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Item Exploring the Nutrition-Related Health of the Ageing Population in Fiji: A Narrative Review.(SAGE Publications, 2024-10-18) Naliva S; Kruger M; Havea P; Wham CFijis' older population aged 55 years and over makes up 14% of the total population and is expected to reach 20% by 2050. This narrative review aimed to examine the health and nutrition status of the aging population of Fiji and sociodemographic determinants. A search strategy was conducted throughout databases, and gray literature from relevant websites was searched. Due to the limited evidence regarding the nutrition, health, and socio-economic factors that impact the aging population in Fiji the inclusion criteria were broad and included both genders (male and female), all publications up until December 2022, all study designs, and gray literature (government/institutional reports, conference proceedings, guidelines, Act, and Policies) . There was no filter for date applied in the search criteria. Studies that did not meet the search criteria were excluded. 20 documents including published articles were included for analysis and result synthesis. Life expectancy at birth for the Fiji population is 68 years. A significant annual increase in mortality rate from endocrine, nutritional, and metabolic diseases has been observed in women aged 75+ but not older men. Women of low-income status are more at risk than men. However, as most investigations aggregate those ≥18 years, there is a lack of information on older adults (≥65 years) health and nutrition status. To improve the health status of older adults, an understanding of the nutritional status of older adults is warranted, especially concerning lifestyle and sociodemographic determinants.Item Secondary School Students and Caffeine: Consumption Habits, Motivations, and Experiences.(MDPI (Basel, Switzerland), 2023-02-17) Turner S; Ali A; Wham C; Rutherfurd-Markwick K; Cornelis M; Tauler PAdolescents may be particularly vulnerable to the effects of caffeine due to a lack of tolerance, their small size, changing brain physiology, and increasing independence. Concerns about adolescent caffeine consumption relate to potentially serious physiological and psychological effects following consumption. Motivations driving caffeine intake are not well understood among adolescents but are important to understand to reduce harmful behavioural patterns. This study explored caffeine consumption habits (sources, amount, frequency) of New Zealand adolescents; and factors motivating caffeine consumption and avoidance. The previously validated caffeine consumption habits questionnaire (CaffCo) was completed by 216 participants (15-18 years), with most (94.9%) consuming at least one caffeinated product daily. Chocolate, coffee, tea, and kola drinks were the most consumed sources. The median caffeine intake was 68 mg·day-1. Gender (boy) and being employed influenced the source, but not the quantity of caffeine consumed. One-fifth (21.2%) of adolescents consumed more than the recommended European Food Safety Authority (EFSA) safe level (3 mg·kg-1·day-1). Taste, energy, and temperature were the main motivators for consumption, and increased energy, excitement, restlessness, and sleep disturbances were reported effects following caffeine consumption. This study provides information on caffeinated product consumption among New Zealand adolescents, some of whom consumed caffeine above the EFSA safe level. Public health initiatives directed at adolescents may be important to reduce potential caffeine-related harm.Item Sarcopenia Prevalence and Risk Factors among Residents in Aged Care(MDPI (Basel, Switzerland), 2022-05-01) Darroch P; O'Brien WJ; Mazahery H; Wham CThe aim of this study was to investigate the prevalence of sarcopenia and associated risk factors among older adults living in three residential aged care (RAC) facilities within Auckland, New Zealand. A total of 91 older adults (63% women, mean age ± SD; 86.0 ± 8.3 years) were recruited. Using the European Working Group on Sarcopenia in Older People criteria, sarcopenia was diagnosed from the assessment of: appendicular skeletal muscle mass/height2, using an InBody S10 body composition analyser and a SECA portable stadiometer or ulna length