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PubMed1985

Nutrient intakes of American infants and children fed cow's milk or infant formula.

Between April 1984 and August 1984, a national survey, the Ross Laboratories Infant Nutrition Survey, was undertaken to assess patterns of food consumption of American infants ranging in age from 6.5 months to 13.4 months. Nutrient intakes of 865 infants were evaluated according to different foods (milk and milk products, non-iron-fortified formula, iron-fortified formula, infant cereal, commercial baby foods, and home-prepared table foods). Results indicated that most American infants consumed nutrients in appropriate amounts. However, a large proportion of infants who were fed a diet that included cow's milk received amounts of sodium, potassium, and chloride that exceeded the recommended safe and adequate ranges. The median intake of iron of infants fed either cow's milk or a non-iron-fortified formula was below the recommended dietary allowance; a low percentage of these infants received medicinal iron supplementation. The results also indicated that the median estimated renal solute load of the diet of infants fed cow's milk was approximately twice the amount of that of infants fed formula. These data may be useful in the development of nutritional programs for older infants.

Animals↗
PubMed1999

Racial bias in federal nutrition policy, Part I: The public health implications of variations in lactase persistence.

The Dietary Guidelines for Americans from the basis for all federal nutrition programs and incorporate the Food Guide Pyramid, a tool to educate consumers on putting the Guidelines into practice. The Pyramid recommends two to three daily servings of dairy products. However, research has shown that lactase nonpersistence, the loss of enzymes that digest the milk sugar lactose, occurs in a majority of African-, Asian-, Hispanic-, and Native-American individuals. Whites are less likely to develop lactase nonpersistence and less likely to have symptoms when it does occur. Calcium is available in other foods that do not contain lactose. Osteoporosis is less common among African Americans and Mexican Americans than among whites, and there is little evidence that dairy products have an effect on osteoporosis among racial minorities. Evidence suggests that a modification of federal nutrition policies, making dairy-product use optional in light of other calcium sources, may be a helpful public health measure.

Adolescent↗
PubMed2002

Translating nutrition research into action in humanitarian emergencies.

Except for the management of severe malnutrition, there has been little research specifically conducted to support emergency food and nutrition programs. Lacking empirically based guidance regarding how accurately to identify problems and select the most effective means to achieve desired objectives, programming decisions have been based on extrapolations, anecdotal evidence and intuition, with hopes of doing the right thing. Consequently, donors, implementers and affected governments, who often hold contradictory opinions, expend time and resources on controversies about when and how to act. These controversies reveal inadequate knowledge for which research is urgently needed. Two past controversies are presented as illustrations: one related to ration energy requirements and the other to sales of food aid. Appropriate action depends on context and research to support emergency programming must encompass a broad range of sectors and disciplines. Furthermore, emergency contexts are characterized by extremes and dynamic change and investigations in such contexts demand special approaches and caution. Institutional structures need to be changed so that they can adequately support emergency nutrition research.

Altruism↗
PubMed1998

The effect of WIC and Medicaid on infant mortality in the United States.

OBJECTIVES: This study examine the impact of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Medicaid on risk of infant death in the United States. METHODS: The 1988 National Maternal and Infant Health Survey was used to consider the risk of endogenous and exogenous death among infants of women participating in WIC and Medicaid during pregnancy and the infant's first year. RESULTS: Participation in the WIC program during pregnancy and infancy was associated with a reduced risk of endogenous and exogenous infant deaths (odds ratios [ORs] = 0.68 and 0.62, respectively). The risk of endogenous death among infants whose mothers participated in Medicaid during pregnancy was equal to that of the privately insured (OR = 1.04). Uninsured infants faced higher risks of endogenous death (OR = 1.42). CONCLUSIONS: These results show that it is important to consider the net effect of WIC and Medicaid participation and to differentiate both the timing of program receipt and cause of death. Evidence suggests that WIC and Medicaid programs have beneficial effects for poor women and their infants.

Adult↗
PubMed2004

Counseling Latina mothers of preschool children about weight issues: suggestions for a new framework.

