Dr Jonathan Tammam

In oncological outpatient settings, patients often require nutritional support after they have developed malnutrition. A delayed dietetic referral can lead to increased difficulties in providing therapies and surgery, and to poorer patient outcomes. The audit described in this article aimed to assess the frequency and completeness of patient record documentation of anthropometric measurements in a day treatment unit (DTU) in a single cancer centre in the UK. The underlying goal was to improve anthropometry monitoring procedures to ensure that documentation is sufficient to indicate weight loss and, hence, allow timely referrals for nutrition support. The results show that, for over 80% of patients, it was not possible to identify a weight trend between the latest two treatments received at the hospital. The audit findings highlight the need to improve malnutrition monitoring and to ensure patient records contain updated and accurate anthropometric measurements in order to facilitate medical staff to recognise early malnutrition risk and refer for appropriate nutritional support when needed.

As part of its mandate from the European Commission, EFSA must review existing advice from the Scientific Committee for Food (SCF) on Dietary Reference Values (DRVs) for energy, macro‐ and micronutrients and other substances with a nutritional or physiological effect, including sodium and chloride. As part of preparatory work for this task, this part of the report summaries current general scientific information for the micronutrients sodium and chloride. Data has been collated via a literature review of published, peer reviewed scientific literature from two online databases: Google Scholar and PubMed. Information contained within a total of 146 documents for sodium and 85 documents for chloride has been evaluated and included. As well as describing the methodological approach, this report covers the occurrence, geology and chemistry of sodium and chloride; approaches to and limitations of the chemical analysis of clinical samples; the biological functions of sodium and chloride and an overview of the health consequences of sodium and chloride deficiency. In addition, sodium and chloride physiology and metabolism in healthy adults, biomarkers of intake, status and function and genotypes affecting metabolism are covered.

Background: 28% of children in England between 2 and 15 yr are  overweight or obese. TV  adverts  significantly  influence children's food choice. Food and drink products  high  in  fat salt and sugar (HFSS) are subject to TV scheduling and adver­ tising restrictions. However, this does not apply to family pro­ grammes which also have a  high  number  of  child  viewers.  This study aims to identify whether the proportions of  food groups advertised on peak-time family television meet recom­ mendations for a healthy balanced diet  portrayed  in  the  Eat­ well guide. Methods: Food and drink adverts were recorded between 17:00 and 20:00 on channel 4 for seven consecutive days in December 2016. Portion  sizes  of  products  from  70  adverts were estimated using carbs and cals. Then organised into food groups represented by the Eatwell Guide plus HFSS and  alco­ hol. One-sample Wilcoxon test was used  to  compare  food groups from individual adverts with those presented in  the Eatwell Guide. An 'EatAsAdvertised' model was  created  from the proportion of food groups from all adverts. Results: Three from five food groups from individual  adverts were significantly different from the  recommended  Eatwell Guide proportions. Carbohydrates and fruit & vegetables were 22% lower (p  =  0.0005,  p =  0.003,  respectively),  Protein  was  7% higher (p = 0.0005), oils  and  spreads  were  0.85%  lower (NS) and Dairy was 7% lower (NS) than in the Eatwell Guide. HFSS foods and alcohol represented 39% and 7%, respectively, however, comparisons are impossible as they are  not accounted for in the Eatwell Guide. Discussion: HFSS featured the most in EatAsAdvertised. Which, concurs with previous  data. Fast  food   companies (n = 25, 36%), contribut ed substantially to  this figure  suggest­ ing that regulation of HFSS food advertising is insufficient to prevent exposure to children. This may contribute to the £19.2 billion cost of diseases  associated  with obesity. Conclusion: The proportions of Starchy Carbohydrates, Pro­ tein, Fruit and Vegetables, HFSS and alcohol present in TV adverts did not correspond with the dietary guidelines repre­ sented in the Eatwell Guide. Suggesting that children are being exposed to messages via television that run contrary to public health guidance.

