Experiences of healthcare practitioners providing nutrition care to people with cancer in New Zealand: A qualitative study

Aim: To explore the perspectives and experiences of healthcare practitioners in providing nutrition care to people with cancer in New Zealand. Methods: Semi-structured interviews were conducted with 16 New Zealand healthcare professionals (HCPs) practicing in specialist secondary and tertiary cancer care (both public and private) who had previously completed an online survey about nutrition in cancer care. Interviews were recorded and transcribed verbatim, and thematic analysis was undertaken. Results: Participants identified nutrition as important in cancer care, from diagnosis to survivorship, in order to maximise recovery and ongoing health. While participants reported that the best person to provide high-quality individualised nutrition care is a dietitian, other HCPs also have a role in nutrition care. Limited nutrition care is currently available, especially for those in rural areas, which impacts health and equity in cancer care. Participants identified a need for increased dietitian capacity in the workforce as well as a need for nutrition resources that were accessible and appropriate. Conclusion: The perspective of participants was that more must be done to provide nutrition care as part of cancer care in New Zealand to improve health and wellbeing among people with cancer.

Measuring Sodium from Discretionary Salt: Comparison of Methods

(1) Background: The best method to assess discretionary salt intake in population surveys has not been established. (2) Methods: This secondary analysis compared three different methods of measuring sodium intake from discretionary salt in a convenience sample of 109 adults in New Zealand. Participants replaced their household salt with lithium-tagged salt provided by researchers over eight days. Baseline 24 h urine was collected, and two further 24 h urine and 24 h dietary recalls were collected between days six and eight. Discretionary salt was estimated from the lithium-tagged salt, focused questions in the 24 h dietary recall, and the 'subtraction method' (a combination of 24 h urine and 24 h dietary recall measures). (3) Results: Around one-third of estimates from the 'subtraction method' were negative and therefore unrealistic. The mean difference between 24 h dietary recall and lithium-tagged salt estimates for sodium from discretionary salt mean were 457 mg sodium/day and 65 mg/day for mean and median, respectively. (4) Conclusions: It is possible to obtain a reasonable estimate of discretionary salt intake from careful questioning regarding salt used in cooking, in recipes, and at the table during a 24 h recall process to inform population salt reduction strategies.

Adjusting the Iodine Content of Iodized Salt to Meet the Recommended Intake for Females of Reproductive Age: A Simulation Study with a Reduced Sodium Scenario

BACKGROUND

The use of iodized salt is a key strategy to increase iodine intake worldwide. In many countries, including New Zealand, females of reproductive age are still at risk of being mildly iodine deficient.

OBJECTIVE

This study aimed to determine the level of iodization of salt needed to ensure that females aged 18 to 40 y have an adequate intake of iodine in 2 scenarios: current discretionary salt intake and reduced discretionary salt intake.

METHOD

Data from nonpregnant, nonlactating females aged 18 to 40 y (n = 795) who took part in the 2008/09 New Zealand Adult Nutrition Survey and completed a 24-h dietary recall were used. Iodine intake was determined from all foods except bread and discretionary salt, which are fortified with iodine. Iodine from bread and salt was estimated at different levels of salt iodization, starting at 25 mg iodine/kg salt and increasing incrementally by 5 mg/kg, and added to calculate total iodine intake. The simulation concluded when the appropriate iodine content in salt was found using the estimated average requirement (EAR) cut-point method.

RESULTS

In the 2 scenarios, current discretionary salt intake (i.e., 400 mg/d) and reduced discretionary salt intake (i.e., 304 mg/d), the iodine concentration of salt is required to be 55 mg/kg and 70 mg/kg for no more than 2% of females to have an iodine intake below the EAR of 100 μg of iodine/d, respectively. In both scenarios and at all levels of iodine concentration, no one was above the upper level of intake of iodine of 1100 μg/d.

