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PubMed2002

Development and implementation of the Clinical Privileges for Dietitian Nutrition Order Writing program at a long-term acute-care hospital.

A patient nutrition care plan is of little value unless it is quickly and efficiently implemented. Recognition of the value of appropriate and timely medical nutrition intervention in improving patients' nutritional status led to the development of the Clinical Privileges for Dietitian Nutrition Order Writing (CPD NOW) program at a long-term, acute-care hospital. CPD NOW is a formalized approach specifying the types of nutrition care orders that may be written by a registered dietitian (RD), allowing nutrition recommendations to be implemented immediately. More than 95% of the facility's primary attending physicians participate in this optional program. Development included an initial evaluation of physician use of RD recommendations, identification of problems in implementing these recommendations, formulation of an efficient nutrition order writing system, and adoption of this system by the medical staff. In the first 5 years of implementation, the benefits achieved by this program were: expedited order implementation, improved patient nutritional response, and increased RD responsibility. A survey demonstrated physician support of this new RD role. CPD NOW may be applicable as a model to develop similar systems in other hospitals.

Critical Care↗

PubMed1994

CATCH: food service program process evaluation in a multicenter trial.

Process evaluation is an essential element of a multicenter trial in order to explain study outcomes and monitor intervention progress. This paper presents the process evaluation model for the Eat Smart School Nutrition Program, the food service intervention component of the Child and Adolescent Trial for Cardiovascular Health (CATCH), and describes the process evaluation strategies developed to assess this program. The paper details (1) measures of program implementation including training, support visits, and program promotion, (2) food service staff characteristics, and (3) measures of mediating variables including secular trends and school meal participation.

Adolescent↗

PubMed2001

Breastfeeding peer counseling: results from the National WIC Survey.

The objective of this study was to examine breastfeeding peer counseling within the context of the organizational structure of state and local Supplemental Nutrition Program for Women, Infants and Children (WIC) agencies. The National WIC Breastfeeding Peer Counselor Survey was distributed to a convenience sample of state WIC breastfeeding coordinators and breastfeeding project coordinators and to a sample of local agency WIC directors and staff, breastfeeding peer counselor coordinators, and peer counselors. The findings indicate that respondents in the WIC state and local organizations perceive peer counseling to be effective in promoting and sustaining breastfeeding among WIC mothers. There is, however, a lack of consistent policies and procedures concerning the recruitment, training, and counseling phases of peer counseling within and across state WIC agencies.

Adult↗

PubMedDate not supplied

Nutrition services in State and local public health agencies. Special supplement: revision of the 1955 guide by the Nutrition Services Project Committee.

The contribution of nutrition in preventing disease, prolonging life, and promoting health through organized community effort is well recognized. While many gains have been made in public health nutrition, it is clear that the American population continues to exhibit nutrition problems. Rene Dubos has said that no community will find it possible to deal simultaneously with all of the health problems inherited from the past and with those brought about by modernization and change. The challenge lies in determining priorities and making difficult choices in the face of shifting responsibilities among levels of government, reduced resources, and increased competition. The purpose of this guide is to help public health officials appreciate the important role nutrition services play in meeting the health needs of their communities. The recommendations for nutrition programs are sensitive to the social, economic, and political forces that are shaping the future of public health. How well public health officials meet the challenge of providing nutrition services in their communities will be a significant factor influencing the health status of the American population in the 1980s and beyond.

Cost-Benefit Analysis↗

PubMed2004

Improvements in nutritional intake and quality of life among frail homebound older adults receiving home-delivered breakfast and lunch.

