Predicting height from ulna length for the determination of weight status in New Zealand adolescents: A cross-sectional study.

BACKGROUND: The measurement of height is crucial for weight status assessment. When standing height is difficult to measure, ulna length may offer a convenient and accurate surrogate of height measure. Adolescence is a period of accelerated linear growth; hence, the validation of age-specific equations that predict height from ulna length in adolescents is warranted. The present study aimed to develop and validate age- and sex-specific equations for predicting height from ulna length in New Zealand adolescents. METHODS: Height, weight and ulna length were measured in 364 adolescents (n = 110 males, n = 254 females) aged 15.0-18.8 years, who were enrolled in the SuNDiAL (Survey of Nutrition Dietary Assessment and Lifestyle) project, a cross-sectional survey performed in 2019 and 2020. Regression models were used to determine equations to predict height from ulna length. Agreement between measured and predicted height, body mass index (BMI) and BMI z-score was assessed with intra-class correlation coefficients (ICC) and Bland-Altman plots. Sensitivity and specificity were calculated for classifying obesity. RESULTS: Strong agreement was found between predicted and measured height (ICC = 0.78; mean difference = 0; 95% confidence interval = -0.5 to 0.5 cm) and BMI (ICC = 0.95; mean difference = 0; 95% confidence interval = -0.1 to 0.1 kg m-2 ). Predicted height was 88.1% accurate when classifiying weight status, showing high sensitivity (93.8%) and specificity (99.4%) for classifying obesity. CONCLUSIONS: Ulna length measurement can accurately estimate height and subsequently weight status in New Zealand adolescents aged 15-18 years.

Dietary Protein Intake and Transition between Frailty States in Octogenarians Living in New Zealand.

Adequate nutritional status may influence progression to frailty. The purpose of this study is to determine the prevalence of frailty and examine the relationship between dietary protein intake and the transition between frailty states and mortality in advanced age. We used data from a longitudinal cohort study of Maori (80-90 years) and non-Maori (85 years). Dietary assessments (24-h multiple pass dietary recalls) were completed at the second year of follow-up (wave 2 and forms the baseline in this study). Frailty was defined using the Fried Frailty criteria. Multi-state modelling examined the association of protein intake and transitions between frailty states and death over four years. Over three quarters of participants were pre-frail or frail at baseline (62% and 16%, respectively). Those who were frail had a higher co-morbidity (p < 0.05), where frailty state changed, 44% showed a worsening of frailty status (robust → pre-frail or pre-frail → frail). Those with higher protein intake (g/kg body weight/day) were less likely to transition from robust to pre-frail [Hazard Ratio (95% Confidence Interval): 0.28 (0.08-0.91)] but also from pre-frail to robust [0.24 (0.06-0.93)]. Increased protein intake was associated with lower risk of transitioning from pre-frailty to death [0.19 (0.04-0.80)], and this association was moderated by energy intake [0.22 (0.03-1.71)]. Higher protein intake in this sample of octogenarians was associated with both better and worse outcomes.

Multiple Micronutrients, Including Zinc, Selenium and Iron, Are Positively Associated with Anemia in New Zealand Aged Care Residents.

Anemia is a significant comorbidity for older adults not fully attributable to iron deficiency. Low-grade inflammation and other micronutrient deficiencies also contribute. This cross-sectional study examined the relationships between nutrient and non-nutrient factors with hemoglobin and anemia in 285 residents (>65 years) of 16 New Zealand aged-care facilities. Blood samples were analyzed for hemoglobin, ferritin, sTfR, hepcidin, zinc, selenium, and interleukin-6 (IL-6), (with ferritin, sTfR, zinc and selenium adjusted for inflammation). Linear regression models examined the relationships between micronutrient biomarkers (iron, zinc, selenium, vitamin B-12 and D), age, sex, and health factors with hemoglobin. Thirty-two percent of participants exhibited anemia, although <2% had either depleted iron stores or iron deficiency. Plasma zinc and selenium deficiencies were present in 72% and 38% of participants, respectively. Plasma zinc and total body iron (TBI) were positively associated (p < 0.05) with hemoglobin, while gastric acid suppressing medications, hepcidin, and interleukin-6 were inversely associated. These relationships were maintained after the application of anemia cut-offs. These findings emphasize the importance of considering multiple micronutrient deficiencies as risk factors for anemia.