OBJECTIVE: To assess Latina mothers' health beliefs and attitudes regarding early childhood weight issues and to use the information to update current nutrition education methods. DESIGN: Data were collected in eight focus group sessions using a semistructured questionnaire. SUBJECTS/SETTING: Forty-three Latina mothers (and grandmothers) with children aged 2 to 5 years were recruited at five different Special Supplemental Nutrition Program for Women, Infants, and Children sites in California. ANALYSIS: Transcripts of focus groups were imported into QSR NUD*IST software, facilitating in-depth iterative analysis of emergent themes. RESULTS: Fifteen emergent themes were identified and organized into four functional domains relevant to nutrition education: health beliefs surrounding weight, impact and cause of overweight, life values and concerns, and strategies for making changes in children's eating and activity patterns. Information from this qualitative study demonstrates that the traditional nutrition counseling paradigm may not be effective with Latina mothers. In addition, cultural beliefs can be barriers to successful prevention and treatment of overweight. To ensure that culturally competent services are provided, educators must be prepared to adjust education approaches according to the cultural background of the clients. Key among the issues was mothers' difficulty acknowledging overweight among their children and their perception that health and weight were poorly associated. Certain cultural values were identified as barriers to adopting healthful behaviors. Mothers were able to identify specific ways in which nutrition education could be improved. APPLICATIONS/CONCLUSIONS: Our findings suggest that nutrition education efforts targeting Latina mothers of young children can be reframed to better address the belief system and cultural framework of the population, like identifying positive eating behaviors rather than focusing on a child's weight.

Adolescent↗
PubMedDate not supplied

Predictors of fat intake behavior differ between normal-weight and obese WIC mothers.

PURPOSE: To determine whether predictors of fat intake behavior were the same for normal-weight and obese WIC mothers when applying the PRECEDE-PROCEED model and to identify predictors for each group. DESIGN: Proportional stratified convenience sampling. SUBJECTS: Five hundred eighty-one nonpregnant, black and white normal-weight (n = 180) or obese (n = 401) women. SETTINGS: The Special Supplemental Nutrition Program for Women, Infants and Children in six counties in southern Wisconsin. MEASURES: The independent variables were predisposing, enabling, and reinforcing factors. Predisposing factors included beliefs in diet and health, beliefs in diet and body shape, health concerns in food choice, health concerns in nutrition, and eating habits. Enabling factors were cost of food, availability of time to prepare food, and accessibility to purchase food. Reinforcing factors were weight control intentions, sensory appeal, and mood. The dependent variable was fat intake behavior. Structural equation modeling was performed. RESULTS: When controlling for covariates, certain factors affectingfat intake behavior differed between the normal-weight and the obese groups. For the normal-weight group, only reinforcing factors were positively associated with fat intake behavior For the obese group, reinforcing and enabling, but not predisposing, factors were positively associated with fat intake behavior. CONCLUSIONS: Interventions to modify low-income women's fat intake behavior might benefit from targeting behavioral predictors that differ with body size. Messages that emphasize weight control intentions, sensory appeal, and mood are likely to affect both normalweight and obese women. Information about cost of food, availability of time to prepare food, and accessibility to purchase food is likely to be more effective with obese women.

Adult↗
PubMed1982

Seasonality and nutritional status. A review of findings from developed and developing countries.

Studies of seasonality and growth from developed nations demonstrate distinct effects on weight and height gains according to the season. When maximal group gains in height are recorded, minimal weight gains are detected. Only a quarter and a third of all children had their minimal and maximal height gains respectively, in the same period as minimal and maximal group gains occurred. Rain and pre-harvest months are usually associated separately with the disease incidence peaks and with lower energy and nutrient intake. In most areas of the developing world, however, rainy months with a higher incidence of diseases coincide with the lean or hungry pre-harvest months. Some communities have devised certain mechanisms which are likely to buffer negative seasonal effects (rainy or pre-harvest months) on health and nutritional status. Thus, either as a result of lower intakes of energy and nutrients and/or less efficient utilization of energy and nutrients, one is likely to find important seasonal effects in poor agricultural communities of developing countries. The importance of adequate knowledge about seasonal effects to support the better use of existing resources allocated to health and nutrition programs is discussed.

Body Weight↗
PubMedDate not supplied

Severe obesity: a growing health concern A.S.P.E.N. should not ignore.