OBJECTIVE: This study evaluated the influence that expanding a home-delivered meals service to include breakfast and lunch would have on the nutritional status and quality of life of at-risk older adults. DESIGN: This cross-sectional field study compared two groups. The breakfast group (n=167) received a home-delivered breakfast and lunch, 5 days per week. The comparison group (n=214) received a home-delivered lunch 5 days per week. Participants' 24-hour food recall, demographics, malnutrition risk, functional status, and surveys of quality of life as health, loneliness, food enjoyment, food security, and depression were obtained. PARTICIPANTS: Study participants were recruited from five Elderly Nutrition Programs involved in the Morning Meals on Wheels breakfast service demonstration project. They formed a geographically and racially/ethnically diverse sample. Participants ranged in age from 60 to 100 years, were functionally limited, and at high nutritional risk. Most were low income, lived alone, and had difficulty shopping or preparing food. STATISTICAL ANALYSIS: Descriptive statistics were used to assess group comparability. Independent sample t tests were used to examine group differences, with Bonferroni's method used to control for familywise Type I error. RESULTS: Breakfast group participants had greater energy/nutrient intakes (P<.05), greater levels of food security (P<.05), and fewer depressive symptoms (P<.05) than comparison group participants. CONCLUSIONS: The addition of a breakfast service to traditional home-delivered meals services can improve the lives of frail, homebound older adults. Agencies should be encouraged to expand meals programs to include a breakfast service to a targeted population.

Aged↗

PubMedDate not supplied

Dietary practices of South Carolina adolescents and their parents.

OBJECTIVE: To assess and identify correlates of adolescents' and parents' compliance with food guide pyramid recommendations (FGPR) and weight-control behaviors (WCB). METHODS: Data were collected from a random sample of adolescents (2,021) and parents (1,231) and were analyzed using multiple and logistic regression. RESULTS: Only 7% eight graders, 4% eleventh graders, and 3% parents met all FGPR. The most significant predictors of FGPR and WCB include knowledge, attitudes, and eating concerns. Extreme dieters were less likely and moderate dieters were more likely to meet recommendations. CONCLUSION: Results have relevance for developing nutritional programs for adolescents.

Adolescent↗

PubMed2005

Longitudinal examination of homebound older adults who experience heightened food insufficiency: effect of diabetes status and implications for service provision.

PURPOSE: Healthful eating is important for optimal diabetes self-care. However, the level of food sufficiency may influence the degree of adherence to dietary self-care behaviors through the affordability of nutritionally appropriate food. This study examines whether homebound older adults with diabetes were at greater risk for heightened food insufficiency over 1 year, despite regular receipt of home-delivered meals. DESIGN AND METHODS: This was a longitudinal study of a randomly recruited sample of 268 homebound older adults in the Nutrition and Function Study (NAFS) who regularly received home-delivered meals and completed baseline and 1-year in-home assessments. Based on an economic context model, self-reported data were collected on fundamental and proximate factors, food-sufficiency status, and intervening events. Determinants of heightened food insufficiency were examined with multivariate logistic regression models. RESULTS: Not only did food-sufficiency status diminish over time in this sample, but it became or remained worse for older adults with diabetes. In addition to diabetes status, heightened food insufficiency was associated with perceived inadequacy of economic resources. IMPLICATIONS: Health care providers and nutrition programs should attempt to identify high-risk older adults - those who have diabetes and are at risk of food insufficiency - and develop community linkages and strategies that integrate nutrition with diabetes care plans, thus supporting a multidisciplinary, chronic care model to improve diabetes management and outcomes.

Aged↗

PubMed2005

[News and advertising on foods, diet and obesity].

In recent decades a new ideal of beauty has evolved characterised by slim women and muscular men; obesity, which in past centuries was considered healthy and attractive, is now "out of fashion". The news media devote ample space, especially during spring and summer, to diet and fitness programs, and many diets and devices, without any scientific evidence, are presented as miracle cures. The business of diets and "natural" products generates intensive campaigns developed to promote foods, nutritional programs, and specific tools for losing weight as rapidly and effortlessly as possible. In this context, general practitioners and specialists have a fundamental role to play in correcting the often distorted messages that the general public receives, through educational programs designed to promote a correct understanding of the cardiovascular risks of obesity and healty methods and treatments for losing weight and safely achieving real health objectives.

Advertising↗

PubMed2005

From concept to practice: using the School Health Index to create healthy school environments in Rhode Island elementary schools.