Developing Dietetic Students' Confidence in Multicultural Communication through Flipped Learning.

Problem: In a Master of Dietetics program, cultural competence was originally taught with lectures of cultural food practices. Course evaluations reflected that students wanted more opportunities to practice multicultural communication skills whereas lecturers felt that students' personal inquiry of cultural competence could be strengthened. This study explores whether the combination of self-directed pre-class learning and in-class activities through flipped learning could address these instructional issues. Three research questions were examined: (1) How did dietetic students' perceived confidence in multicultural communication change before and after undergoing flipped learning? (2) Which aspects of cultural competence influenced students' confidence in multicultural communication before and after flipped learning? (3) Which aspects of cultural competence were students' cultural learning goals based upon after flipped learning? Intervention: The intervention began with an introductory lesson in which students attended a lecture on New Zealand's cultural landscape, self-assessed their cultural influences, and completed self-directed learning of cultural competence concepts. After this, students participated in two flipped learning lessons; the first lesson focused on cultural knowledge and the second on multicultural communication skills. For both lessons, students completed preparatory activities before engaging in small-group activities during the class sessions. Before and after the flipped learning lessons, students wrote online reflections about the reasons underlying their confidence in multicultural communication. Context: The intervention was carried out with 32 early dietetic students who were in their first semester of postgraduate studies and 31 students consented to study participation. The majority of study participants were female (n = 30, 97%), European or Asian (n = 28, 91%), and between 21-30 years old (n = 27, 87%). Impact: Pre and post module surveys submitted by 31 students showed that more of them reported being confident or very confident in multicultural communication after flipped learning. Reflections submitted by 31 students before flipped learning showed that their confidence in multicultural communication was based upon their cultural knowledge and cultural interaction experiences. Reflections submitted by 19 students after flipped learning indicated that they developed cultural skill which helped them become confident in multicultural communication. These students set goals to continue developing their cultural knowledge, engaging in cultural interaction, and optimizing opportunities for applying cultural skill during clinical practice. Lessons learned: The study results showed that flipped learning can be used for cultural learning. As compared to lectures, flipped learning can provide students with more authentic contexts to practice multicultural communication. These learning experiences model how students might continue to self-direct their cultural competence development throughout their professional practice.

A comparison of methods for adjusting biomarkers of iron, zinc, and selenium status for the effect of inflammation in an older population: a case for interleukin 6.

Background: Older people are at risk of micronutrient deficiencies, which can be under- or overestimated in the presence of inflammation. Several methods have been proposed to adjust for the effect of inflammation; however, to our knowledge, none have been investigated in older adults in whom chronic inflammation is common. Objective: We investigated the influence of various inflammation-adjustment methods on micronutrient biomarkers associated with anemia in older people living in aged-care facilities in New Zealand. Design: Blood samples were collected from 289 New Zealand aged-care residents aged >65 y. Serum ferritin, soluble transferrin receptor (sTfR), total body iron (TBI), plasma zinc, and selenium as well as the inflammatory markers high-sensitivity C-reactive protein (CRP), α1-acid glycoprotein (AGP), and interleukin 6 (IL-6) were measured. Four adjustment methods were applied to micronutrient concentrations: 1) internal correction factors based on stages of inflammation defined by CRP and AGP, 2) external correction factors derived from the literature, 3) a regression correction model in which reference CRP and AGP were set to the maximum of the lowest decile, and 4) a regression correction model in which reference IL-6 was set to the maximum of the lowest decile. Results: Forty percent of participants had elevated concentrations of CRP, AGP, or both, and 37% of participants had higher than normal concentrations of IL-6. Adjusted geometric mean values for serum ferritin, sTfR, and TBI were significantly lower (P < 0.001), and plasma zinc and selenium were significantly higher (P < 0.001), than the unadjusted values regardless of the method applied. The greatest inflammation adjustment was observed with the regression correction that used IL-6. Subsequently, the prevalence of zinc and selenium deficiency decreased (-13% and -14%, respectively; P < 0.001), whereas iron deficiency remained unaffected. Conclusions: Adjustment for inflammation should be considered when evaluating micronutrient status in this aging population group; however, the approaches used require further investigation, particularly the influence of adjustment for IL-6.

