Journal of Human Nutrition and Dietetics

Introduction The implementation of telehealth began globally before the onset of COVID‐19 but the use of telehealth, particularly video consultations (VCs), is expected to have increased with pandemic restrictions on face‐to‐face consultations (FTFCs). However, little is known about its actual usage. In Sweden, VCs have the potential to bridge long distances between Registered Dietitians (RDs) and their patients. This study investigates the use and perceptions of VCs among Swedish RDs before and after the onset of COVID‐19. Methods Swedish RDs were invited to participate in web‐based surveys in 2016 (n = 61) and 2021 (n = 112). Data are analysed and later discussed through the lens of Levesque et al.'s framework for patient‐centred access to healthcare. Results More RDs reported having VC‐experience in 2021 compared to the 2016 survey, 67% and 16% respectively. A majority of the RDs (85%–88%) believed that access to dietetic care would increase with the use of VCs compared to FTFCs. In 2021, about half of RDs (55% and 46%) perceived treatment quality and relational quality to be unaffected by VCs, while approximately one‐third (31% and 43%) saw it as being reduced. With their additional experience, there was the caution by 69% of RDs in 2021 that consultations requiring language interpretation services were less suitable for VCs. Conclusions The findings suggest broader VC usage among Swedish RDs participating in the study. Implications for clinical practice include maintained access to healthcare and further practice development to meet quality needs and increased equity.

Background Carotenoids are pigments abundant in fruits and vegetables and can be measured in plasma and skin. This study aimed to evaluate associations between carotenoid intake, assessed by self‐reported usual diet against plasma carotenoid and skin yellowness concentrations in Australian adults (n = 50, aged 39.3 ± 15.4 years, 68% female). Methods Dietary carotenoid intakes were quantified using the Australian Eating Survey (AES) food frequency questionnaire (total, α‐ and β‐carotene, lycopene, β‐cryptoxanthin, and lutein/zeaxanthin). Plasma concentrations of these carotenoids were measured using high‐performance liquid chromatography, while skin yellowness was measured using skin reflectance spectroscopy as a proxy for skin carotenoids. Associations between AES carotenoids, plasma carotenoids and total skin yellowness were analysed using linear regressions. Results AES‐derived carotenoid intakes were positively associated with skin yellowness for all dietary carotenoids (β range 0.25–0.46, p < 0.05) and total dietary carotenoids (β = 0.35 [95% CI 0.07, 0.63], p < 0.05), except lycopene. Similarly, each individual plasma carotenoid was significantly positively associated with their respective individual dietary carotenoids (β range 0.42–0.53, p < 0.05) and total dietary carotenoids (β = 0.38 [95% CI 0.04, 0.73], p < 0.05), except for lycopene. Significant positive associations were identified between skin yellowness and total (β = 0.36 [0.20, 0.52], p < 0.001) and individual plasma carotenoids (β range 0.30–0.37, p < 0.01), excluding α‐carotene and lycopene. Conclusion Dietary carotenoid intakes were significantly associated with plasma carotenoid concentrations and skin yellowness values. Results support use of all three methods for assessment of carotenoid intake, with the exception of lycopene. Future studies should consider cost, accessibility of assessment methods and participant burden when selecting dietary assessment methods. Trial Registration The original study was registered with Australian New Zealand Clinical Trials Registry (ANZCTR‐12619001415190).

Objective This study aimed to examine the effects of mindfulness‐based dietary intervention on body weight and eating behaviors in obese individuals. Methods In total, 35 obese participants were randomized into the diet+mindfulness (n = 18) and diet (n = 17) groups. Participants in the diet group received only an individualized diet program, whereas those in the diet+mindfulness group received an additional 8‐week mindfulness program. The anthropometric measurements and TFEQ‐21 (Three Factor Eating Questionnaire) scores were recorded and compared at baseline and at the study completion. Results The decrease in body weight was higher in the diet+mindfulness group (−5.2 kg [−6.9, −3.5]) than in the diet group (−3.1 kg (−4.2, −1.9) (group*time interaction, p < 0.05). Among the TFEQ‐21 factors cognitive restriction, emotional eating, and uncontrolled eating scores decreased in both groups, and each was higher in the diet+mindfulness group than in the diet group (group*time interaction, p < 0.05). In the diet+mindfulness group, the decrease in cognitive restriction (β: 1.159 (CI [0.490–1.827]), emotional eating (β: 1.093 CI [0.531–1.656]) and uncontrolled eating (β: 0.227 CI [0.036–0.418]) was found to be associated with the decrease in BMI. In the diet group, only the decrease in the uncontrolled eating (β: 0.330 CI [0.044–0.617]) score was associated with the decrease in BMI (p < 0.05). Conclusions Integrating mindfulness practices into standard dietary interventions increased weight loss and improved eating behaviors.