INTRODUCTION: The prevalence of childhood obesity is increasing, and schools are ideal places to support healthy eating and physical activity. In 2000, the Centers for Disease Control and Prevention (CDC) developed the School Health Index, a self-assessment and planning tool that helps schools evaluate and improve physical activity and nutrition programs and policies. Although many state education agencies, health departments, and individual schools have used the School Health Index, few systematic evaluations of the tool have been performed. We examined the physical activity and nutrition environments in Rhode Island's public elementary schools with high and low minority student enrollments and evaluated a school-based environmental and policy intervention that included implementation of the School Health Index. METHODS: As part of a CDC Division of Nutrition and Physical Activity cooperative agreement awarded to the Rhode Island Department of Health, we conducted a needs assessment of 102 elementary schools and implemented an intervention in four inner-city elementary schools. In phase 1, we analyzed the Rhode Island Needs Assessment Tool (RINAT), a telephone survey of principals in approximately 50% of all Rhode Island public elementary schools in the state during the 2001-2002 school year (n = 102). Comparisons of the nutrition and physical activity environments of schools with low and high minority enrollment were calculated by cross-tabulation with the chi-square test. In phase 2, we used process and outcome evaluation data to assess the use of the School Health Index in creating healthier environments in schools. Our intervention--Eat Healthy and Get Active!--involved implementing three of the eight School Health Index modules in four Rhode Island elementary schools. RESULTS: Survey data revealed that schools with high minority enrollment (student enrollment of > or =10% black, > or =25% Hispanic, or both) offered few programs supporting healthy eating and physical activity (P < .05). Schools with high and low minority enrollment both offered nonnutritious foods and beverages. Process evaluation data revealed that 1) principals play a pivotal role on School Health Index teams, 2) schoolwide validation of a team's small successes is crucial for sustaining a commitment to healthy lifestyle policies and programs, and 3) external facilitators are essential for implementation success. Outcome data showed that all schools developed at least one policy or environmental strategy to create a healthy school environment. Only two schools implemented immediate changes. CONCLUSION: Needs assessment, external facilitation, and evaluation are the foundation for sustainable school-based policies. Although the School Health Index is universally perceived as a user-friendly assessment tool, implementation is likely to be less successful in schools with low staff morale, budgetary constraints, and inconsistent administrator support.

Child↗

PubMed2001

Development of scales to measure dietary acculturation among Chinese-Americans and Chinese-Canadians.

OBJECTIVE: To develop simple scales to measure a Chinese immigrant's adoption of Western eating patterns (dietary acculturation). STUDY DESIGN AND PARTICIPANTS: Data are from 244 less-acculturated women of Chinese ethnicity living in Seattle, Wash, and Vancouver, British Columbia, Canada. Interviewers collected information on sociodemographic characteristics, acculturation indices, items that reflect Western and Chinese dietary behavior, and consumption of fruits, vegetables, and fat. STATISTICAL ANALYSES: Analysis of variance and linear regression analyses examined associations among dietary measures and acculturation variables, controlling for age, education, and city of residence. RESULTS: We developed 2 scales to assess dietary acculturation: the Western Dietary Acculturation Scale and the Chinese Dietary Acculturation Scale, measuring Western and Chinese eating behavior, respectively. Although the population in this study was a less-acculturated sample, most participants reported some Western dietary practices, such as drinking milk (78%), eating cheese (78%), eating at Western fast-food restaurants (56%), and eating between meals (72%). Younger, highly educated women employed outside the home had the highest Western dietary acculturation scores (P < .001). Women with high scores on the Western scale reported higher-fat dietary behaviors and had increased fruit and vegetable intake since immigration compared to those with lower scores (P < .001). There was good agreement between the dietary acculturation scales and traditional acculturation indicators (P < .001). APPLICATIONS: Nutrition programs for immigrant/minority groups may be more effective if they are tailored to level of dietary acculturation. Therefore, the ability to accurately assess dietary acculturation is an important component of nutrition education, interventions, and counseling in these populations.

Acculturation↗

PubMed2005

Micronutrient status and intervention programs in Malaysia.

