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Reported eating behavior and attitudes improvement after a nutrition intervention program in a group of young female dancers.

The aim of the study was to evaluate the effectiveness of an intervention program that combined nutrition education and prevention of disordered eating in a group of female professional dance students. Thirty-two dancers, aged 19-25 years, took part in the program. Evaluation was done by a series of questionnaires that participants were asked to complete on 3 occasions. Assessments of body composition and dietary intake were also performed. Significant improvements in nutrition knowledge as well as a decrease in abnormal eating behavior and dietary restraint were observed at post intervention. At 6-month follow-up, the positive effects were maintained and further benefits were recorded; only nutrition knowledge showed a minor decline. Participants who were at higher risk for adopting abnormal eating behavior benefited the most from the program. These findings encourage the implementation of intervention programs in groups of young women that experience particular pressures for controlling body weight.

Adult↗

History and evolution of a successful certification program in nutrition support: the CNSD experience.

As early as the 1970s, articles were published on the role of dietitians in nutrition support. Both the American Society for Parenteral and Enteral Nutrition and The American Dietetic Association addressed the issues of specialization and certification. Development of a specialty area credential requires a strong demand by practicing clinicians, a unique area of clinical practice with a distinct body of knowledge and the commitment to evolve with clinical practice. Numerous dietitians were involved in the inception, development, and leadership that brought forth certification in nutrition support. This article documents the efforts and participation of a dedicated group of professionals whose common goals resulted in the establishment of a successful, sustaining certification in a specialty area of clinical dietetics: certified nutrition support dietitian. The certified nutrition support dietitian program is now in its 15th year with 2,000 dietitians currently certified both nationally and internationally. A primary focus of the credential is to recognize minimum competency for dietitians practicing in the field of enteral and parenteral nutrition and to provide safe and effective nutrition support therapy. This article provides a framework for persons in other specialty areas attempting to develop certification programs.

Certification↗

Comparison of the Micro-Nutrica Nutritional Analysis program and the Russian Food Composition Database using data from the Baltic Nutrition Surveys.

OBJECTIVE: The objective of this study was to compare the nutrient content of foods and diets based on data from two food composition databases used in the Baltic Nutrition Surveys (conducted in Estonia, Latvia and Lithuania in 1997): an adapted version of the Finnish Micro-Nutrica Nutritional Analysis program (used in Estonia) and the Russian Institute of Nutrition Food Composition Database (used in Latvia and Lithuania). DESIGN: The adapted Micro-Nutrica and Russian databases were used to estimate the energy and nutrient (protein, fat, carbohydrate, vitamin C, calcium and iron) content of 15 common foodstuffs in the region and the nutrient intakes of 32 Latvian respondents (based on 24-h recalls). Differences between databases were estimated. RESULTS: There were discrepancies in the energy and nutrient content of the 15 selected foods using the two databases. The adapted Micro-Nutrica database generally gave a lower energy content than the Russian database (median: -6%), and a lower fat content for typically fat-rich foods. Intakes of energy, fat, carbohydrate and calcium by the 32 selected respondents were significantly lower when the Micro-Nutrica database was used. Differences were particularly high for fat (difference=-23.5%, 95% confidence interval=-31.1 to -15.8%, P<0.0001). CONCLUSIONS: The results suggest that reported comparisons of nutrient intakes in the Baltic countries should be treated with caution and that more research is needed for the development of comparable national databases in the region. Potential differences between databases should be investigated early when international surveys of dietary intake are being planned.

Baltic States↗

Stakeholder evaluation of a high-risk prenatal nutrition intervention program in Prince Edward Island.

