Towards a Standardized Definition of Medical Nutrition Therapy and Regulatory Reform in Canada

Various definitions have been proposed to describe Medical Nutrition Therapy (MNT). Broadly, MNT encompasses the provision of nutrition information and advice aimed to prevent, treat, and/or manage health conditions. In Canada, the provision of such information and advice is unregulated, thus allowing anyone to provide MNT services regardless of their education and training. This inevitably poses risks of harm such as the provision of unsafe and/or ineffective nutrition advice as well as delayed evidence-based treatment. Canadian research has further demonstrated that the general public is unable to properly differentiate between regulated, evidence-based nutrition providers (registered dietitians) and those who are unregulated. Therefore, the public is at risk. To reduce nutrition misinformation and ultimately improve the health and well-being of the public, the objective of this paper is, first, to propose a standardized definition of MNT for use across Canada and, second, to propose province- and territory-specific legislative amendments for the regulation of MNT throughout the country. We also present an opposing perspective to the proposed viewpoint. Ultimately, health care regulation across the country requires an overhaul before we expect that nutrition information and advice communicated to the public may be consistently evidence based.

Identifiable Dietary Patterns of Pregnant Women: A Canadian Sample

Purpose: To estimate the percentage of a sample of pregnant women in Canada following a vegetarian, vegan, low-carbohydrate, gluten-free, Mediterranean, or well-balanced diet, before and during pregnancy and to explore if pregnant women received and were satisfied with nutrition information received from health care providers (HCPs). Methods: Participants were conveniently sampled through Facebook and Twitter. An online survey collected data on sociodemographic characteristics, maternal diet, and whether women received and were satisfied with nutrition information from their HCPs. The McNemar test assessed changes in the proportion of diets followed before and during pregnancy. Results: Of 226 women, most followed a well-balanced diet before (76.9%) and during (72.9%) pregnancy (p = 0.26). Vegetarian, gluten-free, vegan, and low-carbohydrate diets were the least followed diets before and during pregnancy (vegetarian: 7.6% vs 5.3%; gluten-free: 4.9% vs 4.0%; vegan: 2.7% vs 2.2%; low-carbohydrate:4.0% vs 0.4%). Overall, the number of women following restrictive diets before pregnancy was significantly reduced throughout pregnancy (19.1% vs 12.0%, p < 0.001). Only 52.0% of women received nutrition information from their primary HCP, and 35.6% were satisfied with the nutrition information received. Conclusions: Most women followed a well-balanced diet before and during pregnancy and approximately one-third were satisfied with the information received from HCPs.

Nutrition education incorporation into mainstream primary school curriculum in Ghana: Stakeholders’ sources of nutrition information and perceived barriers

Introduction Nutrition literacy has been cited as a crucial life skill. Nutrition education as a primary school subject has been treated inconsequentially when compared to other subjects. We investigated an aspect of the current state of nutrition education in Ghana by engaging stakeholders about their sources of nutrition information and the perceived barriers in implementing nutrition education in mainstream primary schools. Methods Three hundred and fifty one (351) primary school children, 121 homebased caregivers, six schoolteachers, two headteachers, two Ghana Education Service (GES) officials, and six school cooks were involved in the study. Surveys were used to collect data on nutrition information acquisition behaviors and to record perceived barriers. Key Informant Interviews were conducted among GES officials, headteachers, schoolteachers and school cooks, while Focus Group Discussions were used among homebased caregivers and children to gather qualitative information. Results Only 36.3% of the primary school children had heard about nutrition, and 71% of those got nutrition information from their family members. About 70% of homebased caregivers had heard or seen nutrition messages, and their source of nutrition information was predominantly traditional media. Schoolteachers mostly received their nutrition information from non-governmental organizations and the Internet, while most of the school cooks stated their main source of nutrition information was hospital visits. Perceived barriers included schoolteachers’ knowledge insufficiency, and lack of resources to adequately deliver nutrition education. Lack of a clear policy appeared to be an additional barrier. Conclusion The barriers to the implementation of nutrition education in the mainstream curriculum at the primary school level that were identified in this study can be resolved by: providing schoolteachers with learning opportunities and adequate nutrition education resources for practical delivery, having specific national policy framework, and including family members and school cooks in the nutrition education knowledge and information dissemination process.

