abstracts – oral presentations

Nutrition & Dietetics 2006; 63 (Supp. 1): A1–A24 A1© 2006 Dietitians Association of Australia

Nutrition & Dietetics 2006; 63 (Supp. 1): A1–A24

NUTRITIONAL GENOMICS AND THE FUTUREOF DIETETICS PRACTICERUTH DEBUSK1

1Nutritional Genomics Practitioner, Tallahassee, Florida, USA

Modern health care is increasingly emphasizing disease prevention.Genetics, because it provides the basic understanding of how an organ-ism functions and how dysfunction/disease arises, gives practitioners anenhanced understanding of disease and, ultimately, of disease preven-tion. Genetic technology is helping to identify those who are suscepti-ble to developing a disease and can do so long before the diseasemanifests. Nutrients and other bioactive food components can poten-tially modify genetic outcomes, thereby ameliorating or, ultimately, pre-venting disease. Early identification of those at risk, coupled withpersonalized nutrition, is a powerful new therapeutic approach fornutrition professionals. No other health care professional has the uniqueskills that this new era demands. This presentation will provide anintroduction to nutrigenomics and explore the ways in which geneticswill impact dietetics and the opportunities for, and the changing expec-tations of, the dietetics professional.

Nutrigenomics (also called nutritional genomics) focuses on those geneswhose expression is modifiable by components in food and on theeffects of variations in these genes on metabolism and nutrient require-ments. The ultimate promise of nutrigenomics is nothing short ofimproving well-being and preventing diet-related disease. The inter-section of genetics, health and nutrition teaches us that the informationin our genes sets the limits of our own personal health continuum butthat where we function on that continuum depends on our lifestylechoices. Our genes are not necessarily our destiny. We have far morecontrol over genetic outcomes than we’ve previously thought.

FOOD IS THE FUNDAMENTAL UNIT INNUTRITION: NUTRIENT MISADVENTURESDAVID R JACOBS JR1

1School of Public Health, University of Minnesota, Minneapolis, MN,55454, USA

In a world in which citrus fruit is rare and scurvy abounds – such asexisted on seagoing vessels in the 1700s – the provision of vitamin Csupplements would have ended the epidemic. Indeed, the mid-1900discovery of vitamins, coupled with a biochemical model of nutrition,was profound. It led to a simplified view of nutrition, based on totaldietary fat and carbohydrate, the dietary lipid-based understanding ofcholesterol and heart disease, uncritical acceptance of refined grain, for-tified white bread that was advertised as just as good as the naturalwhole grain product, and a large industry of dietary supplements.Several failed clinical trials in total fat reduction, beta-carotene supple-mentation, and B vitamin supplementation point to the widespreadinability of this model to predict or explain what a healthy diet is. Thenutrient perspective, while undoubtedly helpful in many situations,apparently has great weakness in understanding the role of diet in mul-tifactorial chronic disease: the great bulk of disease in modern society.In contrast to isolated nutrients, foods derive from living organisms,consisting of thousands of biochemicals, mostly unidentified, as a groupbiologically active for the health of the organism eaten. The complex ofbalanced, biologically active substances may be called the food matrix.Besides energy-bearing and essential nutrients, this matrix includessignal transducers, hormones, sterols, enzymes, enzyme inhibitors,polyphenols, and fungicides. The study of foods such as nutrient-richwhole grains, based on synergy of these substances, may offer animproved model for nutrition, that is, understanding diet and health.

Abstracts – Oral PresentationsFriday 12 May 2006

Plenary Session – Future dietetics/future practice

Concurrent Sessions – Future dietetics

Working towards best practice

MEDICAL NUTRITION THERAPY VERSUSGENERAL NUTRITION EDUCATION INDIABETES CARE – ARE YOU UP TO THECHALLENGE?MELISSA ARMSTRONG1

1St Vincent’s Hospital Diabetes Centre, Darlinghurst, NSW 2010 Australia

One in four Australians have some degree of abnormal glucose toler-ance and diabetes is our seventh leading cause of death. Together with

its associated long-term complications, diabetes has a high health andcost burden. Published literature supports the belief that the clinicaland psychosocial outcomes of diabetes can be improved by providinginterventions that encourage and promote appropriate self-managementin people with diabetes. Dietitians are in a unique position to contributeto this quality of care as dietary management, or more specificallyMedical Nutrition Therapy (MNT), constitutes a key element of dia-betes self-management education. MNT differs significantly fromGeneral Nutrition Education (GNE) because of its focus on the indi-

Abstracts

A2 Nutrition & Dietetics 2006; 63 (Supp. 1): A1–A24

© 2006 Dietitians Association of Australia

vidual. It includes a comprehensive assessment, from which an indi-vidualised nutrition intervention is planned. This intervention is thenimplemented and evaluated, and the plan adjusted, if appropriate, as aconsequence of the ongoing evaluation. Conversely, GNE providesgeneric information in an unstructured format to all patients. Ran-domised control trials in people with type 1 and type 2 diabetes, haveshown MNT provides superior clinical outcomes compared with GNE.MNT requires an in depth knowledge of the disease process and up-to-date clinical management practices. Therefore to differentiate ourselvesfrom those who provide GNE eg. Diabetes Nurse Educators, dietitiansneed to feel confident in their professional practice and ability toprovide MNT. Evidence-based practice guidelines for MNT should beused to improve the skills of dietitians and enable us to provide highquality clinical management of people with diabetes.

WHAT DO CHILDREN IN OBESITYINTERVENTIONS EAT? – A SYSTEMATIC REVIEWTO IMPROVE PRACTICECLARE COLLINS1, JANET WARREN1, BARRIE STOKES2,PENELOPE MCCOY3, MELINDA NEVE1

1School of Health Sciences, University of Newcastle, New South Wales2308 Australia2Clinical Pharmacology, University of Newcastle, New South Wales 2308Australia3Formerly School of Health Sciences, University of Newcastle, currentlyFood and Nutrition Australia, Sydney New South Wales 2001 Australia

Developing effective dietary interventions to address child obesity is aresearch priority. The aim of this review was to describe the dietary com-ponents and subsequent changes made by overweight children and/ortheir families, participating in weight management interventions.English language articles from 1975 to 2003 were retrieved (Cinahl,Medline, Dare, Cochrane, Embase, Austrom, Current Concepts andgovernment reports). Eligible studies were assessed for methodologicalquality using standardized tools from the Joanna Briggs Institute.Thirty-seven randomised control trials were included; with 16 studiesusing the Traffic Light diet and five food or calorie exchange programs.Compliance with the dietary intervention was reported in only twostudies and dietary intake described in 12. A dietitian was involved inthe formulation or delivery of the dietary intervention in 17 studies. Ameta-analysis of eight studies with adequate control groups, suggestedinterventions that include a dietary treatment do achieve relative weightloss. Details of the dietary interventions or food intakes were rarelydescribed and the dietary changes made not reported. Therefore, it isnot possible to describe essential components of effective interventionsfor this group. This is a serious omission if successful nutrition pro-grams are to be widely implemented. To address this gap we recom-mend that future studies report the rationale and details of the dietaryintervention and include measures of intake at baseline and duringfollow-up. There is an urgent need to improve the quality of reportingof both the intervention and food intake changes to improve the evi-dence base for dietary interventions.

Funding Source: Joanna Briggs Institute

ReferencesCollins C, McCoy P, Neve M, Stokes B, Warren J. Measuring Effective-ness of Dietetic Interventions in Child Obesity: A meta-analysis of ran-domized trials. Archives of Pediatrics and Adolescent Medicine (in press).

ARE WE MEASURING THE RIGHT OUTCOMESFOR INDICATORS OF IMPROVED NUTRITIONSTATUS IN THOSE RECEIVING RENALREPLACEMENT THERAPY?SUSAN ASH2,3, KATRINA CAMPBELL2,3, HELEN HEALY1, JULIE HULCOMBE3, LAURE BAUMGARTNER4

1Department of Nephrology, Royal Brisbane and Womens Hospital,Brisbane, Australia2Institute of Health and Biomedical Innovation, Queensland University ofTechnology, Brisbane, Australia3Department of Nutrition and Dietetics, Royal Brisbane and Women’sHospital, Brisbane, Australia4School of Public Health, Queensland University of Technology, Brisbane,Australia

Current evidence based guidelines for the nutritional management ofChronic Kidney Disease recommend protein intakes of 1.2–1.4g/kgideal body weight (IBW) for those requiring haemo-dialysis or peri-toneal dialysis. Recommended clinical outcomes include serumalbumin >35g/L, normalised protein catabolic rate (nPCR) >0.9g/dayand Subjective Global Assessment maintained or improved. Every sixmonths comparison of outcomes against these guidelines has beenapplied to those undergoing haemo-dialysis and peritoneal dialysis, atthe Royal Brisbane and Women’s Hospital. Results for a cohort of 38people receiving haemo-dialysis showed improvements in nutritionalparameters: percent with SGA A (well-nourished) from 80% in 2003 to82% in 2005, percent with serum albumin >35g/L from 68% to 80%and those meeting protein requirements of ≥1.2g/kg IBW improvingfrom 40 to 53%. A cohort of 41 people, receiving peritoneal dialysisbetween 2004 and 2005 showed an increase in mean (±SD) weight from73.4 (±18.6) to 74.9 (±18.7) kg (p = 0.005), percent with SGA Aimproving from 71% to 85% (p < 0.001), percent with serum albumin>35g/L improved from 37% to 39%, and those meeting protein require-ments of ≥1.2g/kg IBW improved from 44 to 55%. nPCR wasunchanged or less at mean (±SD) 0.83 (±0.18) and 0.81 (±0.21) g/day,with 23% and 26% with nPCR > 0.9g/day, respectively. Nutritionalstatus assessed by SGA improved in both cohorts. While those meetingprotein intake guidelines improved, less than 60% met recommendedlevel of 1.2g protein/kgIBW/day. Further research to determine the effect of improved nutritional status on clinical outcomes isrequired.

NUTRITION EDUCATIONAL MATERIALS ONLINE(NEMO) – DELIVERING STATE-WIDE NUTRITIONEDUCATION MATERIALSMERRILYN BANKS1, ANGELA VIVANTI1, SHELLEY WILKINSON2,JACK BELL2, JULIE HULCOMBE2

1Princess Alexandra Hospital Health Service District, Brisbane, 4102,Australia2Royal Brisbane and Women’s Hospital Health Service District, Brisbane,4029, Australia

Survey responses regarding the quality of nutrition education materialscompleted by Queensland Health (QH) dietitians and nutritionistsidentified out-dated and poorly presented materials due to a lack ofresources and review systems. Standardized materials were considered

Abstracts


A REAL EXPERIENCE WITH THE VIRTUALLEARNING ENVIRONMENT IN DIETETICEDUCATIONNOEL ROBERTS1, CHRISTINE ROBERTS1, HELEN TRUBY1

1Division of Nutrition, Dietetics and Food, School of Biomedical andMolecular Sciences, University of Surrey, Guildford, GU2 7XH, UK

E-learning has had mixed success in commercial and academic sectors,with some authors describing the university environment as unsuitedto this mode of delivery. During a restructure of the BSc (Hons) Nutri-tion/Dietetics program at the University of Surrey in 2001, our teach-ing team identified potential applications for e-learning. In 2003 theUniversity of Surrey implemented WebCT Vista®. The dietetics team leda small group of enthusiastic staff who were charged with developingan e-learning strategy for our School in parallel with the developmentand implementation of pilot modules. By September 2004, with thehelp of consultants and the University’s Centre for Learning Develop-ment, the team had developed part or all of 5 subjects across all 4 yearsof the course. We are currently teaching the second cohort of 219dietetic students and finding growing student enthusiasm for the ben-efits of e-learning. We report on our experience and analysis of a rangeof pre and post e-learning experience data collected from 279 under-graduate biomedical students (including dietetics) and their teaching

staff in the first year. We conclude that e-learning is a valuable teach-ing tool that needs careful application in the university environment.We found that designing successful online modules requires a signifi-cant rethink of the pedagogy (art and science of teaching) used in tra-ditional face-to-face teaching. Those who approach it on the basis thatit will save time and money are likely to be disappointed in the shortterm. Those who explore ways e-learning can enhance students learn-ing are more likely to find the right track.

OVER- AND UNDER-REPORTING OF ENERGYINTAKE BY PATIENTS WITH METABOLICSYNDROME USING AN AUTOMATED DIETARYASSESSMENT WEBSITEYASMINE PROBST1, LINDA TAPSELL2

1Smart Foods Centre, University of Wollongong, Wollongong, NSW 2522Australia2National Centre of Excellence in Functional Foods, University ofWollongong, Wollongong, NSW 2522 Australia

The use of computer technology in dietetic practice is often restrictedto analysis of nutrient data rather than assessment of dietary intake.DietAdvice, a website developed to allow patients with metabolic syn-

Use of technology in practice

desirable for statewide availability to health staff, to ensure good qualityclient materials and to reduce duplication of effort. Electronic accesswas considered the best delivery medium. In response, the PrincessAlexandra and Royal Brisbane and Women’s Hospitals committedproject facilitation resources. Expressions of interest regarding priorityareas were canvassed. Participation on related working groups wassought. A facilitation group was formed from chairs of working groupsand steering committee. Working groups assessed all known availablematerials and/or developed materials. Application of NHMRC guide-lines for consumer information combined with active consumer engage-ment achieved quality outcomes. All materials underwent consumerconsultation for usefulness, readability, content and presentation. Thesteering group developed processes to: upload documentation, encour-age broad consultation, obtain feedback, upload finalised documents,undertake two yearly reviews, disseminate information and promotecontinued expression of ideas and needs. Outcomes include: over 60 consumer and peer reviewed nutrition education materials endorsedfor state-wide use via the NEMO site accessible to all QH employees;expedited processes with approval of the Clinical Electronic Publish-ing Reference Group; and generation of significant interest with almost 70 of the state’s 180 nutrition specific workforce involved inresource review and development thus far. The project provides a successful model for achieving professionally reviewed and endorsed,electronically delivered nutrition education materials within currentresources.

Acknowledgment:To all the dietitians and nutritionists who have contributed to thesuccess of this project.

FEATURES OF A BEST PRACTICE DIETETICSERVICE FOR RURAL PATIENTS WITH CANCERUNDERGOING CHEMOTHERAPYLEANNE BROWN1, SANDRA CAPRA2, LAUREN WILLIAMS2

1University Department of Rural Health Northern NSW, University ofNewcastle, Tamworth NSW 2348 Australia2University of Newcastle, Callaghan, NSW 2308 Australia

There is a lack of clarity concerning the delivery of nutrition servicesin the rural setting. This study aimed to determine features of a bestpractice dietetic service for rural patients with cancer undergoingchemotherapy. The study design was a randomised controlled trial,comparing a predetermined best practice protocol with usual care, asprovided by the local hospital. Twenty-four patients were recruited(57% response rate), average age 60.5yrs. At assessment 38% were clas-sified as malnourished using the Patient Generated Subjective GlobalAssessment (PG-SGA), 50% scoring 4 or greater indicating theyrequired nutrition intervention. Participants were surveyed regardingtheir preferred methods of follow-up and service delivery. Care wasindividualised and attempts were made to utilise newer technology todeliver components of the service. A majority lived greater than 20kmfrom the hospital, with 33.3% living greater than 100km away. Serviceswere provided most days of the week and at various times. Patients allo-cated to usual care received fewer services in total. The preferredmethod of review was phone or in person at the time of treatment. Inthe rural setting it seems that highly defined protocols for best practiceare unsuitable. In this study more than half of all the service deliverywas outside the designated clinic times. Services designed for ruralbased patients need to be flexible in; method of delivery, days of serviceprovision and availability of the dietitian. These extra needs should beincluded in any staffing profiles.

Funding support: Early Career Researcher Grant, The University ofNewcastle

Abstracts



drome to self-report their usual dietary intake, has been developed inthe Illawarra region of NSW, Australia. Patients recruited by their GP,use the website and the data is electronically supplied to a dietitian foran individualised dietary prescription using a dietitian’s interface. Theaim of this study is to describe the reporting status of patients using thewebsite from November 2004 to November 2005. Nutrient data wasobtained from the dietitian’s interface. Reported energy intake (EI) wascompared to basal metabolic rate (BMR) for all patients using SPSS forWindows (v12.0.1, 2003, Chicago). Patients were classified as under-reporting if EI:BMR < 1.35 and over-reporting if EI:BMR > 2.40. Twohundred patients were recruited of whom 57 patients had missing dataor did not finish using the website. Of the remaining 143 patients32.3% under-reported their intakes, 21.7% over-reported their intakesand 46.2% were within 1.35–2.40 EI:BMR. Under-reporting appears tobe influenced by computer troubles with some patients only enteringinformation for one meal, while over-reporting appears to be influencedby the patient reporting all foods eaten rather than their usual intake.Findings suggest that computerised assessment of usual dietary intakemay encourage patients to report their usual diet with less bias than ina verbal diet history assessment with a dietitian.

