| Nutritional assessment and intervention in patients admitted with a femoral neck fracture: a chronicle of missed opportunities
Michelle Miller, Maria Crotty, Craig Whitehead, Lynne Daniels and Paul Finucane
Abstract The aim of this study was to document current practice in the nutritional assessment and intervention and treatment of osteoporosis for patients admitted to an Australian teaching hospital with a femoral neck fracture and compare this to established guidelines. We prospectively collected descriptive data on a consecutive sample of 183 femoral neck fracture patients aged 60 years and above. We documented whether a dietetic assessment had been sought and, when relevant, nutritional intervention was recommended. We searched case records and databases for pre-operative measurements of albumin, total lymphocyte count and vitamin D. We noted requests for bone densitometry and medications prescribed on discharge, particularly those used to treat osteoporosis. Pre-operative albumin concentrations were measured in 111 patients and total lymphocytes were measured in 180 patients. These were low in 42 and 130 respectively. Both albumin and total lymphocytes were low in 31 of 111 patients in whom both were measured. Referral for dietetic assessment was made for 47 subjects and 27 received dietary protein-energy supplementation. One subject had vitamin D status measured and another was referred for bone densitometry. On discharge, seven subjects were taking calcium supplements, one was taking hormone replacement therapy and another was taking a bisphosphonate. This audit of current practice at our institution revealed that the care of older adults presenting with femoral neck fracture focuses on the fracture rather than modifiable risk factors for subsequent fractures. We are now working with clinicians to improve implementation of evidence-based practice for treatment and rehabilitation of femoral neck fracture patients. (Aust J Nutr Diet 2001;58:86–91)
Implementation of malnutrition screening and assessment by dietitians: malnutrition exists in acute and rehabilitation settings
Eleanor Beck, Craig Patch, Marianna Milosavljevic, Shellie Mason, Corinne White, Mandy Carrie and Kelly Lambert
Abstract The prevalence of malnutrition within hospital settings is a major concern to all health care workers. The recent development of a simple screening tool for use in such settings has increased the opportunity to identify at-risk patients in a reasonable time frame during their admission. This paper outlines the implementation of a routine nutrition screening and assessment, performed completely by dietitians, across both acute and rehabilitation settings. Dietitians were able to screen, on average, 72% of eligible patients, which ensured timely dietetic intervention. The routine malnutrition screening and assessment process highlighted differences (P < 0.01) in the rates of malnutrition between the acute wards (range 7 to 14%) and rehabilitation ward (49%). Significant differences between acute and rehabilitation patients were also found within the majority of individual diagnostic groups, including all surgery, fractures, cardiovascular incidents and respiratory illness (P < 0.01). The identification of rates of malnutrition between different wards, diagnoses and institutional settings provides dietetic managers with a sophisticated tool that can assist in the allocation of dietetic resources. This operational framework for routine screening of nutritionally at-risk patients in hospital, enables dietitians to develop patient outcomes and an effective nutrition care model. (Aust J Nutr Diet 2001;58:92–97)
A practical approach to monitoring nutrient supplement intake of Australian adults
Mark A. Lawrence, Ingrid H.E. Rutishauser and Janine L. Lewis
Abstract The adoption, in mid-1995, of the revised food Standard A9, which permits the more liberal addition of nutrients to a range of food products, highlighted the need to obtain information on nutrient intake from supplements to complement the 1995 National Nutrition Survey data on nutrient intake from food. This paper describes the method used to obtain quantitative information on nutrient supplement intake and reports on the prevalence of supplement use in different subgroups of the Australian population. Information on supplement intake was obtained in two Australian Bureau of Statistics Population Survey Monitor surveys in August 1995 and February 1996 using the Therapeutic Goods Administration (TGA) registration numbers to identify individual products. Approximately 18% of men and 29% of women aged 18 years and over reported consuming a nutrient supplement on the day before the survey and these proportions increased to 25% and 35% respectively for consumption during the two weeks before the survey. The prevalence of supplement intake increased with age, education level, socioeconomic status, employment status and with fruit and vegetable intake. The substantial proportion of Australian adults who consume nutrient supplements, and the rapidly changing composition of the Australian food supply in response to changes in food regulation, indicate that there is a need for regular monitoring of nutrient intake from supplements. The use of TGA registration numbers to identify supplements provides a practical way to address this need. (Aust J Nutr Diet 2001;58:98–103)
Review paper
Potential essentiality of boron: a ubiquitous dietary constituent
Sotirios Mangas and Samir Samman
Abstract The World Health Organization has classified boron as ‘a trace element that is probably essential’. Boron participates in or regulates a number of metabolic pathways including oestrogen and testosterone synthesis, calcium homeostasis and embryonic growth. Because of its involvement in steroid hormone metabolism, dietary boron has been suggested as having an important role in a number of chronic diseases and in vertebrate development. Extrapolations of data derived from experiments in animals suggest that humans have a boron requirement of 0.5 to 1.0 mg/day. There is uncertainty about the mechanisms through which boron acts. More research is warranted before boron is considered of more clinical and nutritional importance than currently acknowledged. Although there is uncertainty about the mechanisms through which boron acts, there is good evidence that it may impact on disease prevention. Future research should focus on defining the saftey margin between toxic and essential doses and assess its possible therapeutic use. (Aust J Nutr Diet 2001;58:104–106)
