Using the theoretical domains framework to inform strategies to support dietitians undertaking body composition assessments in routine clinical care

BACKGROUND

Malnutrition, sarcopenia and cachexia are clinical wasting syndromes characterised by muscle loss. Systematic monitoring by body composition assessment (BCA) is recommended for the diagnosis, treatment and monitoring of the syndrome(s). This study investigated practices, competency, and attitudes of Australian dietitians regarding BCA, to inform a local implementation process.

METHODS

Applying the Action cycle in the Knowledge to Action framework, surveys were distributed to the 26 dietitians of an 800-bed tertiary hospital. The survey assessed barriers and enablers to performing routine BCA in clinical care. Results were categorised using the Theoretical Domains Framework (TDF) and suitable interventions mapped using the Behaviour Change Wheel.

RESULTS

Twenty-two dietitians (84.6%) completed the survey. Barriers to BCA were identified in all TDF domains, particularly in Knowledge, Skills, Social/professional role and identity, Beliefs about capabilities, and Environmental context and resources. Enablers existed in domains of: Skills; Beliefs about consequences; Goals; Environmental context and resources; Social influences; Intentions; Optimism; Reinforcement.

CONCLUSIONS

This study showed that hospital dietitians experience individual, team, and organisational barriers to adopt BCAs in clinical practice. We were able to formulate targeted implementation strategies to overcome these barriers to assist BCA adoption into routine practice.

The effect of caloric supplementation on selected milk protective factors in undernourished Guatemalan mothers

The level and avidity indices of specific antibodies against tetanus toxoid, Escherichia coli O6 and a pool of 10 common E. coli O antigens, as well as the concentration and daily output of lactoferrin and total secretory IgA (SIgA), were evaluated in the milk of moderately undernourished mothers who were in a random blind design divided into two groups and given different caloric supplementations. Group A received a high caloric supplement (500 kcal/d), and group B received a low caloric supplement (140 kcal/d). Determinations were done using ELISA in various modifications, except for lactoferrin, which was quantified by single radial immunodiffusion. The avidity indices were investigated as an evaluation of the antibody quality. In all the parameters evaluated, the only difference found between the two groups at the end of the supplementation period was in the content of total SIgA, which was lower in group B, both in concentration and daily output. However, the SIgA remained within the normal range. Increases as well as decreases in the levels of specific IgA antibodies occurred within both groups. Avidity was decreased in group B only against one of the antigens tested. We conclude that moderate undernutrition does not impair the levels of milk antibodies, and supplementation does not enhance them but prevents the decrease in the content of total milk SIgA. There is a suggestion that the avidity of certain antibody specificities could be hampered.