CONCLUSIONS

This study found that females of reproductive age need to consume iodized salt at the higher end of the legislated range of 25 to 65 mg/kg. If strategies to reduce sodium intake were adopted, the range would need to increase, or iodized salt would need to be included in a wider range of staple foods.

Salt Substitutes-An Important Tool to Increase Potassium and Reduce Sodium Intakes?

Potassium is an essential mineral and is the main cation in intracellular fluid [...].

National Sporting Organisation Policies: A health promotion opportunity?

The objective was to identify whether National Sporting Organisations (NSOs) have policy documentation on healthy behaviours (smokefree, sun-protection, healthy food/beverages, and alcohol) and, for organisations with such documentation, whether this is in-line with current scientific evidence of past best practice in cancer prevention.

METHODS

This cross-sectional policy analysis study was performed September - December 2018 in New Zealand. A content analysis was undertaken using NSO policy documents matched against a framework of key indicators for best practice within health behaviours of interest. Data analysis of the policy process was undertaken through key informant telephone interviews with NSO staff using semi-structured qualitative interviews.

RESULTS

Of 96 NSOs, nearly half (49%) mentioned smokefree at least once in one of their policy documents, and 47% had an alcohol policy, although in both instances the policies lacked comprehensiveness. Two NSOs had a reasonably comprehensive sun protection policy. Seventeen had at least one specific nutrition policy/guideline. The contents of the latter were primarily related to short-term athletic performance rather than non-communicable disease prevention, specifically promoting hydration during sports participation, and food and nutrition to support sporting performance. Two NSOs had policies relating to the promotion of health food/nutrition more widely. For some NSOs the lack of health-related policies was not a conscious choice but just not considered previously. Other NSOs reported they lacked resources or had other priorities.

CONCLUSIONS

Although this study clearly demonstrates that many NSOs lack adequate health-related policies, this is not necessarily a conscious choice, but the result of a lack of resources, other priorities, or just that they had not considered developing policies in these areas. A number expressed support for these types of policies although it was apparent that some, particularly smaller NSOs would require assistance in policy template development. It seems probable that the development of health-related policies will only occur if partner agencies become involved.

Sodium in the New Zealand diet: proposed voluntary food reformulation targets will not meet the WHO goal of a 30% reduction in total sodium intake

PURPOSE

To simulate the potential impact of the HeartSAFE 2020 programme, a food reformulation initiative by the New Zealand (NZ) Heart Foundation, on sodium intake in the NZ adult population.

METHODS

A representative sample of NZ adults aged 15 years and older completed a 24-h diet recall survey, with 25% of participants completing a second diet recall, in the 2008/09 New Zealand Adult Nutrition Survey (n = 4721). These data were used to estimate sodium intakes of participants. The effect of altering the sodium content of 840 foods in 17 categories and 35 sub-categories included in the NZ HeartSAFE 2020 programme was simulated. The simulated sodium intake reductions in each food sub-category for the entire sample were calculated. Using sampling weights, simulated reductions in population sodium intake and by sociodemographic subgroups were also analysed.

RESULTS

Sodium intake from foods included in the HeartSAFE 2020 programme was 1307 mg/day (95% CI 1279, 1336) at baseline. After applying the HeartSAFE 2020 targets, potential sodium intake was 1048 mg/day (95% CI 1024, 1027). The absolute sodium reduction was 260 mg/day (95% CI 252, 268), corresponding to 20% sodium reduction for the foods included in the NZ HeartSAFE programme.

CONCLUSION

Current sodium targets featured in the NZ HeartSAFE programme will not meet the 30% sodium intake reduction set out by the WHO Global Action Plan. A more comprehensive strategy consistent with the WHO SHAKE Technical Package is needed to advance the goal of sodium intake reduction.