Since 1971, a Prince Edward Island prenatal program has provided nutrition support to pregnant women at high risk for poor birth outcomes. Provincial changes in the delivery of health care services since 1986 have caused concern that the program is becoming less effective. The current research was designed to evaluate stakeholders satisfaction with the program; it was part of a larger study conducted in 1998 and 1999 to evaluate overall program effectiveness. Nutritionists (n=9), referring health professionals (n=57), and clients (n=50) completed a survey. The results indicated that program satisfaction was high for all stakeholders. Perceived program strengths included the counselling approach, program quality, food and income supplements, and accessibility. Perceived program weaknesses included inadequate staff/time, administrative requirements, limited communication/awareness, the counselling approach, and difficulty contacting clients. Recommendations for improvement fall into four key areas: staff services, program delivery, the counselling approach, and communication. The findings suggest that the components of prenatal education considered important vary among clients and staff, and that the relationship developed between staff and clients during counselling is an important contributor to program success.

Cross-Sectional Studies↗

Biennial survey of physician clinical nutrition training programs.

This is the third survey of physician clinical nutrition training programs. Current training programs were identified, descriptive information obtained, and training program content was compared with that recommended at the 1984 Conference on Clinical Nutrition Training. In general, goals as to the quantity of research, clinical, and teaching training are being met. Virtually all programs provide training in nutritional support activities. Most training programs are not as broad in scope of exposure to the less clinical aspects of nutrition nor to all the illness and age groups recommended by the 1984 conference. Consideration of broadening the scope of physician training programs or redefinition of training guidelines is warranted. A program-certifying agency may be helpful in identifying programs achieving certain minimal standards.

Curriculum↗

[Evaluation of a nutritional intervention to reduce cholesterol levels in patients with coronary artery disease].

BACKGROUND: The mainstay of cholesterol reduction therapy is the diet. But the lack of compliance and prescription problems limit its usefulness. AIM: To compare the effectiveness of a nutritional intervention given by a nutritionist with the usual recommendations given by a physician to reduce the LDL cholesterol levels in patients with coronary artery disease, treated at the Regional public hospital in Temuco. MATERIAL AND METHODS: One hundred and forty patients with coronary heart disease (last acute episode at least three months before), without nutritional interventions nor cholesterol-lowering drugs, who gave informed consent, were randomized to receive either instructions by their physician or to take part in a nutritional program. The nutritional intervention consisted in five educational sessions, adapted from the NCEP and from a program of the Nutrition Department of the Catholic University of Chile. Patients randomized to the medical intervention received the standard written recommendations about diet. Lipid profile was measured before the intervention and after a three and twelve months follow up. RESULTS: After one year the group on the nutritionalprogram reduced LDL cholesterol by 11.1% (p=0.03). There were no changes in the medical group. However, only 10% patients on the nutritional intervention group and 8% of those with medical recommendations achieved LDL cholesterol levels less than 100 mg/dl. There were no changes in triglycerides, weight or body mass index during the period. CONCLUSIONS: Although this nutritional intervention proved to be more effective than usual medical instructions, most patients on secondary prevention did not achieve acceptable LDL cholesterol levels.

Body Mass Index↗

Development and implementation of a nutrition education program for medical students: a new challenge.

CONTEXT: Teaching nutrition to medical students is constrained by limitations in curricular time and competition with other topics. OBJECTIVES: To identify time slots and teaching methods for incorporating nutrition into the medical school curriculum, determine students' nutritional knowledge following the program, and their perception of the effectiveness of the program. METHODS: A nutritional workshop was added to the clinical experience weeks of second-year medical students. The first class included 66 students and the second class included 56 students. In order to fully acquaint the students with nutrition, four topics were included: nutritional policy, dietary assessment, nutritional recommendations, and obesity. Students were encouraged to actively participate in the program which included dietary intake interviews, debates regarding nutritional treatments, and actual practice in class. The main outcome measures were nutritional knowledge and evaluation of the program by the students. FINDINGS: Over 90% of the students answered the knowledge questions correctly. The effectiveness of the training was graded (on a scale of 1-7) between 3.7-5.4 in the first year and 3.4-5.7 in the second year. CONCLUSIONS: The ten-hour nutritional workshops within the clinical weeks were well-received by second-year medical students. Using cases relevant to the students' age seems to enhance their interest in the program.