Label information, nutritional composition and screening for bromate in breads sold in Umuahia, Abia State, Nigeria

Non-use of potassium bromate in bread making and printing of reproducible nutrition information/claims on bread labels are vital for consumers’ rights and protection in Nigeria. These norms are rarely observed by bread makers in Umuahia. This study evaluated nutrition information on labels, presence of potassium bromate, chemical composition and sensory characteristics of breads sold in Umuahia. Two structured questionnaires were constructed. The first was administered to 15 randomly selected full-time bread vendors in Umuahia metropolis to identify brands of market bread. The second was designed to analyze sensory quality of breads. Five sliced and five unsliced bread samples randomly selected from identified markets were analyzed for sensory properties using a 20-member sensory panelist, and for nutrient and phytochemical composition. Twenty-seven bread samples were identified; all labeled bromate-free, had varying recipes and nutrient claim/information on labels. The bread samples were bromate-free, high in carbohydrate (49.20% in B10 to 65.69% in B8) and moisture (22.67% in B8 to 38.16% in B10), but relatively low in crude protein (6.65% in B3 to 9.45% in B7) and fat (0.26% in B8 to 0.66% in B1). Ash contents ranged from 1.26% in B6 to 1.86% in B3and fiber contents from 1.24% in B2 to 1.76% in B5. Phytonutrients were low; and oxalate content ranged from 0.66 to 0.95%, tannin from 87.78 to 125.40 mg 100g–1 and phytate from 2.02 to 3.03 mg 100g–1. The bread samples had sensory scores ranging from 4.60 to 8.10 for over-all acceptability. They were all acceptable to panelists, but with B1 (sliced) and B8 (unsliced) most acceptable. Bread samples sold in Umuahia were bromate-free, varied in recipe, nutrition claims, and nutrient composition but were acceptable to panelists.

Relating aspects of adolescents’ critical nutrition literacy at the personal level

Efforts targeting adolescents’ dietary behaviour have often focused on improving their access to nutrition information; however, adolescents report finding nutrition information difficult to understand. Exploring adolescents’ critical nutrition literacy might provide insight into how best to improve their use of available nutrition information. Purpose The purpose of this article is to explore how the two aspects of the critical nutrition literacy - critical evaluation of nutrition information’ and ‘engagement in dietary behaviour’ are linked at personal level. Additionally, the study sought to establish the association between critical nutrition literacy and self-efficacy in nutrition related subjects. Methods Applying a cross-sectional study design, the study sampled 1622 adolescents aged 15-16years, enrolled in 58 secondary schools in Norway. The adolescents responded to scales measuring self-efficacy and CNL. Using Lisrel 9.30, the study evaluated a structural equation model linking CNL and SEBH. Results The study yielded a simple yet theoretically sound model depicting the link between CNL and self-efficacy. Conclusion Efforts promoting adolescents’ nutrition literacy might benefit from increasing their self-efficacy in nutrition-related subjects.

Information seeking behaviors, attitudes, and beliefs about pregnancy-related nutrition and supplementation: A qualitative study among US women

Background: Maternal behavior during pregnancy is crucial to her own and her infant's health, and as such, it is important to understand the nutrition and supplement habits of women during pregnancy and what informs those behaviors. Aim: We aimed to assess the information seeking habits, attitudes, and beliefs about pregnancy-related nutrition and supplementation among pregnant women in the United States. Methods: Qualitative study using key informant interviews with pregnant and recently pregnant ( n = 21) US women. Themes related to concerns, attitudes, behaviors, and information seeking habits were extracted. Results: The mean age was 31.9 years and all had at least a university degree. Two major themes that emerged: (1) nutrition information-related attitudes and beliefs and (2) food and supplement-related attitudes and beliefs. Pregnant women in the US were underwhelmed with their health care provider experience when receiving information about pregnancy-related nutrition and supplementation. Nutrition was most often addressed in a reactive manner while women desired a more proactive approach. As a result, they conducted their own research using the internet as their primary tool, and ultimately made nutrition and supplement decisions based largely on their own instincts. Conclusion: Women interviewed for this study encountered barriers to pregnancy related nutrition information from a lack of clear communication from their health care provider and ambiguity and inconsistencies in information within and between sources. Women relied on themselves for information seeking and nutrition related decision making throughout their pregnancy.