Background Person‐centred care impacts individual and organisational outcomes in rehabilitation and nutrition services. However, there is little evidence regarding person‐centred nutrition and mealtime care within rehabilitation settings. We aimed to develop a conceptual model to guide nutrition and mealtime care in rehabilitation, focusing on factors associated with person‐centred care and interprofessional practice. Methods Employing an interpretivist research approach, we conducted 58 h of ethnographic field work, including observations and interviews with 165 patients, support persons, and staff across three rehabilitation units from September 2021 to April 2022. Data were analysed iteratively using reflexive thematic analysis, with key factors inductively and deductively identified and mapped onto the Nutrition Care Process to create the conceptual model. The model was then refined in collaboration with staff (n = 10) and consumers (previous patients and support persons; n = 7) in expert panel sessions. Results The Person‐Centred Nutrition and Mealtime Care in Rehabilitation model conceptualises person‐centred nutrition and mealtime care through the steps of Nutrition Assessment, Priorities, Intervention, and Monitoring and Evaluation. These steps highlight consumer, team, and organisational factors influencing person‐centred nutrition and mealtime care. The representation and communication of these factors within the model were refined with staff and consumers. Conclusions This study presents an evidence‐informed conceptual model to guide person‐centred nutrition and mealtime care in rehabilitation. By sharing this conceptual model, we welcome its use and adaptation by dietetic staff/managers to support advancing person‐centred nutrition services. This model is designed to support enhanced quality of rehabilitation and nutrition services in line with existing evidence.

Objectives This study aimed to develop and validate a questionnaire to assess health‐related QOL in tube‐fed patients, Zeng's Tube‐feeding Index (ZTI). Methods Expert consultations, patient interviews, and literature reviews were used to design the draft items. Four rounds of expert and patient review were conducted to refine the items. A preliminary survey was conducted for the dimension division. In 2024, a formal study involving 419 tube‐fed patients was conducted to validate the ZTI. The primary diagnoses were haemorrhagic stroke (83, 19.81%), ischaemic stroke (156, 37.23%), traumatic brain injury (70, 16.71%), neurodegenerative diseases (58, 13.84%), head and neck cancer (11, 2.26%), sarcopenia (16, 3.81%), and others (25, 5.97%), respectively. The Cronbach's α coefficient was used to measure internal consistency. Spearman's correlation was used to measure test‐retest reliability. The Dysphagia Handicap Index and subjective QOL scores were used to measure the construct validity. Ten independent experts were included to evaluate content validity. Factor analyses were used for structural validity. Results The ZTI has four dimensions, with a total of 23 items, using a Likert 4‐point scale. The Cronbach's α coefficients were > 0.8 for dimensions and = 0.889 for the scale. The Spearman correlation coefficients were > 0.7 for items or dimensions, and = 0.802 for the scale (p < 0.001). The ZTI showed significant correlations with the Dysphagia Handicap Index and subjective QOL scores in both the total scores and each dimension (|r| > 0.7, p < 0.001). The content validity indices were ≥ 0.8 for items, dimensions, and the scale. The Exploratory Factor Analysis identified four factors that collectively explained > 80% of the variance and built a four‐dimensional model. The model showed a good fit through the Confirmatory Factor Analysis. Conclusions The ZTI is a validated tool for assessing tube‐feeding‐related QOL.

Background There is a direct relationship between omega‐3 and major depression. This study was conducted to investigate the effect of supplementation of omega‐3 fatty acids on serum levels of brain‐derived neurotrophic factor (BDNF) and depression status in patients with bipolar disorder (BD). Methods This double‐blind clinical trial was conducted on 60 men with BD. The patients were grouped into two groups and received 2 g/day of omega‐3 supplements or a placebo daily for 2 months. The serum concentrations of BDNF and depression scores were investigated before and after the intervention. Afterward, the data were analyzed using the non‐parametric Wilcoxon and Mann–Whitney tests. Results The supplementation of omega‐3 fatty acids significantly increased the serum concentration of BDNF compared to pre‐intervention (0.449 ± 0.110 ng/mL vs. 0.756 ± 0.160 ng/mL) and also decreased the scores on the Hamilton test (40.13 ± 9.51 vs. 22.40 ± 7.49) (p < 0.05). The results also showed that supplementation with omega‐3 fatty acids significantly increased the serum concentration of BDNF (0.756 ± 0.160 ng/mL vs. 0.504 ± 0.154 ng/mL) and decreased the scores on the Hamilton test compared to the placebo group (22.40 ± 7.49 vs. 29.35 ± 6.08) (p < 0.05). Conclusions In conclusion, daily supplementation with 2 g of omega‐3 fatty acids for 2 months decreased depression scores and increased serum concentrations of BDNF in BD patients compared to the placebo group.