The definition of malnutrition in the published standards of the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) is any derangement in the normal nutrition status and includes overnutrition, commonly referred to as obesity. The incidence of obesity is increasing and reaching epidemic proportions in the United States and even worldwide. This has significant financial impact as our society spends billions of dollars on fad diets, commercial weight-loss programs, nutrition and dietary supplements, prescription and over-the-counter medications, and health clubs. Another approximately dollars 100 billion are spent to treat the medical consequences of obesity. Currently, for those patients with intractable morbid obesity, defined as having a body mass index >40 kg/m2, surgery offers the only option for achieving meaningful and sustainable weight loss. The resultant weight loss dramatically improves health and decreases the cost of health care for these patients. Years of refinement in technology and the introduction of safer and less invasive procedures have dramatically reduced the short-term morbidities and long-term metabolic consequences of these procedures. This address will review the field of weight loss (bariatric) surgery and will offer a compelling request for A.S.P.E.N. to include obesity in its fabric.

Bariatrics↗
PubMed1976

Interactions between health and population.

Both health and population have multiple direct and indirect, as well as positive and negative, influences on each other and on the development process. There is much evidence to show that high fertility produces multiple health hazards and that family planning is one of the most effective health measures available. Conversely, there are also multiple ways in which health influences fertility. Whereas health services resulting in reduced morbidity and mortality have often been considered a major cause of population growth, the authors argue that health programs can also contribute to a more rapid decline in birth rates by facilitating the increased practice of family planning. Evidence is reviewed to support the position that family planning services can be more effective, efficient, and acceptable when combined with maternal and child health and nutrition programs.

Child↗
PubMed1996

Gestational diabetes: ensuring a successful outcome.

When gestational diabetes is diagnosed, the physician has an opportunity to help the patient deliver a healthy baby by encouraging optimal glycemic control. In this article, the authors describe risk factors, methods of diagnosis, and a plan of management that includes a nutritional program based on ADA guidelines, use of insulin if needed, home monitoring of glucose levels, and appropriate exercise.

Diabetes, Gestational↗
PubMed2003

The European view of hospital undernutrition.

Disease-related undernutrition is significant in European hospitals but is seldom treated or prevented. In 1999, the Council of Europe decided to collect information regarding nutrition programs in hospitals, and for this purpose, a network consisting of national experts from 12 of the Partial Agreement member states was established. The aim was to review the current practices in Europe regarding hospital food provision, to highlight deficiencies, and to issue recommendations to improve the nutritional care and support of hospitalized patients. Five major common problems were identified: 1) lack of clearly defined responsibilities, 2) lack of sufficient education, 3) lack of influence and knowledge of the patients, 4) lack of cooperation between different staff groups, and 5) lack of involvement from the hospital management. To solve the problems highlighted, a combined timely and concerted effort is required from national authorities and hospital staff, including managers, to ensure appropriate nutritional care and support.

Journal Article↗
PubMed1979

Pharmacist as team leader for total parenteral nutrition therapy.

A total parenteral nutrition program in a 635-bed private nonteaching institution which uses the pharmacist as team leader is described. To initiate TPN therapy, the attending physician writes a request for a consulation with the pharmacist. Prior to initiation of TPN therapy, the pharmacist reviews the chart, conducts a physical and nutritional assessment of the patient, orders any laboratory tests needed for further assessment of the patient and uses these results to classify the patient's nutritional status. The pharmacist then writes all TPN-related orders, including orders for laboratory tests and nursing care. Communications between the pharmacist and the attending physician concerning the progress of the patient and TPN changes are conducted orally on rounds and via chart notes. The number of patients receiving TPN therapy has increased each year--from six patients during 1976, to 19 patients during 1977 and 54 in 1978. Of the two preventable complications that developed in these 79 patients, both were quickly resolved by the pharmacist. Physicians who, in the past, opted not to place patients on TPN because of lack knowledge or lack of a TPN consultant, now rely on the pharmacist for this service.

Florida↗
PubMed2004

Altering the perceptions of WIC health professionals about childhood obesity using video with facilitated group discussion.

