Oral Papers: Oral Papers - Wiley Online Library

DOI: 10.1111/1747-0080.12353

DA A

Dietitians Association of Australia

Nutrition & Dietetics 2017; 74 (Suppl. 1): 9–49

Oral papers (in program order) THURSDAY 18 MAY 2017 Concurrent session – Nutrition and Obesity

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EVALUATION OF AN INTUITIVE EATING APPROACH TO SUPPORT WEIGHT MANAGEMENT PATIENTS TO IMPROVE EATING BEHAVIOURS

EFFECT OF THE MEDITERRANEAN DIET ON VISCERAL FAT IN AUSTRALIAN PATIENTS POST CARDIAC EVENT

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FRANICA YOVICH , BEVERLY HAARHOFF , ROZANNE KRUGER2 1 Waitemata District Health Board, Auckland, New Zealand 2 Massey University, Auckland, New Zealand 2

Overweight and obesity numbers continue to increase locally and internationally. The ability to make and maintain dietary changes long-term are difficult for many individuals. Weight management focus has moved towards understanding the impact of psychological factors on managing weight and supporting related changes. This study explored whether an intuitive eating weight management program is an effective intervention for people within the hospital system classified as obese. Participants (n = 34) were enrolled in a 28-week evaluation study: 4-week normal diet run-in; 4-week treatment intervention program; 24 weeks of follow-up. Data were collected at baseline and end of periods for anthropometry, behavioural and cognitive approaches to food, dietary intake and changes in eating habits. Positive change was observed in emotional and external trigger eating style scores, decreasing from mean 2.67 1.04 and 3.06 0.67, respectively at baseline to 1.98 0.86 (P < 0.002) and 2.56 .63 (P < 0.001) at six-month follow-up. Participants reported mean SD intuitive eating level increased from 35.9 22.0 to 60.0 23.5 from baseline to end of intervention (P < 0.000), increasing further at the six-month follow-up (67.50 26.36) (P < 0.001). Participants’ median [95% CI] confidence levels increased significantly after completing the group sessions, from 6.0 [5, 7.5] up to 8.0 [7, 9] (P < 0.001, r = 0.8) and confidence levels remained higher, 7.5 [5,8], at six-month follow-up. Mean SD weight did not change significantly during the study; 112.33 26.67 kg at baseline and 112.04 28.52 kg at six-month follow-up. Group-based intuitive eating weight management programs can support participants to start making changes to improve their food-related behaviour and lifestyle to manage body weight in the long term. Contact author: Franica Yovich – franica.yovich@waitematadhb. govt.nz

CASSANDRA BENDALL1, HANNAH MAYR1,2, MICHAEL KINGSLEY1, AUDREY TIERNEY1, CATHERINE ITSIOPOULOS1, COLLEEN THOMAS1 1 La Trobe University, VIC, Australia 2 Northern Health, VIC, Australia

Limited high level evidence supports the suggestion that Mediterranean diet (MeDiet) is inversely associated with visceral fat. The AusMed Heart Trial is a randomised control trial evaluating whether MeDiet reduces secondary cardiovascular (CV) events in an Australian population. This study aimed to investigate if six-month MeDiet intervention reduced visceral fat in an initial cohort of this high-risk group. Participants (mean age 64 years (87% male), body mass index (BMI) 30 kg/ m2) were randomised to control low-fat (n = 15) or MeDiet intervention (n = 24). At 0, 3- and 6-months, seven-day food diaries were used to determine adherence to the MeDiet and diet composition. Anthropometric, DEXA body composition scan, haemodynamic and blood samples were collected for analysis. Physical activity was measured by accelerometry. Participants demonstrated good compliance with the intervention (MeDiet) by increasing adherence score from 5/14 to 10/14 (F = 66.843, P < 0.001) and significantly increasing monounsaturated fat intake as a proportion of total energy intake (+36% vs −1%, respectively, F = 4.938, P = 0.010). There was no difference in plasma lipid profile between the two groups. Compared to the low-fat diet group, six months Med diet did not change visceral fat (F = 2.837, P = 0.094) nor was there a change in surrogate markers: plasma adiponectin (F = 2.635, P = 0.080), waist circumference (F = 0.233, P = 0.793) or trunk fat (F = 0.157, P = 0.776). MeDiet did not alter physical activity. These findings (in 5% of final sample size) demonstrated that MeDiet improved dietary profile in these high CV-risk patients. Whilst visceral fat and surrogate markers did not change, there are encouraging trends. Contact author: Hannah Mayr – [email protected]

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DO MAKING HABITS OR BREAKING HABITS INFLUENCE WEIGHT LOSS AND WEIGHT LOSS MAINTENANCE? A RANDOMISED CONTROLLED TRIAL GINA CLEO, LIZ ISENRING, RAE THOMAS, PAUL GLASZIOU Bond University, QLD, Australia

Despite the significance placed on lifestyle interventions for obesity management, around 40% of weight loss is regained over the first year following treatment, and much of the rest over the next three years.

Editorial material and organization © 2017 Dietitians Association of Australia. Copyright of individual abstracts remains with the authors.

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Two psychological concepts (habitual behaviour and automaticity) have been suggested as the most plausible explanation of this overwhelming lack of long-term weight loss success. We evaluated the efficacy of two interventions that explore these theories: Ten Top Tips (10TT) and Do Something Different (DSD). 10TT promotes automaticity; this is the ability to perform tasks without awareness or deliberation. Conversely DSD promotes behavioural flexibility by disrupting daily routines, which subsequently promotes mindful behaviour. Participants (n = 75) aged 51 (standard deviation (SD) = 6) years with body mass index (BMI) 34.5 (SD = 4.1) kg/m2 were randomised to 12-week 10TT, DSD or no treatment control and followed up for 12 months. After the 12-week intervention, weight loss averaged 4.6 kg (SD = 3.7) in the 10TT group, 4.1 kg (SD = 3.3) in the DSD group and 1.3 kg (SD = 1.8) in the control group. There was significant improvement in wellbeing in the 10TT and DSD groups. At six-month no treatment follow-up there was a further weight loss of 0.3 kg in the 10TT group and 0.5 kg in the DSD group. Habit-based interventions have shown promising results in sustaining behaviour change. Weight management interventions may benefit from incorporating habit-focused strategies in order to maintain weight loss and should be investigated further. Contact author: Gina Cleo – [email protected]