Background The Australian private practice dietetics workforce has been rapidly expanding, partly due to structural changes in reimbursement policies and the increasing number of dietetics courses that have led to a growing influx of graduates into the private practice dietetics domain. However, graduates and experienced private practitioners have highlighted inadequate exposure to private practice during their training, citing a lack of business skills, minimal counselling skills and limited or no private practice placements. There appears to be a gap between employment realities for graduates and workforce preparation relevant to private practice dietetics. The aim of this study was to analyse the publicly available curriculum information related to private practice dietetics entrepreneurship preparation in accredited Australian dietetics courses. Methods Accredited dietetics course details were obtained from the Dietitians Australia website. Publicly available course information was assessed from university websites. A content analysis of curriculum relating to private practice entrepreneurship including programme and unit descriptions, course and unit learning outcomes, unit content, assessments and placements was completed against a predetermined framework developed from previously published literature. Results This study included all 22 accredited courses across 18 universities, comprising eight bachelor's degrees and 14 master's by coursework. Fifteen courses across 13 universities had units that included elements in the analytical framework. Business planning and development, as well as leadership, were the most commonly covered in the curricula; however, the depth of content was difficult to ascertain due to the limitations of university website content transparency. Private practice placements were included in seven courses; however, placements were often elective or of short duration. Other framework elements such as client retention strategies and legal and regulatory considerations had coverage across a limited number of courses across universities. Conclusions The findings of this content analysis suggest that curriculum pertaining to private practice entrepreneurship, although underdeveloped, is embedded in some accredited courses. Transparency of curriculum content within accredited dietetics courses in Australia varies, limiting prospective students' ability to ascertain what learning experiences they will be exposed to after enrolment. Further research is required to ascertain the curriculum necessary to support the preparation of student dietitians for private practice.

Background Resilience is a crucial protective factor for dietitians, helping them manage the negative impacts of routine stressors and crises in their daily work while maintaining their well‐being. Based on Ungar ecological model of resilience, this study aims to understand the multi‐level resilience resources that help dietitians maintain their well‐being in the context of protracted conflict. Methods The study employed a cross‐sectional design. Data were collected between December 2023 and February 2024 in Israel. Participants were recruited via a snowball sampling to recruit dietitians who graduated from one academic institution. An electronic flyer detailing the study's aims and a link to a Qualtrics questionnaire was emailed to them, with a request to share it with colleagues. A total of 110 participants completed the questionnaire. Results Hierarchical regression analysis revealed that dietitians' personal resilience and their perceptions of the preparedness of the National Nutrition Division in the Ministry of Health to handle crises were negatively associated with strain symptoms beyond the effects of stress levels and control variables (β = −0.31, p < 0.001; β = −0.17, p < 0.05, respectively). However, dietitians' coping strategies and their trust in their organization's management decisions were not significantly related to decreased stress symptoms (p > 0.05). Conclusions The findings highlight the importance of using an ecological framework of resilience and understanding why and under which context‐specific factors each resilience level contributes to dietitians' well‐being. Practical implications involve prioritizing systemic national preparedness support and resilience‐building programmes tailored to the unique challenges faced by dietitians.

Background We assessed the cost‐effectiveness of personalised nutrition in adults with overweight/obesity in Poland and the United Kingdom (UK) using the results of two randomised controlled trials (RCTs). Methods The 4‐month RCTs compared three interventions: personalised plan (PP) plus behavioural change (PP+B), PP only, and a control. Outcomes included body mass index (BMI), health‐related quality of life (EQ‐5D‐5L), quality‐adjusted life years (QALYs), and costs (2020 British pounds). A Markov model estimated lifetime cost‐effectiveness. Different sensitivity analyses were performed. Results Participants were randomised to PP+B, PP, and control groups in Poland (n = 89, n = 88, n = 88) and the UK (n = 20, n = 19, n = 15). Comparing BMI reductions of PP+B and PP with control in both countries showed no significant differences, but wide confidence intervals (CIs) were observed (e.g., PP+B vs. control—Poland: −0.20, 95% CI: −0.86, 0.45 kg/m²; UK: −0.80, 95% CI: −1.60, 0.00 kg/m²). Lifetime analysis suggested potential cost‐effectiveness for PP+B in Poland (£20,404 per QALY gain), and for PP+B (£13,006 per QALY) and PP (£12,222 per QALY) in the UK, since these figures were lower than the willingness‐to‐pay thresholds (£34,000 in Poland and £20,000 in the UK). PP in Poland was dominated by control, but sensitivity analyses suggested potential cost‐effectiveness. Conclusions The PREVENTOMICS interventions may offer a cost‐effective approach to reduce weight and avoid its related complications in both countries. Future studies should be larger and/or longer to reduce uncertainty about effectiveness. Clinical Trial Registration Numbers: Poland ISRCTN51509551 and the UK ISRCTN46063864.