Funding source: ARC linkage project between University of Wollongong, Illawarra Division of General Practice and Xyris SoftwareAustralia

A COMPARISON OF BIOELECTRICALIMPEDANCE WITH DUAL ENERGY X-RAYABSORPTIOMETRY FOR THE DETERMINATIONOF BODY FAT IN OVERWEIGHT AND OBESECHILDREN AGED 5–9 YEARSJESSIE BENNETT1, JANE CLEARY2, SUZIE DANIELS3, MARIJANA MILOSAVLIJEVIC4

1University of Wollongong, Wollongong, NSW, 2500, Australia2–4South Eastern Sydney Illawarra NSW Health, Wollongong, NSW, 2500,Australia

Childhood obesity continues to increase in prevalence worldwide.Various field and criterion methods are available for assessing bodycomposition including Bioelectrical Impedance Analysis (BIA) and Dualenergy x-ray absorptiometry (DXA). DXA is expensive and complex touse. BIA, a field method, is user friendly and inexpensive but needs tobe validated in the population under study. Our aim was to determinethe validity of the Bodystat1500 BIA machine against DXA and find abest estimation equation suited to our study population of overweightand obese children aged 5–9 years. 30 overweight and obese subjectsaged 5–9yrs, with a mean weight of 43.78kg ± 10.88 and a mean BMIof 22.8 ± 3.47 were recruited and underwent assessments for weight,height, DXA and BIA, whilst in the fasted state. BIA output was fedthrough four child specific estimation equations and compared to DXAby Mean T-tests and the Bland Altman method. Percentage (%)Fat wasthe primary indicator. All BIA results correlated highly with DXA (r >0.8). Of the four BIA estimation equations tested, the Schaefer equationhad the lowest mean error and was the only equation not significantlydifferent from the DXA (p = 0.121). Bias graphs indicated the Schaeferequation had the greatest strength for producing valid results in children with %Fat values of 35–50%. We conclude that the Schaefer equation is the most accurate for assessing %Fat in this population of obese and overweight children and has potential applicability in clinical settings.

APPROPRIATE PRACTICE USES APPROPRIATETECHNOLOGYMALCOLM RILEY1

1Department of Medicine, Monash University, Melbourne, VIC 3168Australia

Technology is the industrial application and practice of science andengineering. Its purpose is to respond to identified problems by makingthings ‘better’ – easier, quicker, cheaper, safer, more attractive or a com-bination of these. Every area of dietetic practice directly involves theuse of technology and is also strongly influenced by the technologiesused by others. The implications of the use of technology are not nec-essarily consistent with the aims of dietetic practice. Negative implica-tions may be related to unforseen consequences, inappropriateapplication or to the fact that the technology was developed to addressa problem set that did not include issues that are professionally impor-tant to dietitians. It is a professional responsibility to use the mostappropriate technology, and to support the continued development oftechnology. Classical and current technologies should be improved aswell as new technologies developed. Failure to accept this devalues ourwork – suggesting it need not be made ‘better’. Further, it is a profes-sional responsibility to maintain an awareness and understanding ofdeveloping technologies, consider the broad implications in our areasof expertise and to initiate or support action to address issues impor-tant to us. This principle needs to have a broad focus because tech-nologies are widely integrated into human experience. For example,dietitians might consider the implications of labour saving technologieson the incidence of obesity; and ‘safety’ might have a planetary dimen-sion as well as an individual one. In practice, the technologically appro-priate should be emphasised in preference to the technologicallypossible.

COMPUTERISED MENU MANAGEMENTSYSTEMS: IS MICROS® THE WAY OF THEFUTURE?JUDI PORTER1

1Casey Hospital, Berwick Vic 3806, Australia

Micros Systems is one of the leading developers of computer technol-ogy for the hospitality and retail industries worldwide. Casey Hospitalin Victoria was the first hospital in Australia to implement the Microsfood service system for hospitals. This was an opportunity to imple-ment industry best practice within the Australian health care context.The system incorporates purchasing and inventory control, therapeuticdiet coding and electronic patient meal selection. One of the featuresof the system is the use of the handheld Personal Digital Assistant (PDA)at the bedside to take menu orders which transfer directly to food services for production.Post implementation the Micros system was evaluated against a rangeof parameters drawn from the literature. Advantages identified includedthe responsiveness of the system due to the use of the PDA for menuordering, the interface with hospital admissions and discharges for mealaccuracy and the ability to make regular menu changes. System limita-tions included the volume of work involved in the system set up, theburden on food service and dietetic staff when menu changes occur andthe lack of system ability to integrate preformatted diet codes.Micros uses innovative technology within hospital food services butfurther work in programme development needs to be completed beforethis system would meet the needs of many Australian hospitals. Adetailed evaluation of the organisation’s needs against the functionalityof the system should be completed before committing to its purchase.

Abstracts


The business of future dietetics

BUILDING EVIDENCE FOR THE NUTRITIONALMANAGEMENT OF PATIENTS WITH CANCER –LEADERSHIP STRATEGIESJUDITH BAUER1

1The Wesley Research Institute, Brisbane QLD 4066 Australia

Key strategies for the successful development of a nutrition researchprogram at a private research institute included encouragement of staffand students to undertake higher degrees and providing access tofunding; networking with key stakeholders especially, university col-leagues; presenting and publishing work at a local, national and inter-national level; creation of a joint research position with the universityand a research track record attracting further funding. A theoreticalmodel developed by Splett (1996) has been used as the framework forthe research which depicts a cascade of events required for positive out-comes to be achieved from nutrition intervention – appropriate accessto care (nutrition screening and assessment), quality nutrition care(nutrition intervention), intermediate and final outcomes (clinical, costand patient-centered). The research program has focused on oncologyand four PhD scholars investigated different aspects of the framework.Tools have been developed and/or validated that have become widelyaccepted in clinical practice – the malnutrition screening tool (MST)and Patient-Generated Subjective Global Assessment (PG-SGA). Esti-mation of cancer patient’s energy requirements was reviewed and aportable devise for measurement of energy expenditure investigated.Nutrition prescriptions and intensity of intervention was determined aswell as the importance of dietary compliance. Intervention programswere conducted in patients receiving supportive care, chemotherapyand radiotherapy providing evidence that intensive nutrition interven-tion improves a variety of outcomes. Twenty-five publications in inter-national (22) and national (3) journals have contributed to the evidencebase for the nutritional management of patients with cancer. Externalfunding for future research has been secured.

DIETITIANS AND RENAL SERVICES – NEWCHALLENGES AND OPPORTUNITIESMARIA CHAN1, ADITI PATWARDHAN2

1Department of Nutrition and Dietetics, The St. George Hospital, Kogarah,NSW 2217 Australia2Department of Nutrition and Dietetics, Royal Prince Alfred Hospital,Camperdown, NSW 2006 Australia

Prevalence of Chronic Kidney Disease (CKD) is increasing rapidly inAustralia and imposes a tremendous health burden and cost. Evidencebased clinical guidelines1 have been established for dietitians to managerenal patients. Despite some available recommendations on staffinglevels, it has been a challenge to ensure adequate dietitian services tothis population. A recent survey indicated the inequity of and inade-quate renal dietitian staffing levels which may prevent implementationof best practice in the majority of renal units in NSW2. Dietitians shouldcollaborate with the renal community, e.g. clinicians, researchers andadministrators to lobby for adequate service provision. Lobbying canrange from clinical roles, setting performance indicators, research,quality improvement activities, and to making sure our voice is heardwhen renal services are being planned. Activities such as these have ledto an increase in dietitian staffing and the establishment of an earlynutrition intervention program in pre-dialysis patients. Through theproactive involvement of dietitians at their respective renal units over

time, dietitians now have the opportunities to become committeemembers of the renal services working parties at local area healthservice, state (Greater Metropolitan Clinical Taskforce – GMCT, NSW)and national (Kidney Health Australia) levels. In a recent national strate-gic planning meeting, issues on ensuring adequate staffing levels andthe need for advanced training for dietitains in renal care had gainedtremendous support3. In conclusion, dietitians should implement bestpractice and collaborate closely with the renal community to achievebetter patient outcomes.References1. Evidence Based Practice Guidelines for Nutrition Management of

Chronic Kidney Disease www.daa.asn.au.2. Patwardhan A, Bartlett L, Chan M et al. A survey of renal dietitian

staffing level in New South Wales. Australian and New ZealandSociety of Nephrology 40th annual scientific meeting, conferenceproceedings, September 2004.

3. Kidney Health Australia (KHA) national renal services strategic planning working party committee report (unpublished).

THE COACH PROGRAM (TCP): A NEW CAREERDIRECTION FOR DIETITIANS IN THEMANAGEMENT OF CHRONIC DISEASEMARGARITE VALE1, MICHAEL JELINEK1, JAMES BEST1

1Department of Cardiology and The University of Melbourne Departmentof Medicine, St. Vincent’s Hospital Melbourne, Australia

TCP was developed to bridge the gap between evidence-based medi-cine and usual care. In TCP, dietitians coach patients with CHD overthe telephone to work with their doctors to achieve the target levels fortheir coronary risk factors. The two randomised controlled trials of TCPprove that TCP is highly effective in reducing risk factors in patientswith CHD.1–2 TCP also produced substantial improvements in self-reported fitness, health, mood and reductions in frequency of dyspnoeaand chest pain.2 A 4-year follow-up of the 792 patients in the multi-centre COACH study2 was recently performed by the Victorian government to determine the impact of TCP on deaths and subsequenthospital utilisation. The survival of both coached and non-coachedpatients was 92% 4 years after randomisation. There was a 15% reduc-tion in cardiac bed-days, 16% reduction in hospital admissions for anycause, and a 20% reduction in bed-days for any cause (P < 0.001 forall). TCP is currently operating in VIC from 4 teaching hospitals andone division of general practice and in 2 teaching hospitals in SA withfunding provided by State Governments. Nearly 3,000 patients areenrolled. Results show improvement in the no. of patients achievingtheir risk factor targets and taking recommended medications. Withfurther government support, TCP will be rolled out throughout Aus-tralia. This will provide opportunities for dietitians as coaches toenhance patient care.References1. Vale MJ et al. J Clin Epidemiol 2002; 55: 245–252.2. Vale MJ et al. Arch Intern Med 2003; 163: 2775–2783.Funding source: VicHealth and unrestricted grant from MSD

Abstracts



THE GOOD, THE BAD AND THE MUDDY OFNUTRITION PUBLIC RELATIONSLISA YATES1

1Consultant Dietitian, Frenchs Forest, NSW 2086 Australia

Public Relations (PR) is a method used to try and influence others’ opinions and behaviours. PR is part of the marketing mix and caninvolve a number of activities: publicity/ media relations, promotionsand events. Nutrition PR is quite controversial. Health promotion programs, such as Go for 2&5 fruit and vegetable campaign have usedPR to convince consumers to eat more fruit and vegetables. Companiessuch as Atkins Nutritionals, used PR to convince us to eat low carb andbuy Atkins food products. Which campaign has been more successful?There are 10 “must haves” for a successful PR campaign:1) Funding for advertising and PR2) Credible scientific research supporting arguments for consumption3) Government support4) Key influencer support (health professionals and associations,

NGOs)5) Clearly defined target markets6) Industry support and innovation7) Exciting and/ or controversial key messages8) Credible spokespeople (figureheads and celebrities)9) Media support

10) Consumer support (word of mouth)In 2004 the Australian fruit and vegetable industry and Atkins wereassessed against each criterion. At the time it was clear Atkins excelledin each of these. However in 2005 consumers lost interest in the lowcarb eating fad, Atkins Nutritionals filed for bankruptcy, and slowly andsteadily the evidence indicates that eating fruit and vegetables is becom-ing a fashionable trend. PR is a cost effective means of changing nutri-tion opinions and behaviours of all key audiences and target markets ifused ethically and professionally.

At the time of the review the author had no affiliation with either indus-try. The author is currently employed by the Australian Nut Industry.

scores, logistic regression was used to calculate odds ratios (OR) and95% confidence intervals (CI) for incident disease by quintile of HEIFAfor cardiovascular and cerebrovascular disease and cancer. After con-trolling for age, sex, smoking habit, BMI, serum cholesterol, blood pres-sure and energy intake the risk of vascular disease for the highest (bestdiet) versus lowest HEIFA quintile was reduced (OR 0.42, 95% CI0.22–0.79, P < 0.01). There were no significant associations for risk ofcancer with quintile of HEIFA after multivariate adjustment. Subjectswith food patterns most closely matching Australian dietary recom-mendations have almost a 60% decrease in odds of incident vasculardisease compared with those who had least compliance but no reduc-tion in risk of cancer was apparent.

PUFA-RICH FOODS PROVIDE MOST OF THEDIETARY FAT IN DIETS WITH OPTIMAL FATTYACID PROFILESLYNDA GILLEN1, ANJA HEDEGAARD1, BERIT LARSEN1, MARIJKA BATTERHAM1, LINDA TAPSELL1

1Smart Foods Centre, University of Wollongong, Wollongong, NSW 2522Australia

Overweight and obesity are associated with saturated fat intake. Clinical intervention trials demonstrate the way in which changes

Food and dieteticsDOES A FOOD PATTERN THAT FOLLOWS THEGUIDE TO HEALTHY EATING AND DIETARYGUIDELINES REALLY PROTECT AGAINSTCHRONIC DISEASE?MARGARET ALLMAN-FARINELLI1, ADRIAN BAUMAN1, PAUL MITCHELL2

1Prevention Research Centres, Department of Public Health, University ofSydney, New South Wales 2006 Australia2Centre for Vision Research, Department of Ophthalmology, WestmeadHospital, Westmead, New South Wales 2145 Australia

A variety of scoring systems have been used to assess adherence todietary guidelines and food and nutrition recommendations and sub-sequently their relationships with chronic disease have been analysed.The aim of this study was to devise a Healthy Eating Index for Australians (HEIFA) based on the Dietary Guidelines for AustralianAdults (NHMRC, Commonwealth of Australia, 2003) and incorporat-ing the Guide to Healthy Eating (Smith et al Commonwealth of Australia, 1998) and then evaluate whether it would predict vasculardisease and cancer in a general older population. A total of 1790 participants of the Blue Mountains Eye Study (Mitchell et al Ophthal-mology 1995;102:1450–60) with a completed baseline food frequencyquestionnaire were followed-up after five years. After generating HEIFA

DEVELOPMENT OF PROFESSIONAL SERVICESFOR DIETITIANS USING A SUPPORT PROJECTAPPROACHJANELLE BARNARD1, NERIDA BELLIS-SMITH1, SUE CASSIDY1

1Dietitians Association of Australia, Canberra, ACT 2600 Australia

The Dietitians Association of Australia (DAA) is a professional memberorganisation with a mission to support its members. Member feedbackand organisational planning processes have raised issues relating to par-ticipation in and operation of interest groups (IGs), delivery of con-tinuing professional development (CPD), and the processes for resourceand practice guideline endorsement. We present a case study of a pro-fessional services project developed to respond specifically to theseissues. The project comprised focussed evaluation of the issues andidentification of key strategies to address them. A qualitative review ofkey documents supplemented by DAA staff and member feedbackbased on issues relating to IG participation, CPD delivery and resourceendorsement was undertaken. Themes were drawn from these data toform the basis of a member survey delivered in October 2005. Evalu-ation of practice guideline processes highlighted needs for a standardformat for guideline submission, communication of endorsementrequirements, and publication procedures. Results of the membersurvey will form the basis of strategies aimed at improving service inthe identified areas. Results from evaluation of practice guidelinesprocess and assessment criteria informed a DAA Board approved stan-dard publishing format that has been used to communicate endorse-ment needs to groups developing guidelines. In this case study, targetedresponse to specific needs via project work has enabled positive devel-opments in these key areas of member support.

