Leading articles
The rise of vegetarianism
(See paper by Lea and Worsley, pages 11–21)

Vegetarianism, the avoidance of eating flesh, has been noted ‘to represent one of the key moral and political issues of the late modern period’ (1). This seems an extraordinary statement when it is considered that the pro-portion of vegetarians in developed countries is quite small. For example, the 1995 National Nutrition Survey (2) indicated that the percentage of the Australian adult population that would select ‘vegetarian diet’ as the best description of their usual way of eating was 3.7%. The percentage of self-identified vegetarians in the UK and the USA in the mid-1990s was estimated to be less than 8% (1). Despite the small apparent proportion of veg-etarians, there is a much more substantial proportion of the population which appears to restrict meat (especially red meat) in its diet. For example, from the food fre-quency questionnaire in the 1995 National Nutrition Survey, 40% of Australian men and 48% of Australian women aged 19 years or older stated that they consumed red meat three times or less per week (3).

Lea and Worsley have surveyed South Australian adults and identified a substantial population segment they call ‘cognitive vegetarians’ (4). This consumer seg-ment was identified by utilising mailed responses to general population survey which included questions on beliefs about meat, barriers to vegetarian diets and bene-fits of vegetarian diets. After subjects had identified themselves as vegetarian, semi-vegetarian or non-vegetar-ian,
the authors found that 15% of the non-vegetarians shared similar beliefs about meat and vegetarian diets as the vegetarians. Lea and Worsley examined the character-istics of the ‘cognitive vegetarians’ and compared them with the vegetarians and the remaining non-vegetarians in
their survey.

This interesting approach taken by Lea and Worsley has similarities with social marketing methods (5). They have used consumer research to define a specific con-sumer segment, and profiled this group according to demographic characteristics, behaviour and attitudes.
They have used ‘stages of change’ behavioral theory to assess the likelihood of behaviour change in relation to adopting a vegetarian diet. To follow through with a social marketing approach, their next step might be to tailor spe-cific messages and products that are responsive to the identified wants and needs of the target group and refine
them as necessary. The authors appear to conclude that the identified population group will want a vegetarian diet and is therefore likely to need education about vegetarian diets and the vegetarian diet itself. They point out the implications for the development of program implementa-tion elements by nutrition educators and the food industry.

Some intriguing findings are outlined in this report. It should come as no surprise that there is a substantial pro-portion of people that shares views on meat and vegetarianism with some vegetarians. People may be veg-etarian for a wide range of reasons—these include beliefs relating to religion, economics, philosophy and ethics, politics, the environment and health (1). Historically, the vegetarian movement has had strong links to other social movements such as animal rights, anti-vivisection, paci-fism and the environmental movement. The choice of
what to eat, particularly where food is available in abun-dance, is value laden and strongly related to personal identity. It is not surprising therefore that people who eat no red meat share beliefs with people who eat some, but relatively little, red meat.

In the examination of characteristics of the ‘cognitive vegetarians’, many characteristics appear to be some-where between vegetarians and the remaining non-vegetarians. In comparison with the other non-vegetari-ans, the ‘cognitive vegetarians’ were more likely to be female, born outside Australia and interested in vegetari-anism and less likely to eat red meat as frequently and be employed full-time. There was no difference between these groups in age, income, education or consumption white meat, fish/seafood or eggs.

In some characteristics, the ‘cognitive vegetarians’ did not fall between the vegetarians and the other non-vege-tarians. For example, compared to the other two groups, more ‘cognitive vegetarians’ thought they needed to improve the health of their diet, more ‘sometimes or
often’ used dietitians/nutritionists, doctors and cooking magazines as an information source and more trusted die-titians/ nutritionists as an information source. If the group is generally insecure about how healthy their diet is, one wonders whether they are in the process of changing their diet. If so, are they likely to become more vegetarian or
less vegetarian? Or could it be changing in ways not related to vegetarianism? If their diet is relatively static, for how long do they remain a group that is dissatisfied with the healthiness of their diet (and perhaps other aspects of their lifestyle)? These are questions that might
be reasonably addressed by cohort studies that assess how the attitudes and food behaviours of groups of people vary with time. Cohort studies are typically used (among other things) to make inferences about how and when diet con-tributes to the development of disease. There is surely also substantial interest in investigating why and how people change their dietary intake and attitude toward diet over
time.

Lea and Worsley found that the group of ‘cognitive vegetarians’ were disproportionately female compared to the other non-vegetarians. This was also the finding for self-identified vegetarians in the National Nutrition Survey (2) and probably arises because more females elect
to be vegetarian rather than a gender imbalance in mem-bership of religions that include vegetarianism, or other involuntary circumstances. What set of values associated with being female results in a higher likelihood of being vegetarian, or having a relatively infrequent intake of red meat? The answer to this question might be of particular interest to people who seek to influence dietary change. The percentage of females who were self-identified vege-tarians in the National Nutrition Survey peaked at age 19 to 24 years at 6.2% and fell to half that at age 65 years and over. While this might be a cohort effect (i.e. this group of
vegetarians will remain vegetarians throughout life), it may also be a reflection of a change in values, or a change in life circumstance or opportunity.

