Vitamin D supplementation is an important adjunct therapy for the prevention and management of glucocorticoid-induced osteoporosis. There has been little exploration of the relationship between glucocorticosteroid (GCS) use and serum 25-hydroxyvitamin D [25(OH)D]. The aim of this study was to systematically explore how serum 25(OH)D is altered in adult patients receiving GCS. We reviewed Medline and Cinahl databases between January 1970 and August 2011. Experimental studies were included where 25(OH)D was measured in patients more than 18 yr of age receiving GCS therapy. Studies were excluded if patients received at least 400 IU/d (10 μg/d) vitamin D, if GCS treatment was less than 2-wk duration, if more than 50% of the study population received GCS for renal or hepatic disease or after transplant, or if the study population included patients with Cushing's syndrome. A consensus method was used to classify studies. Of identified studies, 3% met the selection criteria. Data were extracted by a single author. Study quality was assessed using criteria developed by the American Dietetic Association. The weighted mean 25(OH)D (by sample size or sd) was 22.4 [95% confidence interval (CI), 19.4, 25.3] ng/ml and 21.0 (95% CI, 13.5, 28.5) ng/ml, respectively. Random effects meta-analysis was used to compare serum 25(OH)D in patients treated with GCS compared to steroid-naive controls (either healthy or with active disease) and in patients before and after GCS administration. Serum 25(OH)D in GCS users was on average -0.5 (95% CI, -1.0, -0.1) ng/ml lower than in healthy controls (P=0.03; I2=56.4%). Serum 25(OH)D did not differ between GCS users and disease controls [standardized mean difference=0.0 (95% CI, -0.2, 0.3) ng/ml; P=0.793; I2=16.2%]. The suboptimal concentrations of serum 25(OH)D found in adults receiving GCS are inadequate for prevention and management of glucocorticoid-induced osteoporosis. Recommendations for vitamin D supplementation should be adjusted accordingly.

Background/Objectives: Nutritional issues that are associated with Duchenne muscular dystrophy (DMD) remain poorly understood. The aim of this analysis was to describe and explore longitudinal observations of body mass index (BMI) in a cohort of children with DMD. Subjects/Methods: Anthropometric and clinical characteristics were collected retrospectively and longitudinally for boys with DMD seen in two large neuromuscular clinics. BMI Z-scores were determined using the Centers for Disease Control and Prevention reference values for children (2000). Results: Medical records (n=193) were examined from which 75% were included for analysis. The mean age of the cohort at the time of data collection was 11.9 years, with 72% of patients currently or previously using steroids. The highest prevalence of obesity based on the BMI Z-score was 50% at the age of 10 years. Longitudinally, BMI Z-scores from the age of 2 to 12 years plot approximately one s.d. above the mean, after which there is a marked and progressive decline. BMI gainers were identified for whom BMI Z-score increased by 1.65 units compared with the 0.09 units in non-gainers. BMI gainers were younger when they had their first BMI measurement (5.9 vs 7.2 years), and this measure was significantly lower compared with the non-gainers (BMI Z-score: 0.04 vs 1.17). In this cohort, BMI was associated with age, ambulatory status and lung function. Conclusions: This study demonstrates that boys with DMD using steroid therapy experience shifts in BMI. A declining BMI appears to be associated with increasing age. Interpretation of growth patterns is limited here by a lack of normative growth references in DMD.

Evidence-based practice is the foundation of nutrition and dietetics. To effectively apply evidence-based practice, health professionals must understand the basis of research. Previous work has identified the lack of involvement of dietitians in research. As part of a curriculum redevelopment in undergraduate nutrition and dietetics courses, research skill teaching was enhanced. This study evaluated the effect of a new, year two level nutrition research methods unit on the perceived research skills of students. The unit consisted of two key components: a student-led class research project and a small group systematic literature review. Prior to commencement and on completion of the course, students completed a modified version of the Research Skills Questionnaire. Results demonstrated that self-perceived competence increased by a small degree in a set of specific research skills as well as in broader skills such as information gathering and handling, information evaluation, ability to work independently, and critical thinking. The new research unit was also evaluated highly on a student satisfaction survey. Despite these positive findings, students indicated that their general feelings towards research or a career in research were unchanged. In summary, this unit enhanced students’ perceived research skills. Further exploration of students’ attitude towards research is warranted.

There is limited evidence of how Australian low-to-middle income (AUD $40,000–$80,000) households maintain food security. Using a sequential explanatory mixed methods methodology, this study explored and compared the food security (FS) and insecurity (FIS) experiences of these households. An initial quantitative survey categorised participants according to food security status (the 18-item United States Department of Agriculture Household Food Security Survey Module) and income level to identify and purposefully select participants to qualitatively explore food insecurity and security experiences. Of the total number of survey participants (n = 134), 42 were categorised as low-to-middle income. Of these, a subset of 16 participants (8 FIS and 8 FS) was selected, and each participant completed an in-depth interview. The interviews explored precursors, strategies to prevent or address food insecurity, and the implications of the experience. Interview data were analysed using a thematic analysis approach. Five themes emerged from the analysis: (i) food decision experiences, (ii) assets, (iii) triggers, (iv) activation of assets, and (v) consequences and emotion related to walking the food security tightrope. The leverage points across all themes were more volatile for FIS participants. Low-to-middle income Australians are facing the challenges of trying to maintain or improve their food security status, with similarities to those described in lower income groups, and should be included in approaches to prevent or address food insecurity.