Abstracts


within the fat profile might be achieved. This study compared food-based changes in fat intake in response to different approaches to advicefor the management of overweight. Adults (30 male and female) over-weight or obese (BMI = 26–39) were randomized into four differentadvice groups targeting 30% energy (E) from fat and <10%E SFA:general low fat (LF), low fat low energy (LFLE) (2MJ deficit), low fathigh PUFA (Pu), low fat high PUFA low energy (HPuLE). HPu groupstargeted PUFA >7%E and were given exchange lists of PUFA-rich foods.Dietary intakes were assessed at baseline and 3 months using diethistory interviews. Foods were grouped by main fat type: SFA, MUFA,PUFA-rich. Percentage of mean total fat intake was calculated. Frompreliminary data, at baseline all groups consumed most fat from SFA-rich meat, egg, cheese (39%) and least from PUFA-rich fish (3.7%), nuts(1.6%) and legumes (1.1%). At 3 months differences between groupsemerged with LF groups consuming 37.5% of fat from meat, egg,cheese. In contrast, the HP groups consumed most fat from PUFA-richnuts and seeds (HPu = 46.8% and HPuLE = 32.9%). In this way thePUFA target was achieved by 5/5 and 9/10 subjects in the HP groups,respectively. In contrast only 1/8 in LF and 3/7 LFLE groups achievedthe PUFA target. PUFA-rich foods need to provide most of the dietaryfat if optimal fatty acid targets are to be achieved.

Funding Source: National Health and Medical Research Council

DIETARY FATTY ACID INTAKES AND FOODSOURCES IN A POPULATION OF OLDERAUSTRALIANSVICTORIA FLOOD1,2, KAREN WEBB1,3, ELENA ROCHTCHINA2,BRIDGET KELLY1, PAUL MITCHELL2

1NSW Centre for Public Health Nutrition, Department of Molecular andMicrobial Biosciences, University of Sydney, NSW 2006, Australia2Centre for Vision Research, Westmead Millennium Institute, WestmeadHospital, University of Sydney, NSW 2145, Australia3School of Public Health, University of Sydney, NSW 2006, Australia

Knowledge about the food sources of dietary fatty acids provides usefulinformation to inform public health policy and practice. The aim of thisstudy was to document intakes and describe food sources of fatty acidsof a population-based survivor cohort of older Australians from the BlueMountains. In 1997–9, 2334 people aged 55 years and over, partici-pated in a 5-year follow-up of the cohort attending the Blue MountainsEye Study. Dietary data were collected using a semi-quantitative foodfrequency questionnaire by 2005 persons (86% of those examined).Dietary intakes were estimated using Nuttab95, and the RMIT fatty aciddatabase. Mean total fat intake contributed 31.3% of daily energy intake(12.2% saturated fatty acid (SFA), 11.2% monounsaturated fatty acid(MUFA), 5.0% polyunsaturated fatty acid (PUFA)). Mean n-3 PUFAintake was 0.5% energy intake (long chain n-3 PUFA provided meanintake of 260mg) and the n-6:n-3 PUFA ratio was 8.4. The main fattyacids contributing to each class were: palmitic acid to SFA, oleic acidto MUFA and linoleic acid to PUFA. Meat products were the highestcontributors to total fat (24.5%) and MUFA intakes (30%); milk products were the highest contributor to SFA intakes (32.8%); and fatspreads and oils (32.3%), and breads and cereals (15.4%) were the mainfood groups contributing to PUFA intakes. This descriptive study sum-marises information about food sources of fatty acids in an older Australian population.

Funding source: National Health and Medical Research Council

EGGS AND CHOLESTEROL – UNSCRAMBLINGTHE MESSAGESSHARON NATOLI1, MANNY NOAKES2, KARAM KOSTNER3, DAVID LIM4, TANIA MARKOVIC5

1Food & Nutrition Australia, Sydney, Australia2CSIRO Human Nutrition, Adelaide, Australia3Princess Alexandra Hospital, Brisbane, Australia4General Practitioner, Sydney, Australia5Royal Prince Alfred Medical Centre, Sydney, Australia

As eggs contain dietary cholesterol it has been assumed that a limit onegg consumption will reduce the risk of coronary heart disease (CHD)by reducing plasma cholesterol levels, however international heart asso-ciations vary considerably in their recommendations in this area. Addi-tional research shows only 35% of general practitioners (GPs) are awarethat egg consumption has little to no effect on serum cholesterol levels.Due to discrepancies around beliefs, attitudes and recommendationsregarding egg intake, the Egg Nutrition Advisory Group (ENAG) wasconvened in 2004 to review the scientific evidence around eggs, plasmacholesterol and CHD risk. PUBMED and CINAHL databases weresearched for the period 1965 to 2004. Initially, twenty key review andexperimental studies were included, with nine additional studies addedfollowing further review in 2005. A critical summary was developedand circulated to ENAG members and additional expert opinion soughtin the area of lipid metabolism. This process formed the basis of healthprofessional statements developed by ENAG on eggs, plasma choles-terol and lipoproteins, and eggs and the risk of CHD to guide recom-mendations in these areas. The conclusion of the scientific reviewprocess is that in a healthy Western population, there is insufficient evi-dence to excessively restrict egg intake as part of a healthy diet. Eggsshould be considered in a similar way as other protein rich foods andselected as part of a varied diet that is low in saturated fat and containsa variety of cardio-protective foods.

Funding Source: Egg Nutrition Advisory Group

WHAT DO CHILDREN ENROLLED IN ANOBESITY INTERVENTION PROGRAM EAT ATBASELINE?TRACY BURROWS1, JANET WARREN1, CLARE COLLINS1

1School of Health Sciences, University of Newcastle, New South Wales2308 Australia

Current literature suggests that specific family lifestyle and dietarybehaviours be targeted in weight management interventions in children(Ritchie et al 2005). In particular, breakfast eating, reducing intake ofenergy dense snack foods, increasing nutrient dense foods and not eatingin front of the TV. These behaviours are targeted in the nutrition com-ponent of the HIKCUPS study. The aim is to describe the baseline foodbehaviours of children aged 5–9 years enrolled in the HIKCUPS RCTintervention study. Parents (n = 130) completed a 137-question food frequency questionnaire (FFQ) on behalf of their children (n = 78 girls).

Breakfast consumption was reported for 90% of children, over a quarterof children (27%) ate 3 or more snack foods daily. Approximately halfof children had takeaways once a week or more (55%) and soft

Abstracts



The nutrition intervention in HIKCUPS addresses these modifiable foodbehaviours by targeting the parent or caregiver as the main agent ofchange. The FFQ will be repeated at follow up (6, 12 and 24 months)to evaluate the impact of the program.

Funding: NHMRC

drink/cordial twice per day or more (47%). Intakes of fruit, vegetablesand dairy i.e. nutrient dense foods were lower than recommendationsin the AGHE; The majority of children (67%) had one or less serves offruit per day and consumed vegetables with dinner less than four timesper week (50%). Nearly a third of children (30%) ate their eveningmeals while watching TV at least 5 nights a week.

Plenary Session – Dietetics as enterprise

NUTRIENT REFERENCE VALUES (NRVs) FORAUSTRALIANS AND NEW ZEALANDERS: POLICYFORMULATION AND RESEARCHTIM GREEN1

1Department of Human Nutrition, University of Otago, Dunedin (9001),New Zealand

The new NRVs for Australians and New Zealanders replace the 1991Australian Recommended Dietary Intakes (RDI). They differ from theolder recommendations in several important ways. The new NRVsinclude 37 nutrients, up from 19 in 1991, for 12 life-stage groups. TheNRVs were set not only to prevent nutrient deficiency but to optimisehealth and reduce chronic disease risk. Where toxicity data existedupper limits were also set. In addition to the RDI of the 1991 recom-mendations, the NRVs consist of three additional reference intakes: theEstimated Average Requirement, Adequate Intake, and the TolerableUpper Intake Level. The NRVs also include a recommendation foracceptable macronutrient distribution range (AMDR), which representsintakes of macronutrients that minimise the risk of chronic disease. TheNRVs were a joint project funded by the Australian and NZ govern-ments and are based on the recent US/ Canadian Dietary ReferenceIntakes (DRI). The US/Canadian DRIs were based on observational andexperimental studies but data were often scant, particularly for childrenand adolescents. Scientific judgement was often required in setting thevalues. Experts from Australia/NZ were asked to review the US/ Cana-dian recommendations and determine whether they were suitable foradoption. With a few exceptions the US/Canadian DRVs were adopted.In this talk I will discuss the development of the NRVs and provide spe-cific examples of the evidence used to derive them.

THE REVISED NUTRIENT REFERENCE VALUES –A MAJOR HEALTHCARE POLICY CHANGE FORNUTRITION PROFESSIONALSSANDRA CAPRA1

1School of Health Sciences, University of Newcastle, Callaghan, NSW 2308,Australia. DAA representative on the NRV Working Party 2003–2005

The recommendations for nutrient intakes have been unchanged inAustralia for many years. Over the last 3 years, the National Health and Medical Research Council has undertaken a rigorous, formalisedreview process to establish values for use with Australia and NewZealand. Starting with a review of the US values released throughoutthe 1990’s, expert reviewers were engaged to undertake updated reviews of each nutrient with reference to the Australian and NewZealand context. These reviews were then closely evaluated by aworking party comprised of individual experts and representatives from the nutrition community (DAA) and the food industry (Australian

Food and Grocery Council). Forty-two nutrients were viewed with finalrecommendations for reference values for thirty-three. Estimatedaverage requirements, adequate intakes, upper limits and recommendeddietary intakes have been developed. In addition, acceptable macronu-trient distribution ranges and dietary targets for optimising diets forlowering chronic disease risk have been included. Together these recommendations make up the nutrient reference values (NRVs). Fornutrition professionals, there are challenges in terms of long held viewson adequate diets, food groups and optimal macronutrient ranges.Together with changes to food law, these changed recommendationsprovide an environment for opportunities for new foods and new foodgrouping systems, as well as fundamentally affecting programs such as“meals on wheels”and menus in acute and chronic care facilities. Itseems that the Australian Guide to Health Eating will require revision.The NRV changes may well be the most significant change that nutri-tionists will face this decade.

SUPERFOODS: IMPLICATIONS FOR DIETITIANSLINDA TAPSELL1

1National Centre of Excellence in Functional Foods, Wollongong NSW2522, Australia

Food is the currency of dietetic practice. The goals of better health,better nutrition are primarily achieved through better food. Guidingindividuals on food choices requires an extensive knowledge of foodcomposition to provide the best advice on a food pattern that meetsnutritional targets for that particular person. At a population level thisis usually done with reference to core foods that deliver key nutrients.These core foods are generally known as primary or ‘minimally trans-formed’ foods, with a history of safe use and well established nutritionalvalue. In Australia, primary foods play a key role in international tradeso they not only underpin the nation’s health they also support thenation’s economy. It is not surprising then, that substantial R&D invest-ment is made to improve qualities that provide greater health advan-tages as well as enable a strong trade base. This means that primaryfoods are continually being developed. Recent examples include newbiological varieties of milk and wheat with higher selenium levels(addressing Se inadequacies) and fat modified dairy and grain products.Aquaculture and enrichment of foods with omega 3 fatty acids aredevelopments related to fish that address health benefits and createinnovation in the industry. The message is that foods are always beingdeveloped, whether minimally or substantially transformed (as in manufactured products), and these developments are driven by increas-ing scientific knowledge of food composition and health, and by marketforces. As practitioners whose primary currency is food, dietitians needto maintain a sophisticated knowledge of these developments and knowhow to use them effectively in achieving their goals of better nutrition,better health for all.

Abstracts


Concurrent Sessions – Enterprise in practice

Building the knowledge base

RELATIVE VALIDATION OF THE MALNUTRITIONSCREENING TOOL IN ONCOLOGYOUTPATIENTS RECEIVING CHEMOTHERAPY ATAN AUSTRALIAN PUBLIC HOSPITALELISABETH ISENRING1, GIORDANA CROSS1,2, LYNNE DANIELS1,ELIZABETH KELLETT2, BOGDA KOCZWARA2

1Flinders University, Adelaide, South Australia 5001 Australia2Flinders Medical Centre, Adelaide, South Australia 5001 Australia

The Malnutrition Screening Tool (MST) has been previously validatedfor oncology inpatients and outpatients receiving radiotherapy but notspecifically for outpatients receiving chemotherapy. This study aimedto: i) determine the relative validity of the MST compared with a fullnutrition assessment by the scored Patient Generated-Subjective GlobalAssessment (PG-SGA); and ii) assess MST inter-rater reliability. Anobservational, cross-sectional study was conducted at an Australianpublic hospital in 50 oncology outpatients receiving chemotherapy.Inter-rater reliability between nursing/administration staff and thedietitian was assessed in a sub-sample of 20 patients. The MST wasadministered by nursing or administration staff and the nutrition assess-ment was completed by a researcher trained in using the scored PG-SGA. According to PG-SGA global rating the prevalence of malnutritionwas 26%. The MST was a strong predictor of nutritional risk comparedwith PG-SGA (100% sensitivity, 92% specificity, 0.8 positive predictivevalue, 1.0 negative predictive value). MST inter-rater reliability wasacceptable with agreement by administration/nursing staff and thedietitian in 18/20 cases (kappa = 0.83;p < 0.001). In conclusion, theMST has acceptable relative validity, inter-rater reliability, sensitivity andspecificity to identify chemotherapy patients at risk of malnutrition andhence is an acceptable nutrition screening tool.

PREDICTION EQUATIONS FOR CALCULATINGRESTING ENERGY EXPENDITURE: TEACHINGOUR STUDENTSMARIJKA BATTERHAM1

1Department of Biomedical Sciences, University of Wollongong, WollongongNSW 2522, Australia

Accurately estimating the energy expenditure of groups and individu-als is one of the cornerstones of dietetic practice. Recently the American Dietetic Association conducted a systematic evaluation of theaccuracy of prediction equations and concluded that the Mifflin-St Jeorequation was the most likely to estimate resting energy expenditure towithin 10% of measured energy expenditure in healthy adults (bothoverweight and non-overweight). The Harris-Benedict equation gener-ally overestimated REE as has been previously reported, this equationshould no longer be advocated for clinical use. Assessments of theSchofield equation were not presented in a format that could be usedfor analysis in the review. The current NHMRC recommendations advo-cate the use of the Schofield equation. Equations based on FFM ratherthan weight and/or height are commonplace in the literature, howeverhave not been formally reviewed for clinical applicability. The intro-duction of inexpensive portable indirect calorimeters and body com-position analysers now open new avenues for clinical assessment.Equations need to be developed and evaluated in Australian popula-tions and new technology needs to be evaluated for clinical applicabil-

ity. In the interim it is professional best practice that our students are educated to use the equation advocated by systematic review andbe encouraged to understand the development and assessment of pre-diction methods in order to be able to evaluate the accuracy of newequations.

FUTURE DIETITIANS – BREASTFEEDINGCHAMPIONS OR BYSTANDERS?JAN PAYNE1, BARBARA RADCLIFFE2, EMMA BLANK1, ELIZABETH CHURCHILL1, NADIA HASSAN1, ELIZABETH COX2,HELEN PORTEOUS2

1Queensland University of Technology, Brisbane, Qld 4059 Australia2Southern Brisbane and Logan Breastfeeding Promotion and TrainingCoalition, South Brisbane, Queensland 4101 Australia

Breastfeeding promotion and support is a key responsibility of Dietitian-Nutritionists. Vocational training should ensure students gainadequate knowledge, skills, attitudes and beliefs to effectively meet thisresponsibility.

To determine the effectiveness of training at Queensland University ofTechnology, a cross-sectional survey of final year nutrition and dietet-ics students was conducted. This consisted of 50 multiple-choice ques-tions assessing student profile (6), basic knowledge (22), attitudes andbeliefs (15) and future intentions to support and promote breastfeed-ing (6). Despite piloting, two knowledge questions were discarded dueto respondent misinterpretation. The response rate was 71% (n = 38).The majority of participants reported being 17–25 years (81.5%),female (88.9%), not parents (100%) and predominantly breastfed as aninfant (78%).