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ARE SELF-REPORTED METHODS FOR THE ASSESSMENT OF DIETARY INTAKE VALID IN OBESE POPULATIONS? JULIET BOCIULIS1, TOM WALSH2, ALISON YAXLEY1 1 Nutrition and Dietetics, Flinders University, SA, Australia 2 School of Medicine, Flinders University, SA, Australia

The rate of obesity is increasing in Australia and globally. Dietary intake assessment methods are used in dietetics, clinical medicine and research to assess nutritional status, inform treatment plans and develop interventions for patients and populations. The validity of those methods is important for all uses of dietary data to ensure estimated intakes are accurate, particularly for weight management. This systematic literature review aimed to examine the validity of dietary intake assessment methods in morbidly obese populations. Five electronic databases (CINAHL, Cochrane Library, Medline, PubMed and Web of Science) were searched systematically from inception to August 2016. Of the 429 studies identified, 14 studies were deemed suitable for inclusion; one non-controlled trial, two prospective cohort studies and 11 cross-sectional studies. Dietary intake assessment methods investigated included 24-hour recalls, food frequency questionnaires, food records and three and four-day diet recalls. Doubly labelled water, indirect calorimetry and/or the observation of dietary intake in a metabolic room with research teams weighing food before and after consumption were used as reference methods for the dietary intake assessment methods. Energy intake was underreported by obese populations in all methods investigated and in 13/14 studies included in this review by a mean of between 2.0% and 60.7%. Furthermore, five studies found statistically significant differences between reported energy intake and total energy expenditure. These findings indicate that dietary intake assessment methods may not be valid in estimating energy intake in this population and further research is required to establish appropriate methods for use with this group. Contact author: Alison Yaxley – alison.yaxley@flinders.edu.au

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DIETETIC AND DIABETES EDUCATOR INTERVENTIONS IMPROVE CLINICAL OUTCOMES OF CLIENTS LIVING WITH A DISABILITY IN SUPPORTED ACCOMMODATION KERRI HUNT, KATHY STILLER Central Adelaide Local Health Network, SA, Australia

People living in supported care often have a diagnosed mental illness or intellectual disability coupled with a higher prevalence of physical illness, particularly obesity and diabetes. The aim of this study was to evaluate the effect of dietetic and diabetes education services on clinical outcomes of clients with type II diabetes or obesity living with a disability in supported residential accommodation. A retrospective audit was used to retrieve information from client medical records and databases. Clinical outcomes of body weight, body mass index (BMI) and glycosylated haemoglobin (HbA1c) were compared before and after intervention. Ninety-one clients were included: 47 with type 2 diabetes and 44 with obesity-only. All but one had schizophrenia, depression, an intellectual disability or some other psychological condition. After interventions, the diabetic sub-group demonstrated significant decreases in weight (mean [standard deviation (SD)] initial = 101.5 [20.7], final = 97.8 [20.6] kg, P = 0.001) and BMI (mean [SD] initial = 35.8 [8.1] kg/m2, final = 34.4 [7.8] kg/m2, P = 0.001) and a decrease in HbA1c over time. The obesity-only sub-group showed no significant change in clinical outcomes. The presence of schizophrenia had a significant negative impact on at least one clinical outcome (P ≤ 0.017), as did refusal of intervention(s) (P ≤ 0.048). A greater total number of attendances to a dietitian or diabetes educator had a significant positive impact (P ≤ 0.024). These results provide evidence to support the provision of dietetic and diabetes educator interventions to vulnerable clients living with a disability in supported care. Contact author: Kerri Hunt – [email protected]

Concurrent session – Nutrition Informatics 45

eHEALTH READINESS OF AUSTRALIAN DIETITIANS

KIRSTY MAUNDER1, KAREN WALTON1, PETER WILLIAMS2, MAREE FERGUSON3, ELEANOR BECK1 1 University of Wollongong, NSW, Australia 2 University of Canberra, ACT, Australia 3 University of Queensland, QLD, Australia eHealth is now accepted as integral in improving healthcare delivery, patient safety, clinical decision-making, curtailing costs, supporting research and enhancing patient care. However, eHealth solutions which do not support nutrition standards and processes for the delivery of patient care could have adverse effects. This research aimed to determine dietitian eHealth readiness through a longitudinal analysis. A survey was circulated to Australian dietitians in 2013 and 2016 to determine eHealth readiness across five dimensions: access, standards, attitude, aptitude and advocacy. The survey responses (14.5% (747) and 8% (417) of the Dietitians Association of Australia members in 2013 and 2016 respectively) demonstrated a moderate level of eHealth readiness, with limited progress over time. In relation to access and standards, dietitians are well positioned for eHealth advancement. For attitude and aptitude, there is a moderate level of preparedness, with minor improvement occurring over time. There was a significant increase in the awareness that eHealth can reduce medical errors (P < 0.01), and self-reported experience retrieving and accessing electronic data (P = 0.007). Despite significant improvement (P < 0.01), the area of advocacy requires the most development, as 61% of


Abstract

dietitians have ‘no role’ in workplace eHealth solutions. Valuable opportunities to enhance nutrition services and achieve benefits eHealth can deliver may be missed if dietitians do not lead nutritionrelated eHealth initiatives. This research identified that a collaborative approach from the dietetics profession, utilising skills and expertise across practice areas, embracing those with experience, and drawing on the varying expertise demonstrated by different generations would assist in achieving this goal. Contact author: Kirsty Maunder – [email protected]

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TECHNOLOGY TO ENGAGE HOSPITALISED PATIENTS IN THEIR NUTRITION CARE: A QUALITATIVE STUDY OF USABILITY AND PATIENT PERCEPTIONS OF AN ELECTRONIC FOODSERVICE SYSTEM SHELLEY ROBERTS1, ANDREA MARSHALL1,2, RUBEN GONZALEZ1, WENDY CHABOYER1 1 Griffith University, QLD, Australia 2 Gold Coast Health, QLD, Australia

