore the relationship between characteristics of the sarcopenic phenotype and health-related quality of life (HRQoL) in community-dwelling overweight and obese older adults with and without type 2 diabetes mellitus (T2DM). METHODS: Appendicular lean mass (ALM), corrected for height (ALM/m2) was assessed by dual-energy X-ray absorptiometry. Muscle strength was assessed using handgrip strength (HGS), and lower extremity physical function was assessed using the Short Performance Physical Battery (SPPB) and gait speed. HRQoL was determined using the short-form 36 (SF-36) survey. Multiple regression analysis was used to examine the association between characteristics of the sarcopenic phenotype and domains of HRQoL. RESULTS: A total of n = 152 community-dwelling older adults were included (T2DM cohort: n = 87, 71.2 ± 8.2 years, BMI: 29.5 ± 5.9 kg/m2; Obese cohort: n = 65, 68.7 ± 5.6 years, BMI: 33.7 ± 4.9 kg/m2). After adjusting for potential confounders, gait speed and SPPB were positively associated with the physical function subscale of HRQoL (Gait speed: ß = 0.658; P < 0.001; SPPB: ß = 0.478; P < 0.001). This relationship was also maintained for gait speed when assessed independently by cohort (T2DM cohort: ß = 0.637; P < 0.001; Obese cohort: ß = 0.507; P = 0.003). CONCLUSIONS: Our results further contribute to the literature suggesting that lower body extremity function is associated with the physical function subscale of HRQoL. However, larger longitudinal data are required to assess whether lower body extremity function is independently associated with HRQoL, which includes the potential impact of nutrition and physical activity status.

Protein intake is not associated with functional biomarkers of physical frailty: A cross-sectional analysis of community-dwelling older adults with type 2 diabetes mellitus.

BACKGROUND AND AIM: Frailty has emerged as a third category of complication in patients with type 2 diabetes mellitus (T2DM). It has been suggested that adequate protein intake is an important dietary strategy for counteracting frailty. Therefore, we explored the association between protein intake and functional biomarkers of frailty in older adults with T2DM. METHODS AND RESULTS: Frailty was operationalized as the presence of three of the following: exhaustion, low muscle strength, low physical activity, slow gait speed, and weight loss. Functional biomarkers included handgrip strength (HGS), chair stands, the short physical performance battery and gait speed. Eighty-seven older adults (71.2 ± 8.2 years; 66.7% males) were included. A total of n = 6 (~7%) and n = 32 (~37%) participants were identified as frail and pre-frail respectively. No significant difference was observed for protein intake across staging of frailty (pre-frail/frail: 1.3 ± 0.4 g/kg BW; non-frail: 1.4 ± 0.4 g/kg BW; P = 0.320). A significant association was observed for total protein intake and HGS (ß = 0.44; 95% CI: 0.23-1.8; P = 0.01). However, this was no longer significant after adjusting for age, gender, physical activity, energy intake and total appendicular lean muscle (ß = 0.03; 95% CI: -0.45-0.60; P = 0.78). Nil other associations were observed between total protein intake and functional biomarkers of frailty. CONCLUSION: Adequate protein intake was not associated with functional biomarkers in older adults with T2DM. Future research should focus on the efficacy of protein on attenuating functional decline in vulnerable older adults with low protein intake.

Key concepts for dietetic curriculum: An observational study of Australian dietitians' perceptions.