OBJECTIVE: To determine if viewing a documentary video, followed by facilitated group discussion, could alter the perceptions of those providing public health nutrition services about the barriers and solutions to addressing the problem of obesity in low-income preschoolers. DESIGN: Before-after trial to determine how often study participants could identify any of the 17 barriers and seven solutions targeted in the video and during the facilitated group discussion. SUBJECTS/SETTING: One hundred fifty-five attendees of the 2001 Kentucky Maternal and Child Health Conference participated in the study. Sixty percent were nurses, 24% were dietitians or nutritionists, and 64% had Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) counseling experience. INTERVENTION: Participants first viewed a 20-minute documentary video about three families enrolled in WIC. A 40-minute facilitated group discussion followed to highlight the 17 barriers (eg, WIC families are struggling with many demands in their lives that make nutrition a low priority and WIC health professionals "lecture" clients on what they "need to know") and seven solutions (eg, adjusting WIC counseling to assess parenting skills and to increase sensitivity to clients' life context and stresses). MAIN OUTCOME MEASURES/ANALYSES: Participants responded before and after the intervention to the same two open-ended questions, one about barriers and one about solutions. Participant responses were coded to count instances of identifying any of the 17 barriers and seven solutions. RESULTS: At baseline, 51% of participants were unable to record any of the barriers, and 91% could not identify any of the solutions. After the intervention, 37% could identify at least one more of the target barriers than they did at baseline, and 24% could identify at least one more of the target solutions. CONCLUSIONS: A documentary-style video, used with facilitated group discussion, can produce a short-term change in the perceptions of those providing public health nutrition services about addressing the problem of obesity in low-income preschool children.

Adult↗
PubMed1977

Nutritional management of the chronically ill child. Congenital heart disease and myelomeningocele.

We have presented some of the nutritional complications encountered in two major pediatric congenital disorders. Although these conditions represent two more common major defects, it is unlikely that many health care providers will manage large numbers of these patients. Nevertheless, the nutrition principles apply to other nutritional dilemmas of chronically ill children. When an infant consumes a low volume intake, regardless of etiology, concerns such as provision of adequate nutrition, within the confines of the infant's water balance, become paramount. Methods have been discussed for increasing caloric density and for monitoring dietary safety and adequacy. When an infant has a propensity for becoming obese one needs to consider preventive measures such as providing sound nutrition information, support, and follow-up for both patient and family. Nutritional problems can become magnified unless adequate support is provided for total health and social needs of the family. The role of the dietitian must be one active participation within the the framework of an interdisciplianry team so that appropriate innovative nutrition programs can be developed and implemented.

Child, Preschool↗
PubMed2006

Effect of prenatal food supplementation on birth weight: an observational study from Bangladesh.

BACKGROUND: National nutrition programs in Bangladesh have included prenatal food supplementation to reduce maternal and child malnutrition. The knowledge base is weak regarding the effect of prenatal food supplementation on the birth weight (BW) of infants in populations in whom low BW is prevalent and regarding any variation in effect based on maternal nutritional status. OBJECTIVE: We examined whether observational data support an effect of daily prenatal food supplementation on BW by considering the duration of supplementation and whether the effect is modified by maternal postpartum weight (a proxy of prepregnancy weight) groups. DESIGN: A cohort of undernourished pregnant women (n = 777) who received prenatal food supplementation (608 kcal/d) was followed. The association between the uptake of food supplements and BW was analyzed after adjustment for potential confounders (n = 619 with complete information). Differential effects in lower and higher maternal postpartum weight groups were examined. RESULTS: The average BW was 2521 g. On average, the women received daily supplements for 4 mo, which resulted in an increase in BW of 118 g (1.0 g/d). The strongest effect was found for births occurring in January and February. There was a linear dose-response relation between duration of supplementation and BW for women with higher postpartum weights (> or = 42 kg, above the median). In women with lower weights (< 42 kg, below median), a shorter duration of supplementation (< 4 mo) had no such dose-response relation with BW, but there was a linear dose-response relation for longer durations of supplementation. CONCLUSIONS: The association between duration of prenatal food supplementation and BW varies with maternal postpartum weight. A large effect was observed after the season with food insecurity (mid-August to mid-November).

Adult↗
PubMedDate not supplied

Underweight, weight loss and related risk factors among older adults in sheltered housing--a Swedish follow-up study.