Substantial gaps and errors in breastfeeding knowledge were identifiedwith the median knowledge score being 50%; range 8–34%. Ninety-two percent of students reported a future intention to breastfeed orsupport their partner to do so; yet 69% felt bottle feeding was moresocially acceptable and 23% felt that it was easier. Fifty-two percent dis-agreed that exclusive breastfeeding for at least six months was practicalfor over 80% of women. Only 8% had a strong interest to future workin breastfeeding.

Improvements in the curriculum are required to allow new graduatesto develop the appropriate knowledge, skills and passion to trulypromote and support breastfeeding like champions rather than onlygiving it lip service and acting as bystanders. Further research is sug-gested to determine the extent of this issue in other courses and thecurrent workforce.

THE EXTENT AND NATURE OF FOODPROMOTIONS IN SYDNEY SUPERMARKETSKATHY CHAPMAN1, DEBBIE BANOVIC2, PENNY NICHOLAS1

1The Cancer Council NSW, Kings Cross, NSW 1340 Australia2The University of Sydney, Sydney, NSW 2006 Australia

The aim of this study was to describe the nature and amount of foodpromotion directed at children in Sydney supermarkets, in the form of

Abstracts



the group dynamics, value of working together, value of the multidis-ciplinary perspective and relevance of the exercise to future practicepersisted. Negative qualitative themes identified related principally tologistical issues and were more commonly cited by CPL than DL. IPEhas proved to be a positive experience for staff and students alike withresults indicating the facilitation of vital attitudinal change. Furthercourse development will tackle the logistical issues raised to maximizethe learning potential of this approach.References1. Parsell et al. (1998) Shared goals, shared learning: evaluation of a

multiprofessional course for undergraduate learners. Medical Educa-tion, 32, 304–11.

PROMOTING HEALTHY FOOD CHOICE INFAMILY DAY CARE, SOUTH AUSTRALIAIRIS LINDEMANN1, BRON DEKOK2, HEATHER DUNN2, ALISON MARTIN3, LOUISA MATWIEJCZYK3

1Department of Nutrition and Dietetics Flinders University of SouthAustralia2Family Day Care Department Education and Children’s Services3Noarlunga Health Services, Australia

Family Day Care (FDC) in SA provides childcare for 16,000 children.A previous study had identified that Care Providers (CP) believedenhanced organisational support would allow them to promote healthyeating more effectively. The aim of the “Healthy Foods in Family DayCare Project” was to increase the confidence and capacity of CP topromote healthy eating practices to children and families. Using anintersectoral approach between health, education and childcare and anextensive consultation with FDC workers, support strategies weredeveloped and implemented between 2001 and 2004. These includedorganisational changes to implement and support a healthy food policy.Self reported attitudes and behaviours relating to the promotion ofhealthy eating were collected from CP at baseline and follow-up usinga self administered questionnaire and analysed using non-parametricanalysis (X2 and Mann-Whitney U test). Results suggest significantincreases in CP who consider the promotion of healthy eating to be partof their role (p < 0.001) and in CP confidence to discuss and promotehealthy eating to parents (p < 0.001). A reported increased frequencyof health promoting behaviours included encouraging children to trynew foods (p < 0.001), removing refused food calmly (p < 0.001) andtalking to children about healthy foods (p < 0.001). Parental barriersto the policy and children’s food related behaviours were identified asthe most significant ongoing issues. Results support the use of an inter-sectoral, “settings” approach within FDC to improve organisational andworkforce capacity to promote healthy eating to children and families.

Funding Source: National Child Nutrition Program Grant (DepartmentHealth and Ageing)

premium offers, such as giveaways and competitions, and cartoon andmovie character promotions. The study also examined whether pro-motions were used to market healthy or unhealthy foods. Nine super-markets located across the Sydney metropolitan area were surveyed toassess the extent and nature of food promotion directed at children. Thenumber and types of promotions within seven food categories includ-ing sweet biscuits, snack foods, confectionery, chips/savoury snacks,cereals, dairy snacks and ice-cream were measured. Any foods thatutilised promotional tactics were categorised as either healthy orunhealthy, according to set criteria. The study found that within theseven food categories of sweet biscuits, snack foods, confectionery,chips/savoury snacks, cereals, dairy snacks and ice-cream; 10 to 35percent of food products used promotional tactics. The use of televi-sion personalities, movie stars and cartoon characters were the mostcommon methods of product promotion, making up 75 percent of allpromotions. Giveaways and competitions accounted for 13 percent and12 percent respectively of all food promotions used to attract customers.Ninety-four percent of promotions identified were used to market foodsthat are high in energy, saturated fat, sugar and salt and/or low in dietaryfibre and other essential nutrients, with only six percent of promotedproducts being healthy foods. The promotion of unhealthy foods insupermarkets is extensive and is one of many contributing factors totoday’s obesogenic environment.

PROMOTING COLLABORATION INHEALTHCARE: THE INTRODUCTION OFINTERPROFESSIONAL EDUCATION TODIETETIC AND CLINICAL PSYCHOLOGYLEARNERSKATHRYN HART1, MARK HAYWARD2, MATTHEW CHAMPION2, HELEN TRUBY1

1School of Biomedical and Molecular Sciences, University of Surrey,Guildford, Surrey UK2School of Human Sciences, University of Surrey, Guildford, Surrey UK

Interprofessional education (IPE) is cited as an effective means of creating health professionals who are adaptable, flexible, good com-municators, collaborative team workers, and who are united in theirgoals1 yet its optimal integration into health care education remainspoorly defined. This study aimed to evaluate the experiences of dietetic(DL) and clinical psychology learners (CPL) undertaking a universitybased IPE project. A Problem Based Learning (PBL) exercise was devel-oped and delivered to 59 students (34 third year undergraduate DL, 25first year doctorate CPL) organized into mixed DL/CPL groups. Prior tothe exercise positive perceptions about IPE and its benefits for practicepredominated, although response strength varied significantly by pro-fession for the perceived impact of IPE on teamworking skills (p = 0.01),awareness of professional limitations (p < 0.001) and attitudes towardsother professionals (p = 0.03). Post exercise, positive beliefs regarding

Abstracts


Consumer insights

INMATES AS CONSUMERS: ATTITUDES ANDFOOD PRACTICES IN NSW CORRECTIONALCENTRESPETER WILLIAMS1, KAREN WALTON1, NATASHA AINSWORTH2,CHRISTINE WIRTZ2

1Smart Foods Centre, University of Wollongong, NSW 2522 Australia2Department of Biomedical Sciences, University of Wollongong, NSW 2522Australia

The Smart Foods Centre recently reviewed menus in NSW correctionalcentres. A cook-chill system is used for hot evening meals. Recom-mendations for improvements included an additional half serve of fruitdaily and reduction in the saturated fat and sodium content, but menusgenerally provided a well varied selection of foods which met the major-ity of individual nutritional requirements and dietary guidelines –assuming all food provided was consumed. This study aimed to explorehow inmates use the food provided, their views on food quality andsuggestions for improvement. Six focus groups (n = 35) were held inthree centres in Sydney (one minimum and one high security, and onefor women) including Asian inmates and those on special diets. Find-ings included:• Delivery of evening meals as early as 2.30 pm and no facilities for

inmates to keep meals cold or reheat them in cells.• Breakfast and lunch were well accepted but higher self-reported

levels waste of the hot evening meal.• Complaints about food quality (>200 comments), lack of choice (>50

comments), and insufficient milk (men only).• Considerable use of additional purchased food (especially meat, fish

and eggs).• Inmates commonly prepare meals in rice-cookers in their cells, some-

times re-using meal elements (like meat) from the cook-chill meals.Complaints are likely to be influenced by meal times, eating environ-ment and personal choice, not just food or menu quality and, as in manyinstitutions, criticism of food becomes normally expected behaviour.Recommendations included a quantitative study of food waste.

WHAT PRACTICES DO AUSTRALIAN WOMENUSE TO PREVENT WEIGHT GAIN AND HOWWELL DO THEY WORK?LAUREN WILLIAMS1, JOHN GERMOV2, ANNE YOUNG3, VIRGINIA WHEWAY3

1School of Health Sciences, The University of Newcastle, Callaghan, NSW2308, Australia2School of Social Sciences, The University of Newcastle, Callaghan, NSW2308, Australia3Research Centre for Gender and Health, The University of Newcastle,Callaghan, NSW 2308, Australia

Despite health recommendations aimed at weight control, few studieshave examined the weight control practices currently used by the population. This study aimed to describe the prevalence and effective-ness of weight control practices in a population-based sample of womenparticipating in the Australian Longitudinal Study on Women’s Health(ALSWH). ALSWH is a study of health and health determinants, con-sisting of surveys mailed to three age cohorts of women at regular inter-vals. Use of weight control practices in 12,338 mid-age (47 to 52y)women was determined using a nine-item questionnaire included in thesecond survey (S2). Weight change was calculated as the difference in

self-reported weight of the women at S2 in 1998 compared with surveyone (S1) in 1996. Data was analysed using SPSS version 10. Seventypercent of the cohort (N = 8626) reported using weight control prac-tices. Dietary modification was used more frequently than exercise.Two-thirds of the weight-controlling women used a combination ofpractices, the most common being decreased food quantity + healthyeating + exercise (32.6%), and decreased food quantity + healthy eatingwithout exercise (16.4%). Potentially health-damaging practices(smoking, laxatives, fasting) were relatively uncommon (7.2%). Onlyone combination (exercise + decreased food quantity + healthy eating+ commercial program) resulted in mean (standard deviation) weightloss (−0.21 (6.0) kg) over the two-year period, while the mean (standard deviation) weight of the cohort significantly increased (+1.04(4.7) kg (p < 0.0001)) over the same period. The findings can informpromotion of safe and effective weight control practices for women.

INVESTIGATION OF SOCIAL CONTEXT FORLIFESTYLE INTERVENTION FOLLOWINGGESTATIONAL DIABETES POINTS TO ATAILORED FAMILY-CENTRED APPROACHJANELLE BARNARD1, LINDA TAPSELL2

1Smart Foods Centre and Department of Biomedical Sciences, University ofWollongong, Wollongong, NSW 2522 Australia2National Centre of Excellence for Functional Foods and Department ofBiomedical Sciences, University of Wollongong, Wollongong, NSW 2522Australia

Women with recent gestational diabetes mellitus (GDM) are at increasedrisk for developing type 2 diabetes mellitus later in life, but familycontext may limit participation in lifestyle programs for prevention. Theaim of this study was to identify contextual characteristics of womenwith recent GDM that impact on approaches to follow-up intervention.Twenty-one women with recent GDM and ten people identified as theprimary “support” person completed an in-depth qualitative interviewbased on a semi-structured interview format. Guiding questions centredon daily routine, support issues, perception of risk, and health careservice delivery. Interviews were transcribed verbatim and data from thepost-GDM women were inductively analysed for themes using NUD.ISTNvivo (V2.0.161, QSR International Pty Ltd, Doncaster, Australia,2002). The interviews of the support group were used to corroboratethe analysis. The dominant theme was that potential to participate inlifestyle programs depends on the limits on individual empowermentimposed by family systems. Five sub-themes operated within the familysystem context to underpin empowerment: physical capacity of fami-lies, unspoken rules governing support and negotiation, ethic of care,the importance of order, and tangibility of risk. Four distinct groupingswithin the twenty-one women allowed identification of salient in-dividual characteristics important to intervention format. Opportunitiesfor lifestyle intervention in healthcare services are likely to lie within amodel of family-centred therapy with an assessment of dominant indi-vidual needs required to effectively tailor intervention.

Funding source: Smart Foods Centre (University of Wollongong), Meta-bolic Research Centre (University of Wollongong)

Abstracts



A WEB BASED SURVEY OF FOOD SERVICEPRACTICES AND PROVISION IN AUSTRALIANHOSPITALSKAREN WALTON1, PETER WILLIAMS1, LINDA TAPSELL2

1Smart Foods Centre, University of Wollongong, NSW 2522 Australia2National Centre of Excellence in Functional Foods, University ofWollongong, NSW 2522 Australia

An effective food service is imperative for long stay patients in hospi-tals. To assess the barriers to nutrition provision and identify prioritiesfor improvements, a purposive sample of dietitians, food service man-agers and nurse unit managers from Australian hospitals were invitedto complete an online food service questionnaire. Questions were basedon a literature review and focus group data from six stakeholder groupsto determine the key issues that impact positively and negatively onfood service systems and on intakes by patients in NSW hospitals.

Respondents totalled 191, including: 90 dietitians, 39 food service man-agers and 62 nurse unit managers. The response rate was 10.4%, whichcovered 37.4% of the beds in Australian hospitals, with responses byhospital size as follows: 19% of 20–100 beds, 33% of 101–250 bedsand 62% of 250+ beds.

Analysis shows that out of twenty possible key barriers to adequatedietary intakes, the issues ranked in the top three by dietitians included:lack of feeding assistance (36%), lack of flexibility of the food servicesystem (34%) and the limited variety of food offered (31%). The priorities ranked in the top three by dietitians included: food for-tification (48%), additional feeding assistance by nurses (40%) andadditional non-nursing feeding assistance (31%). A future interventionstudy will evaluate a volunteer feeding assistance program with agedcare inpatients.

Funding Source: Smart Foods Centre, University of Wollongong

RECOMMENDATIONS ON INCIDENTNUTRITION AND CATERING FOR THE NSWFIRE BRIGADEHELEN O’CONNOR1, SUIQIAN LIU1, CARMEL LAZARUS2, KIRSTY MEHALSKI1

1University of Sydney, Sydney, NSW 2006, Australia2St Vincent’s Private Hospital, Sydney, NSW 2010, Australia

The NSW Fire Brigades (NSWFB) have a duty of care to provide nutri-tion education and support to firefighters to enable them to maintainoptimal health and work performance. Firefighters may need to attendincidents that last for several hours at a time and work undertaken maybe arduous under extremely hot conditions. Incidents may be in remoteareas where food and beverage supplies are limited or not immediatelyavailable. Although the National Fire Protection Association (NFPA) hasestablished a nutrition requirement for pre-incident and firegroundtraining operations, practical strategies to achieve this are missing. This

project therefore aimed to provide the NSWFB with the theoreticalbackground for practical nutrition recommendations to cover themajority of circumstances, from stationed firefighters expecting minimalincidents to firefighters participating in protracted incidents over manyweeks in metropolitan or remote locations. Our approach included anextensive literature review on occupational stress, focussing predomi-nantly on nutrition issues faced by firefighters of varying ages andfitness levels. We conducted a number of focus groups with NSW fire-fighters, medical and logistics staff to discuss nutritional challengesfaced. Issues addressed included food service facilities available, foodsafety, time to prepare meals, food storage facilities, motivation levelsfor nutritious foods and food variety and availability. Nutrition recom-mendations were provided together with menus detailing practicalstrategies for catering for short and long term incidents to ensure anadequate and safe nutritious food service to firefighters in the majorityof incident situations.

MEETING CONSUMERS’ NEEDS-ARE OURWRITTEN EDUCATION RESOURCES A WASTEOF TIME?JENNIFER COHEN1, LOUISE PERKINS2, PATRICIA CHUI3, MEI FUN TSANG3

1Formerly Royal Prince Alfred Hospital, Camperdown currently SydneyChildren’s Hospital, Randwick NSW 2031 Australia2Formerly Royal Prince Alfred Hospital, Camperdown currently GreatOrmond Street Hospital, London WC1N 2JH England3Formerly Masters students, University of Sydney, NSW 2050 Australia

Written education material plays an important role in effective patienteducation in the current healthcare system. Many recent studies haveshown a discrepancy between the reading ability of patients and thereadability level of the education resources available to patients. Theaverage reading ability level of the Australian population is estimatedto be year 8 level, with 20% of the population being either marginallyor functionally illiterate. Contrary to this, most health educationresources have been found to be between year 9 and second year ter-tiary level. The aim of this study was to determine whether there is agap between the readability levels of Dietetic written education materi-als and the recommended reading ability of the Australian population.The McLaughlin’s SMOG and the Fleisch-Kincaid grade formulae wereused to measure the readability of written education materials (n = 224)regularly used by a Dietetic department based in a large teaching hospital. The mean readability level of the resources was 10.4 (± 1.82).When the readability levels of the written resources were compared bysource, for example Dietitian verses commercial industry, it was foundthat the publications with the highest readability levels were those published by commercial organisations 11.4 (± 1.56) as compared with9.7(± 1.68) for the Dietetic department. Our findings show that mostof the dietary written resources used by a hospital dietetic departmentwere written at a higher readability level than that recommended forthe general public and therefore may be ineffective at conveying usefuldietetic information.

