Dietetics, Volume 2, Issue 1 (March 2023) – 10 articles

Cancer survivors consider nutrition to be highly important and are motivated to seek information about lifestyle changes, including nutrition, to improve their long-term health. Despite this, suboptimal dietary intake is still reported. Understanding cancer-specific barriers and facilitators to healthy eating among this population could help develop targeted interventions for this group. This study explored the barriers and facilitators to following a healthy diet among cancer survivors using the Theoretical Domains Framework (TDF) and COM-B model. Semi-structured focus groups with 20 cancer survivors were conducted between February and August 2021, which were transcribed verbatim. Seven key TDF domains accounted for 87% of all coded responses. These were (a) environmental context and resources; (b) knowledge; (c) behavioural regulation; (d) social/professional role and identity; (e) belief about consequences; (f) social influences; and (g) skills. Key barriers were lack of knowledge, non-specific or irrelevant information, environmental aspects, and family. Facilitators were awareness of the importance of nutrition, the health benefits of a plant-based diet, confidence in cooking skills, organisation, balance, family, time, and viewing themselves as someone who eats healthily and access to fresh produce. Enablement was the most prominently linked intervention function. This work can inform future interventions in this area and ensure they are end-user-centred. Full article

Background: Climate change is a serious threat to human wellbeing and development. Global reduction of meat intake is key to addressing climate change and other modern sustainability challenges. Plant-based and mycoprotein-based meat substitutes are predicted to play a key role in the reduction of meat intake; however, their impact on human health is unclear. The main objective of this meta-analysis was to assess the short-term effects of meat substitutes on important cardiometabolic biomarkers (total cholesterol, TC; LDL-cholesterol, LDL-C; HDL-cholesterol, HDL-C; triglycerides, TG; systolic blood pressure, SBP; diastolic blood pressure, DBP; fasting blood glucose, FBG; weight) in controlled clinical trials. Methods: Embase and MEDLINE were searched to identify controlled clinical trials with meat substitute interventions and cardiometabolic biomarker outcomes. Standardised mean differences in TC, LDL-C, HDL-C, TG, FBG, SBP, DBP, and weight and 95% confidence intervals were pooled using a random effects model. Risk of bias, heterogeneity, sensitivity, and publication bias were assessed. Of the 934 records identified, 12 studies met the inclusion criteria. In the pooled analyses, the consumption of meat substitutes was associated with significantly lower TC (−0.50 mmol/L [95% CIs −0.70, −0.29]), LDL-C (−0.39 mmol/L [−0.57, −0.21]), and TG (−0.15 mmol/L [−0.29, −0.01]), non-significantly lower FBG (−0.08 [−0.23, 0.08]), SBP (−0.32 [−1.79, 1.41]), and weight (−0.12 [−1.52, 1.27]), and non-significantly higher HDL-C (0.01 [−0.02, 0.05]) and DBP (0.49 [−0.30, 1.28]). There was evidence of publication bias, and some heterogeneity was detected. The certainty of evidence was moderate for the TC and HDL-C results, low for the LDL-C, TG, SBP, DBP, and weight results, and very low for the FBG results. Conclusions: Replacement of some or all meat with plant-based or mycoprotein-based substitutes may lower TC, LDL-C, and TG. Full article

Anxiety disorder is characterized by excessive fear or avoidance of perceived threats that can be persistent and debilitating. Diet is a modifiable risk factor that may contribute to the pathogenesis or treatment of anxiety, depending on diet quality. Although the biological mechanisms by which food, specific nutrients, and nutraceuticals impact mental health are not completely understood, implicated pathways include inflammation, oxidative stress, brain plasticity effects, mitochondrial dysfunction, and neurotransmitter metabolism. Essential dietary trace minerals such as zinc, copper, iron, and selenium are critical components for numerous biological proteins and may have a role in these proposed mechanisms related to brain health and anxiety. This narrative review examines the influence of essential trace elements zinc, copper, iron, and selenium on anxiety symptoms based on the latest peer-reviewed scientific evidence. Current research indicates that deficiencies in zinc, iron, and selenium are associated with anxiety, while copper overload may impact anxiety to a greater degree than copper deficiency. Further investigation is needed to understand the specific neurobiological mechanisms involved. Overall, the collective findings demonstrate the importance of optimizing trace mineral homeostasis for the mitigation of anxiety disorders and preservation of mental health. Full article

Supervised practice is a prerequisite to becoming a registered dietitian. Research suggests that environmental and social factors may affect dietary choices. This focus group research aimed to gather opinions from dietetic interns to understand what factors related to supervised practice, if any, affected their dietary habits. Qualitative data were collected via seven recorded virtual focus groups in which trained moderators facilitated a discussion using a series of controlled questions. Participants, dietetic interns (n = 42) who were currently completing or had completed their supervised practice within the previous six months, attended one of seven virtual focus groups. Each focus group had five to eight participants. Transcripts were separately coded by two trained researchers using a grounded theory approach to identify themes and subthemes. Researchers discussed any disagreements in coding and established a consensus. Elements related to the dietetic internship were observed to influence participants’ dietary choices. Main themes included time, finances, food access and availability, physical and mental effects, non-supervised practice factors, and social factors. Dietetic programs and preceptors should explore ways to raise interns’ awareness and minimize the potential negative impacts of these factors on interns’ dietary habits to improve their overall internship experience. Full article

