Objective:To develop and implement a nutrition screening and dietetic referral system for Home and Community Care (HACC) eligible clients. Design: Quality improvement project utilising a prospective, observational design. Setting: Sixteen Australian organisations caring for HACC eligible clients. Subjects: One thousand one hundred and forty-five HACC eligible clients (mean age 76.5 Ϯ 7.2 years) were screened for nutritional risk during 2003-2005. Interventions: Nutrition screening was conducted by trained project officers, allied health staff, community care coordinators and nursing staff using a modified version of the malnutrition screening tool (MST). Dietitians performed a nutrition assessment using the scored Patient Generated-Subjective Global Assessment (PG-SGA) and provided individualised nutrition counselling for those identified to be at risk of malnutrition and agreeing to treatment. Results: According to the MST, 170 clients (15%) were identified as being at risk of malnutrition. Of these, 75 (44%) agreed to the dietetic referral and PG-SGA assessment, and 57 were subsequently assessed as malnourished (PG-SGA category B or C), suggesting a malnutrition prevalence between 5% and 11%. Of the 34 malnourished clients receiving multiple dietetic reviews (mean 4.1 Ϯ 2.0 per client), 28 improved, with 17 achieving a well-nourished PG-SGA A rating. Conclusion: The development and implementation of a nutrition screening and referral system can identify HACC eligible clients who would benefit from services provided by a dietitian. Further research should identify the reasons why some HACC eligible clients are reluctant to be referred to a dietitian.

INTRODUCTION Activity based weight loss programmes may result in modest reductions in weight. Despite the small successes demonstrated by these interventions, there are few examples that specifically address the disparity of obesity for Māori compared to non-Māori. AIM This research highlights the results of a Kaupapa Māori fitness and exercise programme that aimed to assist mainly Māori adults, to lose weight. The programme was designed to support participants by using Māori cultural values. METHODS A Muay Thai kickboxing exercise programme was developed with community involvement. Kaupapa Māori principles underpinned the programme, such as whanaungatanga and tino rangatiratanga. Ninety-three participants were followed for at least 3 months. Participants' blood pressure, weight, body mass index, mental wellbeing scores, and waist and hip circumferences were collected at regular intervals. Multiple linear models were used to calculate estimated changes per 100 days of the programme. RESULTS The mean duration of participation was 214 days. The estimated weight loss per participant per 100 days was 5.2 kg. Statistically significant improvements were noted in blood pressure, waist and hip circumference, systolic blood pressure and mental wellbeing. DISCUSSION The improvements in physical and mental wellbeing are thought to have stemmed, in part, from the use of Kaupapa Māori principles. The success of this programme strengthens the argument that programmes aiming to address the precursors of chronic disease need to be designed for Māori by Māori in order to reduce health inequities.

A survey of nutritional status and dietary problems in adults with learning disabilities aged 20-50 years and living in the general community is reported. The frequency of overweight (BMI 25-30) and obese (BMI >30) women (and in Down Syndrome subjects both men and women) was more than twice that in their community controls. No significant difference in BMI categories was found in the men. Hypertension and hypercholesterolaemia were more frequent in overweight and obese learning disabled women than in their community counterparts. These results indicate a need for specific nutrition education programmes, in concert with proper nutritional assessment and dietary intervention.

An in tervention was designed to improve the nutrition of underweight persons with multiple disabi fities who tived in a large institution. They were given an enriched diet, with increased energy density, for a year. Measurements of anthropometric status, biochemical status and cfinical measures such as antibiotic and suppository usage, were taken before the intervention, at 6 months, and at t 2 months. Basefine measures of the 6 9 subjects showed that they were severely underweight, and had levels of vitamin [9, folate, haemoglobin, and ferritin which were all either low or borderline. Thirty-two individuals had vitamin D levels below the normal range. After 12 months on the diet there were significant improvements in weight, in serum calcium and serum vitamin D levels, and in haematological status. Rates of intercurrent infections were significantly less than in the same season of the previous year. Constipation had signiflcantly diminished. Itwas concluded that dietarytreatment is worth tryingfor similar groups, although it is not possible to claim that dietary trea tm ent was the sole cause of these changes.Persons with severe intellectual disability and multiple disabilities are among the most needy of the disabled population. They require support for all the acts of daily living, and often must be fed by others. Their qualiw of life is dependent on being well nourished. However there is evidence that their nutrition is often inadequate.1Address forcorrespondence: J Intellect Dev Dis Downloaded from informahealthcare.com by University of Auckland on 12/12/14For personal use only.