to estimate standing height; grip strength using a JAMAR handheld dynamometer; and physical performance with a 2.4-m gait speed test. Malnutrition risk was assessed using the Mini Nutrition Assessment–Short Form (MNA-SF). Most (83%) of residents were malnourished or at risk of malnutrition, and 41% were sarcopenic. Multivariate regression analysis showed lower body mass index (Odds Ratio (OR) = 1.4, 95% CI: 1.1, 1.7, ρ = 0.003) and lower MNA-SF score (OR = 1.6, 95% CI: 1.0, 2.4, ρ = 0.047) were predictive of sarcopenia after controlling for age, level of care, depression, and number of medications. Findings highlight the need for regular malnutrition screening in RAC to prevent the development of sarcopenia, where low weight or unintentional weight loss should prompt sarcopenia screening and assessment.Item Tackling malnutrition with a new compact oral nutrient supplement among residents in aged care: a pilot study(CSIRO Publishing, 2022) O'Brien WJ; Jellicoe J; Mazahery H; Wham CIntroduction: There is a high prevalence of malnutrition among older adults entering residential aged care (RAC). Aim: To determine whether 60 mL of a compact oral nutrition supplement (ONS; daily total: 576 kcal, 35 g protein) consumed four times daily with medication rounds improves malnutrition status, body weight, and body composition measures among older adults in RAC. Methods: Residents (n = 20; mean age: 86.7 ± 6.8 years; 50% female) screened for malnutrition (20% malnourished, 80% at risk of malnutrition) using the Mini Nutritional Assessment-short form were recruited during April–June 2021. Participants received 60 mL of an ONS four times daily using the Medication Pass Nutrition Supplement Programme (Med Pass). The ONS intake and participant compliance were recorded. Body mass index, fat, and muscle mass (bioelectrical impedance), malnutrition risk, depressive symptoms, and quality of life were assessed at baseline and following the 18-week intervention. Results: Median overall compliance was 98.6%. An ONS intake did not significantly increase mean ± s.d. any body composition measures or improve health and wellbeing outcomes; however, it resulted in increased body weight and body mass index (BMI; 13/20 (65%) participants), body fat mass and percentage (10/16 (63%) participants) and muscle mass (9/16 (56%) participants). Malnutrition risk scores improved in 65% (13/20) of participants, resulting in 10% being assessed as malnourished, 65% at risk of malnutrition, and 25% with normal nutrition status. Discussion: Delivery of a compact oral nutrition supplement with the medication round was accepted by residents. Its efficacy in improving malnutrition risk and body composition among residents warrants further investigation.Item Enablers and barriers to prevent weight-regain post bariatric surgery - A qualitative enquiry(Elsevier Ltd, 2022-12) Billing-Bullen G; Nielsen D; Wham C; Kruger RBackground Weight-regain is commonly experienced after bariatric surgery. This qualitative enquiry aimed to explore participants' self-reported enablers and barriers to prevent future weight-regain post-surgery. Methods Eligible adults were recruited at 12-months post-bariatric-surgery at Counties Manukau, Auckland. Participants were invited to attend data collection at their 18-month group nutrition-education session, and to participate in a focus group at 21-months post-surgery. Thematic analysis was used to evaluate patient experiences. Results Participants (n = 28) were mostly female (73.2 %), New Zealand European (41.5 %), and had gastric sleeve surgery (92.3 %). Five key themes emerged from the analysis: A Life Changing Health Journey - participants experienced a decrease in obesity-related comorbidities and a subsequent decrease in medications. Weight change and food intolerances impacted quality of life. Challenge of managing a New Healthy Lifestyle - financial stress, buying healthier foods and social events were new challenges, often centred on food. Changing Eating Behavior - all participants struggled managing eating behaviors. Mindset Changes - post-surgery most participants had a positive mindset, increased confidence, and feelings of happiness. However, many struggled with mindset around weight and food. A need for On-going Support - most felt under-supported