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FRONTIERS IN THE GLOBALISATION OF THEPROFESSION OF DIETETICSBEVERLEY WOOD1

1Consultant in food, nutrition and dietetics, Carlton, Victoria 3053Australia

The American Dietetic Association was formed in 1918 and themembers, together with American Doctors, assisted first the Canadians,the British, the New Zealanders, and then the Australians to developlocal employment and training courses for dietitians. This occurredsomewhat opportunistically but Associations of Dietitians were estab-lished within 20 years in Canada (1935), in Victoria-Australia (1935),in Britain (1936), in New South Wales-Australia (1939), and in NewZealand (1943). The stimulus came from the desire to make a differ-ence and from external sources such as recovery from the depression,woeful hospital food services, discovery of the vitamins, improved dia-betes management, the first population food and nutrition surveys, andincreasing population health consciousness. Many risk taking and hardworking individuals travelled abroad in search of training and to con-tribute to the work necessary to establish the new profession of dietet-ics. They returned home with established international networks andcommunications, more tolerance of other cultures and increased knowl-edge and skills. They set to work enthusiastically and professionally, tofight for improvements in hospital care, food service management,public health, and their new profession. The early frontier for theexchange of dietitians and information on dietetics between nations wasexciting. It demonstrated that enthusiasm, competent networking andconsistent effort is required to achieve and maintain professional stan-dards that support globalisation and expansion of the profession ofdietetics.

THE BEEF TASTES LIKE SOME OLD COW, ANDTHE CHICKEN TASTES LIKE SOME OLD FOWL:HOW IMPORTANT IS FOOD QUALITY TORESIDENTS IN LONGER-STAY CARE?OLIVIA WRIGHT1, LUKE CONNELLY1, SANDRA CAPRA2

1Centre of National Research on Disability and Rehabilitation Medicine(CONROD), The University of Queensland, Queensland, Australia2School of Health Sciences, The University of Newcastle, New South Wales,Australia

This study investigated one of the major causes of malnutrition, i.e.poor client satisfaction with institutional food, and developed a mea-surement instrument for the regular evaluation of client satisfactionwith longer-stay foodservices. Following thorough development andpre-testing (n = 40), the pilot version of the Resident Foodservice Satisfaction Questionnaire was used to survey 313 respondents, in bothlonger-stay hospital and residential aged care settings. Ordered probitregression analyses indicated that foodservice satisfaction was signifi-cantly moderated by client age (p < 0.05). Marginal effects analysis onoutcome probability estimates demonstrated that clients aged 75–84years were more likely than those aged less than 65 years to rate overallfoodservice satisfaction as “very good” (Pr = 0.23), and this positiveassociation also occurred for clients aged 95 years or more (Pr = 0.27);however, clients aged 85–94 years were less likely to provide this overallrating (Pr = 0.19), suggesting a non-linear relationship between satis-faction and age. Furthermore, the results suggest that foodservice vari-ables representing client autonomy and choice, appetite and perceived

health status appear to exert a greater influence in the longer-stay settingthan food quality per se. The results provide evidence for modificationsto current menu planning and foodservice delivery methods, particu-larly regarding the reduction of the time-lapse between resident mealchoice and consumption. In addition to these practical service deliverychanges, the results may be applied to refine the food and nutritioncomponents of the existing Aged Care Accreditation Standards toimprove their applicability to clients of residential aged care facilities.

Funding source: Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland

ESTABLISHING A NSW HEN REGISTRYGLEN PANG1, WENDY ANDREWS1, CATH CLARKSON1, JOHN DWYER1, MAEVE EIKLI1, MICHELE HUGHES1, HELEN JACKSON1, KELLY LAMBERT1, KATHLEEN MCCARTHY1,MEGAN PATON1, KAREN ROBERTSON1, BRONWYN SCOTT1,EMMA STRADLING1, PETER TALBOT1, SCOTT WAGNER1, KELLI WARD1, GMCT HEN GROUP1

1Greater Metropolitan Clinical Taskforce, NSW 2113 Australia

The Greater Metropolitan Clinical Taskforce (GMCT) is one of 13 priority health taskforces established by NSW Health. Home EnteralNutrition (HEN) is a special program funded by GMCT with the aimof achieving equitable funding and access to HEN services for allpatients across NSW. HEN is defined as the provision of nutritionsupport either orally or by tube into the gastrointestinal tract in the home setting. Worldwide, HEN is growing at 20–30% per annum.Currently, information of HEN patients in NSW is limited. The numberof HEN patients in NSW is unknown. There is no centralised databaseof HEN patients. A NSW HEN register has been established and aminimum dataset has been defined. Preliminary results indicate theincidence of HEN is ∼250 patients per month (∼80 tube fed; ∼170 oral nutrition support) and the prevalence of HEN is ∼3000 patients(∼1000 tube fed: ∼2000 oral nutrition support). This database willprovide valuable information on the numbers of HEN patients, theirdistribution throughout NSW, socio-demographic details, reason forHEN, mode of delivery, disease and outcome data. This will assist inplanning for future HEN services.

SCREEN TIME, TELEVISION ACCESS ANDWEIGHT STATUS IN AUSTRALIAN CHILDRENMONIEK VAN ZUTPHEN1, COLIN BELL2, PETER KREMER3, BOYD SWINBURN4, KATHY MCCONELL5

1,2,3,4School of Exercise and Nutrition Sciences, Deakin University 1Gheringhap Street, Geelong, Victoria 3220, Australia5Department of Human Services, Melbourne, Victoria, Australia

Objective: To describe the time children spend watching television(TV) and playing electronic games and to assess associations betweentelevision access and weight status.Methods: Child weight status was based on measured height andweight collected in 2003/2004 as part of a large cross-sectional studyin the Barwon South-Western region of Victoria, Australia. Parentsreported the amount of time children watched TV/video and playedelectronic games and described aspects of the family environment medi-ating television access.Results: A total of 1943 children aged 4–12 years participated. Parent-reported mean ± SE screen time for the previous school day was 94 ±

Healthcare services and policy development

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1.6 minutes and 22% of children had more than two hours of screentime. Children who lived in a family with tight rules governing TVviewing time (22%), or who never watched TV during dinner (34%),or had only one TV in the household (22%) or had no TV in theirbedroom (81%) had significantly less screen time than their counter-parts. Overweight children had significant more screen time thanhealthy weight children (99 ± 3.1min vs 92 ± 1.9min, p = 0.026). Theywere also more likely to have a TV in their bedroom (25% vs 17%, p < 0.001).Conclusion: Strategies to reduce screen time should be included as partof broader strategies to prevent childhood obesity. They should includemessages to parents about not having a TV in children’s bedrooms,encouraging family rules restricting TV viewing, and not having the TVon during dinner.

THE NUTRITIONAL SIGNIFICANCE OF HOMEDELIVERED MEALSJUDY APPLETON1, MICHELLE JORNA1, CHLOE FAST1

1School of Exercise and Nutrition Sciences, Deakin University, Victoria3125 Australia

Home delivered meals (HDM) provided by Home and Community Care(HACC) Food Services are utilised by 4.8% of the elderly aged 70 yearsor above and 8.7% of the elderly aged more than 80 years (Dept. ofHuman Services & Municipal Association of Victoria, Review of HACCProgram Food Services – Draft Discussion Paper 2003). A HDM shouldprovide two-thirds of the Recommended Dietary Intake (RDI) forvitamin C, one-half of the RDI for other vitamins, proteins and minerals and at least one-third of the RDI for energy (Dept. of HumanServices Victorian HACC Program Manual 2003; http://www.dhs.vic.gov.au). The aim of this study was to determine how much the delivered meal contributes to the overall daily energy and nutrientintake of each participant. A cross-sectional study of 192 men (n = 79)and women (n = 113), receiving delivered meals was conducted acrosssix Councils within metropolitan Melbourne. Food intake was obtainedusing a single day food record and nutritional data was assessed usingFood Works Professional Edition 2005 (version 4). The mean energyintake for males and females over the 24 hour food record period was8MJ (SD ± 1.8MJ) and 7.4MJ (SD ± 1.9MJ) respectively. The HDMcontributed 38% of the mean daily energy intake for both genders. Themean calcium intake from the HDM for both men and women was sig-nificantly less than the HACC guideline (P < 0.001). These results haveimplications regarding the recommended daily intakes of nutrients andthe required food groups and food portion sizes necessary to achievethe HACC guidelines.

Funding source: Meals Victoria

CARE PROVIDERS: ATTITUDES AND PRACTICEIN NUTRITIONAL CARE FOR PEOPLE LIVINGWITH HIV/AIDS IN THAILANDSIMON SADLER1, CHINTANA CHATURAWIT2, NITTAYA PHANUPHAK2, SUNARD TAECHANGAM3, JULIAN GOLD1, PRAPHAN PHANUPHAK2, EMORN WASANTWUSIT3

1Albion Street Centre, Surry Hills, NSW 2010 Australia2Thai Red Cross AIDS Research Centre, Pathumwan, Bangkok, Thailand3Institute of Nutrition Mahidol University, Salaya, Nakornpathom,Thailand

The ‘Thai-Australian Collaboration in HIV Nutrition’ (TACHIN) projectis a three year intervention aiming to enhance the care of people livingwith HIV/AIDS (PLWHA) through a range of clinical and communitybased nutrition interventions. Care providers have a key role in patienteducation, nutritional screening, development and implementation ofnutrition interventions. This study aimed to gather information fromcare providers about attitude and current practice in providing nutri-tional care for PLWHA in Thailand.

A survey targeting urban based Thai health care providers was designedand implemented among a range of care providers including peer edu-cators, counsellors, nurses, social workers, research and medical staff.The survey gathered information about the presentation and frequencyof common nutritional related symptoms among PLWHA. The partici-pants were asked if they currently provided nutritional advice orresources to patients.

Seventy-Two (72) care providers representing four institutions com-pleted the surveys. A high proportion of respondents 51/72 (70%) ratednutritional status as being very important in the health of PLWHA.However 62/72 (86%) rated their nutritional knowledge as poor tobasic and only 23/72 (32%) rated their confidence in providing nutri-tional advice to patients with HIV as either “fairly confident” or better.

Data collected will be used to develop future nutrition training pro-grams for care providers to help build nutritional knowledge and coun-selling skills. It may also contribute to identifying relevant Information,Education and Communication (IEC) resources and other communityinterventions for development and implementation amongst PLWHA tohelp address nutritional needs.

Funding Source: this project was funded as part of the AustralianHIV/AIDS Partnerships Initiative (AHAPI), funded by the AustralianAgency for International Development (AusAID)

Food nutrigenomics and complementary medicine

SOY AND HEALTH BENEFITS – EVIDENCE ANDIMPLICATIONS FOR DIETETIC PRACTICELYONS-WALL PM1, HANNA K2

1School of Public Health, Queensland University of Technology, Qld 4059Australia2School of Health and Social Care, University of Chester, Chester CH1 4BJ,England

Over the past 15 years, soy products have received increasing attentionregarding possible health benefits. Triggered by promising scientific evi-

dence and an upsurge of interest and curiosity in the community, man-ufacturers have been quick to realise the market potential, and an arrayof products is now available in supermarkets and health food stores.But is soy effective? How much do we need? Are there any adverseeffects? The aim of this paper is to critically review the scientific evi-dence and present an informed viewpoint on appropriate practicaladvice for clients in relation to three major areas: heart disease, bonehealth and menopausal symptoms. The strongest evidence is for pro-tection against heart disease. Numerous studies in animals and humanshave demonstrated the ability of soy protein to lower blood cholesterol.In 1995, a meta-analysis of 38 clinical trials3 concluded that 25–50g

http://www.dhs

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daily of soy protein was required to achieve these effects, and subse-quently over 55 randomised controlled trials have confirmed these find-ings. The relationship between soy and bone health is an emerging area,with 12 clinical trials published since 1998. Results indicate that long-term intervention with soy protein or isoflavones can improve bonemineral density and bone turnover markers, although not all findingsare supportive and benefits appear to be site specific. A systematicreview of 20 clinical trials conducted in menopausal women since19954, concluded that soy or isoflavones did not significantly improvemenopausal symptoms, however methodological limitations could havecontributed to inconsistent findings, especially in relation to hotflushes5.References3. Anderson JW, Johnstone BM, Cook-Newell ME. N Engl J Med 1995;

333: 276–282.4. Krebs EE, Ensrud KE, MacDonald R, Wilt TJ. Obstet Gynaecol 2004;

104: 824–836.5. Hanna K, Day A, O, Neill S, Patterson C, Lyons-Wall P. Nutr Diet

2005; 62: 138–151.

ADIPONECTIN: A KEY ADIPOKINE WHICHLINKS THE METABOLIC SYNDROME AND LIVERINJURY IN PATIENTS WITH TYPE 2 DIABETESINGRID J HICKMAN1, JONATHAN P WHITEHEAD1, JOHANNES B PRINS1 AND GRAEME A MACDONALD1

1Centre for Diabetes and Endocrine Research, University of Queensland,Princess Alexandra Hospital, Brisbane, Queensland, Australia

Adiponectin is an adipokine with insulin-sensitising and anti-inflam-matory properties. Adiponectin levels are negatively associated withobesity and type 2 diabetes (T2DM). Patients with obesity and co-morbid T2DM are at increased risk of nonalcoholic fatty liver disease(NAFLD) and cirrhosis, and are more likely to have hypoadiponectine-mia. We investigated the relationship between the metabolic syndrome(MS), adiponectin levels and abnormal liver enzymes in 187 patientswith T2DM. The MS was identified according to International DiabetesFederation criteria in 136 patients (72%). In patients with the MS, 38(28%) had raised alanine transaminase (ALT > 40U/L) including 8 (6%)whose ALT was twice the upper limit of normal. In contrast, only 6(11%) patients without the MS had abnormal ALT levels with no patienthaving values that were greater than twice normal. Patients with raisedALT had significantly lower serum adiponectin compared to those withnormal ALT despite no difference in mean HbA1c or fasting bloodglucose. The presence of the MS was independently associated withraised ALT (p = 0.003) and decreased adiponectin (p = 0.005). Inpatients with T2DM, the MS is associated with liver injury independentof diabetic control. Adiponectin may be the link between the metabolicsyndrome, T2DM and the development of NAFLD. The presence of themetabolic syndrome is an independent risk factor for increased ALT andmay be an important clinical indicator for further investigation ofchronic liver disease in patients with type 2 diabetes.

Funding Source: National Health and Medical Research Council Australian Clinical Research Fellowship (IH) and the Centre for Clinical Research Excellence

UNDER-RECOGNISED VITAMIN D DEFICIENCY:CASES FROM REHABJAYNE TAYLOR1, BERYL DAWSON1

1Balmain Hospital, Balmain, NSW Australia 2041

Low serum levels of vitamin D are often seen in hospitalized olderpeople, especially those housebound or in residential care, and dark

skinned women (particularly if veiled). It is generally assumed,however, that younger people are less likely to be Vitamin D deficient.We report two cases of unrecognised severe vitamin D deficiency in twomiddle-aged men presenting for rehabilitation. A 41-year-old morbidlyobese man with a history of diabetes was admitted following a com-minuted distal femoral fracture. Despite a vitamin D level of 11nmol/l(severe deficiency <12.5nmol/l) with elevated PTH, replacementtherapy post fracture repair was not commenced. Four months later,depressed and weighing >200kg, he was admitted for 8 weeks non-weight bearing rehabilitation, found to be hypoalbumaemic (albumin20g/l; RR40–50) and vitamin D was <10nmol. The second case, a 56-year-old man with a history of progressive leg weakness, long termsodium valproate usage (a known VitD antagonist) and previoushumeral fracture, was admitted with a necrotic foot requiring an emer-gency through-knee amputation. Albumin was 30g/l and pre-albumin0.13g/l (RR 0.17–0.35). Vitamin D status was initially reported as 12nmol/l, increasing rapidly on replacement therapy. Thus, althoughVitamin D status is rarely assessed in younger “at risk” people, levelsshould be part of a detailed nutritional assessment in younger peoplewith a history of fractures, especially those obese but poorly nourishedindividuals with reduced mobility or those on anti-convulsant medication.