Adult↗

A survey of physician clinical nutrition training programs in the United States.

This survey contacted 90 medical schools and 241 universities believed to offer physicians special training in human nutrition. Seventy-two of the medical schools described an existing (67/72) or planned (5/72) clinical fellowship program. In 40 of these 67 programs, nutrition was a major clinical and research focus (greater than 30% and up to 100% of trainees time) and in 27, the nutrition emphasis was definite but more modest (about 30% of time). Between 1976 and 1981, 470 physicians completed training from these programs. Fifty-two of the universities described graduate degree courses (PhD, MPH, MS) in human nutrition open to physicians. Between 1976 to 1981 24 of these schools had enrolled and graduated 152 physicians. The results are discussed in terms of the need for standardization of the content of training programs and a certification process, recognized by the American Board of Medical Specialties.

Certification↗

Qualitative assessment of participant utilization and satisfaction with the Seattle Senior Farmers' Market Nutrition Pilot Program.

INTRODUCTION: The Seattle Senior Farmers' Market Nutrition Pilot Program delivered fresh fruits and vegetables to homebound seniors in King County, Washington, from June through October 2001. A primary objective of the program was to increase participants' intake of fruits and vegetables. A qualitative study was conducted to examine the impact of the program on participating homebound seniors. METHODS: Semi-structured interviews were performed with 27 participants in their homes to identify benefits and barriers they encountered and to measure their use and sense of satisfaction with the program. RESULTS: Analysis of the transcribed interviews revealed several common themes: Participants appreciated the variety and quality of the fresh fruits and vegetables. Some participants would not have had access to fresh fruits and vegetables without the program. Home-delivered baskets of fresh fruits and vegetables brought participants joy, stimulated interest in healthy foods, and improved quality of life. The program newsletter supported consumption of fresh produce. CONCLUSION: Program success was rooted in the multiple ways the program addressed potential barriers and reinforced behavioral intent.

Aged↗

Effective nutrition education program for medical students.

The existing nutrition education luncheon program at the University of Iowa Hospitals is an effective method of teaching clinical dietetics to third-year medical students. The development of a Nutrition Reference Handbook has made a significant impact on attendance at the luncheons, which is voluntary, and has become an integral part of the program.

Education, Medical↗

EFNEP: a nutrition education program that demonstrates cost-benefit.

OBJECTIVE: Data on the economic value of nutrition education programs, such as the Expanded Food and Nutrition Education Program (EFNEP), can help decision makers choose among alternative programs based on costs and benefits. A cost-benefit analysis of EFNEP was conducted to determine if participants' savings in food expenditures exceeded program implementation costs. DESIGN/SUBJECTS: Costs were collected over 6 months using expenditure reports and other records. Benefits were determined using prospective data from 371 women enrolled in EFNEP who completed a 24-hour food recall and behavior survey, and recorded the amount of money spent monthly on food at program entry and exit. Two treatment groups received nutrition education and one group did not receive education. One treatment group estimated food expenditures from recall and the other collected register receipts or recorded expenditures. Control group subjects reported expenditures from recall. Net present value (NPV) was calculated using mean EFNEP cost per participant subtracted from the mean change in family food expenditures per participant over a 5-year period at three discount rates. STATISTICAL ANALYSES: Analysis was designed to compare food expenditures among the two experimental groups and control group and food and nutrient intakes and survey scores between the combined experimental group and control group. RESULTS: The average EFNEP program cost perparticipant was $388, and graduating participants reported that family food expenditures decreased on average by $10 to $20 per month or $124 to $234 over a year. When benefits were projected to last 5 years, the NPV was $147 to $696 depending on the method of food expenditure estimation and the discount rate. At the same time individuals reduced food expenditures, they increased intakes of iron, vitamin C, vitamin B-6, and fiber. They added less salt when cooking and read nutrition labels more often. They also reported not running out of food at the end of the month as often. APPLICATIONS/CONCLUSIONS: Findings from this research showed that EFNEP is cost-beneficial. The magnitude of the savings in food expenditures is sensitive to the method of food expenditure reporting and assumptions about how long participants will retain the behaviors they learn.