The authors state that the ‘cognitive vegetarians’ may be susceptible to the promotion of vegetarianism sup-ported by their finding that more of this group were thinking of making (and expected to make) changes
towards vegetarianism than the other non-vegetarians. The term ‘susceptibility’ has similar meaning to ‘vulnera-bility’ or ‘weakness’ and may imply that ‘cognitive vegetarians’ should be taken advantage of by nutrition educators or food producers—but it may be that at this
point in time, a relatively large proportion of the adult population is considering making dietary changes towards vegetarianism and would resist being pushed in that direc-tion. There is some suggestion that the previous dominant health sector concern about the risks of inadequacy of a vegetarian diet is being replaced by the dominant expecta-tion
of likely benefits (6). However the benefits of a largely plant-based diet need not exclude meat. In any case, over the coming decades an increasingly large pro-portion of the population of the developed world may be driven toward a vegetarian diet, not by concerns of nutri-tional
health, ethics or philosophy, but by ecological necessity and population pressure (7,8). If this trend was to eventuate, it would be worth knowing much more about how personal values influence dietary intake and about the semi-vegetarians and the ‘cognitive vegetarians’.

Malcolm Riley
Associate Professor, Nutrition and Dieteteics
Department of Medicine
Monash University
Monash Medical Centre

Original research
What proportion of South Australian adult non-vegetarians hold similar beliefs to vegetarians?
Emma Lea and Anthony Worsley

Abstract (Nutr Diet 2004;61:11–21)
Objective: The aim of this study was to determine the proportion of non-vegetarians with similar beliefs as vegetarians, and to examine their personal characteristics.
Design: Mail survey on meat and vegetarianism beliefs, personal values and information sources.
Subjects and Setting: One thousand people were randomly selected from the South Australian population via the telephone directory. Approximately 600 questionnaires were obtained (71% of those able to be contacted participated). An additional non-random survey of 106 vegetarians and semi-vegetarians was conducted, total-ling 707 participants.
Main outcome measures: (1) Identification of the proportion of non vegetarian respondents with similar beliefs as vegetarians (‘cognitive vegetarians’); (2) Examination of their personal characteristics and a com-parison with vegetarians and the remaining non-vegetarians (e.g. meat consumption, interest in vegetarianism, personal values, use of and trust in information sources).
Statistical analyses: Categorical principal components analysis was performed and a plot of object points labelled by dietary group identified cognitive vegetarians. The characteristics of cognitive vegetarians, vege-tarians and the remaining non-vegetarians were examined using cross-tabulation analyses.
Results: We found that 15% of non-vegetarians shared similar beliefs about meat and vegetarianism as vege-tarians. Cognitive vegetarians formed a distinct group, e.g. they were less likely than the remaining non-vegetarians to eat red meat as frequently or identify as Anglo-Australian, but were more likely to be female and interested in vegetarianism.
Conclusion: A significant proportion of the population may be susceptible to the promotion of vegetarianism and, hence, plant-based diets. This has implications for health professionals and promoters of plant-based and
vegetarian diets.

Key words: vegetarian diet, social psychology, meat, questionnaires, Australia

ViewPoint
Dietetics and functional foods
Craig S. Patch, Linda C. Tapsell and Peter G. Williams

Abstract (Nutr Diet 2004;61:22–29)
This paper reviews ‘functional dietetics’ through which specific brand-name foods may be prescribed as part of medical nutrition practice. Dietitians will be increasingly called on to translate nutrition science in many forums for functional foods creating complex professional and ethical challenges. Scientific evidence should be the basis for the formulation and targetting of functional foods and communication about their effects. Functional foods may provide opportunities for the use of highly specific dietary prescription in nutrition interventions and dietary counselling, in order to improve compliance and client outcomes. However, caution is required when foods are introduced with a population target in mind and a full evaluation of risks and bene-fits is also required. Functional foods are currently established in the Australian food supply and dietetics practice needs to encompass consideration of their use in research, food product development, regulation, edu-cation, therapy for individuals and the development of population-based nutrition strategies. These new roles have implications for dietetics training and entry-level competencies for dietitians.