BACKGROUND: Underweight and weight loss are important factors in detecting malnutrition. OBJECTIVE: To describe underweight, weight loss and related nutritional factors after 12 months among individuals 75 years or older and living in sheltered housing. A further aim was to identify possible risk factors associated with underweight and weight loss. DESIGN: This is a part of a cross-sectional follow-up study from a county in Sweden, examining the disabilities, resources and needs of 719 older adults in sheltered housing units. Data were collected twice, with a 12-month interval using the Resident Assessment Instrument. RESULTS: Among the 503 remaining chronically ill individuals with cognitive and functional disabilities, 35% were classified as underweight at the initial assessment and 38% at the second, a non-significant difference. A further analysis showed 39% had decreased weight, 27% remained stable and 28% gained weight. A weight loss of 5% occurred in 27% of the older adults and a loss of 10% occurred in 14%. Risk factors associated with being underweight and weight loss, using scales derived from the instrument were cognitive and functional decline. Dementia and Parkinson's disease, eating dependencies and constipation were the strongest risk factors when analyzed as single items. CONCLUSION: A high percentage was underweight or exhibited weight loss and several risk factors were identified. Ensuring adequate nutritional status in individuals with a variety of diseases and declining health status is challenging. Increased combined efforts using a wide range of measures, nutritional programs and routines need to be regularly implemented.

Aged↗
PubMed2005

Nutritional management of acute renal failure.

Acute renal failure (ARF) is associated with fundamental alterations of metabolism and immunocompetence with the induction of a pro-oxidative and proinflammatory state. Thus, the objectives of nutritional therapy include not only conventional goals such as maintaining lean body mass and stimulating immunocompetence and repair functions, but also mitigating the inflammatory state and improving the oxygen radical scavenging system and endothelial functions. Moreover, pre-existing and/or hospital-acquired malnutrition has been identified as an important factor contributing to the persistent high mortality in acutely ill patients with ARF. A nutritional program for a patient with ARF must consider not only the specific metabolic consequences associated with renal failure and with the underlying disease process, but also the profound alterations in nutrient balances induced by replacement therapy. Nutrient requirements thus may differ widely between individual patients and during the course of disease, and nutrition therapy must be coordinated with renal replacement therapy. Whenever possible, enteral nutrition should be provided in patients with ARF because even small amounts of luminal nutrients will help to maintain intestinal function. Nevertheless, in many patients parenteral nutrition, at least supplementary and/or temporarily, will become necessary. Because of the complex alterations in the use of various nutrients and the impaired tolerance to electrolytes and volume load, metabolic complications of nutritional support frequently occur in patients with ARF. Therefore, nutrition therapy must be more closely monitored in patients with ARF than with other diseases.

Acute Kidney Injury↗
PubMed2003

Increased blood pressure in adolescents of low socioeconomic status with short stature.

The nutritional programming hypothesis, which has been studied since the 1970s, proposes that intrauterine undernutrition continuing during the first years of life causes permanent metabolic disorders. These alterations are amplified with time, depending on the quality of the diet and on environmental factors. The aim of this cross-sectional study was to detect blood pressure alterations in teenagers with nutritional deficit. The study sample consisted of 53 adolescents living in shantytowns of São Paulo City, Brazil; 27 boys and 26 girls ranging in age from 11 to 16 years were studied. Weight, height, skinfold thickness, and blood pressure were measured during a medical visit. Anthropometric data were compared with the reference values of the National Center for Health Statistics and Frisancho, and arterial pressure data were compared with the reference values of the 1996 Task Force. The adolescents studied are among the 10% poorest stratum of the Brazilian population, with a per capita income of U.S. $45/month. The anthropometric results revealed nutritional deficiencies for the entire sample. The major marker of malnutrition was height, with a mean height deficit of 7 cm among boys and of 5 cm among girls. The overall prevalence of arterial (diastolic) hypertension for the sample was 21% (95% confidence interval 10%-32%). No significant difference was observed between sexes. The prevalence of cases with a systolic or diastolic arterial pressure above the 90th percentile, adjusted for height, was 51% ( n=27) (95% confidence interval 37%-65%); 6% ( n=3) of these individuals had simultaneous systolic and diastolic arterial hypertension. In conclusion, the prevalence of arterial hypertension was elevated among malnourished adolescents. The mechanisms involved in the genesis of hypertension seem to be related to malnutrition during an early phase of life, supporting the programming hypothesis.

Adolescent↗