A varied and diverse diet in childhood supports optimum long-term preferences and growth. Previous analysis from 14-month-old Australian children in the NOURISH and South Australian Infants Dietary Intake (SAIDI) studies found higher formula intake was associated with lower dietary diversity. This analysis investigated whether formula intake and dietary diversity at 14 months of age is associated with dietary quality at 24 months. This is a secondary analysis of intake data from NOURISH and SAIDI cohorts. Scores for dietary diversity, fruit variety, vegetable variety and meat/alternative variety were combined using structural equation modelling to form the latent variable 'Dietary quality' (DQ) at age 24 months. A longitudinal model examined influence of formula (grams), cow's milk (grams) and dietary diversity at 14 months and covariates, on DQ. At age 24 months (n = 337) 27% of children obtained a maximum dietary diversity score (5/5). Variety scores were relatively low - with mean variety scores (and possible range) being four for fruit (0-30); five for vegetables (0-36); and three for meat/alternatives (0-8). Dietary diversity at 14 months (β = 0.19, p = 0.001), maternal age (β = 0.24, p < 0.001) and education (β = 0.22, p < 0.001) predicted DQ at 24 months while Child Food Neophobia Score was negatively associated with DQ (β = -0.30, p < 0.001). Formula intake was negatively associated with diversity at 14 months, but not DQ at 24. Diversity and variety were limited despite sociodemographic advantage of the sample. Diversity at 14 months, degree of neophobia and sociodemographic factors predicted DQ at 24 months. There is an ongoing need to emphasise the importance of repeated early exposure to healthy foods, such that children have the opportunity to learn to like a range of tastes and texture, thereby maximising dietary diversity and quality in infancy and early toddlerhood.
Background: In patients who underwent lower limb amputation (LLA), the prevalence of malnutrition and its association with clinical outcomes are unclear. Objectives: This systematic review aims to identify literature and summarise existing information on (1) the prevalence of malnutrition in the patients with LLA and (2) the association between pre-operative nutritional status and post-surgery clinical outcomes in patients who require amputation. Methods: A search was conducted in four electronic databases (Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL and Scopus) to identify eligible studies. The search strategy was based on keywords – amputation, malnutrition and undernutrition. Article were included regardless of the study design; and if they were written in English; included adult patients with lower limb or foot amputation; and performed pre-amputation nutrition assessments. Results: Seven articles met the eligibility criteria. Malnutrition was assessed by biochemistry and/or anthropometry – none of which are validated nutrition assessment tools. Nevertheless, abnormal biochemistry and/or anthropometry results were associated with delayed wound healing, complications and failed amputation compared to normal ranges. The association between abnormal biochemistry and/or anthropometry parameters and mortality was less consistent. Only one study used a validated nutrition screen tool and found half of the population with LLA were at risk of malnutrition, but no association was reported. Conclusions: The association between malnutrition and clinical outcomes in patients who underwent LLA remains unclear as all the eligible studies that investigated association used unvalidated nutrition assessment tools. There is an urgent need to address this knowledge gap in future research.
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