Potassium

Potassium is an essential nutrient that performs a vital role in cellular functions including maintaining fluid balance and osmolality of cells. Potassium balance is maintained by the kidney and the majority of ingested potassium is excreted in the urine. There is strong evidence of a negative association between dietary potassium and blood pressure, and some evidence (much of it indirect) of negative associations between dietary potassium and cardiovascular disease (particularly stroke and coronary heart disease) and kidney disease (chronic renal failure, and kidney stones). Blood pressure lowering is particularly associated with high potassium and low sodium diets. Important dietary sources of potassium include fruit and vegetables (including rice, potatoes, legumes and wholegrains), dairy products, and animal proteins. Worldwide, diets are low in potassium compared to dietary guidelines. Interventions focused on increasing dietary potassium will have major benefits including improvements in diet, reducing non-communicable disease and enhancing planetary health.

Anticardiolipin antibodies in the polymyalgia rheumatica-temporal arteritis syndromes

A series of seven patients with the polymyalgia rheumatica-temporal arteritis (PMR-TA) complex is presented, each of whom during the clinical course demonstrated the presence of anticardiolipin antibodies (ACLs). Presenting symptoms consisted of proximal myalgias and stiffness characteristic of PMR in five patients and of visual symptoms and headache suspicious for TA in two patients. Two of the five PMR patients later developed jaw claudication characteristic of TA. Six of the seven cases demonstrated clinical evidence of a vasculopathic process such as a cerebrovascular infarct or a vasculitic syndrome. Previous studies have suggested an association between ACLs and PMR-TA, and this series of patients appears to provide more supporting evidence. Even patients who only manifested PMR symptoms without suggestion of accompanying TA developed vascular complications. An increasing range of symptoms have been recognized in association with ACLs, and the vasculitic syndromes of PMR-TA should be included as a possible association. While this series together with previous studies may suggest that the presence of ACLs in patients with PMR-TA symptoms may serve as a marker for the development of vascular complications, larger longitudinal studies will be necessary in the future.

Bone and joint manifestations of hypothyroidism

Hypothyroidism is frequently accompanied by musculoskeletal manifestations ranging from myalgias and arthralgias to true myopathy and arthritis. A case is presented in which an arthropathic process in the hip was the isolated finding in a young man who was severely hypothyroid. Previous literature on bone and joint manifestations of hypothyroidism is reviewed, with emphasis on cases where such manifestations were the presenting symptoms of thyroid dysfunction. Most cases of arthropathic changes in adult-recognized hypothyroidism involved the knees and hands, while the hip and the epiphysis of the femoral head appear more commonly involved in children. Thyroid hormones have known effects at the cellular level on proliferation and differentiation of bone and cartilage. The hypothyroid state appears to induce abnormalities in these tissues, which result in such clinical manifestations as epiphyseal dysgenesis, aseptic necrosis, possibly crystal-induced arthritis, and an arthropathy characterized by highly viscous noninflammatory joint effusions primarily affecting the knees, wrists, and hands. Neuropathic and myopathic symptoms accompanying hypothyroidism may manifest as joint region abnormalities when in fact there is no underlying arthropathy.

Magnesium and its therapeutic uses: a review

Magnesium has been reported as an effective medical therapy in an expanding array of conditions. Evidence investigating magnesium's use is presented, with a number of studies suggesting it should be seriously considered in such conditions as ischemic heart disease, cardiac arrhythmias, and asthma. Magnesium balance and metabolism are briefly reviewed, and then various hypotheses are presented that may explain magnesium's physiologic mechanisms of action, most likely involving calcium and potassium flux across cellular membranes in smooth muscle. In a number of the conditions to be discussed, it has been uncertain whether magnesium administration serves the purpose of merely correcting an underlying deficiency state or of utilizing a specific pharmacologic effect of magnesium. Magnesium deficiency is a relatively common condition, and predisposing factors as well as recent methods for assessing total body stores of magnesium are discussed. Physicians should be familiar with the numerous conditions and therapeutics that are risk factors for an underlying magnesium deficiency and in which empiric magnesium replacement should be considered. Guidelines for administration of parenteral magnesium are presented with specific focus on the low risk of adverse effects, as suggested by the large and rapid dosing regimens used in many of the clinical studies discussed here.