The aim of this survey was to identify, (1) use of Dietitians Australia best practice guidelines, (2) contemporary practices/knowledge, and (3) professional development needs of Australian dietitians in relation to management of clients with overweight or obesity. A cross-sectional online survey consisting of 67 multiple choice and Likert scale questions on the three survey aims was administered. Data were collected between 2020–2021 and reported descriptively as frequency (%). Of 178 survey attempts, 80 respondents completed all questions (45%). Most respondents spent >50% of their time working with individuals with overweight/obesity, usually in private practice (47%). Two thirds of respondents had accessed best practice guidelines, but only 12% had completely read best practice guidelines. General healthy eating was the most frequent dietary approach used (77%). Seventy-five percent (n = 56) of dietitians reported that dietary interventions were selected based on client preference. Almost half of dietitians rated their knowledge and level of skill in management of obesity as good. Approximately 60% (n = 41) dietitians reported their skill gap was related to providing behavioural therapy/counselling. Results of the current survey indicate that use of best practice guidelines is low. However, dietitians surveyed reported that they had a good understanding of obesity management and choose a client centred approach to management, which is in line with current recommendations. Professional development activities, particularly regarding behavioural counselling are of particular interest to dietitians working with individuals with obesity. Full article

Technological advances, such as the GloboDiet software, have enabled the development of instruments to standardize dietary data collection through the 24-h dietary recall (24HR). Thus, the aim of this study was to evaluate the feasibility of using the Brazilian version of the GloboDiet software. The 24HR method guided by the GloboDiet software was applied by face-to-face (n = 2093) interviews and a second measurement by telephone (n = 1084) interviews with participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The adherence rate was calculated using data from control worksheets filled out by interviewers, whereas the Chi-square test was used to assess differences between sociodemographic groups and the participants’ final adherence status. For the interview’s duration, the data were presented as the median and the interquartile range—IQR (Q1–Q3 (25–75%)). Non-parametric tests were used to assess differences among individuals in terms of the total duration and stages of the interview. Adherence rates were 82.8% face-to-face and 68.4% telephone interviews. The total duration of the face-to-face and telephone interviews was 30.7 (IQR, 23.3–40.7) and 35.3 (IQR, 25.3–49.7) minutes (p < 0.001). These results evidence that the GloboDiet software is viable for the routine of an epidemiological study. Full article

Background: Diabulimia is associated with “resistance to treatment”, impaired glycemic control, and increased risk of diabetic complications. The aim of this study was to explore the possible lifestyle and diet factors associated with diabulimia using the “Diabetes Eating Problem Survey-Revised” (DEPS-R), a questionnaire assessing the risk of diabulimia in patients with T1DM. Methods: 100 outpatients with a diagnosis of T1DM for over a year, from two hospitals in Athens, Greece were asked to complete a questionnaire about their medical history and lifestyle behaviors along with the Eating Attitudes Test (EAT-26), the Beck Depression Scale (BDI-II) and the DEPS-R. Results: Multivariate linear regression analysis showed statistically significant associations between DEPS-R score and HbA1c% levels (b = 4.447, 95% CI 3.220–5.675), sex (male) (b = −4.413, 95% CI −8.778–−0.047, weight perception higher than normal (b = 9.896, 95% CI 5.266–14.526), time spent walking minutes per week (b= −0.019, 95% CI −0.031–−0.006), having received diabetes nutritional education (b = −5.128, 95%CI −10.141–−0.115), eating breakfast (b = −6.441, 95% CI −11.047–−1.835) and having a first relative diagnosed with an eating disorder (b = 6.164, 95%CI 0.030–12.298). The presence of these factors could help highlight the profile of potential individuals at risk of diabulimia and enhance preventive interventions. Full article

Purpose: A diet rich in fruits and vegetables is vital for prolonged health and wellness. Yet, the consumption of fruits and vegetables remains low in some regions. Methodology: This exploratory quantitative study utilized a web-based survey instrument to probe the likelihood of consumption by Canadian consumers. Canadians who have lived in the country for 12 months or more and were 18 years of age or older were surveyed. Care was given to get a representative sample from all Canadian regions. Findings: Barriers to produce consumption include cost (39.5%), lack of knowledge and preparation skills (38.5%), and confusion surrounding health benefits (6.3%). There is further confusion surrounding the nutrition of frozen vs. fresh vegetables. Finally, respondents were concerned about pesticide residue on imported produce (63.4%). Originality: Although evidence that fruits and vegetables can mitigate disease and that promotion of fruit and vegetable consumption has been a key policy area for the Canadian government, consumers still fail to integrate sufficient fruits and vegetables into their diets. To our knowledge, this is the only study probing consumers on their fresh produce intake in the Canadian context. Public awareness and education about the regular consumption of fruits and vegetables and their nutritional value and health-promoting benefits can increase consumption in many Canadian regions and demographics. Full article

In India, indigenous communities are nutritionally vulnerable, with indigenous women suffering the greater burden. Studies and surveys have reported poor nutritional outcomes among indigenous women in India, yet systematic documentation of community-specific nutrition data is lacking. We conducted a narrative review of 42 studies to summarise the nutritional profile of indigenous women of India, with details on their food and nutrient intakes, dietary diversity, traditional food consumption and anthropometric status. Percentage deficits were observed in intake of pulses, green leafy vegetables, fruits, vegetables, flesh foods and dairy products when compared with recommended dietary intakes for moderately active Indian women. Indices of diet quality in indigenous women were documented in limited studies, which revealed poor dietary diversity as well as low consumption of diverse traditional foods. A high risk of nutritional inadequacy was reported in all communities, especially for iron, calcium, and vitamin A. Prevalence of chronic energy deficiency was high in most communities, with dual burden of malnutrition in indigenous women of north-eastern region. Findings from this review can thus help guide future research and provide valuable insights for policymakers and program implementers on potential interventions for addressing specific nutritional issues among indigenous women of India. Full article