Associations between socio-demographics, nutrition knowledge, nutrition competencies and attitudes in community-dwelling healthy older adults in Singapore: findings from the SHIELD study

Background Nutrition literacy refers to an individual’s knowledge, motivation and competencies to access, process and understand nutrition information to make nutrition-related decisions. It is known to influence dietary habits of individuals including older adults. This cross-sectional study was designed to: (1) understand the nutrition knowledge, competencies and attitudes of community-dwelling older adults in Singapore, (2) examine the differences between their nutrition knowledge, and socio-demographic factors, competencies and attitudes and (3) identify factors associated with better nutrition knowledge in older healthy adults in Singapore. Methods A total of 400 (183 males and 217 females) nourished community-dwelling older adults aged 65 years and above took part in this study. Malnutrition Universal Screening Tool (MUST) was used to determine individuals who were at low risk of undernutrition. Nutrition knowledge, competencies, attitudes and sources of nutrition information were measured using a locally developed scale. Nutrition knowledge scores were summed to form the nutrition knowledge index (NKI). Associations between NKI, competencies, attitudes and socio-demographic variables were examined using Chi-square and Fisher’s exact tests. Factors associated with NKI were determined using a stepwise regression model with resampling-based methods for model averaging. Results Bivariate analyses found significant differences in NKI scores for gender, monthly household earnings, type of housing, the self-reported ability to seek and understand nutrition information and having access to help from family/friends. Females had higher NKI scores compared to males (p < 0.001). Compared to females, more males left food decisions to others (p < 0.001), and fewer males reported consuming home-cooked food (p = 0.016). Differences in educational level were found for competencies like the self-reported ability to seek (p < 0.001) and verify nutrition information (p < 0.001). Stepwise regression analysis showed that being female, Chinese, self-reported ability to understand nutrition information and having access to help from family/friends were associated with higher NKI scores. Conclusions Our study revealed that nutrition knowledge of older males in Singapore was lower than females and more left food decisions to others. Nutrition education programs could be targeted at both the older male, their caregivers and minority ethnic groups. Trial Registration This study was registered on 7 August 2017 at clinicaltrials.gov (ref. NCT03240952).

Essential food and nutrition knowledge and skills for primary school children: Australian parents' opinions

PurposeThis paper examines the views of Australian primary school parents regarding the food and nutrition education (FNE) curriculum. Associations with personal values (Universalism and Hedonism) and demographic measures were also explored.Design/methodology/approachAn online survey was conducted among 787 parents in March 2021. Parents rated the importance of 17 FNE topics. They were also asked about their support for six curriculum improvements and to state their own improvement suggestions.FindingsParents viewed the “Effect of food on health” and “Food hygiene” as the most important topics. Three FNE components were derived: (1) food safety and preparation, (2) health and nutrition information, (3) food origins and environmental sustainability. The “Food safety and preparation” component score was associated with both universalism-nature and hedonism values but negatively associated with parental education. The “Health and nutrition information” component score was associated with universalism-nature value and main language spoken at home. Lastly, the “Food origins and environmental sustainability” component score was associated with universalism-nature value. The two personal values, universalism-nature and hedonism, were more strongly associated with parents' views of curriculum topics than parental demographic characteristics. Parents had several criticisms of current FNE, including school food environments not resonating with FNE taught in the classroom and that FNE might increase the risk of eating disorders. They also suggested that the FNE curriculum should support both parents and teachers by providing relevant resources and training.Originality/valueAustralian parents' views of the importance of FNE topics and how to improve FNE in primary schools have been under-examined.