AIM: A concept-based approach to dietetic curriculum design has been proposed to prevent content overload and promote critical thinking. Fifty-six concepts were identified in a previous study. The aim of the present study was to investigate whether the dietetic profession views these concepts as representative of current practice and key for nutrition and dietetics education, and identify any new or emerging concepts. METHODS: Accredited Practising Dietitians (APDs) were invited to participate in a self-administered online survey that included scale responses on the relevance of the 56 concepts and open-ended suggestions of additional concepts. Respondent characteristics were also collected. RESULTS: Ninety-eight APDs completed the survey. Greater than 65% of respondents agreed/strongly agreed that all 56 concepts were relevant. There was less agreement on the concepts of acid-base balance; leadership; management; physical activity, exercise and health; quality assurance and improvement; risk; safety; stakeholder; standards; sustainability; systems and technology and health informatics. Respondents working in regional, rural and remote areas were less likely to agree that leadership was a key concept (χ2 = 4.45, P = .035). Respondents working in teaching and education were more likely to agree that sustainability was a key concept (χ2 = 7.02, P = .008). No new concepts were identified. CONCLUSIONS: The existing 56 concepts were considered key for nutrition and dietetics education. Although the respondents to this survey view these concepts as relevant to current practice, this may not represent the entire profession. It is yet to be determined if the concepts will meet future priorities for the dietetic workforce.

Outcomes of a nutrition service provided by dietitians at a major multi-cultural competition event: An observational study.

AIM: The nutrition service available for athletes competing at major events varies significantly and is dependent on advocacy for dietetic inclusion. The aim of this study was to describe the outcomes of a nutrition service designed and led by dietitians at a major international competition: the 2017 Taipei Universiade. METHODS: Athletes (university students aged 17-25 years) and officials that used the service were invited to participate. Occasions of service were recorded using standard pro formas and dietary analysis of consultations was conducted using Foodworks. RESULTS: The scope of the service included 242 enquiries, 884 weight checks, 25 skinfold measures and 37 consultations. A significantly higher proportion of females asked about food allergy/intolerance (26.2% vs 12.5%, P = .039) than males. Most athletes who sought a nutrition consultation had not received previous nutrition support (86.5%) and wanted performance-related meal plans and advice (81.1%). On average, their diets were adequate in micronutrients with the exception of calcium, and low in serves of vegetables and dairy products. The majority of athletes (72.9%) seeking a consultation reported that they did not follow a specific diet for their sport. Sports supplements, performance enhancers and vitamin-mineral supplements use was 45.9% (n = 17), 13.5% (n = 5) and 13.5% (n = 5), respectively. Most athletes were of a high international calibre, however, reported low confidence in their nutrition knowledge and did not consistently apply knowledge to practice. CONCLUSION: This demonstrates a need for nutrition services by dietitians at this and similar events to improve the dietary intake of young adult athletes.

Using document analysis to identify core concepts for dietetics: The first step in promoting conceptual learning.

Concept-based approaches to curriculum design have been proposed in nursing and health sciences education to address the issue of content overload in curricula but have not been described in dietetics. This study aimed to identify core concepts for the dietetics discipline in Australia and investigate the commonality and differences in these concepts across different dietetic organizations across the world. This study used document analysis of a purposive sample of international dietetics competency or proficiency standards identified from English-speaking dietetic organizations worldwide. Content analysis was applied to the performance criteria or equivalent from 10 documents (nine organizations) to identify the most common elements. A total of 1,007 statements were analyzed. Fifty-six concepts were developed. The four most frequent concepts coded across all statements were "critical thinking," "communication," "nutrition and dietetic service," and "quality assurance and improvement." There were 55 concepts common to all standards. The concept of "food security" was not present in one of the standards from the United States. The concepts that emerged from this study were common across different English-speaking dietetic organizations across the world. Small differences on the emphasis of concepts, between different competency standards may reflect the health needs; health, political, economic, and social systems; and the cultural context of a country. Identifying core concepts in dietetics is the first step to help to inform curriculum design, which may address overcrowded curricular and promote conceptual learning.

Assessing the construct validity of nutrient profiling models for restricting the marketing of foods to children in South Africa.