Background: Advertising is a powerful medium for food and drink promotion, which can influence public perceptions of 'normal'  food choices(  1 2       Food  and  drink  advertising  may  run contrary to current healthy eating guidance. Greater under­ standing of this phenomenon may create opportunities to sup­ port health promotion. This study aimed to  analyse  the content of foods represented in television advertising, in order to compare with the national dietary guidelines. Methods: Peak-time (7- 9 pm)  terrestrial  television  broadcast­ ing (ITV) was recorded for seven consecutive days during November 2015. One researcher estimated portion sizes of advertised meals in 53 adverts using a photographic food  por­ tion guide. Proportions (by food group)  were  compared  to dietary guidelines. Food group proportions within individual advertised meals were compared to corresponding Eatwell pro­ portions and analysed using Wilcoxon Signed  Rank  test  (on SPSS software). Estimated proportions of all food groups were represented as an 'EatAsAdvertised' model. Results: Almost all advertised food groups were significantly different to guidance: fruit and vegetables (F&V) were 35% smaller (P = 0.008), dairy was 5% lower (P = 0.039), and car­ bohydrates were 22% lower (P =  0.216)  whereas  protein  was 5% higher ( P = 0.005). Oils were not  advertised.  High  fat, sugar, and salt (HFSS) foods represented 35% of advertised. Discussion: The highest proportions of  food  advertised  were from the alcohol and HFSS group, yet these  now appear  exter­ nal (and unquantified) to the current Eatwell guide. This agrees  with   previous   research(  3 l  ,    which   also  identified   HFSS foods as the most commonly advertised (41 %), compared to protein (3%), F&V (4%), dairy (10%) and carbohydrate foods (20%).Thi s phenomenon may promote unhealthy food beha­ viours in conflict with the Eatwell Guide. Lack of quantifiable comparison guidance in the Eatwell guide model regarding alcohol and HFSS is a limitation of the tool, as is the seasonal nature of the advertising surveillance. Future research  may include adverts recorded over a longer time frame and at dif­ ferent times of year, as well as over multiple channels. Conclusion: The emphasis on high energy-density food and drink in UK television advertising, and underrepresentation of F&V, does not compare favourably to the Eatwell Guide.

Background: In areas of deprivation, where health inequalities exist, deficiencies in adolescent diets are amplified1 with long‐term health consequences. This study aimed to analyse relative percentage of food group consumption of adolescents’ diet in an underprivileged area.

Method: A secondary analysis of one hundred and seventeen seven‐day food diaries of 13–16 years olds from a state school in a deprived borough of Greater London was carried out as part of a larger study investigating the behavioural effects of supplementary nutrition2. Portion sizes according to manufacturers weights were used where available otherwise estimates were taken. All diaries were analysed including those completed with

Results: The average adolescent diet consisted of 29% fatty and sugary foods, 30% starchy foods, 18% meat and other proteins, 14% fruit and vegetables and 9% dairy foods. Adolescents consumed a mean average of 1.27 portions per day of fruit and vegetables. 68% of the sample had inadequate dairy intakes, but having breakfast cereal positively correlated to dairy consumption (r = 0.42 p

Discussion: The adolescent diet was of a poorer composition than Eatwell Plate guidelines. The typical diet showed limited variety with a reliance on nutrient poor and energy dense foods, which could have long‐term health consequences. 98% of these adolescents did not meet the NDNS mean average intake of 2.9 portions of fruit and vegetables3. However, the NDNS sample is derived from a more affluent and relatively small sample size and it may not be representative of deprived areas. 35% of adolescent's soft drink intake alone contributed to more than 10% of their daily energy intake, therefore exceeding the recently proposed guidelines for free sugars4. These alarming proportions may explain high levels of dental caries in the area and suggests that proposed 5% free sugar targets4 might be unrealistic for this population.

