Auditing dietetic services.
In this last article of a four-part series on auditing dietetic services, the authors present a detailed description of a quality assurance program for dietetic services.
Diet Therapy↗
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[Findings of the importance of dietetic fiber in the regulation of cholesterolemia].
We studied the variations of some lipid indexes in cholesterolemia, lipidemia and triglycerides in relation to a diet rich in bulk. Seven adult male subjects in good health were tested for cholesterol, lipid and triglycerides before and after a two week period of a dialy diet of 40 g of whole wheat bran containing about 10g of fiber. At the some time the lipid, cholesterol and triglycerides limits were measured in 3 groups of rabbits. The first groups was subjected to a normal diet, the second group was subjected to a diet of bleached flour and vitamins, and the third group had a diet similar to the second group but with the addition of 40 g whole wheat bran. The results of our investigation demonstrated a statistically significant decrease of cholesterol lipid and triglycerides levels the special diets at the some time we did not see in increase in the third group of rabbit. Our study seems to indicate that dietetic fibers exercise a vital role in regulating the concentration of plasma lipids even if the subject continues to consume a diet rich in fats. From this we see to importance of the dietetic fibers as a protective factor in the prevention of ateriosclerotic.
Adult↗
[Changes in the active body-mass ratio (fatty mass) in hyperlipoproteinemias as affected by a combined dietetic regimen].
Ninety nine patients with hyperlipoproteinemia (HLP) were examined--type IIA--48; type IIB--36 and type IV--15. The patients were put, in the course of 25 days, on a combined dietetic regimen, including fruit foodstuffs, enriched with high-esterified pectin, soy-bean meal and skimmed yoghourt "Vita". The patients with type IIA HLP have almost a normal body mass (BM) and the body composition is not substantially changed under the treatment effect, whereas in the patients with type IIB HLP--a considerable lipid mass (LP) was found with rather low relative BM. The patients with type IV HLP are with the highest relative BM and the most pronounced reduction resulting from the treatment. The combined dietetic regimen leads to favourable changes in the body composition in patients with HLP types IIB and IV--reduction of LP and increase of the ratio active BM/LM.
Adult↗
[Effect of dietetic and ethological factors on reproduction in cows].
The application of dietetic and ethologic factors on three cow farms led to the improvement of the reproduction parameters. Basic dietetic factors were the correction of the energy--protein ratio, and the percent of the crude protein in the diet. In so far as the ethologic factors were concerned greatest attention was paid to the organization of work on the farms, the strict observance of the daily regime, and the principle of the herd hierarchy. The "independence period", i.e. the period between the time of calving and the time of the following first estrus dropped by 16, 8 and 10 days, respectively. The conception rate at first insemination rose by 25, 25 and 14.9 per cent, and the impregnation rate up to the 60th day--by 9, 13 and 3 per cent, respectively. Milk productivity increased by 1000 1 for the first two farms and by 300 1 for the third one. The number of calves obtained per 100 cows rose by 13, 14 and 2, respectively.
Animal Feed↗
[Comparative status of dietetic and therapeutic measures in idiopathic hyperlipidaemia (author's transl)].
The indications for dietetic and therapeutic measures vary according to the type of hyperlipidaemia. A low fat diet is difficult to maintain and has exceptional and precise indications. It is indispensable in type I hyperlipidaemia, particularly since there is at present no drug capable of reducing hyperchylomicronaemia. It is also indicated in type V hyperlipidaemia in association with a low carbohydrate diet--a dietetic treatment which may become troublesome in long terme and must be supervised by highly specialized dieticians. In all other types of hyperlipidaemia systematic reduction of fats is wrong on theoretical grounds and must be firmly rejected on account of its detrimental consequences. When the patient's weight is normal, a normolipidic diet should be prescribed, with emphasis on unsaturated fats. In obese patients, but only at the onset of treatment, an overall low calorie diet with restriction of fats and carbohydrates should be advised. As soon as the target weight is reached, however, this should be replaced by another weight-stabilizing, isocaloric and normolipidic diet. It is, in fact, this kind of diet which all patients with type II, III and IV hyperlipidaemia will finally require.
Diet, Reducing↗
[An evaluation of dietetic treatment in juvenile hypercholesterolemia].