UNRECOGNISED MULTI-NUTRIENT DEFICIENCYMASQUERADING AS ODYNOPHAGIABERYL DAWSON1, EMMANUEL J FAVALORO2, JAYNE TAYLOR1,ARUN AGGARWAL1

1Balmain Hospital, Balmain, NSW Australia 20412Institute of Clinical Pathology and Medical Research, Westmead Hospital,Westmead, NSW Australia 2145

Odynophagia is experienced by many older people and necessitatesmultiple invasive and unpleasant investigations. We report two recentcases of odynophagia related to unrecognised multinutrient deficiency.In one representative case, a 75-year-old woman was admitted withischaemic colitis requiring emergency hemicolectomy. Odynophagiadeveloped within three weeks, and she underwent multiple investiga-tions (including gastroscopy, psychiatric reviews, numerous medica-tions for suspected thrush/infection). Transferred for rehabilitation 11weeks post admission, nutritional assessment revealed generalisedweakness, significant weight loss (30%), unhealed abdominal wounds,severe odynophagia, intractable nausea, red denuded tongue, crackedlips and swollen scaly legs. Amino acid profiling revealed reduced Tryptophan (<5umol/l; RR 35–110), albumin (30g/l; RR 40–50) andPreablumin (<0.12g/l; RR 0.17–0.35). Pellagra was diagnosed, due toniacin deficiency and secondary to protein energy malnutrition (niacinabsorption was limited by a previous partial gastrectomy, and niacinconversion from tryptophan, requiring vitamins B2 and B6, was no longer possible). Slow re-feeding and pharmacological doses (∼150mg/day) of nicotinamide over five days plus multi-vitaminsresulted in resolution of the odynophagia within three days and she wasalso able to walk over 50 metres unaided. Prealbumin rose rapidly,reflecting improved protein intake, but albumin levels remainedunchanged. Case two represented multiple nutritional deficiencies,including tryptophan, and presented with pain on swallowing that alsoresolved with nutritional support. Thus, patients presenting withodynophagia should be actively investigated for nutritional deficiencies.Measurements of prealbumin and amino acid profiles allow better monitoring of nutritional status than albumin alone.

THERE IS A ROLE FOR THE MEDITERRANEANDIET IN TYPE 2 DIABETES EDUCATIONCLAIRE PALERMO1, RACHEL STONEY2, SHAY OCCHIUTO3,LOUISE MILLER3, KAREN WALKER1

1Monash University Nutrition and Dietetics Unit, Monash Medical Centre,Melbourne, VIC 31682Alfred Hospital, Melbourne, VIC 3181 Australia3Peninsula Community Health Service, Mornington, VIC 3931 Australia

Mediterranean-style diets have established health benefits. They haveutility for management of type 2 diabetes but have not been widely usedin a community setting. A study was therefore undertaken to comparethe effects of a high vegetable Mediterranean diet (HVM) to a standardhigh carbohydrate low fat (HCLF) diet in 46 people with type 2 dia-betes educated in small groups at a community health centre. Thesewere randomized individually into groups for education to either diet.Subjects ( (mean ± SD) BMI 29.3 ± 3.9kg/m2) attended group educa-tion sessions once per week for 4 weeks and their change in body

weight, HbA1c and blood lipids were reviewed at 4 and 12 weeks.Forty-one subjects completed the study (mean age HCLF diet: 68 ± 8years and HVM 66 ± 9 years). Both diets resulted in similar favorableeffects, including significant decreases in BMI, waist circumference, totalcholesterol and triacylglycerol (all P < 0.05). Answers to questionnairesindicated similar compliance to each diet although subjects were morelikely to eat vegetables while on the HVM diet (P < 0.05). A similar hospital-based study was carried out on 25 subjects of whom 22 com-pleted the study (BMI 30.5 ± 4.4kg/m2). These subjects (mean ageHCLF diet: 61 ± 9 years and HVM 46 ± 11 years) were educated individually by identical protocols for the two diets. Unlike the groupeducation, significant favorable effects were not found at 12 weeks.Reflective qualitative interviews with the nutrition educators indicatedthat the Mediterranean-type diet nutrition messages of “choose olive oil”and “eat more vegetables” and “less carbohydrate” foods were easy todeliver and were well retained by participants. Education in the com-munity setting, with group support and message reinforcement overtime appears most conducive to favorable diabetes outcomes.

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Saturday 13 May 2006

Plenary Session – Food frontiers

LOW FAT, LOW CARB, LOW CALORIES – WHERESHOULD THE DIETARY FOCUS BE FOR WEIGHTLOSS?BERIT L HEITMANN1

1Research Unit for Dietary Studies, at Institute of Preventive Medicine,Copenhagen, 1399 Denmark

With the generally increasing trends for obesity in most societies thereis a great demand for effective diets to prevent further weight gain andinduce weight loss. Most official recommendations for weight loss eitherencourage the reduction of dietary fat intake, or composing dietsaccording to national dietary guidelines (often 30% fat, 55% carbohy-drate and 15% protein) with modest caloric restriction, which in bothcases generally results in lower fat and energy intakes, higher carbohy-drate intake and weight loss. Lately many alternative quasi-scientificdiets have gained popularity, such as Atkins diet, the zone-diets,glycemic index, and blood type or stone age diets, that all are based onlower carbohydrate, and higher protein and fat intakes. Short-termstudies suggest that such diets are equally, or potentially more efficientthan the scientifically more well established diets. However, long-termresults, that are important not only for the body weight regulation butalso for the future risk of chronic disease, are lacking.

Official recommendations for preventing weight gain are likewise oftenreferring to national dietary guidelines and reductions in total fat intake.However, there is a lack of evidence that fat intake plays a specific rolefor obesity development among healthy populations.

The influence of diet composition for obesity prevention and treatmentwill be discussed, and it will be concluded that there is no compellingevidence that any diet composition plays a specific role for weight loss,weight maintenance, or weight development beyond energy restriction.

WEIGHT LOSS – THE DIETETIC PERSPECTIVE:LINKING THE SCIENCE WITH PRACTICEMANNY NOAKES1

1CSIRO Human Nutrition, Adelaide, SA 5000 Australia

A growing body of evidence now confirms that lifestyle interventionspecifically aimed at achieving long term weight loss can be successful.That modest weight losses of 4 kg sustained for up to 4 years can reducethe occurrence of type 2 diabetes in susceptible individuals even moreeffectively than pharmaceutical agents has renewed confidence indietary management as a legitimate preventive and therapeutic strategy.Furthermore, the additional benefits that even small weight losses candeliver on ameliorating lipid profile, blood pressure and glucose andinsulin homeostasis could radically reduce the need for and cost ofpharmaceuticals. A greater emphasis on the successful delivery ofdietetic advice requires knowledge of the emerging literature on weightmanagement and a willingness to broaden our approaches beyond theconventional. Whilst the Dietary Guidelines provide a valuable tool forguidance of the population, tailoring nutritional strategies to individu-als and groups may often require a sophisticated tool box of approaches.Meal replacements, higher protein lower carbohydrate dietary patterns,low GI diets, diets low in energy density, supplements and structuredmeal plans can all provide part of the diversity of approaches at thedietitian’s disposal which have evidence to support them. Although ata societal level, the effectiveness of dietary strategies for weight man-agement in the long term will require a change in eating culture, anyweight loss strategy for individuals must provide a significant amountof follow-up and support to sustain these benefits longer term. Thereis a growing body of literature on a diversity of approaches to main-taining cost effective weight management support.

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Concurrent Sessions – Food frontiers

Fundamentals of food and nutrition: adequacy and toxicology

MANDATORY FORTIFICATION AS A PUBLICHEALTH STRATEGY: AN EXPERT VIEWPOINTJUDY SEAL1, ROSCOE TAYLOR1, FIONA STANLEY2, COLIN BINNS3, JIM MANN4, CRESWELL EASTMAN5

1Department of Health and Human Services, Hobart, Tasmania 7000Australia2Telethon Institute for Child Health Research, Centre for Child HealthResearch, The University of Western Australia, Nedlands, WesternAustralia 6009 Australia3Curtin University, Bentley, Western Australia 6102 Australia4University of Otago, Dunedin New Zealand5Insitute of Clinical Pathology and Medical Research, Westmead, NewSouth Wales 2145 Australia

Mandatory food fortification with iodine and folate is under con-sideration in Australia and New Zealand. Policy guidelines on food for-tification state that mandatory fortification should be required only if it isassessed as the most effective public health strategy to address the healthproblem (ANZFRMC, 2004). This paper describes the finding thatmandatory fortification is the most effective public health strategy underspecific conditions. Using the National Public Health Planning Frame-work (NPHP, 2000), a panel of four public health experts was convenedand assessed the merits of mandatory fortification compared to volun-tary fortification, supplement use, dietary education and maintainingstatus quo. Case studies were reviewed and used to generate assessmentcriteria for comparing alternative strategies. The assessment criteriainclude effectiveness, equity, efficiency, certainty, feasibility and sus-tainability. The panel concluded that mandatory fortification is the mosteffective public health strategy to increase nutrient intakes where:• there is evidence that current intakes are inadequate to protect the

health of the population or a significant population sub-group• nutrient requirements cannot be met by realistic dietary practices• increasing intake is considered safe at the levels likely to be

experienced.Significant limitations were identified with voluntary fortificationincluding inequity, lack of sustainability, and uncertainty in the level ofnutrient available for consumption. This work has been used to informkey decision makers in Australia and New Zealand about the relativemerits of mandatory fortification and has important implications forfood fortification policy.

Funding source: Tasmanian Department of Health and Human Services

IMPLICATIONS OF CURRENT CHILD DIETARYINTAKE FOR HEALTH PROMOTIONANTHEA MAGAREY1, LYNNE DANIELS1, LILY CHAN1

1Flinders University, Adelaide, SA 5034 Australia

Prevalence of overweight is increasing globally and 19% of South Australian 4–5-year-olds in 2002 were overweight. Identification ofbehaviours which increase the risk of positive energy balance willinform prevention programs to promote healthy eating habits from an

early age. The aim of this study was to describe the dietary intake ofchildren aged 12 to 36 months and the frequency of feeding practicesthat promote healthy eating habits. A self-completed questionnaire wassent to 740 mothers of children aged 12 to 36 months randomlyselected by birth date in four 6 month age bands from the Child andYouth Health database. Valid completed questionnaires were returnedfor 361 (49%, 53% female) children. In the previous 24 hours 11% hadno fruit (cooked or raw), 8% fruit juice only, 15% no vegetable. Theproportion consuming sweetened beverages (soft drink, cordial, fruitjuice drink) was 35%, (66% if fruit juice included). Of 12 specified highfat/sugar foods, 33% children had consumed none, 37% one, 19% two,and 11% three or more in the previous 24 hours. Children in the oldestage group were more likely to consume these foods and less likely tohave these foods restricted (p varied <0.01 to <0.001). Parents’ reportedresponses to food refusal suggest potential benefit from programs thatpromote key principles for the development of healthy eating behav-iours such as multiple repeated exposure to new foods, avoidance ofuse of food as a reward, and recognition and appropriate response tothe child’s cues on hunger and satiety.

NUTRITIONAL STATUS AND LENGTH OF STAYIN PATIENTS ADMITTED TO AN ACUTEASSESSMENT UNITJOLENE THOMAS1, ELISABETH ISENRING2, DANIELLE GUERIN1,ELIZABETH KELLETT1

1Flinders Medical Centre, Adelaide, South Australia 5001 Australia2Flinders University, Adelaide, South Australia 5001 Australia

The Redesigning Care initiative at Flinders Medical Centre aimed toimprove access to timely, consistent, quality care. This led to the creation of an Acute Assessment Unit (AAU) where all patients wereassessed by the Allied Health team on admission. This study aimed to:i) determine the nutritional status of patients admitted to the AAU usingthe Patient Generated-Subjective Global Assessment (PG-SGA); ii)determine the association between nutritional status and length of stay(LOS). Nutritional status (PG-SGA) was assessed in 64 patients within48 hours of admission. LOS data was collected prospectively. Accord-ing to PG-SGA global rating, 34 of 64 (55%) patients were malnour-ished. The mean age of patients was 80 (±11) years and 15 (23%) weremale. A third of patients (34%) lived alone without supports, and 5(8%) came from high level residential care. Malnourished patientsweighed significantly less with a mean body weight of 57kg comparedwith 69.7kg in well-nourished patients (p < 0.001). Malnourishedpatients also had a significantly higher median PG-SGA score (p <0.001) which reflected a higher number of nutrition impact symptomsthan well-nourished patients. There was no relationship between thePG-SGA global rating and LOS (Z = −0.988, p = 0.323), which may bedue to the short LOS of patients (median = 4 days, IQR = 4.25).However, there was a weak association between PG-SGA score and LOS(r = 0.250, p = 0.046). In conclusion, a significant proportion ofpatients admitted to the AAU were malnourished indicating a criticalneed for nutritional management. While there was only a weak associ-ation between PG-SGA score and LOS, the lower than anticipatedmedian LOS indicates that at this facility LOS is not a useful outcome

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measure. Implications for practice: While nutrition support in hospitalis useful in reinforcing dietary education, the short LOS emphasized theimportance of discharge education and follow-up. Malnourishedpatients received a discharge education pack with nourishing diet ideas,supplement samples and an outpatient follow-up appointment.

THE PREVALENCE OF MALNUTRITION AND THEPROCESSES CONTRIBUTING TO INADEQUATENUTRITIONAL CARE IN NEWCASTLE ACUTECARE HOSPITALS: BASELINE DATA FOR AQUALITY IMPROVEMENT PROJECTALLISON FRASER1,2, BRIGID HORAN1, CHERYL WATTERSON1

1John Hunter Hospital Newcastle NSW 2305, Australia2Royal Newcastle Hospital Newcastle NSW 2300, Australia

Malnutrition is associated with increased infection rates, increasedlength of stay and increased readmissions to hospital [Stratton et al(2003) Disease-Related Malnutrition. CABI Publishing: UK]. Thisquality improvement project aimed to establish the baseline prevalenceof malnutrition in Newcastle acute hospitals and the contributingprocesses that lead to inadequate nutritional care and subsequent carein the community. A cross-sectional audit was conducted of all in-patients in selected adult wards across three sites including rehabilita-tion, medical and surgical patients. 273 patients were screened formalnutrition across the three sites using the SGA (78.4%) or MNA(21.6%). Data collection included length of stay, ward environment,nurse to patient ratios at meal times, feeding assistance requirement,dietary intake, referrals, transfer of care and documentation in themedical record of nutrition status, cognitive function or physicalimpairment. The prevalence of mild-moderate nutritional risk was iden-tified to be 37% (SGA B and MNA R) with evident malnutrition in afurther 35% (SGA C and MNA M). Malnourished patients have threetimes the length of stay compared to well-nourished patients (p <0.001). The referral rate of patients with evident malnutrition was39.6%. 82% of patients requiring full feeding assistance were mal-nourished. Average actual dietary intake was inadequate. Total AlliedHealth input was greater in malnourished patients. Rates of dietetictransfer to appropriate agencies for care post discharge were poor. Hospital malnutrition is prevalent, unrecognised and untreated. Thisbaseline data will be used to improve practice for identification andmanagement of malnourished patients across the continuum of care.

DOES NUTRITIONAL STATUS CORRELATE WITHMICRONUTRIENT LEVELS IN ELDERLYPATIENTS IN A REHABILITATION WARD?FIONA O’LEARY1,2, JOSEPH WAI2, JODIE BENNETT1, SAMIR SAMMAN2, PETER PETOCZ3

1Calvary Health Care Sydney, Kogarah, NSW 2217 Australia2School of Molecular and Microbial Biosciences, University of Sydney, NSW, 2006, Australia3Department of Statistics, Macquarie University, NSW, 2109, Australia

Malnutrition and micronutrient deficiencies are common in the elderly.This has implications for healthcare facilities in terms of wound healing,fracture risk and length of stay. This study aimed to determine the levelof malnutrition in patients admitted to the aged care rehabilitation unitand to determine if nutritional status correlated with vitamin B12, folateor vitamin D status. Sixty-seven consecutive patients admitted over a

six-week period, aged 60 years or older underwent nutrition screeningusing the Mini Nutrition Assessment (MNA) and the currently unvali-dated modified MNA (mMNA) which incorporates Australian proteinand anthropometric indices. Blood screening was undertaken to assess protein and micronutrient status. Using the MNA, 18% were malnourished and 61% were at risk of malnutrition, whereas using themMNA, 27% were malnourished and 61% were at risk of malnutrition, indicating increased sensitivity of the mMNA. Eighty seven percent ofpatients were admitted with hypoalbuminaemia (<33g/L). Twenty-sixsubjects (40%) were deficient in vitamin B12 (<220pmol/L), 2 subjects(3%) were deficient in folate (<6.5nmol/L) and 53 subjects (78%) weredeficient in vitamin D (<50nmol/L). Spearman’s correlation found apositive relationship between serum folate and mMNA (r = 0.28, p < 0.05) but not MNA. No correlation was found between vitaminsB12 or D and either screening tool as ageing can cause reduced absorption or synthesis of these nutrients. The high levels of malnutri-tion and deficiencies of vitamin B12 and D found in this populationsupport validation of the mMNA, routine nutritional screening which includes serum vitamin levels and appropriate management ofdeficiencies.