Conclusion: Food group analysis of adolescent diet in a deprived area suggests that there are significant variances between the percentages of food groups eaten in comparison to recommended National guidelines; fruit and vegetable intake at 1.27 portions per day versus 5‐a‐day target and 21% of the daily energy intake derived from snacks and soft drinks versus a free sugar target of 5% are particularly stark examples. Identifying these at risk populations and targeting public health initiatives towards correcting this poor food group dietary composition will be paramount in averting future health implications.

Background: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation is thought to be beneficial in the treatment of hypertriglyceridemia and rheumatoid arthritis (1–2). However supplement price can be variable. The primary aim of this study was to investigate the cost of using omega‐3 fatty acid supplements readily available on the UK market to meet EPA and DHA recommended intakes. The secondary aim of the study was to investigate whether there is a significant difference in the EPA and DHA content of premium and high street store own brand supplements.

Methods: Twelve products from a UK high street chemist online store were selected. Four products were categorised as ‘own brand’ supplements and eight as ‘premium brand’ supplements. Cost (£/mg EPA+DHA) for each product was determined and used to calculate the cost of meeting EPA and DHA intake recommendations. Seven recommendations were investigated: North Atlantic Treaty Organisation (NATO), 1989; European Academy of Nutritional Sciences (EANS), 1998; European Food Safety Authority (EFSA), 2010; International Society for the Study of Fatty Acids and Lipids (ISSFAL), 2004; National Heart Foundation of Australia (NHFA), 2008, American Heart Association (AHA), 2003 and Arthritis Research UK (ARUK), 2012. An independent samples t‐test was performed assess differences in the costs of meeting recommended intakes between product groups. An independent t‐test was performed to assess differences in total EPA and DHA content between product groups.

Results: No significant difference was found in EPA and DHA content between the own brand products and the premium brand products (own brand = 292.5 mg (±158.0); premium brand = 375.5 mg (±175.5); p = 0.445). A significant difference was found in the cost of meeting the recommended intakes between own brand and premium brand supplements (Table 1; (p = 0.018).

Discussion: The results of this study may be useful in evaluating cost effectiveness of omega‐3 supplementation in several medical conditions. The results indicate that the significant difference in cost of high street own brand and premium brand supplements is unlikely to be due to differences in EPA and DHA content. This is supported by the results of another study (3). Thus consumers may not need to purchase more expensive products in order to meet EPA and DHA recommended intakes. However these results may have limitations due to use of a single vendor and reliance on the manufacturers’ stated EPA and DHA content.

Conclusions: The results of this study indicate that there is a significant difference in the cost of meeting EPA and DHA recommendations using high street own brand and premium brand supplements, but there is no significant difference in the EPA and DHA content of supplements in these groups.

Background: Males represent less than 4% of registered dietitians within the UK (British Dietetic Association, 2014). To date little research has been conducted to investigate the views, influences, and experiences of student dietitians regarding this under representation in the UK. The aim of this study was to compare the views and experiences of student dietitians regarding the current gender representation within the profession.

Methods: All UK universities offering an under‐ and post‐graduate pre‐registration dietetics programme were invited to forward an online questionnaire to their dietetics students. The questionnaire, which was not pre‐piloted, included a combination of multiple choice, multiple response and Likert scale questions. Descriptive statistics were used to interpret questions. Where an appropriate response sample size (n > 5) allowed, Fisher's Exact test was used to determine significant differences between male and female responses. Ethical approval was obtained from the University of Hertfordshire's Health and Human Sciences Ethics Committee.

Results: From 14 universities, 11 confirmed forwarding the questionnaire to students. The study recruited 213 students, 21 of which were male. Significantly more males compared with females believed that increasing the number of males within dietetics would enhance the profession (95% vs. 72% respectively, p = 0.018). The majority of females (57% vs. 19% males) first discovered dietetics whilst in secondary school or sixth form; males more often (81% vs. 43% females) discovered the profession at a later stage. Of the 213 respondents, 25% (33% males vs. 24% females) agreed that there were discriminatory factors associated with males entering the profession, yet 4.7% of respondents (all female) reported there were discriminatory factors associated with females entering the profession. The majority of both males and females (76.2% vs. 63% respectively) agree that the profession should actively try to increase the number of males within dietetics.