Nutrition is vital for health and recovery during hospitalisation. As many patients do not meet their nutritional needs during this time, targeted interventions to improve nutrition intakes in hospital are warranted. Previous research has shown that when patients participate in their nutrition care, their intakes are improved. Advances in technology are creating new opportunities for patient participation. This qualitative study aimed to assess the usability and patient perceptions of an electronic foodservice system for participating in their nutrition care in hospital. Thirty-two patients were interviewed using (a) the ‘Think Aloud’ technique, to assess usability; and (b) semi-structured interviews, to explore patient perceptions of an electronic foodservice system. Functions of the system tested included patient-generated Malnutrition Screening Tool and intake monitoring. Overall, most patient found the system acceptable and easy to use. Several factors seemed to influence acceptability and usability. Patients’ responses formed five categories: (1) familiarity with technology can affect confidence and ability but is not essential to use system; (2) user interface design significantly impacts usability; (3) seeing benefits to technology increases its acceptance; (4) technology enables participation, which occurs to different extents; and (5) degree of participation depends on perceived importance of and ability to contribute to nutrition in hospital. Within each of these categories were a number of sub-categories. In conclusion, hospitalised patients are willing to use an electronic foodservice system to participate in their nutrition care. Several factors need to be considered in the development and implementation of such technology to maximise usability and acceptability. Funding source: This research was funded by Griffith University Contact author: Shelley Roberts – s.roberts@griffith.edu.au

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SOCIOECONOMIC INEQUITIES IN DIET QUALITY AMONG AUSTRALIAN ADULTS KATHERINE LIVINGSTONE1, DANA LEE OLSTAD1, REBECCA LEECH1, KYLIE BALL1, BETH MEERTENS2, JANE POTTER2, XENIA CLEANTHOUS2, RACHAEL REYNOLDS2, SARAH MCNAUGHTON1 1 Institute for Physical Activity and Nutrition, Deakin University, VIC, Australia 2 National Heart Foundation of Australia, Australia

Poor diet quality represents a key pathway by which socioeconomic disadvantage leads to adverse health outcomes, including hypertension, type 2 diabetes, coronary heart disease and certain cancers. This cross-sectional study aimed to examine associations between socioeconomic position and diet quality in a nationally representative sample of Australian adults. Adults (n = 4875; aged 19–85 years) were included from the nationally representative Australian Health Survey 2011/13. Dietary intake was assessed using two 24-hour recalls and diet quality was calculated using the Dietary Guideline Index, a foodbased score designed to reflect compliance with the 2013 Australian Dietary Guidelines. Multi-variable adjusted linear regression analyses investigated associations between socioeconomic position (index of socio-economic disadvantage [quintiles]; education level [tertiary qualification; high-school/diploma; some high school] and household income [quintiles]) and diet quality. Following adjustment for covariates, diet quality was lower in individuals living in areas with greater socio-economic disadvantage (coefficient (coef ): −0.88, standard error (SE) 0.22; P-trend < 0.001), those with a lower education level (coef: −2.25, SE 0.46; P-trend < 0.001) and those with lower income (coef: −0.59, SE 0.23; P-trend = 0.015). Lower socioeconomic position, based on area-based socioeconomic disadvantage, education and income, was associated with lower diet quality in a nationally representative sample of Australian adults. Given that these dietary inequalities may increase risk of obesity and chronic disease in disadvantaged groups, tailored healthy eating strategies that are sensitive to the needs of people experiencing socioeconomic disadvantage are warranted. Funding source: NHMRC, Deakin University Contact author: Sarah McNaughton – sarah.mcnaughton@deakin. edu.au

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PREVALENCE OF VITAMIN D DEFICIENCY AND PREDICTORS OF SERUM 25-HYDROXYVITAMIN D CONCENTRATIONS IN THE AUSTRALIAN POPULATION

PEIHUA (RACHEL) CHEANG1, JILL SHERRIFF1, ROBYN LUCAS2, ROBIN DALY3, CARYL NOWSON3, LUCINDA BLACK1 1 Curtin University, WA, Australia 2 Australian National University, ACT, Australia 3 Deakin University, VIC, Australia An initial report from the 2011–2013 Australian Health Survey (AHS) showed that just under one in four adults were vitamin D deficient (25-hydroxyvitamin D (25(OH)D) 2300 mg/day). Time-to-MS and time-to-relapse was longer in the sodium category 3 group (HR 0.507, P = 0.025) and (HR 0.885, P = 0.141), respectively. The linear regression showed that sodium categories 2 and 3 were not statistically significant in predicting change in disability score alone (P = 0.072, P = 0.086, respectively). The linear regression model predicted smaller changes in disability for categories 2 and 3, however these predictors were not significant. This study showed a positive association between sodium intakes above the Upper Limit and MS disease outcomes. Further research should assess the relationship between MS and dietary sodium to determine a potential anti-inflammatory role of sodium in MS onset and progression. Contact author: Erin Mowbray – [email protected]

Dietitians have an important role in supporting nutrition outcomes for people from diverse cultural backgrounds, however, multiple barriers to service access exist. Migrants and refugees are also at increased risk of poorer health and disease related to food insecurity, malnutrition and obesity. This program began when teachers from Melbourne

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NUTRITION MANAGAMENT OF ACQUIRED BRAIN INJURY REHABILITATION: A CROSSSECTIONAL SURVEY