Background Family therapy for anorexia nervosa (FT‐AN) is the first‐line outpatient treatment for young people with anorexia nervosa (AN) in the UK. However, some require more intensive interventions, such as day programmes (DPs), which provide structured multidisciplinary care, including nutritional rehabilitation. Despite the integral role of dietitians in DPs, their specific responsibilities remain under‐researched. This study explores clinician perspectives on the role of dietitians in adolescent AN treatment to inform future research and consensus guidelines. Methods A qualitative study using semi‐structured interviews was conducted with 11 clinicians working in one DP for young people with AN. Participants were recruited from the Intensive Treatment Programme at the Maudsley Centre for Child and Adolescent Eating Disorders. Reflexive thematic analysis identified key themes regarding dietitians' contributions to treatment. Results Clinicians emphasised the dietitian's role in early treatment containment, reinforcing therapeutic approaches and empowering parents in meal planning and nutritional rehabilitation. Dietitians were seen as crucial in personalising treatment based on cultural and sensory needs and adapting meal plans as young people progressed. They also played a key role in guiding transitions between treatment phases, particularly from weight restoration to maintenance. However, challenges included an over‐reliance on dietitians for nutritional decisions and a ‘good cop, bad cop’ dynamic, where therapists avoided difficult conversations about food. Discussion Findings highlight dietitians' essential role in DP treatment for AN but suggest that excessive reliance may limit therapist autonomy. Strengthening collaboration through shared decision‐making and bidirectional learning is recommended. Further research should explore these dynamics across diverse settings.

Introduction Dietitians play a key role in the care of people with dementia, yet there is a lack of literature on the education of dietitians in this area. Dietetic students at the University of Surrey undertook the Time for Dementia programme as a mandatory component of their training to improve their knowledge of, and attitudes towards people with dementia. The programme was delivered online due to COVID‐19 restrictions. Students met with people with dementia and their carers over a 2‐year period. This study aimed to understand the learning experiences of dietetic students in Time for Dementia, and their perceptions of online delivery. Methods All dietetic students undertaking the Time for Dementia educational programme during 2020 and 2021 were invited to take part in a qualitative study. Three focus groups were completed with 14 students on completion of a 2 year Time for Dementia programme. A semi‐structured topic guide was used to explore students' self‐reported learning outcomes, their experiences of online learning, and their learning experiences around dementia. The data was analysed using reflexive thematic analysis. Results Three main themes were identified from the data. First, gaining a holistic understanding of the experience of life with dementia, described student learning on the lived experiences and the challenges faced by people with dementia. Second, shaping future practice, adapting approaches for dementia care, concerned the skills and attitudes that students highlighted as valuable for their future careers, and third, optimising learning in an online environment, outlined student's views and recommendations on online dementia education. Conclusions Longitudinal contact with people with dementia can improve knowledge about the realities of life with dementia and inform future practice. The positive learning outcomes reported in this study suggest that online contact with families with dementia can be successfully incorporated into the dietetic undergraduate curriculum.

Aims Malnutrition is prevalent in Australian hospitals, affecting 30%–40% of inpatients. Enhancing patient mealtime experience is a recognised strategy to support improved dietary intake and clinical outcomes. Yet, there is little published data on mealtime experience in acute hospital settings in Australia. This study aims to capture patient mealtime experience in an acute care setting at a regional Australian hospital, using a modified version of the Austin Health Patient Mealtime Experience Tool. Methods A cross‐sectional study was undertaken across six acute care wards at Bendigo Health between July and September 2024. Patient mealtime experience was explored through interviewer‐administered surveys, including 32 Likert scaling items and 6 open‐ended responses. Descriptive statistics were used to analyse quantitative data, whilst deductive thematic analysis was applied to qualitative data to describe mealtime experience. Results Eighty‐one patients participated in the study. Patients were most dissatisfied with food quality, particularly sensory characteristics and variety, in both the quantitative and qualitative results. Patients were most frequently satisfied with staff interactions (90% ‘always’ or ‘often’ positive), although the qualitative results highlighted insufficient mealtime care. The physical environment was generally highly rated, with a majority of patients (> 70%) reporting that noise, visitors, room surroundings and smells and odours ‘rarely’ or ‘never’ impacted food intake. The food ordering system was rated favourably, with 89% of participants rating meal timing as ‘always’ or ‘often’ positive and 73% rating meal accuracy as ‘always’ or ‘often’ satisfactory. However, qualitative results revealed usability issues related to the electronic meal ordering system. Finally, qualitative responses identified nutrition impact symptoms as a barrier to mealtime experience and intake. Conclusion Food quality, sufficient mealtime care, management of nutrition impact symptoms and improving usability of electronic ordering systems are areas highlighted for improvement in mealtime experience. Addressing these factors through targeted quality improvement initiatives can enhance mealtime satisfaction and support nutritional intake. Integrating patient perspectives into service planning is essential for fostering patient‐centred hospital foodservices and improving patient outcomes.