Adolescent↗

Leptin expression in offspring is programmed by nutrition in pregnancy.

Birth weight is a determinant of blood leptin concentrations in adults. Since nutrition during pregnancy can affect birth weight, the hypothesis that feed intake during pregnancy alters leptin expression in progeny was examined. Leptin mRNA was measured in subcutaneous adipose tissue and leptin protein was measuredin blood plasma from 59 day old female pigs whose mothers were fed at the same restricted rate except that half were permitted to consume 35% more feed during the second quarter of pregnancy. Leptin mRNA abundance in adipose tissue (P=0.015) and plasma leptin concentration (P=0.01) were higher in progeny from mothers provided with more feed. Body weight at birth was negatively correlated with the abundance of leptin mRNA in subcutaneous fat at 59 days of age (P=0.01). This study shows for the first time that maternal nutrition during pregnancy programs postnatal leptin expression in offspring.

Adipose Tissue↗

The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults.

OBJECTIVES: This study was undertaken to test the effectiveness of the Stanford Nutrition Action Program, an experimental trial to reduce dietary fat intake among low-literacy, low-income adults. METHODS: Twenty-four paired adult education classes (351 participants, 85% women, mean age = 31 years) were randomly assigned to receive a newly developed dietary fat curriculum (the Stanford Nutrition Action Program) or an existing general nutrition curriculum. Food frequency and nutrition-related data, body mass index, and capillary blood cholesterol were collected at baseline and at two postintervention follow-ups. RESULTS: The Stanford Nutrition Action Program classes showed significantly greater net improvements in nutrition knowledge (+7.7), attitudes (/0.2), and self-efficacy (-0.2) than the general nutrition classes; they also showed significantly greater reductions in the percentage of calories from total (-2.3%) and saturated (-0.9%) fat. There were no significant differences in body mass index or blood cholesterol. All positive intervention effects were maintained for 3 months postintervention. CONCLUSIONS: The Stanford Nutrition Action Program curriculum, tailored to the cultural, economic, and learning needs of low-literacy, low-income adults, was significantly more effective in achieving fat-related nutritional changes than the general nutrition curriculum.

Adult↗

The effects of a family fitness program on the physical activity and nutrition behaviors of third-grade children.

This study examined the efficacy of a school-based exercise and nutrition program with a parent component. Third-grade children (N = 238) from six elementary schools participated in the study, with three schools randomly assigned to a program group and the other three schools to a control group. The program group received a health-related fitness school-based program and a home program that required parents and children to complete activities and earn points for nutrition and exercise activities. The control group received their traditional physical education and nutrition education program. Univariate analysis of variance on pre- and posttest scores were completed on the following variables: height, weight, body mass index, skinfold, blood cholesterol, mile run, exercise and nutrition knowledge, calories, protein, carbohydrates, total fat, saturated fat, dietary cholesterol, fiber, sodium, percentage of calories from carbohydrates, and percentage of calories from fat. At pretest, the treatment and control groups did not significantly differ on the measures using schools as the unit of analysis. Girls scored significantly higher than boys on skinfold and pretest knowledge. At posttest, the treatment group scored significantly higher than the control group on exercise and nutrition knowledge and significantly lower than the control group on total fat intake, using schools as the unit of analysis. There was no improvement in physiological measures, including blood cholesterol. The study demonstrated that schools can adjust curriculum to meet some health needs of students and achieve modest changes in exercise and nutrition knowledge and diet. The family component of the program provided a practical approach to improving physical activity and nutrition behaviors for elementary school teachers who teach many participants in a crowded curriculum.

Child↗

[The effects of a PMS nutritional education program for college students].