JANE STEWART, GEORGINA KONIDARIS, EMILY BUTLER, JACQUI MORARTY Alfred Health, VIC, Australia Adequate nutrition is integral in the rehabilitation of patients with an Acquired Brain Injury (ABI). However, there is a lack of nutrition practice guidelines for ABI rehabilitation. This survey aims to document current practice in the nutritional management of patients at Specialist ABI Rehabilitation Centres in Australia, New Zealand and selected international expert reference centres. A purposive sample of 23 dietitians working in ABI Rehabilitation was surveyed using an online questionnaire that examined current nutritional management practices and dietetic staffing levels. No service met the dietetic staffing level recommended by the Australasian Faculty of Rehabilitation Medicine (AFRM). In the inpatient setting, screening for malnutrition and unintentional weight gain were routinely performed, however there was no consistency in the screening tools used. Oral nutrition support and enteral nutrition via gastrostomy were common. Variation in nutrition prescription was noted and most dietitians deemed further research into this area is required. Weight and body mass index were the predominant outcome measures used to evaluate efficacy of nutrition intervention. Nutrition services in community rehabilitation and Transitional Living Service were limited. No service screened for malnutrition and only one third screened for unintentional weight gain. This survey highlights that nutritional management following ABI varies between services. Dietetic staffing levels fall below AFRM recommendations. These findings indicate a need for more research; and the development of evidence-based guidelines which are prescriptive and clearly define the role of the dietitian in the management of patients undergoing ABI rehabilitation. Contact author: Jane Stewart – [email protected]

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A BEHAVIOUR CHANGE INTERVENTION IMPROVES NUTRITION OUTCOMES IN PATIENTS WITH HEAD AND NECK CANCER: THE EATING AS TREATMENT (EAT) JUDY BAUER1, AMANDA BAKER2, BEN BRITTON2, CHRIS WRATTEN2, GREGORY CARTER2, LUKE WOLFENDEN2, ALISON BECK2, KRISTEN MCCARTER2 1 University of Queensland, QLD, Australia 2 University of Newcastle, Australia

Malnutrition in patients with head and neck cancer (HNC) is common and weight loss ≥8% is independently associated with reduced survival. The aim of this study was to evaluate a health behaviour intervention delivered by dietitians to decrease malnutrition in patients with HNC undergoing radiation therapy (RT). EAT is a multi-site randomised stepped wedge randomised controlled trial (n = 307, 79% male, mean age 58 (standard deviation 18–81) years, stage IV 64%, III 18%, II 14%). It is based on behaviour change counselling methods including motivational interviewing and cognitive behaviour therapy, and incorporates clinical practice change theory. Psychologists provided intensive training to the participating dietitians. EAT is designed to improve motivation to eat despite a range of barriers and provide patients with behaviour change strategies. Using logistic mixed model regression analysis, nutritional status as measured by the Patient-Generated Subjective Global Assessment score was significantly lower in the intervention group compared to the control group (−1.48 (standard error (SE) .72), P < 0.05) at the end of RT. Those in the intervention group were significantly more likely to be well-nourished (odds ratio (OR) = 2.81 (SE 1.07), P < 0.01) across all follow up time points.

Almost all participants lost weight from baseline (99%) however the control group lost a significantly higher percentage of their baseline weight (1.20 (SE .57)%, P < 0.05). Weight loss ≥8% was experienced by 63% of the control group compared to 52% of intervention participants (P > 0.05). Dietitians successfully delivered a health behaviour intervention that improved nutrition outcomes. This intervention serves as a model for dietitians to use to improve outcomes in other patient groups. Funding source: NHMRC APP1021018 Contact author: Judy Bauer – [email protected]

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VITAMIN D STATUS OF HOSPITALISED PATIENTS RECEIVING NUTRITIONAL SUPPORT

ALISON WOOLLACOTT1, JENNIFER HAMLYN1, BONNIE LAI1, PRIYA NAIR2,3,4, VICKI FLOOD5,6 1 Department of Dietetics, St Vincent’s Private Hospital, Sydney, NSW, Australia 2 Intensive Care Unit, St Vincent’s Hospital, Sydney, NSW, Australia 3 Garvan Institute for Medical Research, Sydney, NSW, Australia 4 University of NSW, Sydney, NSW, Australia 5 Faculty of Health Sciences, University of Sydney, NSW, Australia 6 St Vincent’s Health Network (Honorary), Sydney, NSW, Australia The importance of vitamin D (VD) beyond its role in musculoskeletal health, particularly for immunity, is well-recognised. VD deficiency is common in Australia with the Australian Health Survey reporting a 23% prevalence. VD deficiency is associated with poorer intensive care unit (ICU) and surgical outcomes, greater risk of falls and hospital acquired infections (HAI). The aim was to prospectively identify the risk of VD deficiency in hospitalised patients receiving nutritional support. Serial patients were studied over a one-year period in a private hospital. Demographic data, body mass index (BMI), sun exposure, prior VD supplementation and skin colour were collected. VD levels were measured in patients at risk. Information on falls risk, HAI, intravenous antibiotics, surgery and ICU stay were collected in patients with a VD level. Of 392 patients studied, 185 (47.2%) were male. The mean (standard deviation, SD) age was 73.9 (15.5) years with a median (interquartile range) length of stay of 16 (10–24) days. 165 (42.1%) patients had prior vitamin D3 supplementation (≥1000 IU/day). 109 (27.8%) patients were at risk for VD deficiency. In those, the mean (SD) 25-hydroxy-vitamin-D was 44.5 (20.6) nmol/L with 99 (90.8%) having insufficient (2 children (MP: 30 (55%); O: 70 (30%), P < 0.01). Maori-Pasifika women reported being 8 kg heavier at conception (M: 79 (20) kg, body mass index (BMI) 29.3 7.6 kg/m2; O: 71 19 kg, 26.3 6.6 kg/m2, P < 0.01) and were more often obese (MP: 23 (40%); O: 67 (24%), P < 0.05). Maori-Pasifika women were more likely to gain weight in excess of pregnancy recommendations (MP: 30 (56%), O: 94 (35%), P < 0.05). Most (80%) women did not know the recommended pregnancy weight gain for their BMI. Despite respondents reporting low intake of vegetables during pregnancy (2 1 serves), two-fifths (41–42%) reported interest in nutrition education during and after pregnancy. Given the known risks associated with inappropriate weight gain and poor food choices during pregnancy, more nutrition education provided to women may be critical for optimal maternal outcomes. Contact author: Andrea Cruickshank – [email protected]

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A DISCRETE CHOICE EXPERIMENT: A PILOT STUDY ELICITING THE HEALTH PRIORITIES OF WOMEN DURING PREGNANCY