Background Picky eating behaviour is characterised by an unwillingness to eat familiar foods, try new foods, and/or strong food preferences. Prevalence peaks at about 3 years of age and usually declines during school years but behavioural characteristics may persist. Parental pressure may influence this. Our aim was to assess food choices in a school setting, away from the family environment, of 13‐year‐old children who were preschool picky eaters compared with those who were never picky eaters. Methods Children were recruited at birth in south‐west England and followed to age 13 years. Children ( n = 7554) were classified as never (26%), low (59%) or high picky eaters (15%) based on parental responses to questionnaires completed when they were pre‐schoolers. In a questionnaire completed at age 13 years ( n = 5348) the children were asked about frequency of consumption of lunchtime food items at school. Adjusted binary logistic regression modelling was used to determine the associations with picky eating classification. Results There were no differences between picky and non‐picky eaters in the frequency of packed lunch compared with school dinner uptake. Both high and low picky eaters were less likely to have meat, fish or cheese/egg sandwiches, or fruit or salad in packed lunches than non‐picky eaters. High picky eaters ate fewer ham/meat sandwiches (OR 0.49 [95% CI 0.39, 0.61]) and fruits (0.62 [0.49, 0.80]) than non‐picky eaters. Picky eaters were more likely to choose meat products in school dinners (e.g. meat burgers/sausages 1.29 [1.06, 1.57]) and have similar intakes of roast meats and fruit, but were less likely to have cooked vegetables or salad (0.68 [0.52, 0.90] and 0.62 [0.46, 0.83] respectively) than non‐picky eaters. Conclusion Behaviours characteristic of picky eating, such as avoiding meat, fish and fruit, were less evident in school dinner than packed lunch choices. However, avoidance of vegetables/salad persisted. It is likely that family norms have a stronger influence over packed lunch content than over school dinner choices where the child has more autonomy and may be influenced by their peers.

Introduction In 2024, 95% of 3–4‐year‐old children in England attended early years settings (EYS). This study aimed to estimate energy and nutrient content of packed lunches provided for and consumed by children attending EYS, along with food type, cost and level of processing and whether these differed by area deprivation. Methods An observational cross‐sectional weighed intake and nutrient analysis of food and drinks in packed lunches provided to and consumed by children attending eight EYS over 5 days. Food type, packaging and processing were coded and lunch costs calculated. Results A total of 67 children ate 185 packed lunches. Lunches included fruit (76.2%) more often than vegetables (38.9%). Lunches in areas of higher deprivation less frequently contained fruit ( p = 0.003) or vegetables ( p < 0.001), and more frequently contained meat products ( p < 0.001), savoury snacks ( p < 0.001), cakes/biscuits ( p = 0.038) and confectionery ( p < 0.001). Use of pre‐packaged foods was common (40.1% items), and ultra‐processed foods provided 65.5% energy. Overall, lunches provided sufficient fibre and micronutrients, but high protein and excess energy, fat, saturated fat, free sugars and sodium. Provision of most nutrients varied by area deprivation, but consumption in areas of higher deprivation was only higher for free sugars ( p = 0.002) and lower for fibre ( p = 0.003) and vitamin C ( p = 0.003). Median packed lunch cost was £1.26, with no difference by area deprivation ( p = 0.422). Healthier lunches were cheaper than less healthy lunches ( p < 0.001). Conclusions Use of pre‐packed, ultra‐processed foods was high, and provision of vegetables low. Lunches were high in sodium and free sugars, with less healthy lunches provided in areas of higher deprivation.

Introduction Forecasting how workforces will meet projected challenges faced by future populations is essential to future‐proof professions. This paper aims to describe the specific actions required for nutrition professionals (nutrition scientists, nutritionists, dietitians) to realise the professions' workforce development vision of the future. Methods A qualitative interpretive approach was employed. Individual interviews were conducted with nutrition leaders and external thought leaders. Focus groups were also conducted with experts within the nutrition and dietetics professions, academic dietetics educators and students/recent nutrition science and dietetics graduates (total sample n = 68). Key nutrition‐related issues and challenges, drivers for change and potential future roles of the profession were explored. This paper documents the actions required to achieve these outcomes. Data were analysed using a team‐based thematic analysis approach. Results Analysis and interpretation of participant interviews identified five key actions to strengthen the profession: ‘Enhance and harness the diversity of the profession’; ‘Develop a cohesive profession with a strong identity’; ‘Decolonise teaching and practice’; ‘Retain science as the fundamental basis of the profession with trans‐systems knowledge integration’; and ‘Build opportunities for an agile nutrition workforce’. Conclusions Future‐proofing the nutrition profession rests on mobilising current strengths and embracing growth and change. There will be confronting challenges for members of the profession and for a united profession. Individual professionals, professional associations, educators and education institutions need to work together to instigate change towards a more equitable future to support optimal health and wellbeing for individuals, communities and populations.

