Journal of Human Nutrition and Dietetics

The UK dietary guidelines for cardiovascular disease acknowledge the importance of long‐chain omega‐3 polyunsaturated fatty acids (PUFA) – a component of fish oils – in reducing heart disease risk. At the time, it was recommended that the average n‐3 PUFA intake should be increased from 0.1 to 0.2  g day⁻¹. However, since the publication of these guidelines, a plethora of evidence relating to the beneficial effects of n‐3 PUFAs, in areas other than heart disease, has emerged. The majority of intervention studies, which found associations between various conditions and the intake of fish oils or their derivatives, used n‐3 intakes well above the 0.2 g day⁻¹ recommended by Committee on Medical Aspects of Food Policy (COMA). Furthermore, in 2004, the Food Standards Agency changed its advice on oil‐rich fish creating a discrepancy between the levels of n‐3 PUFA implied by the new advice and the 1994 COMA guideline. This review will examine published evidence from observational and intervention studies relating to the health effects of n‐3 PUFAs, and discuss whether the current UK recommendation for long‐chain n‐3 PUFA needs to be revisited.

Background  The relationship between socioeconomic position (SEP) and diet has been examined mainly on the basis of food and nutrient intake. As a complement to this work, we focused on the socioeconomic patterning of food purchasing, as many educational dietary messages emphasize behaviours such as food choice when shopping. Also, the type of food people buy influences the quality of their nutrient intake.

Methods  A probability sample of households in Brisbane City, Australia (n = 1003, 66.4% response rate). Data were collected using face‐to‐face interviews. SEP was measured using education, occupation and household income. Food purchasing was examined on the basis of grocery items (including meat and chicken) and fruit and vegetables.

Results  Significant associations were found between each socioeconomic indicator and food purchasing. Persons from socioeconomically disadvantaged backgrounds were less likely to purchase grocery foods that were comparatively high in fibre and low in fat, salt and sugar. The least educated, those employed in blue‐collar (manual) occupations and residents of low income households purchased fewer types of fruit and vegetables, and less regularly, than their higher status counterparts.

Conclusions  Health promotion efforts aimed at narrowing socioeconomic differences in food purchasing need to be designed and implemented with an understanding of, and a sensitivity to, the barriers to nutritional improvement that difficult life circumstances can impose.

The Digital Photography of Foods Method accurately estimates the food intake of adults and children in cafeterias. When using this method, images of food selection and leftovers are quickly captured in the cafeteria. These images are later compared with images of ‘standard’ portions of food using computer software. The amount of food selected and discarded is estimated based upon this comparison, and the application automatically calculates energy and nutrient intake. In the present review, we describe this method, as well as a related method called the Remote Food Photography Method (RFPM), which relies on smartphones to estimate food intake in near real‐time in free‐living conditions. When using the RFPM, participants capture images of food selection and leftovers using a smartphone and these images are wirelessly transmitted in near real‐time to a server for analysis. Because data are transferred and analysed in near real‐time, the RFPM provides a platform for participants to quickly receive feedback about their food intake behaviour and to receive dietary recommendations for achieving weight loss and health promotion goals. The reliability and validity of measuring food intake with the RFPM in adults and children is also reviewed. In sum, the body of research reviewed demonstrates that digital imaging accurately estimates food intake in many environments and it has many advantages over other methods, including reduced participant burden, elimination of the need for participants to estimate portion size, and the incorporation of computer automation to improve the accuracy, efficiency and cost‐effectiveness of the method.

Aim  The aim of this study was to explore the dilemmas experienced by women and men in their everyday lives in relation to their coeliac disease, and to explore the qualities of these dilemmas in relation to specific situations and living conditions.

Methods  We interviewed 43 informants, aged 20–40 years, using ‘The Critical Incident Technique’. Interviews focused on situations that gave rise to confusion or discomfort in relation to disease. The interviews were transcribed verbatim and analysed qualitatively.

Results  We found 195 dilemmas, experienced in five arenas: food situation at work, during purchases, when travelling, in relation to meals at home and meals outside the home. Emotions, relationships and the management of daily life were the three main categories of dilemmas that emerged through the analysis. Specific emotions were experienced in relation to the disease, such as isolation, shame, fear of becoming contaminated by gluten and worries about being a bother. In the relationship with other persons the informants experienced a number of complicating dilemmas such as unwanted visibility, neglect, being forgotten, disclosure avoidance and risk taking. Dilemmas related to the management of daily life were restricted product choice, double work and constantly being on call.

Conclusions  The lived experiences of coeliac disease were more varied and profound than expected. It is important to take psychological and social aspects into account in the treatment of patients with coeliac disease.

Background  Most estimates of nutritional status rely on accurate recording of not only body weight but also height. Standing height is difficult to measure accurately in older adults due to mobility problems and kyphosis. Surrogate methods have been developed to estimate height including arm‐span, demi‐span and knee height. There are currently little data on the accuracy of these methods in the sick elderly population or which method is the most suitable in the clinical situation.

Objective  To compare three commonly used clinical measurements that can estimate height and analyse their agreement with current height. Also to evaluate which method can be used most frequently.

Methods  We used data collected as part of a larger intervention trial, in which elderly in‐patients (over 65 years), were measured for demi‐span, half arm‐span, knee height and standing height.

Results  The results showed that demi‐span and half arm‐span could be measured in the largest proportions of our population, 75.6 and 72.3%, respectively. The correlation coefficients were high for all three estimates of height, r = 0.86 for demi‐span, r = 0.87 for arm‐span, and r = 0.89 for knee height (P < 0.0001 for all three). However, agreement analysis demonstrated very poor agreement between standing height and all the methods of estimation. The mean differences were 4.33 cm for demi‐span, 7.04 cm for arm‐span and −0.6 cm for knee height.

Parents represent a potentially powerful intermediary in behaviour change strategies aimed at improving the lifestyle behaviours of young children. However, to fulfil this role, parents need to have the necessary knowledge and motivation to assimilate dietary guidelines. This study aimed to assess these psychosocial constructs, and subsequent parental receptiveness to nutrition education, through investigation of the barriers and benefits perceived by parents to the provision of a healthy diet and adequate exercise for their children. A qualitative methodology was employed and 41 parents took part in seven focus groups separated by socio‐economic status (SES).

Across the groups, a combination of reported external barriers and unconscious internal barriers, stemming from high optimistic bias, low perceived control and unrealistic health expectations, were observed. SES differences were suggested in restrictive feeding practices, the responsibility attributed to the school and in the level and format of desired nutrition education. Overall a demand for interventions focusing on behavioural techniques rather than fact transmission was uncovered, in particular the promotion of parental self‐awareness to reduce negative influences within the family food environment. Providing realistic definitions of appropriate behaviour and empowering parents to tackle children's weight issues were indicated as important targets for future education programmes.