PURPOSE: This study was conducted to identify the effects of a PMS nutritional education program for college nursing students. METHOD: Subjects consisted of nursing students(experimental group: 29, control group: 27). The experimental group participated in a PMS nutritional education program for 8 weeks (including group and individual involvement). Data was collected before and after the education, and measurement tools were premenstrual symptoms, PMS knowledge, and self health behavior. RESULTS: After the intervention, the experimental group showed a significant increase in PMS knowledge(Z=6.32, p=.000) and self health behavior(t=3.00, p=.004) compared to the control group. After the intervention the experimental group showed a significant increase in PMS knowledge(Z=-4.64, p=.000) and self health behavior(t=-3.04, p=.005) than before the intervention. CONCLUSIONS: These results suggest that the short term effects of a PMS nutritional education program for nursing students was proven useful and the program should be applied to PMS nutrition education for PMS clients as well as health professionals.

Adult↗

Nutrition surveillance and intervention, South Africa.

Under the apartheid regime there was no national framework for development in South Africa. Now, for the first time in South Africa, the government of national unity has provided a framework for development. This is a people-centered development strategy that calls for intersectoral collaboration and a vision for community involvement. Within this framework, the Department of Health has developed an integrated nutrition program with a health-based component and a community-based aspect. There is now a movement towards community-based program and nutrition surveillance. Although it is still early, there are some lessons that can be learned from these programs: growth monitoring can be used to promote community-based surveillance and to provide information upon which the communities can act; training, supervision, and information dissemination is essential, and it is also important to identify indicators to monitor success; building on existing infrastructure and capabilities within communities and linking up with NGOs and other organizations who have long-standing relationships with the communities is essential; identifying and capitalizing on indigenous resources and capabilities within countries is important; and there has to be political commitment.

Africa↗

[Descriptive study of 43 nutritional education programs in Venezuela].

This study aimed to determine the existing resources and specific characteristics of non-formal nutrition education programs in Venezuela. Of the 174 institutions initially contacted, 43 were involved in these activities-22 official and 21 private institutions. The bulk of the programs fell under the official health sector and the private food industry. While objectives of the former were to motivate and educate the audience, the latter's goal was basically commercial. Forty-three per cent of the program content dealt with basic nutrition concepts; only 19% of programs included information on breast feeding, and maternal and child nutrition. There is a significantly greater use of interpersonal communication (65%) as compared to mass media (35%), irrespective of the type of institution. In the majority of programs, the nutritionist-dietitians and medical doctors carry out their activities, primarily oriented towards homemakers and school-age children. The official health sector gears its programs toward the poor, while the main interest of private industry are the middle and upper class communities. A total of 46% of the official programs and 55% of the private institutions do not include an evaluation component. It is concluded that the nutrition education programs in the country appear to follow traditional concepts as far as objectives, program content, media and target groups are concerned. This could have contributed to the apparent lack of impact of non-formal nutrition education in the country; thus the re-planning of existing programs, is suggested. This should be based on well-defined and measurable objectives: include messages geared toward the practical solution of specific nutrition problems, and the use of combined techniques of social communication with as much participation of the community as possible, not only in program implementation but also in its conception and planning.

Communication↗

A regional diabetes nutrition education program: its effect on knowledge and eating behavior.

The effect of a nutrition education program on knowledge and self-care behavior in a group of individuals with diabetes was evaluated. The nutrition education program was developed using outlines and knowledge tests produced by the University of Michigan Diabetes Research and Training Center. The program, sponsored by the American Diabetes Association, Akron Chapter, was presented free of charge to Northeast Ohio area residents. Forty-four individuals participated in the study. Results indicated a statistically significant (p < 0.01) gain in knowledge but no statistically significant change in eating behavior for the sample. However, post-food records indicated that the mean for the percentage of total kcalories (kcals) from protein and fat (ie, 20% and 28%, respectively) were within the American Diabetes Association's recommendations of no more than 20% of kcals from protein and 30% of kcals from fat. In addition, the percentage of kcals from carbohydrate and the recommended total number of kcals improved toward the recommended levels.

Adult↗