LAUREN HURST1, JUDITH MAHER1, ELIZABETH SWANEPOEL1, SUSIE DE JERSEY2,3,4, PETER K DUNN1 1 University of Sunshine Coast, QLD, Australia 2 Institute of Health and Biomedical Innovation, Queensland University of Technology, QLD, Australia


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Advanced Accredited Practicing Dietitian, Department of Nutrition and Dietetics, QLD, Australia 4 Royal Brisbane and Women’s Hospital, QLD, Australia Maternal health choices during pregnancy play an important role in predisposing women and children to the development of chronic disease. The aim of this study was to determine the feasibility of a discrete choice experiment (DCE) to elicit the health priorities of women during pregnancy and to gain further insight into what health and lifestyle choices pregnant women prioritise. Method: Pregnant women were recruited through social media to complete an online DCE comprising of 18 different choice sets. Participants were asked to choose one of two options that described two hypothetical health and lifestyle scenarios. For each scenario attributes of diet quality, food safety, pregnancy supplementation, physical activity, and mental wellbeing were described. Data were analysed using conditional logistic regression. Main findings: A total of 81 pregnant women completed the DCE. Overall the results identified that women placed value on higher diet quality, pregnancy supplementation and minimising food safety risk. However, sample size and survey design limitations prevented clear elicitation of the value women place on physical activity and mental wellbeing. Conclusions: This pilot study provides evidence that a DCE can be used in this context. However, results suggest further work is needed in the design of the experiment with a larger sample size. Although women are infrequently achieving the dietary recommendations for pregnancy, in this study their choices indicate prioritisation of a higher diet quality, pregnancy supplementation and food safety risk. These findings provide health professionals with the information to provide targeted interventions to promote positive health behaviour change for women during pregnancy. Contact author: Lauren Hurst – [email protected]

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DEVELOPMENT, TRANSLATION AND EVALUATION OF A CULTURALLY APPROPRIATE FUSSY EATING RESOURCE IN KOREAN, CHINESE AND ARABIC ERIN KERR, AMY BONNEFIN, HELEN DIRKIS, RUBY POKHREL Sydney Local Health District, NSW, Australia

The prevalence of overweight and obesity among children is a global health issue. Child-feeding practices have been identified as potential modifiable risk factors for childhood obesity. Consistent approaches are suggested in the literature to promote positive feeding practices; however, there are limited translated and culturally appropriate tools to assist parents/carers or childcare educators from culturally and linguistically diverse (CALD) backgrounds. According to the 2011 Census, 34% of residents in Sydney Local Health District (SLHD) were born in predominately non-English speaking countries. This study aims to determine the acceptability and relevance of a translated, culturally adapted educational fussy eating resource among parents and childcare educators from three main CALD groups in SLHD. After reviewing literature and existing resources as well as consulting with dietitians, an educational fussy-eating poster and fact sheet were developed in partnership with a multicultural children’s service. Ten key messages were consolidated and graphically depicted. The fact sheet was translated into Chinese, Korean and Arabic languages. Three focus groups involving seven Arabic parents, six Chinese parents and eight Arabic, Korean and Chinese educators were held. A facilitator, aided by an interpreter, asked semistructured questions to explore participants’ understanding of the key messages. Responses were analysed using thematic analysis. Five themes emerged across all focus groups: language, appearance, translation, content and cultural appropriateness. The results from the focus groups informed the final development of the resource. The findings also provided insight into cultural nuances in regards to child feeding practices and will guide future development of culturally appropriate resources. Contact author: Erin Kerr – [email protected]

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DOES MANDATORY FORTIFICATION SUSTAIN IODINE NUTRITION? – FINDINGS FROM THE 2016 URINARY IODINE SURVEY OF TASMANIAN SCHOOL CHILDREN KRISTEN HYNES1, JUDY SEAL2, JOHN BURGESS3, PETR OTAHAL1, MONIQUE REARDON2 1 Menzies Institute of Medical Research, University of Tasmania, TAS, Australia 2 Department of Health and Human Services, TAS, Australia 3 School of Medicine, Faculty of Health, University of Tasmania, TAS, Australia

Iodine is an essential micronutrient required for thyroid hormone synthesis. Evidence suggests even mild iodine deficiency in-utero and childhood results in suboptimal neurocognitive development. In 2001 the Tasmanian Government introduced a voluntary fortification program as an interim measure to address mild iodine deficiency. Bakers were asked to replace regular salt with iodised salt in bread. This program was replaced in 2009 when mandatory iodine fortification was introduced in Australia and New Zealand. Iodine nutrition is routinely monitored in Tasmania through surveys of school children in accordance with World Health Organisation guidelines. The aim of the 2016 survey was to determine if improvements in iodine nutrition observed post-mandatory fortification had been sustained. A total of 39 grade four classes were randomly selected from all Tasmanian government, Catholic and independent schools using a representative cluster sampling method. Urine samples were collected from 413 children in selected classes (response rate 52%). Iodine concentration was measured from spot urine samples. The median urinary iodine concentration (mUIC) was 130 μg/L with 3% of samples below 50 μg/L, well within the optimal range (mUIC 100–200 μg/L; 7 days. Rates of hyperglycaemia, hypertriglyceridaemia, parenteral nutrition-associated liver dysfunction and linerelated infections in adult hospital patients receiving three-in-one parenteral nutrition containing an olive oil-based intravenous fat emulsion are comparatively low. These findings may inform practice guidelines relating to use of such parenteral nutrition products, and minimise future risk of parenteral nutrition-related complications. Contact author: Ruth Vo – [email protected]