Approximately 70% of the world's malnourished children live in Asia, giving that region the highest concentration of childhood malnutrition worldwide. Prevalence of stunting and underweight are high especially in south Asia where one in every two preschool children is stunted. Iron-deficiency anemia affects 40%-50% of preschool and primary schoolchildren. Nearly half of all vitamin A deficiency and xerophthalmia in the world occurs in south and southeast Asia. Iodine deficiency disorders have resulted in high goiter rates in India, Pakistan, and parts of Indonesia. Compared with other developing countries in Asia, the nutrition situation in Malaysia is considerably better, owing to rapid economic and socioeconomic development that has occurred since Malaysia gained its independence in 1957. Prevalence of undernutrition and micronutrient deficiency is markedly lower in Malaysian children. Nonetheless, undernutrition in the form of underweight, stunting, and anemia can be found in poor communities throughout the country. A prevalence of 25% underweight and 35% stunting is reported among young children from poor rural households. Anemia and subclinical forms of vitamin A deficiency were reported in children under 5 years old. Typical of a country in nutrition transition, Malaysia faces the dual burden of malnutrition in children, with the persistence of under-nutrition problems especially among the poor and the emerging overweight problem especially in urban areas. Since 1996, nutrition programs of the government sector are coordinated under the National Plan of Action for Nutrition. These activities and other nutrition intervention efforts by other agencies are discussed in this paper.

Child↗

PubMed2005

Nutrition trends during 150 years of children's cookbooks.

This paper identifies trends in children's cookbooks for nutrition messages, cultural content, and food themes according to food guidance of the time. Except for those developed in government-sponsored nutrition programs since the 1970s, children's cookbooks seemingly have a preponderance of high-calorie dessert and party/fun recipes and limited vegetable recipes. In the past 150 years, the science of nutrition has grown from a focus on nitrogen to one on multiple nutrients and their interrelationships. Foods in the market have diversified in number and form, and a children's nutrition specialty has been introduced and expanded in many dimensions-including in the publishing of children's books. Because children's early food choices influence both their growth and health, factors impacting food choices need to receive more attention.

Books↗

PubMed1982

Nutrition and public health in the Dominican Republic.

A nutrition survey was carried out in a mountainous region southwest of Santiago, Dominican Republic, to determine the extent of malnutrition in the area and to obtain information regarding food beliefs and practices needed to design a viable nutrition program. A stratified cluster sampling technique was used to interview 295 mothers of preschool children and examine 448 of their children under five years of age. The incidence of moderate and severe malnutrition was less than expected. Only 12.3% of the children were less than or equal to 75% of the National Center for Health Statistics (NCHS) reference standard for weight/age; however, 6.5% were greater than 110% of the standard. Children from large, poor families were most vulnerable to growth retardation. Definite meal patterns were identified that included varied sources of cereal products and animal and mixed vegetable proteins. Milk and sausage consumption had a significant positive association with all three growth parameters. Suggestions were made for further research and program development.

Child, Preschool↗

PubMed2006

Maternal and child characteristics associated with infant and toddler feeding practices.

OBJECTIVE: To describe maternal/child characteristics associated with important practices of feeding US infants and toddlers aged 4 to 24 months. DESIGN: Cross-sectional analysis of data collected in the 2002 Feeding Infants and Toddlers Study. Maternal/child characteristics associated with compliance to American Academy of Pediatrics feeding guidelines, and maternal/child characteristics associated with specific feeding patterns were assessed. SUBJECTS: A national random sample of mothers (n=2,515) whose infants and toddlers aged 4 to 24 months made up the Feeding Infants and Toddlers Study cohort. STATISTICAL ANALYSIS: Student t tests were used to compare the means and standard errors and were considered significant if P<.05. To predict if the mother/child met a particular recommendation, logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals. RESULTS: Having a college education was the maternal characteristic associated with the largest number of positive child feeding behaviors. Mothers with a college education were significantly more likely than mothers without a college education to initiate breastfeeding and breastfeed the child to age 6 and 12 months (OR 2.8, 3.2, and 3.9, respectively). College-educated mothers were significantly more likely to comply with the American Academy of Pediatrics juice and complementary feeding recommendations (OR 1.4 and 2.0). In addition, infants and toddlers whose mother had a college education were more likely to consume fruit and less likely to consume sweetened beverages and desserts or candy. Ever breastfeeding the sample child, living in the western region of the United States, and being married and older were also associated with multiple positive practices. The child being in day care was associated with decreased duration of breastfeeding at age 6 and 12 months as well as with consumption of salty snacks. CONCLUSIONS: Initiatives to improve infant and toddler feeding practices should focus on assisting mothers who have less than a college education, who are unmarried, whose child is in day care, or who are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children.