OBJECTIVE: To evaluate compliance with dietetic treatment and its influence on levels of cholesterol and lipoproteins in hypercholesterolaemia in young children, over a period of two years. DESIGN: A descriptive longitudinal study. SETTING: Two paediatric clinics at the "Soria Norte" Health Centre. PATIENTS: 47 patients between 3 and 10 years old, with overall cholesterol levels > 185 mg/dl and C-LDL > 110 mg/dl. MEASUREMENTS AND MAIN RESULTS: 51% of the children correctly followed the dietetic advice given and at the 6 months follow-up showed an overall decrease in cholesterol and C-LDL. This decrease was less significant at a year from the start of the treatment. CONCLUSIONS: Diet is an efficacious treatment of hypercholesterolaemia in children. However, it is difficult to maintain over a long period.
Child↗
Position of the American Dietetic Association and Dietitians of Canada: nutrition intervention in the care of persons with human immunodeficiency virus infection.
Infection with the human immunodeficiency virus (HIV) and the development of acquired immunodeficiency syndrome (AIDS) have had a significant impact on domestic and global health, social, political, and economic outcomes. Prevention and treatment efforts to control HIV infection are more demanding than in previous decades. Achieving food and nutrition security, and managing nutrition-related complications of HIV infection and the multiple aspects of disease initiated by or surrounding HIV infection, referred to as HIV disease, remain challenges for patients and for those involved with HIV/AIDS prevention, care, and treatment efforts. Confounding clinical issues include medication interactions, coinfection with other infections and diseases, wasting, lipodystrophy, and others. Dietetics professionals, other health care professionals, and people infected with HIV will need to understand and address multiple complex aspects of HIV infection and treatment to improve survival, body functions, and overall quality of life. Individualized nutrition care plans will be an essential feature of the medical management of persons with HIV infection and AIDS.
Acquired Immunodeficiency Syndrome↗
Position of the American Dietetic Association: benchmarks for nutrition programs in child care settings.
It is the position of the American Dietetic Association that all child care programs should achieve recommended benchmarks for meeting children's nutrition and nutrition education needs in a safe, sanitary, and supportive environment that promotes healthy growth and development. Use of child care is the norm for America's families. It is essential, therefore, that nutrition professionals work in partnership with child care providers and with children's families to ensure that meals and snacks consumed in child care settings meet children's nutrition needs and provide them with excellent models of healthy dietary patterns. This position provides guidance and information about resources for nutrition professionals, health care practitioners, child care providers, and parents regarding meal plans, food preparation and food service, physical and social environment, and nutrition consultation and training for child care.
Benchmarking↗
Position of the American Dietetic Association: individual-, family-, school-, and community-based interventions for pediatric overweight.
The American Dietetic Association (ADA), recognizing that overweight is a significant problem for children and adolescents in the United States, takes the position that pediatric overweight intervention requires a combination of family-based and school-based multi-component programs that include the promotion of physical activity, parent training/modeling, behavioral counseling, and nutrition education. Furthermore, although not yet evidence-based, community-based and environmental interventions are recommended as among the most feasible ways to support healthful lifestyles for the greatest numbers of children and their families. ADA supports the commitment of resources for programs, policy development, and research for the efficacious promotion of healthful eating habits and increased physical activity in all children and adolescents, regardless of weight status. This is the first position paper of ADA to be based on a rigorous systematic evidence-based analysis of the pediatric overweight literature on intervention programs. The research showed positive effects of two specific kinds of overweight interventions: a) multicomponent, family-based programs for children between the ages of 5 and 12 years, and b) multicomponent, school-based programs for adolescents. Multicomponent programs include behavioral counseling, promotion of physical activity, parent training/modeling, dietary counseling, and nutrition education. Analysis of the literature to date points to the need for further investigation of promising strategies not yet adequately evaluated. Furthermore, this review highlights the need for research to develop effective and innovative overweight prevention programs for various sectors of the population, including those of varying ethnicities, young children, and adolescents. To support and enhance the efficacy of family- and school-based weight interventions, community-wide interventions should be undertaken; few such interventions have been conducted and even fewer evaluated.
Adolescent↗
Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders.
It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling, by a registered dietitian (RD) is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders during assessment and treatment across the continuum of care. Diagnostic criteria for eating disorders provide important guidelines for identification and treatment. However, it is thought that a continuum of disordered eating may exist that ranges from persistent dieting to subthreshold conditions and then to defined eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder. Understanding the complexities of eating disorders, such as influencing factors, comorbid illness, medical and psychological complications, and boundary issues, is critical in the effective treatment of eating disorders. The nature of eating disorders requires a collaborative approach by an interdisciplinary team of psychological, nutritional, and medical specialists. The RD is an integral member of the treatment team and is uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. RDs provide nutritional counseling, recognize clinical signs related to eating disorders, and assist with medical monitoring while cognizant of psychotherapy and pharmacotherapy that are cornerstones of eating disorder treatment. Specialized resources are available for RDs to advance their level of expertise in the field of eating disorders. Further efforts with evidenced-based research must continue for improved treatment outcomes related to eating disorders along with identification of effective primary and secondary interventions.