Investigations on the origin and metabolism of the carbon skeleton of ornithine, arginine and proline in selected animals

The origin and metabolism of the carbon skeletons of the amino acids ornithine and arginine have been investigated in selected animals--an earthworm, an edible mollusc, a starfish, a sea-squirt, a freshwater crustacean and a rat. Only in the rat and microorganisms of sea water was any evidence obtained for the conversion of glutamate (or N-acetylglutamate) to ornithine. Apart from the crustacean, the other animals were able to synthesise the amidine moiety of arginine. All animals were able to hydrolyse (arginase) the amidine moiety from arginine and had the enzymic capacity to convert ornithine to proline. All the animals had some enzymic ability to oxidise proline to pyrroline-5-carboxylic acid. The crustacean (Cherax destructor) was able to conserve the high concentrations of arginine in its tail muscles during fasting. The hypothesis is put forward that, as arginine appears to be an essential amino acid in the diet of this animal, its demonstrated cannibalism is, among other things, a way of supplementing dietary arginine. The results are discussed in relation to the evolution of different phosphagens derived from arginine.

Synthesis of phosphocreatine and phosphoarginine by mitochondria from various sources

Mitochondria from heart, skeletal muscle and the liver of the rat have been shown to synthesise phosphoarginine through ATP if supplied with arginine and lobster arginine kinase. Liver mitochondria have been shown to synthesise phosphocreatine through ATP with the aid of the cytosolic isomer of creatine kinase. Mitochondria prepared from muscles of a crustacean, a fish and a bird have been shown oxidatively to synthesise phosphocreatine (crustacean) and phosphoarginine (fish and bird) provided they are supplied with the appropriate kinase and catalytic amounts of ATP. Within one second of the addition of either cytosolic kinases, mitochondria from skeletal muscle and liver begin a steady state synthesis of phosphoarginine or phosphocreatine. The results suggest that, with respect to phosphagen synthesis, the addition of the cytosolic enzymes can substitute for the mitochondrial enzyme. It is difficult therefore to accept a special vectorial function for the bound mitochondrial enzyme at the biological concentrations of ATP and the cytosolic enzymes normally associated with phosphagen synthesis.

On the possible significance of the transamidination reaction in evolution

The origin of the various muscle phosphagens during evolution is considered in the context of the need to conserve ornithine for the synthesis of proline for connective tissue necessary for structural strength and flexibility and/or a complicated musculature. In each phosphagen, arginine is known to have contributed its amidine moiety thus maintaining the function of the phosphagen and setting free the proline precursor ornithine. Tissues from an earthworm, a starfish and a sea-squirt have been found to contain the enzymes arginase, ornithine aminotransferase and pyrroline-5-carboxylate reductase which are necessary to convert arginine to proline. For each of the animals studied analysis for the relevant free amino acids and for the characteristic amino acids (Pro, Oh-Pro, Oh-Lys, Gly) of collagen are presented. The amino acid composition of the diet of the sea-squirt Pyura stolonifera and of the starfish Coscinasterias calamaria is presented along with the level of the phosphagen kinases of the animals studied. The significance of the experimental results is discussed in connection with the importance of the transamidination reaction.

A study of the plasma lipoproteins and the tissue lipids of the migrating lamprey, Mordacia mordax

Sea lampreys, Mordacia mordax, were collected in spring from the Yarra River, Victoria, during their upstream spawning migration, to study the lipid composition in their tissues and plasma and their lipid transport system. Plasma lipoproteins were isolated by preparative ultracentrifugation and their chemical compositions were analyzed. The major classes of lipoproteins were found to be similar to those of man and higher animals. Lipids from the muscle and liver were analyzed for fatty acids. The striking feature of the lipids in the migrating lamprey is the presence of very high levels of cholesterol in both plasma and muscle. The possible metabolic roles of cholesterol have been discussed.