Adult↗

PubMed2001

Assessing potential risk factors for child malnutrition in rural Kerala, India.

Studies indicate that 42-57 per cent of all child deaths in developing countries are due to the potentiating effects of malnutrition on infectious disease, of which over three-quarters can be attributed to mild-to-moderate malnutrition. Risk factors for underweight status in children under 3 years of age were assessed in Kerala, India. Mothers of 34 children weighing below -1 SD for their age and 59 children weighing more than 1 SD for their age, were interviewed for information about maternal health, child feeding patterns, and sibling gender and age data. Statistical analysis showed that current maternal weight (odds ratio = 8.25, p = 0.0009), current maternal body mass index (OR = 4.55, p = 0.03), infant birth weight (OR = 4.87, p = 0.01) and excessive maternal vomiting in pregnancy (OR = 4.48, p = 0.04) were significant risk factors for current child underweight status. Based on this observed relationship of maternal nutritional factors with child weight-for-age status, further studies on interventions to address the health problems of adolescent girls and all women of reproductive age in Kerala are suggested, in addition to continuing the emphasis in current rural health and nutrition programs for pregnant and lactating mothers.

Adult↗

PubMed2006

Fruit juice intake predicts increased adiposity gain in children from low-income families: weight status-by-environment interaction.

OBJECTIVE: Our goal was to test the hypothesis that increased fruit juice intake and parental restriction of children's eating are associated with increased adiposity gain and whether exposure to nutritional counseling predicted reduced adiposity gain among children. PATIENTS AND METHODS: A sample of parents or guardians of children aged 1 to 4 years who attended 1 of 49 Special Supplemental Nutrition Program for Women, Infants, and Children agencies in New York State were surveyed in 1999 or 2000 (N = 2801). The survey addressed children's dietary intake, parental feeding practices, and parental exposure to nutritional counseling messages to increase fruit, vegetable, and low-fat milk intakes. Each child's height and weight were measured approximately every 6 months for up to 48 months. A prospective cohort design was used in which survey variables were the predictors and the outcome was change in children's adiposity, defined as change in age- and gender-standardized BMI per month (ie, BMI z-score slope). RESULTS: Controlling for gender and ethnicity, the relationship between juice intake and adiposity gain depended on children's initial overweight status. Among children who were initially either at risk for overweight or overweight, increased fruit juice intake was associated with excess adiposity gain, whereas parental offerings of whole fruits were associated with reduced adiposity gain. Each additional daily serving of fruit juice was associated with an excess adiposity gain of 0.009 SD per month. Feeding restriction was greater among parents whose children were initially at risk for overweight or overweight compared with those at a healthy weight. Parental exposure to nutritional messages was not associated with reduced child adiposity gain. CONCLUSION: This study supports the Institute of Medicine recommendations to reduce fruit juice intake as a strategy for overweight prevention in high-risk children.

Adipose Tissue↗

PubMed1991

Nutrition & specialized care.

We live in a time of specialized medical care. Now, patients can find myriad healthcare centers that offer state-of-the-art treatment for their particular ailments & disabilities. As therapy regimens have become more sophisticated, so has the role food & nutrition programs play in patient care. Featured on the following pages are five programs that are tailored to patients living with chemical dependencies, eating disorders, cardiovascular disease, cancer & mental illness. In each, directors & dietitians are working actively with other healthcare professionals to provide the kind of nutritional support patients need to regain their health or, in some cases, even to survive.

Cancer Care Facilities↗

PubMed1993

[Protein metabolism after total small bowel resection].

Stable isotope 15N-lysine, 15N-alanine and 15N-glycine were used to evaluate the protein metabolism in a patient sustained by TPN for more than 4 years after total small bowel resection. Compared to normal control, the patient's total amount of absorption and urinary excretion were lower but utilization higher, the patient was considered in a status of increased protein synthesis and catabolism. Hence, the patient was vulnerable to nutritional failure if nutrition supply is not efficient. The results suggest that the nutritional program should be individualized, especially in the patient with total small bowel resection.

Adult↗