Vitamin D status and its predictors in New Zealand aged-care residents eligible for a government-funded universal vitamin D supplementation programme.

OBJECTIVE: The provision of prescribed vitamin D to all aged-care residents has been implemented in New Zealand as part of a government-led falls prevention programme. To our knowledge, there has been no evaluation of this universal programme on vitamin D status and functional and health outcomes. Thus, we aimed to determine 25-hydroxyvitamin D (25(OH)D) concentrations and their predictors in aged-care residents across the country and to investigate whether the government-funded programme was associated with adequate vitamin D status. DESIGN: Cross-sectional survey of sociodemographic, biochemical, anthropometric, dietary and health characteristics. Blood samples were analysed for serum 25(OH)D and other biochemical measures. Multiple regression was used to examine predictors of vitamin D status. SETTING: Sixteen residential aged-care facilities throughout New Zealand. SUBJECTS: Residents aged ≥60 years with residency duration >12 weeks (n 309). RESULTS: Mean serum 25(OH)D was 89·9 (95 % CI 85·2, 94·5) nmol/l and monthly supplements (1250 µg (50 000 IU)) were taken by 75 % of all residents. Of those not taking a funded supplement, 65·3 % had serum 25(OH)D 125 nmol/l. CONCLUSIONS: Residents taking supplemental vitamin D had adequate vitamin D status; however monitoring of long-term supplementation should be considered, due to the high proportion of participants with high serum 25(OH)D levels.

Iodine Status of New Zealand Elderly Residents in Long-Term Residential Care.

In response to the re-emergence of iodine deficiency in New Zealand, in 2009 the government mandated that all commercially made breads be fortified with iodized salt. There has been no evaluation of the impact of the program on iodine status of the elderly, despite this population group being vulnerable to iodine deficiency or excess. The aim of this study was to describe the iodine status of elderly New Zealanders in residential aged-care homes following the implementation of the bread fortification program. A cross-sectional survey was conducted, involving 309 residents (median age 85 years) from 16 aged-care homes throughout NZ. Information on socio-demographic, anthropometric, dietary and health characteristics were collected. Casual spot urine samples were analysed for urinary iodine concentration (UIC). Blood samples were analysed for serum thyroglobulin, thyroglobulin antibodies, and other biochemical indices. The median UIC (MUIC) of the residents was 72 µg/L, indicating mild iodine deficiency, and 29% had a UIC < 50 µg/L. Median thyroglobulin concentration was 18 ng/mL and 26% had elevated thyroglobulin concentration (>40 ng/mL), suggesting iodine insufficiency. Diuretic use was associated with lower MUIC (p = 0.043). Synthetic thyroxine use was associated with lower odds of having a UIC < 50 µg/L (OR 0.32, p = 0.030)) and lower median thyroglobulin (-15.2 ng/mL, p = 0.001), compared with untreated participants. Frailty was associated with elevated thyroglobulin (p = 0.029), whereas anemia was associated with lower thyroglobulin (p = 0.016). Iodine insufficiency persists in New Zealanders residing in residential aged-care homes despite increasing iodine intake from fortified bread. Research is required to establish optimal iodine intake and status in the elderly.