IMPROVED TEAM MANAGEMENT OFNUTRITION IMPACT SYMPTOMS DURINGRADIOTHERAPY FOR HEAD AND NECK CANCERELIZABETH MCBRIDE1, WENDY DAVIDSON2

1Queensland University of Technology, Brisbane, Queensland 4059Australia2Princess Alexandra Hospital, Brisbane, Queensland 4102 Australia

Intensive nutrition intervention has been shown to improve outcomesfor patients receiving radiotherapy for head and neck (HN) cancer.Good symptom control is a key aspect of nutrition support. Patientssometimes fail to report new or inadequately controlled symptoms totheir doctor, delaying the implementation of recommendations from thedietitian. A literature review was conducted on symptoms experiencedby HN patients, patients’ response to information from health profes-sionals and the impact of nutrition intervention. Oral function andnutrition impact symptoms worsen during radiotherapy to the HN area.Informal discussions were held with patients, carers and health profes-sionals within the radiation-therapy unit regarding symptom manage-ment. Patients considered information on diagnosis, treatment sideeffects and ways to address symptoms to be important. Radiotherapy tothe HN area can cause communication difficulties due to pain, loss of voice and medication-induced drowsiness. Patients interviewedexpressed an interest in receiving information that was concise and relevant to their stage of treatment. A symptom-identifying checklistwas developed based on review of the literature and stakeholder feed-back. This checklist is for use by patients prior to weekly reviewappointments to optimise consultation time with health professionalsand ensure patient concerns are addressed. Since implementing thechecklist, team members report more timely reporting of symptomssuch as constipation. Using a simple written checklist may facilitatesymptom management for this high nutritional risk group. Furtherstudy is warranted to examine the impact on nutrition outcomes andpatient satisfaction.

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Food nutrition in health and disease

NUTRITION AND MENTAL ILLNESSADRIENNE FORSYTH1, PETER WILLIAMS2, FRANK DEANE1

1Illawarra Institute for Mental Health, University of Wollongong,Wollongong NSW 2522 Australia2Smart Foods Centre, University of Wollongong, Wollongong NSW 2522Australia

Many in-patients and out-patients accessing dietetics services presentwith primary or comorbid mental illness. However, standard medicalnutrition therapy for mental illness does not exist. This review seeks toestablish evidence for best practice with patients with mental illness. Asearch of electronic databases (Cochrane, Medline, ScienceDirect andWeb of Science) from 1966 to 2005 was conducted using the searchterms nutrition, nutrient, diet, mental health, mental illness, depres-sion, depressive symptoms, anxiety, substance misuse, substance abuse,drug abuse and alcohol abuse. All eligible studies were reviewed. A totalof 32 publications were found (3 case reports; 14 reviews; 5 controlledtrials; 7 reports of survey and observational data; 3 models and opinions). Support for the use of nutrition intervention in the treatmentof mental illness is based in large part on case study evidence, withlimited support from larger studies of diet-disease relationships. Thereis limited support for the role of medical nutrition therapy for mentalillness; key nutrients have been identified for consideration includingiron, folate and omega-3 fatty acids. Further investigation is requiredbefore evidence-based practice recommendations can be developed.

Funding source: National Health and Medical Research Council

ARE CHILDREN AND ADOLESCENTS OFMOTHERS WITH GESTATIONAL DIABETES ATINCREASED RISK OF OBESITY? A REVIEWMELINDA MORRISON1, CLARE COLLINS2

1Diabetes Australia-NSW, Sydney, New South Wales 2001 Australia2School of Health Sciences, University of Newcastle, New South Wales2308 Australia

While lifestyle related risk factors for the development of childhoodobesity have been established, the role of intrauterine factors includingmaternal gestational diabetes mellitus (GDM) in the aetiology of child-hood obesity is less clear. The purpose of this literature review was toevaluate the evidence relating maternal GDM to risk of offspring obesity.Medline, Cinahl and Cochrane electronic databases were searched from1990–2005 using a combined keyword search strategy. Six studiesspecifically examining childhood obesity in offspring of women withGDM were identified (one epidemiological, four prospective and oneretrospective cohort). Methodological quality was assessed, howeverdue to the small number of studies, all were included for review andtheir limitations discussed. GDM was positively associated with the riskof offspring obesity in four of the reviewed studies. However multi-variate analysis indicated that GDM was not an independent risk factorfor offspring obesity with maternal body mass index (BMI), paternalBMI and birth weight attenuating risk. While these studies suggest thatGDM may be a risk marker for the development of offspring obesity, itsrole as a casual factor has not been established. Differences in GDMdiagnostic criteria, maternal glucose control and critical time periodsfor assessing childhood obesity also limit the interpretation of thesefindings. Further studies are required to determine the strength of thisassociation; in particular the role of maternal BMI and shared familial

lifestyle patterns that may play a role in the development of obesity inthis population.

Funding source: DAA Unilever Postgraduate Research Scholarship

PRACTITIONER CONSENSUS ABOUT THEEFFECTIVENESS OF LEGISLATIVE ANDECONOMIC STRATEGIES FOR OBESITYPREVENTIONROGER HUGHES1

1School of Public Health, Griffith University, Gold Coast, Queensland,4217, Australia

There is now near universal recognition amongst health organisationsand many governments worldwide that the associated health and economic burden of obesity is increasing and threatens to compromisepublic health globally. In response numerous countries have, or are inthe process of, developing strategies and action plans to address thispublic health problem. Because government generated obesity preven-tion plans are developed in the context political imperatives, there hasbeen limited consideration and analysis of politically and socially unac-ceptable (unpopular) strategy options for obesity prevention. This studyaimed to assess consensus about the effectiveness of unpopular strate-gies based on legislative and economic strategies, amongst practi-tioners involved in, and knowledgeable of, obesity prevention. Thispaper reports on the first two rounds of a Delphi study conductedamongst a panel of 20 Australian based obesity prevention practition-ers. This technique involved a first round survey including a summaryof the literature with questions imbedded in the discussion. Once com-pleted these were returned via email for analysis. Round two surveysincluded a summary of the panel feedback with further questions building on round 1. There is strong consensus that regulatory strate-gies that support nutrition and physical activity promotion are, orwould be, effective if implemented. Similarly strong consensus existsthat these strategies are inevitable strategy pre-requisites for effectiveobesity prevention in the Australian context.

Funding source: Griffith University New Research Grants Program

TEAM TEACHING IN CLINICAL DIETETICS –STUDENT FEEDBACK AND STUDENTOUTCOMESELEANOR BECK1, TANYA HAZLEWOOD2, ROBYN MACDONALD2, NAOMI CROCKETT3

1Department of Biomedical Science, University of Wollongong, NSW 25222Liverpool Hospital, Liverpool NSW 2170, Australia3St George Hospital, Kogarah NSW 2217, Australia

Limited opportunities for student placements in clinical dietetics havenecessitated a review of placement procedures for universities. The aimof this research was to evaluate the effectiveness of a team teachingmodel for clinical dietetic student training. Thirty-four final year dieteticstudents were placed in teams of 2 (4 students) or 3 (30 students) witha single supervisor, for their first clinical placement. Student satisfac-tion with team teaching was measured using a survey requiringresponses relating to team process, advantages, disadvantages, per-

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ceived progress, access to student facilitators and barriers to programcompletion. In addition, supervisors at student’s subsequent (second)placement completed a questionnaire documenting their progress inrelation to the clinical milestones listed in the student placementmanual (NSW Placement Evaluation Group, Combined UniversitiesDietetic Placement Manual, p51–53, 2005). The number of studentsrequiring additional clinical placement time (greater than 10 weeks) wasalso monitored. Evaluation of student satisfaction with placementshowed the majority of students (16 of 20 responses) rated the experi-

ence as positive and eighteen of twenty students were pleased with theirprogress. The main benefits of team teaching related to students learn-ing from their peers. Supervisor evaluations from second placementshowed good skill acquisition with the majority of students achievingcompetency in nutrition assessment and counselling of simple cases.Three of thirty four students required additional placement time(ranging from 1 to 3 weeks). In conclusion, team teaching maintainsstudent satisfaction and outcomes yet is less resource intensive.

Working in the food environment

SALT REDUCTION FOR PUBLIC HEALTH –LESSONS FROM THE FOOD INDUSTRYMEGAN COBCROFT1, SEDA CAN1

1Unilever Australasia, Sydney NSW 2121, Australia

Reductions in the sodium content of widely consumed foods couldresult in a significant decrease in population blood pressure. While Australian data is limited, it is estimated that 75% of salt in the Westerndiet comes from processed foods.

We present a case study on sodium reduction across a range ofprocessed foods. Generic sodium benchmarks were derived fromWHO/FAO and national dietary recommendations. Product specificbenchmarks were developed where generic benchmarks were notapplicable due to a combination of dietary, technological and tastereasons. These were derived from existing food approval program cri-teria. Benchmarks were used to assess products and to plan and imple-ment a sodium reduction program. Initial large sodium reductions wererelatively easy to achieve. Subsequent reductions were smaller andlimited by consumer acceptance and a lack of acceptable salt substi-tutes. The results of the program so far have been a 25% reduction insodium in more than 130 products and an estimated removal of 36tonnes of salt from the Australian food supply.

Sodium reduction presents a challenge to the food industry. Reductionsmade tend to be small and gradual to allow for consumer taste adap-tation. While the benefits of sodium reduction are clear to dietitians,consumer interest in reducing salt intake is low.

The food industry and health practitioners need to work together topromote the importance of sodium reduction and agree on bestapproaches to achieve significant and sustainable changes in the foodsupply.

HEALTH BENEFITS OF RESISTANT STARCHALONG THE GASTROINTESTINAL TRACT: APRACTICAL GUIDEJANE MUIR1

1Department of Gastroenterology, Monash University, Clive Ward Centre –Level 8, Box Hill Hospital, Box Hill, Victoria, 3128, Australia

Many of the health benefits derived from fruit, vegetables, grains andcereals relate to the rate and/or extent of digestion of the carbohydratecomponent along the gastrointestinal tract. Most foods that are high inresistant starch (RS) are also slowly digested and absorbed along thesmall intestine (i.e. produce a lower glycemic index) as well as beingfermented in the colon. The beneficial effects of RS on colonic healthare becoming well understood. It is clear that RS: increases the con-centrations of luminal SCFA (particularly butyrate), lowers luminal pH,reduces the concentrations of potentially deleterious products of proteinfermentation (eg. ammonia, phenols) and stimulates the growth of pre-biotic bacteria. Some of these effects are relevant to reducing the riskof colorectal cancer. RS, however, has only modest effects on faecalbulking and tends to delay rather than hasten intestinal transit time (see

ABSTRACT WITHDRAWN

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Muir et al Am J Clin Nutr 2004;79:1020–8). RS is found naturally in awide range of starch-containing foods including; legumes, firm bananas,whole grains and cereals. These foods also tend to have a low glycemicindex. It is possible that the protective role for RS-containing foods inrelation to colorectal cancer may also relate to the systemic effects ofslowly digested and absorbed carbohydrate. Current daily intake of RS is around 5g/day in Australia (Muir Asia Pacific J Clin Nutr1999;8(Suppl):S14–S21). Health benefits may require levels of at least20g/day. Practical strategies will be presented on how to maximize thebenefits of RS along the gastrointestinal tract.

LACK OF NUTRITIONAL EQUIVALENCE IN THE‘MEATS AND ALTERNATIVES’ GROUP OF THEAUSTRALIAN GUIDE TO HEALTHY EATINGBILL SHRAPNEL1, KATRINE BAGHURST2

1Shrapnel Nutrition Consulting Pty Ltd, Sydney, NSW 2119, Australia2Consultant nutritionist, Bridgewater, SA 5155, Australia

The ‘meats and alternatives’ group of the Australian Guide to HealthyEating comprises foods that differ in iron, zinc, vitamin B12 and long-chain omega 3 (LCPUFA) content. The implications of choices withinthe ‘meats’ group were assessed in a dietary modelling exercise. Two setsof diets were modelled with a single or multiple serves of foods fromthe ‘meats’ group. Nutrient contents of diets were assessed against theEstimated Average Requirements (EAR). At relevant energy levels, dietswith a single ‘animal’ serve provided more iron (125–175% EARwomen; 45–65% EAR pregnant women) than diets with a serve of vegetable origin (65–110% EAR women; 25–45% EAR pregnantwomen). Zinc content was above the EAR for men (110–120%) in dietswith a single serve of red meat and below it (55–70% EAR) with anyserve of vegetable origin. Multiple serves of lentils and split peas, butnot peanuts, pine nuts and seeds, achieved the EAR for iron for women.Five serves of vegetable origin did not achieve the EAR for zinc for men.Diets including single serves of red meat or fish contained adequatevitamin B12 and LCPUFA but those containing multiple serves of vegetable origin did not. The lower bioavailability of iron and zinc andthe absence of vitamin B12 and LCPUFA in foods of vegetable origin

in the ‘meats’ group limit their capacity to deliver recommended nutrient intakes. Consideration should be given to the number of‘meats’ serves and the placement of legumes, nuts and seeds in futurefood guides.

Funding source: Meat & Livestock Australia

PROFILING HEALTHIER FOODS – GUESSINGGAME OR SCIENCE?TONI FEAR1

1National Heart Foundation of Australia, Sydney, NSW 2010, Australia

Nutrient profiling has been described as ‘the science of categorisingfoods according to their nutritional composition’. The National HeartFoundation of Australia’s Tick Program has been profiling healthier foodchoices for 16 years and is widely regarded as a pioneer in the field ofnutrient profiling. By challenging manufacturers to meet demandingnutrition standards, the Tick Program aims to improve the food supplyfor ultimate public health gains, while helping consumers with theirchoices at point-of-sale. The three main factors that determine theappropriateness and usefulness of nutrition standards for healthierfoods are their intended purpose or use, the nutritional priorities forthe target population and the nutritional characteristics of the range offoods in question. As a result of the criteria development process, manycategories in the Tick Program have criteria related to saturated fat,sodium, energy and/or fibre content. Each category now also has a cri-terion that addresses positive nutritional contribution. Examples arefibre content, calcium content in dairy foods, or percentage of the corefood eg peanuts in peanut butter. The profiling process must be rigorous to ensure consumers are not misled about what constitutes a healthier food choice. This presentation will highlight some of thechallenges of nutrient profiling and issues that need to be addressed toproduce the best possible nutrition standards for healthier food choices.For the Tick Program, nutrient profiling is not a guessing game, but arigorous process underpinned by nutrition policy and science.

Food science and technology

INMU RESEARCH IN FOOD AND NUTRITIONFOR HEALTH PROMOTIONEMORN WASANTWISUT

PITFALLS AND PROBLEMS IN PLANNING ANATIONWIDE NUTRIENT COMPOSITIONSURVEY OF AN AUSTRALIAN COMMODITYHEATHER GREENFIELD1, JANE BARNES2

1University of New South Wales, Sydney NSW 2052, Australia2Foodsense, 75 Paraween St, Cremorne NSW 2090, Australia

Feeding regimes and butchering techniques for Australian pigs havingchanged since the nutrient composition analyses of pork in 1985 and1994. An updated nutrient analysis project for Australian Pork Ltd(APL) takes into account: nationwide representative results, pork vari-ability, nutrients of importance to human health, and compatability

with the Australian food composition program. A sampling and nutrient analysis program to comply with these needs has been devised.Sampling from the capital cities of three states, Western Australia,Queensland and Victoria, representative of retail pork supply to allmajor cities, covers minor variations in feeding regime. The design takesinto account socioeconomic class, statistical local area, butchers andsupermarkets, and produces duplicate samples from each state. Grosscomposition measured by Food Science Australia (FSA) is for all indi-vidual 72 purchases (24 from each state). Composites (fat and lean,cooked and raw) are being freighted to the National Measurement Insti-tute (NMI) in Melbourne for nutrient analysis. One cut, loin chop, isbeing studied across the three states for all nutrients. Twelve other porkcuts will be analysed as individual nationwide composites for thosenutrients demonstrated to be present. Data will be presented 100g andcut size basis. Data analysis will show important sources of variation.Initial data will be presented and final data will be available at the endof 2006. There are particular barriers to commodity nationwide nutri-ent analysis projects in Australia and these have implications for the

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training of dietitians particularly those planning to work for the foodindustry.

