Despite the recognition of the importance of providing quality health care, the notion of quality in dietetic care has received little attention in the Australian dietetic literature. Quality remains difficult to define and measure. The author proposes that quality of dietetic care is multidimensional and includes at least the following elements - improving health, conformity to professional standards, effective use of resources, and meeting the needs of customers. This paper will focus on the last dimension and the author argues that meeting the needs of customers is the core activity of the profession. The Dietitians Association of Australia (DAA) recognises that it is essential to determine how customers perceive and evaluate the products and services provided by dietitians. However there is a significant gapin the dietetic literature about quality of care from a customer perspective. This paper provides a five step 'customer-benefit' framework, based on a marketing perspective, for ensuring the delivery of quality dietetic services from the customer perspective. The author argues that marketing is more than 'promotion of the profession' and by nature of it's customer orientation, is central to understanding quality. The author also identifies that customers of dietitians value the service components (reliability, responsiveness, assurance and empathy) in addition to the technical accuracy of information. It is noted that there are currently inadequate instruments to measure dietetic service quality from the customer perspective. It is proposed that two instruments from the marketing literature, SERVQUAL and SERVPERF, may be adapted to fill this gap. Future areas of research are outlined. (Aust J Nutr Diet 1996;53:48-51)

Under-reporting of energy intake in two methods of dietary assessment in the Nambour Trial.
Bronwyn Ashton, Geoffrey Marks, Diana Battistutta, Adele Green, the Nambour Study Group.

Under-reporting of energy intake (EI) was investigated among 114 adults participating in the Nambour Skin and Eye Disease Prevention Trial (Nambour Trial). EI was determined using six two-day weighed food records (WFRs) over the period of one year. A semi-quantitative food frequency questionnaire (FFQ) had previously been completed by all study participants. The ratio of EI to basal metabolic rate (EI:BMR) was calculated for both dietary methods and compared with previously determined cut-off limits. Participants whose EI:BMR fell below the 95% cut-offs were identified as under-reporters. An under-reporting rate of 35.1% (95% confidence interval [CI]:26.3-43.9%) was found for the WFRs while for the FFQ it was 19.3% (95% CI: 11.9-26.7%). Under-reporters in the WFRs were more likely to be female and to have a higher body weight and body mass index (BMI), while under-reporters in the FFQ were more likely to be male and have a higher body weight, BMR and probably BMI. Occupation also appeared to be associated with under-reporting. For both methods, under-reporters were more likely to report a higher percentage of EI as protein. These results have implications for the administration and analysis of work using dietary methods which will affect both individual and public health research. (Aust J Nutr Diet 1996;53:53-60).

Dietary modifications in children with asthma.
Tanya Griffin, Joanne Jones, Dianne Stevens, Richard Henry.

Anecdotal evidence suggests that many children with asthma have their diets modified by their parents. The aims of this study were to determine the dietary practices of children with asthma and to explore the perceptions of parents and paediatricians about the importance of food as a trigger to asthma. A semi-structured interview was conducted with the parents of forty children who presented with asthma to the John Hunter Hospital. A postal questionnaire was sent to Hunter paediatricians to collect similar data. Although only one of the forty parents regarded food or food additives as a trigger for her child's asthma, 24 parents (60%) implemented some form of dietary modification. Thirteen of the 24 who made dietary changes (54%) reported a benefit. These perceived benefits included decreased mucous production on removal of milk, decreased cough and wheeze on removal of margarine and improved control of asthma on removal of food additives, colouring and preservatives. Paediatricians also regarded food and food additivies as relatively unimportant triggers of asthma. In contrast to the practices of many of the parents, they did not recommend altering the diet of childrenwith asthma. In spite of parental awareness that foods were not a trigger to childhood asthma, dietary modifications were common and were perceived by the parents to be beneficial. (Aust J Nutr Diet 1996;53:62-64)

Nutrient intake of short slowly growing children without growth hormone deficiency prior to and after six months of growth hormone.
Sarah Garnett, Anne Craighead, Bin Moore, Chris Cowell, Geoff Ambler.

The aim of this study was to evaluate the nutrient intake of 28 short slowly growing (SSG) children prior to commencing and after six months of growth hormone (Genotropin) therapy. Subjects were recruited from those participating in a prospective multicentre study examining the effects of two doses (0.6 IU/kg/week or 1.2 IU/kg/week) of growth hormone (GH) compared to placebo. Prior to commencement of therapy three subjects had anthropometric measurements indicating inadequate energy intake and analysis of food records indicated a low energy intake for many children compared to the Food and Agriculture Organization/World Health Organization/United Nations University recomendations. Sixteen (57%) and 12 (43%) of the subjects had intakes of calcium and zinc respectively below 70% of the Australian recommended dietary intake for age. After six months of therapy a significant increase in growth velocity (p<0.001) was observed in all three groups. However, a significant increase in energy intake (p<0.05) was seen only in the high dose GH group. The results suggest that nutrient intake was not limiting growth. Nevertheless there was a sufficient number of subjects identified to be at nutritional risk by anthropometry and food record to suggest routine nutritional assessment of SSG children. (Aust J Nutr Diet 1996;53:66-71,73).

The iodine content of salt used in 1311 households in the National Capital Territory of Dehli, India.
Umesh Kapil, Sanjeev Bhasin, Arcana Shah, Deepika Hayar.

Iodisation of salt is the most successful strategy for the prevention of iodine deficiency disorders. Since 1989, the government of the National Capital Territory of Dehli has banned the sale of non-iodised salt for edible purposes. In the study reported here, the iodine content of salt as provided under the National Iodine Deficiency Disorders Control Programme and consumed by a population residing in urban, rural and urban-slum areas of Dehli was determined, using the standard iodometric titration method. Salt samples were collected from 763 urban, 250 rural and 298 urban-slum families selected through schools in the various areas. It was found that approximately 17% urban, 43% rural and 65% of urban-slum families were consuming salt with an iodine content of less than the 15 ppm which is the government stipulated level of iodisation of salt. The results indicate a need for continued monitoring of the quality of iodised salt consumed. (Aust J Nutr Diet 1996;53:72-73).