Introduction Hyperphosphataemia is a common complication of paediatric chronic kidney disease (CKD), despite the use of phosphate binders and the numerous strategies employed to reduce dietary phosphate (P) intake. This article describes the development of two self‐administered semi‐structured Phosphate Understanding and Knowledge Assessment (PUKA) questionnaires. The purpose of these is to assess challenges with adherence and measure declarative nutrition and procedural knowledge of phosphate in children and young people (CYP) with CKD and their caregivers. The aim is to create questionnaires that will be used for future studies investigating the relationship between knowledge and blood P‐levels. Methods Questions were generated from a literature review, clinical experience and feedback from a survey sent to UK paediatric kidney dietitians. The content, format and style of the questions were adapted and validated via expert consensus (including a psychologist, play therapist, paediatric kidney dietitians and nephrologists from the international Paediatric Renal Nutrition Taskforce, and our Young Persons’ Advisory Group), two caregivers and two CYP. A draft questionnaire was piloted with five caregivers and CYP with CKD to ensure face and content validity. To allow utilisation in a planned multi‐centre trial, it was translated into five languages (Dutch, French, German, Italian and Turkish). The final English version questionnaires were used in a sample of CYP with CKD stages 4–5 and on dialysis (CKD4‐5D), and caregivers, from three UK paediatric kidney centres. Results From an initial pool of 80 questions, 37 were included in the final PUKA questionnaire. Thirteen were knowledge‐based, and a knowledge score was developed. An adult and a child‐friendly format were designed. Pilot testing confirmed face validity to ensure the questions were understandable. Forty‐four CYP with CKD4‐5D and 33 caregivers completed the final English PUKA questionnaires, with over 80% rating it easy to complete. The median time required to complete it was 11:06 min (IQR: 7:22–16:31). Conclusions The PUKA questionnaires are a valid and reliable tool for measuring P‐related knowledge and experiences of managing phosphate in CYP with CKD and their caregivers.

Background Many people in hospital after a stroke are at risk of reduced food intake, leading to less effective post‐stroke recovery. Finger foods (foods that can be easily transferred from the plate to the mouth without cutlery) have the potential to increase food intake and enable mealtime independence. However, the components of a well‐designed trial evaluating a finger food menu in a hospital are unclear, with little published evaluation of how to implement a finger food menu in hospitals. This study aimed to implement a finger food menu and to evaluate the feasibility of using it in a stroke rehabilitation ward. Methods The feasibility study was a prospective, before‐and‐after intervention study. Thirty‐one hospital inpatients from a stroke ward in a National Health Service hospital in the United Kingdom were included. A finger food menu was offered over two lunchtime meals and compared with the standard lunchtime menu. Feasibility was assessed by evaluating recruitment and retention of patients to the study, feasibility of data collection methods, interrater reliability of plate waste estimations using digital photography and assessing change in food intake. Intervention costs were assessed to support a cost‐consequence analysis. Barriers and facilitators to implementation were evaluated through qualitative observations. Results Thirty‐one participants were recruited (mean age 80, SD 8.5). Retention to the study was low, with 40% of patient participants not completing the study. Attrition was due to participants moving from the study ward. Dietary intake measures were successful via plate waste photography with good interrater reliability κ = 0.709 (95% CI: 0.64–0.77). A cost‐consequence analysis identified food costs and staff costs as key to delivering the finger food menu. The ward context and use of an internal facilitator to support the delivery of the intervention are important factors to consider. Conclusion Using finger foods in hospitals for older people after stroke is feasible and warrants a future cluster randomised control trial with minor adaptions to the protocol.

Introduction Dietitians play a crucial role in delivering medical nutrition therapy in outpatient settings where overnight admission of patients is not required. Despite the increasing focus on value‐based healthcare and patient‐reported measures (PRMs), there have been no recent reports synthesising patient experiences of dietetic outpatient care. This study aims to synthesise existing literature on patient preferences and experiences of outpatient dietetic care and to provide updated guidance for dietitians to improve patient‐centred care. Methods A qualitative systematic review with meta‐ethnography was conducted. The review included studies that reported patient experiences of dietetic care provided at outpatient settings detailed through focus groups, interviews, surveys or questionnaires, regardless of language, year or nationality. Participants’ quotes and second‐order concepts were extracted verbatim and synthesised. Main themes and sub‐themes were then developed. Results Five database searches yielded 5786 articles. After title and abstract screening and full‐text review, 72 articles were included. Three overarching themes were identified: (1) the process of accessing and receiving dietetic care was problematic; (2) the delivery and content of dietetic advice were suboptimal at times and (3) personal attributes of the dietitian and a desire for speciality expertise influenced perceptions of the quality of dietetic care. Conclusion The findings from this study provide actionable insights for dietitians to tailor their outpatient services by improving accessibility, refining the delivery of care and enhancing specialised expertise to meet individual patient needs and expectations effectively.