Anorexia Nervosa↗
Position of the American Dietetic Association: weight management.
It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity. Americans are increasing in body fat as they become more sedentary. Obesity has reached epidemic proportions and health care costs associated with weight-related illnesses have escalated. Although our knowledge base has greatly expanded regarding the complex causation of increased body fat, little progress has been made in long-term maintenance interventions with the exception of surgery. Lifestyle modifications in food intake and exercise remain the hallmarks of effective treatment, but are difficult to initiate and sustain over the long term. The dietitian can play a pivotal role in modifying weight status by helping to formulate reasonable goals which can be met and sustained with a healthy eating approach as outlined in the Dietary Guidelines for 2000. Any changes in dietary intake and exercise patterns which decrease caloric intake below energy expenditure will result in weight loss, but it is the responsibility of the dietitian to make sure the changes recommended are directed toward improved physiological and psychological health. A thorough clinical assessment should help define possible genetic, environmental, and behavioral factors contributing to weight status and is important to the formulation of an individualized intervention. The activation of treatment strategies is often limited by available resources and cost. Reimbursement by third party payers for services is limited. Health care dollars are consumed for treatment of weight-related diseases. Public policy must change if the obesity epidemic is to be stopped and appropriate weight management techniques activated.
Body Weight↗
Position of the American Dietetic Association, Society for Nutrition Education, and American School Food Service Association--Nutrition services: an essential component of comprehensive school health programs.
It is the position of the American Dietetic Association (ADA), the Society for Nutrition Education (SNE), and the American School Food Service Association (ASFSA) that comprehensive nutrition services must be provided to all of the nation's preschool through grade twelve students. These nutrition services shall be integrated with a coordinated, comprehensive school health program and implemented through a school nutrition policy. The policy should link comprehensive, sequential nutrition education; access to and promotion of child nutrition programs providing nutritious meals and snacks in the school environment; and family, community, and health services' partnerships supporting positive health outcomes for all children. Childhood obesity has reached epidemic proportions and is directly attributed to physical inactivity and diet. Schools can play a key role in reversing this trend through coordinated nutrition services that promote policies linking comprehensive, sequential nutrition education programs, access to and marketing of child nutrition programs, a school environment that models healthy food choices, and community partnerships. This position paper provides information and resources for nutrition professionals to use in developing and supporting comprehensive school health programs. J Am Diet Assoc. 2003;103:505-514.
Adolescent↗
Dietetic guidelines on food and nutrition in the secondary prevention of cardiovascular disease - evidence from systematic reviews of randomized controlled trials (second update, January 2006).
AIM: To update dietetic guidelines based on systematic review evidence on dietary advice to prevent further events in people with existing cardiovascular disease (CVD) (secondary prevention). METHODS: The Cochrane Library, MEDLINE and EMBASE were comprehensively searched to January 2005 for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomized controlled trials relating to diet and secondary prevention of CVD. Each review was critically appraised by at least two members of the UK Heart Health and Thoracic Dietitians Group. The quality and results of each review were discussed and summarized at a group meeting. RESULTS: Evidence-based strategies that reduce cardiovascular events in those with CVD include reduction in saturated fat and substitution with unsaturated fats. Individuals who have suffered a myocardial infarction may also benefit from adopting a Mediterranean type diet and increasing intake of omega 3 fats, but it is not clear whether they are beneficial for all patients with CVD. There is no systematic review evidence to support the use of antioxidant vitamins supplements, low glycaemic index diets, or homocysteine lowering therapies in this group. CONCLUSION: There remains good evidence that reducing saturated fat reduces morbidity in patients with CVD. This advice is consistent for most manifestations of CVD, with the addition of Mediterranean dietary advice and increased omega 3 fats for those who have had a myocardial infarction.
Antioxidants↗
Position of the American Dietetic Association: legal and ethical issues in feeding permanently unconscious patients.