Original research
Patterns of fish consumption and levels of serum phospholipid very-long-chain omega-3 fatty acids in children with and without
asthma, living in Perth, Western Australia
W.H. Oddy, J.L. Sherriff, G.E. Kendall, N.H. de Klerk, T.A. Mori, K.V. Blake and L.J. Beilin

Abstract (Nutr Diet 2004;61:30–37)
Objective: To measure patterns of fish intake and to investigate the extent to which these may predict serum phospholipid levels of the very-long-chain (VLC) omega-3 fatty acids, eicosapentaenoic (EPA C20:5 omega-3) and docosahexaenoic (DHA C22:6 omega-3) acids in a sample of children.
Design: A subset within a nested case control study provided serum phospholipid samples for fatty acid analyses.
Setting: Perth, Western Australia.
Subjects: A nested case control study (n = 335) of eight-year-old children with (n = 166) and without asthma (n = 169) and blood samples for fatty acid analyses from a subset of these (n = 60).
Methods: Data on fish type and intake over the previous year were collected from parents on behalf of their children using the Commonwealth Scientific and Industrial Research Organisation (CSIRO) food frequency questionnaire. Fasting venous blood samples from the subset of children were analysed for fatty acids meas-ured by gas liquid chromatography. Analysis of variance and Spearman’s correlation methods were applied in the analysis to determine associations between fish intake and serum VLC omega-3 fatty acids.
Main results: Fresh fish accounted for 33% of fish consumed once a week or more by children in the dietary study. The mean concentration of EPA and DHA in serum phospholipids increased significantly from the low-est to the highest fish consumption categories. There were significant correlations between frequency of fish intake as estimated by questionnaire and EPA, DHA, and EPA + DHA combined, as measured in the serum. No differences in serum VLC omega-3 fatty acids were evident in children with and without asthma.
Conclusions: In this sample, most children consumed fish at least once per week and the frequency of fish intake as measured by food frequency questionnaire was a valid predictor of EPA and DHA levels in serum
phospholipids.

Key words: fish intake, omega-3 fatty acids, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), biomarkers, children

Original research
Work practices of the community and public health nutrition workforce in Australia
Roger Hughes

Abstract (Nutr Diet 2004;61:38–45)
Objective: To assess the roles, practice and work-related attributes of the community and public health nutri-tion workforce in Australia.
Design: Cross-sectional survey using self-administered mail or email delivered questionnaire.
Setting and Subjects: 240 practitioners working in community and public health nutrition positions in the
Australian health system.
Main outcome measures: Self-reported core functions, frequency of work-related practice activity and extent of multidisciplinary and inter-sectoral collaboration.
Results: An 87% questionnaire response rate was achieved. The demographic and educational profile of the sample showed female practitioners (95%) from 26 to 45 years (67%), from dietetics training backgrounds (75%) employed in state health department community health services as community dietitian/nutritionists (54%) and public health nutritionists in government health or non-government organisations (18%). Public health nutrition type of positions tended to report most frequently core functions in project management, nutri-tion education resource development, health professional education, evaluation and policy development. Dietitian type of positions in this sample reported core functions that tended to reflect functions such as clini-cal and group education, professional advisory services and implementing community-wide nutrition education and food supply programs. Public health nutrition positions reported more multidisciplinary and inter-sectoral collaboration than the dietitian type of positions. Health promoters, community health nurses and general practitioners were the most common professional groups and community organisations and other state government departments the most common inter-sectoral organisations involved in workforce collaborations.
Conclusions: This section of the workforce performs a mix of functions, many of which are in the clinical domain of individual care and education. The small number of practitioners predominantly practising in a way
consistent with public health core functions and the clinical service orientation of the existing community die-tetics workforce, limits the capacity of the public health nutrition workforce. It also indicates a need for strategic workforce growth, practice reorientation and workforce development research to increase the work-force’s capacity for effective public health nutrition action.

Key words: public health nutrition, workforce, core functions, practices

Insight
The effect of intensive dietetic intervention on the nutritional status of hospitalised patients on chemotherapy
Elisabeth Isenring, Judy Bauer and Sandra Capra

Abstract (Nutr Diet 2004;61:46–49)
The goal of nutrition intervention is to maintain or improve nutritional status. Patients receiving chemotherapy face challenges in achieving this goal due to the effects of the tumour, side effects of the treatment or a combi-nation of both. This paper describes observations made of the effect of intensive dietetic intervention on the nutritional status of hospitalised patients with cancer receiving chemotherapy using the scored Patient-Generated Subjective Global Assessment (PG-SGA). There was a significant linear trend in change in PG-SGA score for those patients who improved, maintained or declined in nutritional status according to SGA
(F (1,15) = 19.2, P = 0.001). There was no significant linear trend between the time spent by the dietitian in direct patient care and change in nutritional status according to SGA (F (1, 15) = 3.62, P = 0.08), however the trend was in the anticipated direction.

Key words: nutrition assessment, nutritional status, scored patient-generated subjective global assessment, malnutrition, cancer, outcomes