Introduction Replacing dietary animal protein with plant protein reduces greenhouse gas emissions and improves human health. Hospital foodservices can support change, but require buy‐in and collaboration between people across the system. Methods A qualitative descriptive study aimed to explore hospital patient menu content expert perspectives regarding increasing the proportion of plant to animal protein in hospital patient menus and outline actions required to do this. Semi‐structured interviews were completed with hospital or foodservice contractor employees and data were analysed using a general inductive approach. Results Twenty‐five of the 35 content experts interviewed supported increasing the proportion of plant to animal protein foods. All voiced concerns, including patients not eating meals, jeopardising protein intake and increasing malnutrition rates, and the prohibitive cost of plant‐based protein foods. Participants described steps to change patient menus, including a cyclical design process. This entailed consultation with stakeholders, setting a target, choosing a strategy, developing a menu and recipes, finding food product, planning the system and operations, and checking it works. Most felt the best ways to increase the proportion of plant to animal protein were to swap ingredients in familiar recipes or replace entire menu items ( n = 21), add plant‐based options to the menu ( n = 25), and move the position of plant‐based meals on the menu ( n = 22). Conclusion This study conceptualised a process for increasing the proportion of plant to animal protein in hospital patient menus for use by hospitals or policymakers. Future studies should test these suggested menu changes, assessing impacts on greenhouse gas emissions, plate waste, malnutrition indicators, cost and patient satisfaction.

Background Coeliac disease is an autoimmune disorder resulting from the consumption of gluten in genetically susceptible individuals. Current treatment is a lifelong gluten‐free diet that significantly affects quality of life. Food‐related quality of life (FRQoL) refers to the impact of food, nutrition, eating and drinking on the psychosocial aspects of life. The aim of this study was to examine FRQoL in patients with coeliac disease. Methods Patients with confirmed coeliac disease completed the validated FR‐QoL‐29 questionnaire adapted for coeliac disease (FR‐QoL‐29‐Coeliac) and provided demographic and clinical information. Results Questionnaires were completed by 138 adults (62% female, mean age 52.3 SD ± 18.6). FR‐QoL‐29 scores were mean 85.8 (SD ± 23.1). The lowest FR‐QoL‐29 scores were in the 18–35 year age group (76.6 ± 17.2) compared with the highest in the 56+ age group (92.5 ± 22.3, p = 0.002). Patients with ≥ 4 gastrointestinal (GiS) symptoms had significantly lower FR‐QoL‐29 scores (77.9 ± 20.7) compared with those with 1–3 GiS (96.7 ± 21, p = 0.0001). Conclusions FRQoL is impaired in coeliac disease and is particularly lower in younger people and those with greater GI symptom burden. Further research should examine the mechanisms that reduce FRQoL in coeliac disease to identify interventions that minimise the burden for patients.

Introduction High‐quality clinical documentation is critical for ensuring patient safety, enhancing quality of care and outcomes management. Despite the recognised importance of standardised clinical documentation, particularly through the Nutrition Care Process (NCP) and its associated terminology, studies indicate flaws in current practices that may have negative impacts on patient outcomes and interprofessional communication. Regular auditing of clinical documentation could help in improving clinical documentation quality. Despite the availability of validation studies of clinical documentation audit tools, information on their use and dietitians' requirements is lacking. This study aimed to investigate the dietitians' use of clinical documentation audit tools internationally and to learn about their requirements for these tools. Methods A quantitative cross‐sectional online survey was conducted in October 2021 using a newly developed and pretested 26‐item questionnaire among dietitians identified through convenience sampling. The survey, developed through a multi‐step approach including expert review and pretesting, collected data on clinical documentation audit tool use, purpose of auditing, preferred tool formats, and perceived enablers and barriers. Descriptive statistics and inferential analyses were applied to compare current practices and desired future applications of current auditors and non‐auditors. Results A total of 154 respondents from 16 countries completed the survey, with more than half working in patient‐related fields. Fifty‐three percent indicated that clinical documentation audits were conducted in their workplaces Audit purpose was primarily improving clinical documentation quality, reinforcing NCP understanding, and enhancing clarity, with significant differences observed between current and desired uses regarding result comparability and quality reporting (p < 0.001). Key enablers included management support, education/training, time, and helpful manuals, while barriers included lack of knowledge, time constraints, and insufficient training. Auditors used the tools mainly in paper format (33%) or as a text processing/spreadsheet file (26%), with 51% preferring a web application in the future. Additional requirements included further manual development, benchmarking capabilities, and cross‐cultural adaptations. Conclusion The process of clinical documentation auditing is not well established in the nutrition and dietetics community but has the potential to enhance clinical documentation quality. Key requirements include best practices for clinical documentation auditing processes, educational resources and user‐friendly, web‐based tools. Future research should validate clinical documentation audit tools across different settings and explore barriers to clinical documentation auditing as well as evaluating the use of artificial intelligence for clinical documentation auditing, ensuring improved clinical documentation quality translates to better patient care.