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IMPROVED NUTRITIONAL STATUS IN FEMALE AGED-CARE RESIDENTS WITH 12 MONTHS OF DAIRY SUPPLEMENTATION: A CLUSTER RANDOMISED TRIAL IULIANO SANDRA1, SHIRLEY POON1, JUDY ROBBINS1, HENRIETTE EJLSMARK-SVENSSON2, ANGELA SONES3, EGO SEEMAN4 1 University of Melbourne / Austin Health, VIC, Australia 2 Aarhus University, Denmark 3 Austin Health, VIC, Australia 4 University of Melbourne/Australian Catholic University, VIC, Australia

from therapeutic diets for chronic conditions such as diabetes. However, our emerging ageing population are more likely to be overweight and at least a third of older adults are likely to have diabetes. This presentation aims to present findings from a mixed methods study examining characteristics of older adults and their experiences of dietary management of diabetes, both for individuals in RAC and baby boomers in the community. On examination of aged care resident demographics, the young old with diabetes (65–74 years) were more likely to present to RAC with obesity and comorbidities, and maintain weight over a typical admission of 24 months, than their predecessors (>85 years). In addition, focus groups suggest that whereas the oldest old are more likely to be passive in their experience of ageing, diet and diabetes; the young old are already anxious about services being inflexible and unable to accommodate an individualised approach, particularly novel dietary management of diabetes. Food is an integral part of the aged care experience and while current residents (>85 years) are more likely to ‘make do’; the young old are looking for autonomy in health management and food choices, as well as the quality and service of meals being more likened to a hotel than our current aged care food services. As such, this presents a potential need for change in current RAC practices and for dietetic best practice guidelines. Contact author: Olivia Farrer – olivia.farrer@flinders.edu.au

16 Malnutrition is common in institutionalised elderly, exacerbated by inadequate provision of protein-rich foods. Dairy foods are a good source of high-quality protein therefore we aimed to determine if increasing dairy intake (~4 serves daily) would improve nutritional markers in female aged-care residents with inadequate protein intakes. Data were analysed for 57 females (mean age 86 8 years) with low protein intakes (77 16% of the recommended dietary intake) from 27 agedcare facilities randomised to 12 months of high-dairy (n = 8) or usual (n = 19) menu. Food service specialists assisted staff to implement highdairy menus. Food consumption was measured and nutritional assessment undertaken using the mini nutrition assessment (MNA) tool. Fasting morning bloods were analysed for nutritional biomarkers. Recommended protein intakes were based on Australian standards. Group differences were determined using analysis of variance (ANOVA). When consuming from regular menus, reductions in albumin (37 3 vs 35 3 g/L) and haemoglobin (Hb) (130 13 vs 123 12 g/L) were observed (P < 0.001), while levels were maintained in those consuming from high-dairy menus (albumin: 36 4 vs 3 5 4 g/L; Hb: 128 11 vs 129 14 g/L). Both absolute and percentage differences between groups for albumin and Hb were significant (P < 0.05). No differences were observed for insulin-like growth factor 1 (IGF-1) or MNA. Improving protein intake using dairy foods abated age-related declines in albumin and maintained haemoglobin in elderly females in aged-care. Funding source: Dairy Australia on behalf of a consortium of seven dairy organisations Contact author: Iuliano Sandra – [email protected]

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THE MODERN AGED CARE RESIDENT – WHAT DO THEY LOOK LIKE, WHAT DO THEY WANT AND WHAT CHALLENGES DOES THAT PRESENT FOR DIETITIANS?

OLIVIA FARRER1, ALISON YAXLEY1, KAREN WALTON2, MICHELLE MILLER1 1 Flinders University, SA, Australia 2 University of Wollongong, NSW, Australia

FAMILY CARER EXPERIENCES, ROLES AND SUPPORT NEEDS: IMPLICATIONS FOR DIETITIANS IN REHABILITATION SKYE MARSHALL1, DIANNE REIDLINGER1, ADRIENNE YOUNG2, LIZ ISENRING1 1 Bond University, NSW, Australia 2 Royal Brisbane and Women’s Hospital, QLD, Australia

The engagement of family carers as part of the rehabilitation nutrition team may improve patient outcomes; however, research is needed to explore the role and needs of carers. The purpose of this longitudinal qualitative study was to determine the nutrition and food-related roles, experiences and support needs of female family carers of communitydwelling malnourished older adults admitted to rehabilitation units in rural New South Wales, both during admission and following discharge. Four female carers were interviewed during their care-recipients’ rehabilitation admission and two-weeks post-discharge. The semi-structured interviews were audiotaped, transcribed and analysed reflecting an interpretative phenomenological approach by three researchers. Three interrelated ‘drivers’ were developed and discussed: responsibility, family carer nutrition ethos and quality of life. A key finding was that although carers may recognise nutritional problems and assume primary responsibility for nutrition support even in the rehabilitation setting, they may fail to engage with formal nutrition support for a variety of reasons including a fear of financial implications or a belief that dietitians would not provide individualised assistance. Further, carers may hold strong nutritional beliefs that are incongruous with an evidence-based approach, leading to the use of inappropriate nutrition strategies. Findings revealed that carers may have a principal focus on quality of life as both a nutritional strategy and outcome for their care-recipients. Broadly, the findings of this study challenge current dietetic practice, revealing that ‘family care’ should be integrated with ‘formal care’ in the rehabilitation setting. Suggestions for practice were developed based on the findings; however, interventional research is needed. Contact author: Skye Marshall – [email protected]

Current dietary practices in residential aged care (RAC) are primarily aimed at managing malnutrition in older adults, and have moved away

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Abstract

Concurrent session – Dietary assessment and Food Composition 292

HAND GRIP STRENGTH ALONE IS NOT AN ACCURATE INDICATOR OF MALNUTRITION IN OLDER PATIENTS BEFORE, DURING OR AFTER ADMISSION TO SURGICAL WARDS