Funding source: Australian Pork Limited

GLYCEMIC INDEX, GLYCEMIC LOAD ANDGLYCEMIC RESPONSE ARE NOT THE SAMEALAN BARCLAY1, JENNIE C. BRAND-MILLER1, THOMAS MS WOLEVER2

1School of Molecular and Microbial Biosciences, University of Sydney, NSW,2006, Australia2Department of Nutritional Sciences, University of Toronto, Toronto,Ontario, Canada M5S 3E2

The glycemic index (GI) compares equal quantities of available carbo-hydrate in foods, and provides a measure of carbohydrate quality. Avail-able carbohydrate, on the other hand, can be calculated by summingthe average quantity of total available sugars, starch, oligosaccharides,glycogen and maltodextrins. The glycemic load (GL), is a function of afood’s glycemic index and its total available carbohydrate content anddefined as: Glycemic Load = GI (%) × Carbohydrate (g).

It can be seen from the equation that either a low GI-high carbohydratefood or a high GI-low carbohydrate food can have a low GL. While theeffects on post-prandial glycaemia may be essentially the same, there isevidence that the two approaches will have very different metaboliceffects on insulin sensitivity, triglyceride concentrations and free fattyacid levels1. In addition, satiety, weight management and cardiovascu-lar risk are not the same. This has important health implications forpeople with diabetes, or cardiovascular disease, and those trying toprevent these conditions.

The simplest way to habitually consume a moderate-high carbohydrate,low GI diet is to follow the Dietary Guidelines and to incorporate therecommendations of the WHO/FAO3. The Dietary Guidelines promotea moderate-high carbohydrate diet and the WHO/FAO recommend thatthe GI be used to compare foods of similar composition within foodgroups, and to choose the lower GI option. By choosing the lowest GIfood within a food group, an individual will most likely be choosingthe food with the lowest GL, because by definition, the macronutrientprofile is essentially the same within a food group.References1. Wolever TMS and Mehling C. Long-term effect of varying the source

or amount of dietary carbohydrate on postprandial plasma glucose,insulin, triacylglycerol, and free fatty acid concentrations in subjectswith impaired glucose tolerance. Am J Clin Nutr. 2002; 76 (1): 5–56.

2. Hodge AM, English DR, O’Dea K and Giles GG. Glycemic Index andDietary Fiber and the Risk of Type 2 Diabetes. Diabetes Care. 2004;27(11): 2701–2706.

3. Carbohydrates in human nutrition. 1998. Report of a Joint FAO/WHO Expert Consultation. FAO Food and Nutrition Paper – 66.

DEVELOPMENT OF AN UPDATED RED MEATNUTRIENT COMPOSITION DATABASEVERONIQUE DROULEZ1, PETER WILLIAMS1

1National Centre of Excellence in Functional Foods, University ofWollongong, NSW, Australia

Updated nutrient composition data for red meat was required to reflectcurrent butchering and consumer trimming practices. Since the amountof total separable fat of retail red meat cuts varies, a meaningful descrip-tor is required to ensure consistency in the use of food tables. Australianretail samples of fifteen beef, eleven lamb, four veal and two muttoncuts were purchased from 10 retail outlets (butchers and supermarkets)in different socio-economic areas of Sydney and Melbourne. For bothraw and cooked samples, the average percentage of separable internal,external and total fat, lean and waste was determined by dissection ofeach cut. For raw beef, total separable fat varied from 1% to 12% andfor lamb and mutton from 2% to 22%. To reflect this variability, redmeat nutrient data was described in terms of ‘as purchased’, ‘semi-trimmed’ and ‘lean’ red meat. ‘As purchased’ red meat is the mean pro-portion of lean, internal separable fat and external separable fatmeasured for each cut. ‘Semi-trimmed’ red meat was calculated usingproportions of the lean and internal separable fat only since consumerresearch indicates that consumers who trim fat off meat remove all ofthe external fat. “Lean’ red meat was based on samples with little inter-nal separable fat and no external separable fat. In this study, approxi-mately a third of the purchases collected for each cut met thespecifications for ‘lean’ red meat. These descriptors provide a visual‘picture’ of red meat cuts for selecting appropriate data.

Funding Source: Meat and Livestock Australia

THE NEW ERA OF INNOVATION IN THE FOODSUPPLY – DIETITIANS NEED TO BE INVOLVEDANNE-THERESE MCMAHON1

1University of Wollongong, Wollongong NSW 2522 Australia

Dietitians face a new challenge in assisting patients and the communityto understand the changing food supply related to food productionfrom farm to table including its regulation. There are multiple changesthrough innovation in agricultural practices, food handling and moni-toring systems. These include food safety and quality issues, manufac-ture, distribution and even home preparation highlighted in foodscience journals and seen in food products on shelf and changes in foodregulation. To support new graduates entering this changing environ-ment a new subject has been introduced into the undergraduate Nutri-tion and Dietetic program at the University of Wollongong Nutrition andFood Innovation. The subject focuses on current and emerging changesin the food supply and the scientific support drawing upon experts frombroad ranging areas of practice in the food supply. Evidence has beencollated from experts, research literature and industry journals. Toensure dietitians can be effective in policy changes that impact on theintegrity of the food supply a broad understanding is essential on thefood science and technology interface with nutrition and dietetics. Someof these are more obvious such as nutrigenomics and genetically modified foods but others such as new processing and packaging technologies including High Pressure Processing and the use of Nanotechnology require dietitians to be exposed to areas that are moredistant from main clinical practice. Assisting dietitians to update theirknowledge of food supply innovation will be vital in our continued rolein enabling people to make effective food choices for their health.

Abstracts


A NUTRITION REALITY CHECK: ATTITUDES,BEHAVIOURS, TRENDS AND FUTUREIMPLICATIONSNEER KORN1

1Heartbeat Trends, Sydney, NSW 2010, Australia

While debate about health, nutrition and diet continues among experts,what are the views of the Australian population? Drawing on eight yearsof research with Australian of all ages this presentation will focus onseveral key insights and their implications for the future.

Australians feel bombarded by (sometimes contradictory) health mes-sages from experts, corporations and journalists. Their response is toignore them all. Their guiding mantra is common sense, self-relianceand moderation, and they think believe doing just fine without inter-ference. With Australia’s abundance of fresh ingredient it seems youcan’t go wrong. It’s no surprise that word-of-mouth is a far more trustedan information source than any other. This is the key for effective communication.

Moderation is defined by each household as a healthy balance. In today’sholistic mindset there are no good or bad foods, just ones to have moreor less of. And emotional wellbeing is just as critical as physiological,perhaps even more so.

The obesity debate is something Australians have chosen to ignore.Indeed, they resent the very idea. This is partly due to misperceptionsbut more to do with a parental focus on their kids’ self-esteem. Happi-ness is more important than the BMI.

With kids have a greater influence on household decision making,pester-power having given way to negotiation. One key to future behav-iour change lies strongly in kids, just as they introduced recycling intoAustralian households.

In a world where negativity reigns the focus for education and behav-iour change is in presenting the positives. It’s no surprise ‘The BiggestLoser’ has struck a chord with audiences. It’s all about the positiveeffects of behaviour change rather than warnings of doom.

Plenary Session – Closing session

Best of the best: Student presentations

LONG-TERM WEIGHT STATUS IN WOMENFOLLOWING A 12-WEEK STRUCTURED WEIGHTLOSS PROGRAM, AND PREDICTORS OF WEIGHTLOSS MAINTENANCEXENIA CLEANTHOUS1, MANNY NOAKES1, JENNIFER KEOGH1,PHIL MOHR1, PETER CLIFTON1

1CSIRO Human Nutrition, Adelaide 5000 Australia

Structured weight loss programs are currently a key treatment forobesity but outcomes are generally poor and little work has been per-formed to investigate factors that influence long-term weight status. Toestablish current weight and attempt to determine predictors of longterm weight status in women, we conducted a 3-year follow-up studyof 87 female participants in a 12-week structured weight loss program(Noakes et al. Am J Clin Nutr 2005;81:1298–36). Participants reportedtheir weight and completed an 18-question telephone interview. Statis-tical analysis was conducted using both parametric (t-tests, Pearson’scorrelation) and non-parametric (Mann-Whitney U, chi-square) mea-sures, as appropriate. There were 37 Maintainers (44%) (weight loss ≥ 5% since beginning the program), who lost a mean 9.8 ± 4.2% and48 Regainers (56%) (weight loss <5% since beginning the program)who lost a mean 0.1 ± 3.4%. Key triggers for weight regain includedemotionally-related adverse life events (n = 17) and lifestyle influences(job, home) (n = 17). The key factor perceived to aid successful weightmaintenance for Maintainers (n = 22) and Regainers (n = 30) was com-ponents of the program (eg. counseling sessions, weigh-in’s). For bothgroups, lack of self-discipline/willpower (Maintainers: n = 9, Regainers:n = 14) and food-related social occasions (Maintainers: n = 8, Regainers: n = 10) were the two most common factors perceived tomake successful weight maintenance difficult. After three years, 44% ofparticipants maintained a clinically important weight loss, and the

remaining participants, on average, still had some degree of net weightloss. Weight history, eating patterns, physical activity habits and psychological effects on wellbeing did not differentiate Maintainers from Regainers.

Funding source: CSIRO Human Nutrition

SURVEY OF HEALTH CLAIMS FOR FOODS MADEON INTERNET SITESHELEN DRAGICEVICH1, PETER WILLIAMS2, LEISA RIDGES2

1Department of Biomedical Science, University of Wollongong, NSW 2522,Australia2Smart Foods Centre, University of Wollongong, NSW 2522, Australia

Australia and New Zealand are currently preparing a new food stan-dard, which will allow the use of health claims on food products andin associated advertising. The aim of this study was to obtain prelimi-nary information about the current use of health claims on the Inter-net and the level of compliance of these claims with existing regulations.From August to October 2005, a survey was conducted of 1,068 web-sites associated with the top 20 food processing companies in Australia,and an additional 683 websites for food products found in previousstudies of product labels and magazine advertisements to carry healthclaims. The results were compared with those from a 2003 survey onhealth claims on the labels of 7850 products. The survey found that14.5% of food product websites carried a health claim, and 40.7% and37.0% of products previously identified as carrying claims on productlabels or in magazines respectively, had Internet claims. 21.2% of claimswere located directly on the food product web page, but the majority(78.6%) were on associated links within the manufacturer’s website.

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Many of the claims (19.7%) were high level or therapeutic claims, notpermitted by current standards. The results suggest health claims arenot made more frequently on websites compared to product labels(14%), but there is a greater prevalence of high level and therapeuticclaims made on the Internet. In future food standards enforcement willneed to give greater priority to monitoring the use of health claims onthe internet.

BODY COMPOSITION IN YOUNG WOMEN WITHEATING DISORDERS: ETHNIC DIFFERENCES INTHE RELATIONSHIP BETWEEN BODY FATLEVELS AND BODY MASS INDEXNERISSA SOH1, STEPHEN TOUYZ1,2, TIMOTHY DOBBINS3, LOIS SURGENOR4, SIMON CLARKE5,7, MICHAEL KOHN6,7, EE LIAN LEE8, VINCENT LEOW9, ELIZABETH RIEGER2, KEN UNG10, GARRY WALTER1,11

1Discipline of Psychological Medicine, The University of Sydney, Sydney,NSW 2006, Australia2School of Psychology, The University of Sydney, Sydney, NSW 2006,Australia3School of Public Health, The University of Sydney, Sydney, NSW 2006,Australia4Department of Psychological Medicine, Christchurch School of Medicineand Health Sciences, University of Otago, New Zealand5Adolescent Medical Unit, Westmead Hospital, Westmead, NSW 2145,Australia6The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia7Faculty of Medicine, The University of Sydney, Sydney, NSW 2145,Australia8Eating Disorders Clinic, Department of Behavioural Medicine, SingaporeGeneral Hospital, Singapore 169608, Singapore9Peter Beumont Centre for Eating Disorders, Wesley Private Hospital,Ashfield, NSW 2131, Australia10Department of Psychological Medicine, National University Hospital,Singapore 119074, Singapore11Thomas Walker Hospital (“Rivendell”) and Area Child, Adolescent &Family Mental Health Services, Central Sydney Area Health Service,Concord West, NSW 2138, Australia

There has been no study to date into ethnic differences and body com-position in eating disorder (ED) patients. This study investigates therelationship between body fat levels and BMI in North European Caucasian (NE) and East Asian (EA) women with and without a clinical ED. Participants were 153 women aged 14–38 from Sydney, Australia, and Singapore. ED participants were recruited through teach-ing hospitals and controls through advertising on the university campusin Sydney and through hospital nursing staff and a school in Singapore:in Sydney, 34 ED and 32 control NEs and two ED and 22 control EAs; in Singapore, 18 ED and 33 control EAs and 12 control NEs.Height, weight and skinfolds at four sites were assessed. Multiple linear regression of the sum of skinfolds against BMI was undertaken withED/control status, age, ethnicity and country of residence as covariates.

BMI was significantly and positively associated with the sum of skin-folds (p < 0.001). After adjusting for BMI, ED women had significantlylower sums than controls (p < 0.001), suggesting ED women have lessbody fat for the same BMI. EA women had significantly greater skinfold sums than NE women (p = 0.002), indicating greater levels of body fat for the same BMI. This suggests underweight is defined by a lower BMI in EA women and the relationship persisted in womenwith EDs. Age and country of residence were non-significant. Moni-toring of body fat indices together with BMI when managing EDpatients and application of lower BMI targets for EA patients may bewarranted.

Funding support: Edith Mary Rose Travelling Scholarship, Faculty ofMedicine, The University of Sydney

USE OF THE ACUTE CARE HOSPITALFOODSERVICE PATIENT SATISFACTIONQUESTIONNAIRE TO MONITOR TRENDS INPATIENT SATISFACTION WITH FOODSERVICEAT AN ACUTE CARE PRIVATE HOSPITALANDREW FALLON1, STEPHEN GURR1, MARY HANNAN-JONES1,JUDITH BAUER2

1Queensland University of Technology, Brisbane QLD 4006 Australia2The Wesley Research Institute, Brisbane QLD 4066 Australia

The Acute Care Hospital Foodservice Patient Satisfaction Questionnaire(ACHFPSQ) is a validated foodservice satisfaction tool. The aim of thisstudy is to demonstrate how the ACHFPSQ has been used to monitortrends in foodservice satisfaction at a 440 bed private hospital.

Statistical analysis was carried out using SPSS for Windows (version12.1. Response rates from 2002–2005 were 42–60%. Overall satisfac-tion with foodservice has been high for three years (Factor Scores4.42–4.52). In 2005, there was no significant difference in overall satisfaction by age (4.52 ≥ 60 years v 4.29, <60 years; p = 0.198),gender (4.44 females v 4.39 males; p = 0.673), diet (4.49 standard v 4.30 therapeutic; p = 0.395), or length of stay (4.44 – <8 days v 4.47 – ≤20 days v 4.21 – >20 days; p = 0.570). Factor Scores werehigh for each dimension – service/staffing issues (4.79), meal servicequality (4.52), physical environment (4.52) and food quality (4.33). Forthree years, service/staffing issues has ranked the highest dimension andfood quality the lowest, with no clinically significant change in factorscores over time. The ACHFPSQ is able to highlight specific areas ofthe foodservice to target for quality improvement initiatives. In 2005,the lowest scores were for statements relating to texture of the cookedmeat (3.95) and vegetables (4.06) and range of initiatives has beenintroduced to improve these scores.

In conclusion, the ACHFPSQ can be used to monitor patient satisfac-tion with foodservice and to identify target areas for continuous qualityimprovement initiatives.

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