BACKGROUND: In an effort to combat childhood obesity the WHO has called on governments to restrict the marketing of unhealthy foods to children. Regulators have turned to nutrient profiling (NP) to provide the evidence for their decisions. This has resulted in the development of NP models, of which the validity of only a few have been established. The aim of this study was to assess the construct validity of various NP models for the purpose of restricting the marketing of unhealthy foods to children in South Africa by comparing the classification of foods by the models to the ranking of the same foods by registered dietitians. METHODS: Six current NP models were identified, then a representative food database of 120 foods was developed and each individual food was classified by each of the six models. Lastly dietitians were recruited to rank the healthfulness of the same 120 foods. RESULTS: Dietitians allowed 24% of the included foods for marketing to children, whereas the percentage of foods allowed by the included models ranged from 7 to 47%. Majority of pairwise comparisons between the NP models and dietitians yielded Ò¡ statistics >0.6, indicating substantial agreement. An almost perfect pairwise agreement was found between dietitians and the WHO Regional Office for Europe model. CONCLUSION: The included NP models displayed good construct validity by agreeing with dietitians on what are 'less healthy' foods, thus the foods not allowed for marketing. The findings of this study contributes to the process of establishing validity of NP models.

A variant in OLFML3 is associated with pectinate ligament abnormality and primary closed-angle glaucoma in Border Collies from the United Kingdom.

PURPOSE: Canine primary closed-angle glaucoma (PCAG) is a complex disease caused by multiple genetic factors. A c.590G>A variant in OLFML3 was recently reported to be a candidate for pectinate ligament abnormality (PLA) and PCAG in the Border Collie. We investigated the association of this variant with PLA and PCAG in Border Collies from the United Kingdom. METHODS: The OLFML3 variant was genotyped in 106 Border Collies comprising 90 with normal eyes (controls) and 16 with PLA (n = 11) and/or PCAG (n = 5) (cases). Genotyping was performed in an additional 103 Border Collies to estimate variant frequency within the population. To investigate the association of the variant with disease in other breeds, genotyping was performed in 337 non-Border Collies with PLA and/or PCAG. RESULTS: Of the 90 controls, 71 were homozygous for the wild-type allele, two were homozygous for the variant, and 17 were heterozygous. Of the 16 cases, three were homozygous for the wild-type allele, 11 were homozygous for the variant, and two were heterozygous. The association of the variant allele with disease was significant (P = 1.1 x 10-9 ). We estimated the frequency of this variant to be 4.4% within the United Kingdom Border Collie population, and it was not identified in clinically affected dogs of any other breed. CONCLUSIONS: This study confirms the association of the OLFML3 variant with PLA and PCAG in Border Collies from the United Kingdom. DNA testing for the variant and selective breeding can reasonably be expected to result in a reduction of PLA and PCAG prevalence in the breed.

Disordered eating behaviours in female physique athletes.

Despite substantial growth in participation rates in physique sports, little is known about the modern day female physique athlete. The extreme physique traits of successful female physique athletes suggest this population may be particularly at risk of developing disordered eating (DE). The aim of this study was to determine if female physique athletes across the main divisions of bikini, fitness, figure and bodybuilding were at risk of DE and to explore possible associated risk factors. Furthermore, we aimed to investigate differences in incidence of DE across divisions given differences in physique requirements. Female physique athletes (n = 348) were recruited using targeted methods and completed an online survey based on validated questionnaires, including the Drive for Thinness, Body Dissatisfaction, and Bulimia subscales of the Eating Disorder Inventory (EDI), Pathogenic Weight Control Measures (PWCM), and the Cognitive Dietary Restraint subscale of the Three-Factor Eating Questionnaire (TFEQ-CDR). Athletes scoring above the cut off values for one or more of the EDI subscales or engaged in at least one of the most concerning PWCM (binge eating, laxative use, and self-induced vomiting) were considered at risk of DE. Approximately half of the participants were identified with DE (46.6%), independent of division, with 27.3% exhibiting clinical and 19.3% having subclinical DE. Furthermore, approximately half (48.9%) of participants engaged in at least one of the most concerning PWCM within the past three months, with a smaller proportion (5.2%) engaging in all three PWCM. Weak but significant correlations were found between some EDI subscales and reason for sport participation, BMI and body composition goals. Drive for thinness and body dissatisfaction were positively associated with use of PWCM. In conclusion, a high proportion of female physique athletes were identified with DE, with a concerning number of athletes engaging in harmful PWCM.

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.