ANGELA BYRNES1, ADRIENNE YOUNG2,3, ALISON MUDGE2,3, MERRILYN BANKS2,3, JUDY BAUER1 1 The University of Queensland, QLD, Australia 2 Royal Brisbane & Women’s Hospital, QLD, Australia 3 Queensland University of Technology, QLD, Australia Hand grip strength (HGS) has been proposed as a surrogate measure of nutritional status that may be more sensitive to changes in nutritionrelated muscle function than other body composition measures. This makes it particularly attractive for use in the acute setting. This study aimed to determine accuracy of HGS as an indicator of malnutrition in an acute older population. Measures were undertaken at pre-admission appointment, during acute admission (day 4–6), and/or at postdischarge follow up appointment in surgical patients ≥65 years. HGS was recorded as the mean of three trials using a Jamar® hydraulic hand dynamometer and standardised as a percent of the lower limit of the 95% confidence interval (CI) of the mean. Impaired HGS was defined as below the lower limit of the 95% CI of population norms, and malnutrition was defined as Patient-Generated Subjective Global Assessment (PG-SGA) rating B or C. Dichotomised HGS and PG-SGA were used to determine diagnostic accuracy. A total of 99 patients (mean age 73.5 6.4 years, 60% male) were recruited. Impaired HGS did not accurately identify malnutrition at pre-admission, during acute admission, or post-discharge (Area Under the Curve (95% CI): 0.360 (0.085–0.635), 0.408 (0.239–0.578) and 0.392 (0.184–0.601), respectively). There was only a difference in standardised HGS between malnourished and not malnourished groups at post-discharge (mean 96.0 8.6% vs 108.2 20.7%, P = 0.017). As a standalone measure, HGS was not a suitable surrogate of nutritional status before, during or after admission for older surgical patients. As such, assessment of nutritional status via validated tool by an appropriately trained clinician remains the preferred method. Contact author: Angela Byrnes – [email protected]

methods. A sample of 45 patients (52% male, mean (standard deviation) age 43 (12) years, body mass index 27 kg/m2 (4)) completed the BFQ and at least one 24-hour urine collection. No significant difference was found between the BFQ and 24-hour urine volume (2620 ml vs 2510 ml, P < 0.001). A moderate correlation (r = 0.54) was observed between total daily fluid intake and urine volume. Bland–Altman plots revealed good agreement with no obvious bias, however, the limits of agreement were wide. The BFQ shows potential as a valid tool for assessing fluid intake in people with CKD due to ADPKD. Contact author: Carly Mannix – [email protected]

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NEW DATA FOR VITAMIN D3 AND 25HYDROXYVITAMIN D3 CONTENT IN EGGS

ELEANOR DUNLOP1, JUDY CUNNINGHAM2, HEATHER GREENFIELD3, JAYASHREE ARCOT3, JILL SHERRIFF1, LUCINDA BLACK1 1 Curtin University, WA, Australia 2 Independent Advisor, QLD, Australia 3 University of New South Wales, NSW, Australia Vitamin D deficiency ( 0.05). Relapses were not significantly predicted from survival models (P > 0.05). This research affirms the recommendation for healthy intakes of fruit and vegetables, as per the Australian Dietary Guidelines, in MS populations. Contact author: Tamara Bosward – [email protected]


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Abstract

327

WHAT’S DAD COOKING? ASSESSING THE CONTRIBUTION OF FATHERS TO HOUSEHOLD COOKING IN AUSTRALIA VIA SOCIAL MEDIA

SARA GRAFENAUER, NATALIE LATHAM, MAREE HALL, SALLY MOLONEY, FELICITY CURTAIN DAA, Australia Social media platforms were used to assess the contribution of fathers to household cooking. This method of data collection is both cost effective and can be targeted demographically. Prizes were offered as an incentive and the hashtag #DadsInTheKitchen encouraged engagement online with >18 800 reach on Facebook, >13 500 impressions on Twitter and >360 post likes on Instagram. Fathers aged 25–54 years (n = 360) responded to an electronic survey providing demographic details, quantified the number of times they cook per week, the degree to which they like cooking, and an open question about what they cook which was categorised for analysis. Most (71%) reported cooking between two and five times a week, with 16% reporting cooking more than six times per week. Fifty-three percent report liking cooking ‘a lot’, whereas very few (5%) reported a dislike of cooking. There was a correlation (r = 0.41; P < 0.05) between number of meals cooked per week and ‘liking’ cooking. A diverse range of meals were described with more than one-third describing an international cuisine, predominantly Italian and a similar proportion described a basic meat meal. More complex meals were described by participants also reporting the greatest ‘liking’ of cooking. It is apparent from this sample that dads are cooking a variety of dishes and may be taking a greater role in food preparation for the household (compared to our 2015 survey of men). Social media proved useful in gathering the responses from this target group and could also be a useful platform for education and health awareness campaigns. Funding source: DAA Contact author: Sara Grafenauer – [email protected]

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EXPLORING COMPETENCE IN A STUDENT-LED DIETETIC ASSESSMENT ENVIRONMENT GEMMA QUAYLE1, JANICA JAMIESON1, CLAIRE PALERMO2 1 Edith Cowan University, WA, Australia 2 Monash University, VIC, Australia

Assessment of competence in the work-based setting is complex. Programmatic assessment offers a student-centred approach and acknowledges the multiple pieces of evidence and multiple assessors that should inform competence decisions. In 2016 Edith Cowan University implemented a student-led program of assessment in the practicum component of the course. The aim of this study was to evaluate how students in this new program viewed the role of assessment in developing dietetic competence. All (n = 13) final year students of the dietetic program were invited to participate in one focus group. Questions explored the understanding, experience, motivations, opinions and ideals of students in relation to competence and competency-based assessment. Focus group data were transcribed and analysed for themes using inductive coding. Four final year dietetic students participated (30% response rate). All participants were Masters students with mean age 35 15 (range 24–57) years. Participants described competency development as an individual journey in which external feedback directs learning goals and builds confidence and multiple perspectives can support learning and outcomes. Participants recognised that viewing competency development as a continuum allows for the grey areas to be recognised and directs focus to the process of competency development. These rich insights into students’ perspectives of competency development suggest that a student-led approach can shape students’

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understanding of competency-based assessment and foster an environment in which assessment drives learning. Contact author: Gemma Quayle – [email protected]

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DIETETIC EDUCATION IN THE 21ST CENTURY: IS IT ALL JUST FUN AND GAMES? HATTIE WRIGHT1, JUDITH TWEEDIE1, UWE TERTON2, GRAEME SMYTH2, KATRYNA STARKS2, WERNER RAVYSE3, THERESA ASHFORD4 1 School of Health and Sport Sciences, USC, QLD, Australia 2 Faculty of Arts and Business, USC, QLD, Australia 3 North-West University, Serious Games Institute, South Africa 4 Faculty of Science, Health, Education and Engineering, USC, QLD, Australia