Discussion: The majority of male and female respondents agreed that increasing the number of males within dietetics would enhance the profession. These findings concur with data from Canada (Lordly, 2012), which identified that the majority of the respondents also believed this to be the case when asked a similar question. However, the British Dietetic Association does not yet appear to have a strategy to promote the profession to the male population as part of diversity or widening participation agenda (British Dietetic Association, 2015). The reasons behind males discovering dietetics at a later stage in their life is unclear and warrants further investigation. The data suggest that recruitment strategies for males might benefit from targeting secondary school and sixth form students. Discrimination towards minorities within a profession still occurs (Shih, 2013) – a phenomenon discovered in the present study, albeit regarding entering the profession. It would be prudent to further define what the perceived discriminatory factors within dietetics are.

Conclusion: The findings suggest that an increase in the number of male dietitians could enhance diversity and the profession in general. It appears that discriminatory factors might exist, however the present study has not identified if these factors impact those entering or already within the profession.

Background: Many cultures encourage breastfeeding, yet formula milk is often given by choice in the UK. The Pakistani culture, however, exhibits high rates of breastfeeding as normal practice (1). The influence of the UK culture of formula feeding on a Pakistani mother's decisions to breastfeed was investigated. The aim of this qualitative study was to compare the views and experiences of breastfeeding from British Born Pakistani mothers (BBPMs) with Pakistani born mothers (PBMs; immigrated within last 10 years) in order to ascertain differences in influencing factors to breastfed.

Method: An interview was carried out on ten participants who were of Pakistani ethnicity and belonged to Ahmadiyya Muslim community of which the lead researcher is a member. The study was advertised by a brief announcement and held in the mosque before weekend events. Ethical approval was granted from University of Hertfordshire Ethics Committee. Participants were selected for interview on a first come first serve basis. The first five BBPMs and five PBMs participants, who agreed to take part were selected. They were given full information about the study, provided consent, and were interviewed in a private room. The interviewer used a semi‐structured questionnaire, the questions of which were informed by the breastfeeding literature. Each interview was audio recorded lasting 10–15 min. The interviews were transcribed manually and coded using thematic analysis, generating common themes. Theme saturation was reached after eight interviews.

Results: The participants ranged in age from 23 to 36 years. All the PBM were housewives, whereas all the BBPM had an occupation: teacher, pharmacist, nurse and a doctor. All the PBM breastfed for 12–24 months, whereas the BBPM breastfed for 1–4 months, with two BBPMs still breastfeeding.

Discussion: The general trend showed that PBM tend to breastfeed longer than BBPM, despite the research limitations (small study, single Islamic sect, limited range of occupations). Religion had equally the greatest influence on both groups. This concurs with previous research (3) and was not surprising as all participants were Muslim and the Quran gives direct guidance about breastfeeding. Culture was a theme that influenced decisions to breastfeed especially for PBM, as the Pakistani culture encourages involvement and support from relatives for breastfeeding‐ a factor known to increase breastfeeding (1). Education/occupation influenced BBPM decisions to breastfeed, also in line with previous research (2). A similar study (1) showed lower breastfeeding rates in Pakistani mothers in UK compared to mothers in Pakistan, however, there is limited research exploring the impact of acculturation on Pakistani mothers’ breastfeeding choices.

Conclusion: The three emergent themes could provide healthcare professionals with a greater understanding of different influencing factors between PBMs and BBPMs in order to encourage breastfeeding.