Background Coeliac disease (CD) is an autoimmune disorder treated with a gluten‐free diet (GFD), requiring substantial changes in food choices and eating habits. This study explores the challenges faced by adults living with CD focusing on the theme of food literacy (FL), namely functional, relational, and system FL competencies. Methodology A secondary analysis of data obtained through an online questionnaire was conducted. Adults living with CD in Québec, Canada and subscribed to Coeliaque Québec's newsletter were invited to complete a questionnaire. Using the critical incident method, respondents described a negative experience in their journey living with CD. Content analysis was done in a deductive and inductive manner, based on the 2022 Slater Food Literacy framework adapted to CD. Results A total of 743 patients were included in the analysis. The qualitative analysis resulted in 11 codes under the three themes of FL. Patients reported challenges in finding reliable nutrition and medical information, managing a GFD in social settings, explaining CD and preventing gluten contamination, preparing balanced gluten‐free (GF) meals, and making informed food choices. Patients reported on the negative impact of the GFD on their relationship with food, and how CD inhibits conviviality. Finally, patients addressed the need to advocate for GF food access in grocery stores and restaurants. Conclusions This study highlights the broad impacts of effectively managing CD and the GFD on patients’ functional, relational and system FL competencies. Future research should explore how social and economic factors further interact with FL competencies of adults living with CD.

Background This study examines the organic halo effect, specifically how organic labels influence perceptions of caloric content and consumption recommendations for high and low calorie food items. Previous research suggests that organic labels can create a perception of healthiness, but it is unclear how these perceptions vary with food calorie content. Methods An online experiment was conducted with 198 participants, who were randomly assigned to evaluate 20 food items (10 high‐calorie and 10 low‐calorie) labelled as either organic or conventional. Participants rated the calorie content and recommended consumption frequency of each item using Likert scales. The analysis included multilevel regression models to account for nested data and interactions between labels, calorie content, and participants' propensity to read nutrition information. Results The organic label led to a significant underestimation of calorie content for high‐calorie items and an overestimation for low‐calorie items. Participants who frequently read nutritional information were more sensitive to the organic label, showing a stronger organic halo effect. Consumption frequency recommendations were influenced by the label only for low‐calorie items, with conventional items being recommended more frequently. Discussion The study shows that the organic halo effect is more pronounced for high‐calorie foods, leading to an underestimation of their calorie content, which may result in occasional overconsumption. Frequent readers of nutritional information are more susceptible to the organic halo effect, contradicting previous findings. The dissociation between calorie perception and consumption frequency highlights the need for clearer nutritional labelling to mitigate misperceptions and support healthier consumer choices. Further research with larger samples and real‐world settings is recommended to validate these findings.

Background Visceral fat (VF) is a key contributor to metabolic disorders, including type 2 diabetes and cardiovascular diseases. Predominantly plant‐based diets (PPBDs) have been linked to improved body composition and metabolic health. This systematic review and meta‐analysis (SRMA) evaluated the impact of PPBDs on VF. Methods A systematic search of PubMed, EMBASE, Scopus, Web of Science and Cochrane Library (up to November 2024) identified 13 studies (10 cross‐sectional, 2 randomized controlled trials [RCTs], 1 non‐randomized intervention) with a total of 4000 participants reporting VF outcomes. Risk of bias was assessed using RoB 2.0, ROBINS‐I and JBI tools. Meta‐analyses used random‐effects models, with heterogeneity and publication bias assessed via statistical tests and Doi plots. Results RCTs indicated a trend toward VF reduction in those following a PPBD (pooled mean difference: −177.99 cm³; 95% CI: −475.83 to 119.85). Cross‐sectional studies showed significantly lower VF with high adherence to the Mediterranean diet (SMD: −0.45; 95% CI: −0.73 to −0.17; I² = 70%) and modest reductions with vegetarian diets (SMD: −0.24; 95% CI: −0.47 to −0.02; I² = 0%). Sensitivity analyses confirmed the robustness of findings. Certainty of evidence was rated very low. Conclusion PPBDs appear to be associated with lower VF and improved metabolic health, though the certainty of evidence remains very low. Further, well‐powered RCTs are needed to confirm these findings. Trial Registration PROSPERO; ID: CRD42024617129. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024617129.