Globally the higher education (HE) sector is including more technology rich learning environments for the twenty first century student. Today’s learners are uniquely different from previous generations as they have grown-up immersed in digital technology which impacts the way we teach in HE. This study aims to shed light on academic and student perceptions on the value of online serious games (SG) and usability as a learning tool. This study forms part of a bigger project to develop an online SG to assist the development of clinical reasoning skills of student dietitians. Separate online surveys were developed informed by literature and focus group discussions with academics and student. Surveys were deployed through Survey Monkey® to all University of the Sunshine Coast students and Academics on the Sippy Downs campus in Queensland, Australia. Key findings include that all students (n = 49) and most academics (n = 14, 93%) want to use SG in their course/s if it has a clear fit for purpose. Students want to use SG to apply knowledge to a real-life scenario (90%), to practise skills (88%), orientate them to a real-life environment (74%), and for assessment (52%). Conversely, most academics tied the use of SG to assessment (92%) or an optional extracurricular activity (67%). Barriers to use online SGs reported by academics included limited support, lack of resource, and availability. These findings provide an interesting perspective on differences in perceptions between academics and students on how serious games can be integrated into curriculum, highlights potential barriers, and provide recommendation on its use in relation to assessment. Contact author: Hattie Wright – [email protected]

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A CONSENSUS MODEL FOR ASSESSING COMPETENCE

RACHEL BACON1, JANE KELLETT1, JANEANE DART2, REBECCA METE1, SUSAN ASH3, CATHY KNIGHT-AGARWAL1, CLAIRE PALERMO2 1 University of Canberra, ACT, Australia 2 Monash University, VIC, Australia 3 Queensland University of Technology, QLD, Australia In a traditional positivist paradigm, competence is viewed as objective, linear and stable. An alternative perspective is to view assessments as ‘interpretations’ and truth as a matter of ‘consensus’. A recently developed programmatic interpretivist model was used by a panel of assessors to make a consensus judgement of competence, based on multiple sources of evidence from a range of contexts over time. The aim of this research was to explore the student perceptions of this new approach to competency-based assessment. Following completion of all summative assessment required for the Masters of Nutrition and Dietetics, all students (n = 27) participated in a personal interview with an academic from the project team. Data were audio-recorded, transcribed verbatim,


Abstract

cross checked for consistency and thematically analysed using a qualitative descriptive approach. Three themes emerged from the data: (1) The model empowered students to engage in sustainable learning and assessment practices that informed their development and demonstration of competence; (2) The role of the site educator varied within placements and across contexts; and (3) More support, training and refinement to the assessment tools are required to maximise the benefits of the model. This research supports the use of a programmatic assessment approach that is learner centred, uses evaluation as a catalyst for learning and incorporates panel assessments for high stake decisions. This is shift towards a more interpretivist approach to viewing competence. This study was funded by a University of Canberra research support grant. Funding source: University of Canberra Research Support Grant Contact author: Rachel Bacon – [email protected]

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ETHNOGRAPHY: A USEFUL METHODOLOGY TO EXAMINE MEALTIME CULTURE, ENVIRONMENT AND SOCIAL PRACTICE ON THE SUBACUTE WARD ELLA OTTREY1,2, JUDI PORTER1,2, CATHERINE E. HUGGINS1, CLAIRE PALERMO1 1 Monash University, VIC, Australia 2 Eastern Health, VIC, Australia

Ethnography is a research approach concerned with the study of people and their culture. Although deeply rooted in the field of anthropology, diversification has seen ethnography applied to research in other domains, such as business and education. This research aimed to illustrate how an ethnographic approach can be applied effectively to explore and understand patterns of mealtime culture, environment and social practice on the subacute ward. A series of three qualitative studies were conducted on two subacute wards in Melbourne, Australia. Data were collected over a 16-month period using participant observation, interviews and focus groups. Participants included managers, clinical and support services staff, volunteers and visitors. Data were analysed using an inductive, thematic approach. Immersion was achieved by conducting 130 hours of fieldwork. Complexities in mealtime processes, practices and interactions were realised by observing over 260 participants, generating 233 pages of single-spaced typed field notes. Mealtime experiences, perspectives and attitudes were accessed by speaking to more than 90 participants in interviews and focus groups. Successful application of the ethnographic approach was demonstrated by repeated integration on the study wards and

prolonged engagement with participants, enabling the research questions to be answered. Ethnography offers a useful way to discover patterns and meaning, and provide a comprehensive understanding of way of life. Opportunities exist to apply this approach to other areas of dietetics research, including program or intervention evaluation, consumer behaviour, and patient or student experience studies. Funding source: Ella Ottrey is supported by an Australian Government Research Training Program scholarship Contact author: Ella Ottrey – [email protected]

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AGGREGATING PERSPECTIVES – THE BENEFITS OF FOOD HUBS AS AN ALTERNATIVE FOOD SYSTEM IN AUSTRALIA MEGHAN HOCKEY Monash University, VIC, Australia

Escalating rates of health disparities suggests that the food system is failing in its ability to provide a healthy diet for all Australian’s. There is growing interest in alternative food systems, for their potential to reduce these inequities and promote a more sustainable food supply. Food Hubs have increasingly gained traction for their role in aggregating, distributing and marketing food products primarily from local and regional producers. Through localising the food system, Food Hubs have been proposed to promote societal and sustainable benefits, however there is limited evidence of this within the academic literature. This study used a qualitative case study approach to explore the benefits of seven Food Hubs within the Australian and international setting. A 50-item questionnaire that explored background, key values, factors for sustainability, governance and finance, producers and suppliers, infrastructure, challenges and opportunities for success, was developed. This was administered in-person, over the phone or via email between April and June 2016. A thematic analysis, conducted on questionnaire responses from seven Food Hub coordinators, revealed that the benefits reported by Australian Food Hubs were comparable to those internationally. These benefits emerged as four prevailing themes and implied that Food Hubs; (1) increased community access to nutritious foods; (2) improved customers’ knowledge and awareness of food; (3) supported the local food environment and (4) built a sense of community. These findings provide a foundation for understanding the benefits of Food Hubs within the Australian context, with further evaluation required by Food Hubs to attain their long-term benefits. Contact author: Meghan Hockey – [email protected]


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