Nutrient deficiencies have been implicated in anti-social behaviour in schoolchildren; hence, correcting them may improve sociability. We therefore tested the effects of vitamin, mineral and n-3 supplementation on behaviour in a 12-week double-blind randomised placebo-controlled trial in typically developing UK adolescents aged 13–16 years (n 196). Changes in erythrocyte n-3 and 6 fatty acids and some mineral and vitamin levels were measured and compared with behavioural changes, using Conners’ teacher ratings and school disciplinary records. At baseline, the children’s PUFA (n-3 and n-6), vitamin and mineral levels were low, but they improved significantly in the group treated with n-3, vitamins and minerals (P=0·0005). On the Conners disruptive behaviour scale, the group given the active supplements improved, whereas the placebo group worsened (F=5·555, d=0·35; P=0·02). The general level of disciplinary infringements was low, thus making it difficult to obtain improvements. However, throughout the school term school disciplinary infringements increased significantly (by 25 %; Bayes factor=115) in both the treated and untreated groups. However, when the subjects were split into high and low baseline infringements, the low subset increased their offences, whereas the high-misbehaviour subset appeared to improve after treatment. But it was not possible to determine whether this was merely a statistical artifact. Thus, when assessed using the validated and standardised Conners teacher tests (but less clearly when using school discipline records in a school where misbehaviour was infrequent), supplementary nutrition might have a protective effect against worsening behaviour.

The present document has been produced and adopted by the bodies identified above as author(s). This task has been carried out exclusively by the author(s) in the context of a contract between the European Food Safety Authority and the author(s), awarded following a tender procedure. The present document is published complying with the transparency principle to which the Authority is subject. It may not be considered as an output adopted by the Authority. The European Food Safety Authority reserves its rights, view and position as regards the issues addressed and the conclusions reached in the present document, without prejudice to the rights of the authors.

Developmental dyslexia affects 5%–10% of the population [1], resulting in poor spelling and reading skills. While there are well-documented differences in the way dyslexics process low-level visual [2, 3] and auditory [4, 5] stimuli, it is mostly unknown whether there are similar differences in audiovisual multisensory processes. Here, we investigated audiovisual integration using the redundant target effect (RTE) paradigm. Some conditions demonstrating audiovisual integration appear to depend upon magnocellular pathways [6], and dyslexia has been associated with deficits in this pathway [7]; so, we postulated that developmental dyslexics (“dyslexics” hereafter) would show differences in audiovisual integration compared with controls. Reaction times (RTs) to multisensory stimuli were compared with predictions from Miller’s race model [8, 9]. Dyslexics showed difficulty shifting their attention between modalities; but such “sluggish attention shifting” (SAS) [10] appeared only when dyslexics shifted their attention from the visual to the auditory modality. These results suggest that dyslexics distribute their crossmodal attention resources differently from controls, causing different patterns in multisensory responses compared to controls. From this, we propose that dyslexia training programs should take into account the asymmetric shifts of crossmodal attention.

Background: Nutritional screening tools are central to identifying malnourished patients, but their efficacy is often reduced as a result of difficulties in obtaining height for body mass index (BMI) calculations. The present study aimed to evaluate the validity, reliability and acceptability of the Imperial Nutritional Screening System (INSYST); a tool that does not require the BMI.

Methods: Patients were screened by the researcher within 72 h of admission using INSYST I & II, Malnutrition Universal Screening Tool (MUST) and Mini Nutritional Assessment (MNA), including taking height and weight. Routine INSYST data, completed by nursing staff, were subsequently collected. At risk and malnourished patients were combined for statistical analysis. Inter‐tool and inter‐rater agreement (kappa, κ) was evaluated. Sensitivity and specificity were calculated. Nurses were timed using INSYST. Acceptability, including ease and speed of use, was evaluated.

Results: Kappa (agreement) scores (all P 

Conclusions: INSYST has shown promising levels of concurrent validity (versus MUST and MNA), inter‐rater reliability and acceptability, suggesting that BMI (and therefore height) is unnecessary for identifying malnourished patients.