Dietary and lifestyle factors influencing iron stores in Australian women: an examination of the role of bio-available dietary iron
Amanda J. Patterson, Wendy J. Brown and David C.K. Roberts
Abstract Research to date has not been able to adequately describe the relative impact of dietary and lifestyle variables on iron status. While total iron intake appears unrelated to iron status, bio-available dietary iron should correlate with iron stores, after adjustment for iron losses. Therefore, the objective of this study was to examine dietary and lifestyle variables that are important in the determination of iron status for Australian women of child-bearing age. Serum ferritin was measured in 52 iron-deficient and 24 iron-replete women. Dietary data were collected using seven-day weighed food records and bio-available dietary iron calculations were performed using the algorithms developed by Monsen et al., Monsen and Balintfy, and Tseng et al. Self-reported data on demographic characteristics, parity, breastfeeding, oral contraceptive pill, intrauterine device and hormone replacement therapy use, menstruation, smoking, alcohol intake, exercise, dieting, vitamin and mineral supplement use and blood donation were collected. Multiple linear regression was used to examine dietary and lifestyle factors associated with serum ferritin. Current oral contraceptive pill use and alcohol intake were positively associated (P = 0.01 and P = 0.001 respectively) and phytate intake was negatively associated (P = 0.05) with serum ferritin. Total iron, haem iron and bio-available dietary iron intakes were not associated with iron stores. Bio-available dietary iron estimates were well below the recommended intakes for menstruating women, suggesting possible problems with either the algorithms or the assumptions built into the current Australian recommended dietary intakes. Further work to accurately determine bio-available dietary iron estimates for Australian women is needed. (Aust J Nutr Diet 2001;58:107–113)
Nutrient intakes of two- and three-year-old children: a comparison between those attending and not attending long day care centres
Roslyn Soanes, Margaret Miller and Andrea Begley
Abstract Recommendations around Australia regarding the amount of food provided to children in full-time attendance at long day care centres (LDCCs) vary between 50% and 70% of the recommended dietary intake (RDI). The aim of this study was to assess the appropriateness of the recommendation that the proportion of food supplied by LDCCs should provide 50% of the RDIs, and the feasibility of achieving it. In this study 33 children attending LDCCs and 32 non-attending children were sampled to determine the total daily energy and nutrient intake of a group of two- and three-year-olds. Three-day weighed food intake records were collected for each child in order to determine the nutrient intake from food in the different care environments. Results indicate no significant difference in the total daily intake of energy, protein and carbohydrate between LDCC attenders and non-attenders. The mean fat intake of LDCC non-attenders was significantly greater than the LDCC attenders (P < 0.05). The mean daily intakes of iron, calcium and zinc were less than 100% of the RDI for both groups, but this was only statistically significant for LDCC attenders (P < 0.05). During the time that would be spent in long day care the mean energy intakes of both LDCC attenders and non-attenders was less than 50% of the RDI. No child in the study consumed 50% of their total daily nutrient intake during long day care hours. The total daily intake of all nutrients studied exceeded 70% of the RDI, that is, intakes were adequate allowing for safety margins. Thus it is reasonable to recommend that LDCCs provide meals with 50% of the RDI, but not 70%. (Aust J Nutr Diet 2001;58:114–120)
Height, weight and body mass index distribution data for Queensland schoolchildren aged ten to 18 years
Angela Vivanti and Jeanie Sheffield
Abstract
Objective: To compare measured and perceived height and weight in a sample of Queensland primary and high school students, calculate their body mass indexes (BMIs), and compare these with age- and sex-specific BMI percentiles developed by the Australian Council for Health, Physical Education and Recreation (ACHPER).
Setting: The study was conducted in both public and private primary and high schools in the West Moreton region in Queensland.
Design: A cross-sectional survey of a sample of children (n = 1822) in grades 6 to 12 (age ten to 18 years) attending a compulsory or core curriculum class, in one of the selected schools on the day of the survey.
Methods: Students completed a range of standardised questions on measures of body image and eating attitudes as part of the health survey. Students’ heights and weights were measured (n = 1683) by the trained interviewers.
Main outcome measures: BMI percentiles calculated from both self-reported and measured heights and weights.
Statistics: Chi-squared analyses were used to compare the sample group with the Australian census data, the demographic characteristics of those who were measured and those who were not measured, and the differences between the current data and the ACHPER percentile data. Correlations between reported and measured heights and weights were calculated, and ANOVA was used to assess significant differences between mean BMI values for males and females and for menarche-related differences.
Results: Distribution occurred across all ACHPER percentile ranges, although a greater proportion of students was clustered at each extreme end of the distribution than would be expected. However, only two age groups (14-year-old males and 12-year-old females) were found to be significantly different to the ACHPER data (P < 0.001). Children tended to overestimate their height and underestimate their weight. The majority thought that their weight was right for their height although a quarter of males and one-third of females disagreed. Compared with males, females significantly under-reported weight (P < 0.006) and consequently BMI (P < 0.002).
Conclusion: The percentage of schoolchildren with a BMI, calculated from accurate measurements, greater than the 95th percentile exceeded the number in the ACHPER study of a decade earlier in the 12-year-old female and 14-year-old male groups.
(Aust J Nutr Diet 2001;58:121–127) |
Australian Journal of Nutrition and Dietetics, Volume 58, Number 2, June 2001