and expressed a need for longer, specific follow-up care. Conclusion Post-surgery group education sessions provided participants with increased support from both health professionals and peers on the same journey, to overcome struggles such as binge eating or identifying new coping strategies. Findings provide important insights into the challenges patients with bariatric surgery face and key learnings to develop specific supports for future care practices.Item Nutrient Dense, Low-Cost Foods Can Improve the Affordability and Quality of the New Zealand Diet-A Substitution Modeling Study(MDPI (Basel, Switzerland), 2021-07-27) Starck CS; Blumfield M; Keighley T; Marshall S; Petocz P; Inan-Eroglu E; Abbott K; Cassettari T; Ali A; Wham C; Kruger R; Kira G; Fayet-Moore FThe high prevalence of non-communicable disease in New Zealand (NZ) is driven in part by unhealthy diet selections, with food costs contributing to an increased risk for vulnerable population groups. This study aimed to: (i) identify the nutrient density-to-cost ratio of NZ foods; (ii) model the impact of substituting foods with a lower nutrient density-to-cost ratio with those with a higher nutrient density-to-cost ratio on diet quality and affordability in representative NZ population samples for low and medium socioeconomic status (SES) households by ethnicity; and (iii) evaluate food processing level. Foods were categorized, coded for processing level and discretionary status, analyzed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods were 56% unprocessed (vegetables, fruit, porridge, pasta, rice, nuts/seeds), 31% ultra-processed (vegetable dishes, fortified bread, breakfast cereals unfortified <15 g sugars/100 g and fortified 15–30 g sugars/100 g), 6% processed (fruit juice), and 6% culinary processed (oils). Using substitution modeling, diet quality improved by 59% and 71% for adults and children, respectively, and affordability increased by 20–24%, depending on ethnicity and SES. The NZ diet can be made healthier and more affordable when nutritious, low-cost foods are selected. Processing levels in the healthier, modeled diet suggest that some non-discretionary ultra-processed foods may provide a valuable source of low-cost nutrition for food insecure populations.Item Malnutrition Risk: Four Year Outcomes from the Health, Work and Retirement Study 2014 to 2018(MDPI (Basel, Switzerland), 2022-05-26) Wham C; Curnow J; Towers AThis study aimed to determine four-year outcomes of community-living older adults identified at 'nutrition risk' in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49-87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time.Item Motivations for Caffeine Consumption in New Zealand Tertiary Students(MDPI (Basel, Switzerland), 2021-11-25) Stachyshyn S; Wham C; Ali A; Knightbridge-Eager T; Rutherfurd-Markwick KCaffeine-related health incidents in New Zealand have escalated over the last two decades. In order to reduce the risk of substance-related harm, it is important to understand the consumers' motivations for its use. This is especially true for tertiary students who are presumed to be at a higher risk due to seeking out caffeine's well-known cognitive benefits as well as the targeted marketing of such products to young adults. This study examined the habits and motivations for caffeine consumption in tertiary students in New Zealand. A previously validated caffeine consumption-habits (CaffCo) questionnaire was administered online to 317 tertiary students (n = 169 females), aged ≥16 years. Of the 99.1% of participants who regularly consumed caffeine, coffee (76.3%) tea (71.6%) and chocolate (81.7%) consumption were the most prevalent. Motivations for caffeinated-product consumption differed according to caffeine source. Tea was consumed for the warmth and taste, coffee was consumed to stay awake and for warmth, and chocolate, for the taste and as a treat. Marketing was not identified by participants as influencing their consumption of caffeinated products. Knowledge of motivations for caffeine consumption may assist in identifying strategies to reduce caffeine intake in those New Zealand tertiary students who regularly consume amounts of caffeine that exceed safe level.Item Caffeine Consumption Habits of New Zealand Tertiary Students(MDPI (Basel, Switzerland), 2021-04-28) Stachyshyn S; Ali A; Wham C; Knightbridge-Eager T; Rutherfurd-Markwick KAdverse effects associated with excessive caffeine consumption combined with increasing numbers and availability of caffeine-containing products are causes for concern. Tertiary students may be at increased risk of consuming excessive amounts of caffeine due to seeking caffeinated products with well-known wakefulness effects and cognitive benefits. This study explored caffeine consumption habits of New Zealand tertiary students (317; ≥16-years) using a previously validated caffeine consumption habits (CaffCo) questionnaire. Most (99.1%) regularly consumed caffeinated products, especially chocolate, coffee and tea, with coffee, tea and energy drinks contributing most to total caffeine intake. Median estimated caffeine intake was 146.73 mg·day-1, or 2.25 mg·kgbw-1·day-1. Maximum and minimum intakes were 1988.14 mg·day-1 (23.51 mg·kgbw-1·day-1) and 0.07 mg·day-1 (0.02 mg·kgbw-1·day-1), respectively. One-third (34.4%) of caffeine consumers ingested caffeine above the adverse effect level (3 mg·kgbw-1·day-1) and 14.3% above the safe limit (400 mg·day-1). Most caffeine consumers (84.7%), reported experiencing at least one 'adverse symptom' post-caffeine consumption, of which 25.7% reported effects leading to distress or negatively impacting their life. Experiencing 'adverse symptoms' did not, however, curtail consumption in the majority of symptomatic participants (~77%). Public health initiatives directed at tertiary students may be important to reduce potential caffeine-related harm.Item Is the Utility of the GLIM Criteria Used to Diagnose Malnutrition Suitable for Bicultural Populations? Findings from Life and Living in Advanced Age Cohort Study in New Zealand (LiLACS NZ)(Springer Nature, 2023-01) MacDonell SO; Moyes SA; Teh R; Dyall L; Kerse N; Wham CObjectives To investigate associations between nutrition risk (determined by SCREEN-II) and malnutrition (diagnosed by the GLIM criteria) with five-year mortality in Māori and non-Māori of advanced age. Design A longitudinal cohort study. Setting Bay of Plenty and Lakes regions of New Zealand. Participants 255 Māori; 400 non-Māori octogenarians. Measurements All participants were screened for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II). Those at high nutrition risk (SCREEN-II score <49) had the Global Leadership Initiative in Malnutrition (GLIM) criteria applied to diagnose malnutrition or not. Demographic, physical and health characteristics were obtained by trained research nurses using a standardised questionnaire. Five-year mortality was calculated from Government data. The association of nutrition risk (SCREEN-II) and a malnutrition diagnosis (GLIM) with five-year mortality was examined using logistic regression and cox proportional hazard models of increasing complexity. Results 56% of Māori and 46% of non-Māori participants had low SCREEN-II scores indicative of nutrition risk. The prevalence of GLIM diagnosed malnutrition was lower for both Māori and non-Māori (15% and 19% of all participants). Approximately one-third of participants (37% Māori and 32% non-Māori) died within the five-year follow-up period. The odds of death for both Māori and non-Māori was significantly lower with greater SCREEN II scores (better nutrition status), (OR (95% CI); 0.58 (0.38, 0.88), P < 0.05 and 0.53 (0.38, 0.75), P < 0.001, respectively). GLIM diagnosed malnutrition was not significantly associated with five-year mortality for Māori (OR (95% CI); 0.88 (0.41, 1.91), P >0.05) but was for non-Māori. This association remained significant after adjustment for other predictors of death (OR (95% CI); 0.50 (0.29, 0.86), P< 0.05). Reduced food intake was the only GLIM criterion predictive of five-year mortality for Māori (HR (95% CI); 10.77 (4.76, 24.38), P <0.001). For non-Māori, both aetiologic and phenotypic GLIM criteria were associated with five-year mortality. Conclusion Nutrition risk, but not malnutrition diagnosed by the GLIM criteria was significantly associated with mortality for Māori. Conversely, both nutrition risk and malnutrition were significantly associated with mortality for non-Māori. Appropriate phenotypic criteria for diverse populations are needed within the GLIM framework.