Health care team members, including the dietitian, must set patient-centered treatment goals that are handled individually and that respect the unique values and personal decision of the patient. The patient's expressed desire is the primary guide for determining the extent of nutrition and hydration once the patient is diagnosed as being in a PVS. Within the extent of the law, the family should share decision making when the patient's preference is not stated and the family is in agreement about medical care. The health care team will need to discuss with the family as needed the issues of ethics, values, religious guidelines, and pastoral advice. If the patient's choice is feeding, the dietitian will ensure that the composition of the feeding promotes nutritional health. If the patient's choice is cessation of feeding, the dietitian should explain what is known about the duration of time between cessation of feeding and death. Sensitivity to the family's needs and responsiveness to their questions are imperative in both scenarios. Within institutions, the ethics committee should help establish and implement defined written guidelines for care of the permanently unconscious. The dietitian should be required to be a member of or consultant to such a committee and should serve an integral role in development of institutional policy. The dietitian must provide education about nutrition and hydration issues, serve as a patient advocate, and participate in the legal and ethical issues regarding feeding. The dietetics community is involved in the legislative arena at the state and local level to promote the use of advanced directives and to affect legislative and societal changes that result in appropriate care for patients in a PVS.
Dietetics↗
The use of a programmable pocket calculator in clinical dietetics.
The application of programmable pocket calculators to clinical dietetics is described. The development of programs for the HP-67 and 97 for the evaluation of nutritional intakes of patients with obesity, renal disease, etc. and for the calculation and interpretation of food intakes in nutritional surveys is given in detail. The calculators simplify the practical work, shorten the calculation time substantially and allow direct incorporation of newly published data into analysis.
Diet↗
Retrospective analysis of the use of a standardized reference form in admissions to a dietetics internship program.
Although the letter of recommendation is the most commonly requested information relating to the personal qualities of applicants to dietetics internship programs, little research has focused on its value in selection decisions. The purpose of this study was to review how 318 letters of recommendation submitted on a standardized form related to the source of the reference and to the admission status of the applicants. The form contained 40 attributes that raters assigned to one of six categories. Nine of the 40 attributes were not rated by more than 75% of the raters, and 3 of the attributes were rated as outstanding by more than 60% of the raters. We concluded that these attributes did little to distinguish among applicants. The attribute maturity correlated 0.70 with 5 attributes and 0.99 with 2 attributes, so duplication of information existed. Raters were categorized as follows: adviser, major professor, other professor, employer, and other. The highest mean ratings were given by advisers; major professors rated students lowest. Analysis of variance supported a significant difference in rating by type of rater. Our findings suggest that fewer items should be used on a standardized form and that the type of rater should be specified if references are to distinguish among applicants.
Analysis of Variance↗
Quality delegation grid: a decision tool for evaluating delegation of management tasks in hospital dietetics departments.
This research was designed to determine perceptions of the quality of task performance; identify personnel currently performing selected management and food production tasks in a hospital dietetics department; and develop a grid for examining delegation strategies. Information on task quality and delegation was obtained from 309 dietitians and 208 support personnel in 151 hospitals. This information was used to develop a quality delegation grid. The grid is divided into four quadrants: High Quality/High Delegation; High Quality/Low Delegation; Low Quality/High Delegation; and Low Quality/Low Delegation. The grid was used to evaluate the delegation of management tasks reported by participants in this study. Our results indicated that the majority of tasks were placed in the High Quality/High Delegation quadrant (28 tasks) and the Low Quality/Low Delegation quadrant (17 tasks), suggesting that delegation was appropriate for the quality expected if the task was delegated. Three tasks were placed in the Low Quality/High Delegation quadrant indicating that tasks were delegated even though quality of the completed task was perceived as low when delegated, suggesting that dietitians should have performed these tasks themselves. Four tasks were placed in the High Quality/Low Delegation quadrant indicating that dietitians were performing tasks that were perceived to have high quality when performed by support personnel, yet these tasks were rarely delegated. Foodservice directors could use the grid to identify training needs, differentiate perceptions between dietitians and support personnel, and evaluate current delegation patterns.
Dietetics↗
Position of the American Dietetic Association: nutrition--an essential of medical education.
The public is increasingly nutrition conscious and actively seeks reliable sources of nutrition education. Physicians with appropriate training in nutrition can and should be a powerful force in providing accurate nutrition information and quality health care. As physician educators, dietetics professionals can facilitate this outcome. Appropriate use of nutrition resources and professionals will efficiently and effectively maintain or improve the nutritional status of the public and, ultimately, the health of our nation.
Dietetics↗