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PubMed2002

Position of the American Dietetic Association: domestic food and nutrition security.

In 2000, over 10% of United States (US) households, including more than 33 million people, experienced food insecurity. Food insecurity negatively affects the dietary intake and nutritional status of adults leading to poor health and increased risk for the development of chronic diseases. Food insecurity also negatively affects children's health, psychological and cognitive functioning, and their academic achievement. It is the position of the American Dietetic Association that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the US. Immediate and long-range interventions, including adequate funding for and increased utilization of food and nutrition assistance programs, the inclusion of food and nutrition education in all programs providing food and nutrition assistance, and innovative programs to promote and support the economic self-sufficiency of individuals and families, are key to ending domestic food insecurity. Dietetics professionals can play a key role in ending food insecurity not only through competent and collaborative practice, but also through advocacy efforts at the local, state, regional, and national levels.

Dietetics↗
PubMed2001

Nutrition education in health professions programs: a survey of dental, physician assistant, nurse practitioner, and nurse midwifery programs.

OBJECTIVE: This study determined the perceived needs and curriculum recommendations for nutrition education, and expected competencies in nutrition of graduates, of predoctoral dental, physician assistant, nurse practitioner, and midwifery programs. SUBJECTS: Surveys were mailed to all dental schools (n = 54) and physician assistant (n = 95), nurse practitioner (n = 150), and certified nurse midwifery programs (n = 42) in the United States. Surveys were addressed to the program directors of physician assistant, nurse practitioner, and certified nurse midwifery programs and the associate or assistant dean of academic affairs of dental schools. DESIGN: A 4-page survey was designed and pilot-tested. The survey included questions on respondents perceptions of and recommendations for their programs in nutrition education and expected nutrition competence level of their graduates. A reminder postcard was mailed 2 weeks after the initial mailing to nonrespondents; a second survey was mailed to nonrespondents 1 month after the postcard mailing. STATISTICAL ANALYSES: Data were analyzed using JMP-IN software. Frequencies, and chi 2 analyses, Wilcoxon rank sum test, Pearson chi 2 test. RESULTS: The overall response rate was 80.7% (n = 276). Perceived needs for competence in nutrition varied by respondents. Most of the physician assistant nurse midwifery, and nurse practitioner program directors had similar perceptions of graduates' competence in nutrition. Dental school academic administrators differed significantly from the program directors about the perceived need for knowing how to counsel on a modified diet and how and when to refer to a registered dietitian. Time was the most important factor that would enhance provision of nutrition education in the programs. Computer-based programs were the most frequently requested education tool to enhance nutrition education. APPLICATIONS/CONCLUSIONS: The disciplines agreed that graduates of dental schools and physician assistant, nurse practitioner, and nurse midwifery programs need some level of competence in nutrition relative to their discipline. Registered dietitians involved in health professions education can play an active role in developing practice-based, time-sensitive, and flexible strategies for nutrition education of these health professions groups.

Chi-Square Distribution↗
PubMed1996

[Cyclic enteral nutrition].

Cyclic enteral nutrition consists in continuous infusion of nutrients with a pump over a 12 to 14 hour period at night. Different reports have demonstrated that cyclic enteral nutrition is well tolerated in malnourished ambulatory patients. The incidence of pneumonia by inhalation in this type of patients is less than 2%. Excepting patients with major amputation of the small intestine and important functional consequences, the increased infusion rate required by cyclic enteral nutrition does not diminish digestive tract absorption making the technique as effective as continuous 24-hour infusion. The main advantages of the cyclic infusion are the preservation of physiological balance between fasting and feeding, improved physical activity during the day with its beneficial effect on protein-energy metabolism, compatibility with oral nutrition during the day in nutrition reeducation programs, and the psychological impact in patients who are free to move about, further improving tolerance. Finally, cyclic enteral nutrition is adapted to enteral nutrition programs conducted in the patient's homes.

Appetite Regulation↗
PubMed2002

Securing the future of nutritional sciences through integrative graduate education.

The new millennium has ushered in unprecedented opportunities for research and discovery in the nutritional sciences. These have arisen from major advancements in the social and biological sciences, notably genetics, genomic technologies, computational statistics, and behavioral sciences. The most exciting academic challenges and employment opportunities for nutritional sciences graduates interface with other disciplines, and doctoral training programs in the nutritional sciences must respond to the wealth of these emerging opportunities. The American Society for Nutritional Sciences (ASNS) Graduate Nutrition Education Committee suggests that three major challenges face the nutritional sciences: (a) to train doctoral students to be full and active participants in interdisciplinary research and discovery, and (b) to achieve this goal while maintaining nutrition's unique academic identity and (c) fostering a cohesive academic community. The committee proposes that these objectives are best engaged at the level of graduate education and that the future of ASNS will be secured by strengthening graduate nutrition programs. This manuscript reviews educational strategies that address these challenges and advocates that ASNS actively engage graduate doctoral programs in nutritional sciences.

Education, Graduate↗
PubMed1990

Managing inpatient clinical nutrition services: a comprehensive program assures accountability and success.

A major challenge facing clinical dietitians today is justifying inpatient clinical nutrition services. To meet this challenge, a comprehensive program for the delivery and management of clinical nutrition services was developed at Yale-New Haven Hospital. It is based on seven nutritional risk factors--age, diagnosis/treatment, diet, metabolic or mechanical problems, significant lab values, pertinent medications, and weight for height. These risk factors are used to categorize patients into one of seven classifications. In essence, this classification system is the screening tool used to provide the foundation for standards of practice and nutrition assessment and intervention. The inherent advantage of such a program is that it identifies patients at high nutritional risk, regardless of wide variations in patient population or diagnosis. It also provides standardized criteria for evaluating quality of care, patient acuity, and productivity and staffing. Clinical nutrition services can then be measured for both quality and quantity. Because protein-calorie malnutrition poses a serious threat to cost containment and quality patient care, this type of program can appeal to hospital administrators, physicians, and site visitors alike. It can serve as an adaptable model for the delivery and management of inpatient clinical nutrition services in a wide variety of health care facilities.

Adult↗
PubMed1993

[Methods for quality control in parenteral nutrition. III: application of the program to therapeutic results].

Therapeutic results of parenteral nutrition are evaluated by clinical nutritional benefits and by its safety with respect to the potential complications related to the method of administration and its inherent metabolic complications. In this context, a quality control programme was applied retrospectively to 148 patients and was evaluated according to the following indicators: a) PN suspension; b) a nutritional evaluation on termination of the parenteral nutrition; c) catheters inserted; d) mechanical complications; e) septic complications; f) routine controls; g) complete controls, and h) biochemical changes. The compliance percentages obtained were 92.8, 100, 85.1, 81.4, 84.9, 60.0, 33.1 and 43.8 respectively. These results allow us to see, for the first time, the profile of therapeutic quality in patients with parenteral nutrition. Likewise, it constitutes an obligatory methodology of intrahospital reference for continued improvement of parenteral nutrition received by patients admitted to this hospital.

Adolescent↗
PubMed1985

Nutrient intake of institutionalized developmentally disabled individuals: impact of the nutrition knowledge of paraprofessionals.

The role of the caretaker in enhancing nutrient intake of developmentally disabled individuals living in an institutional setting was examined. Eighty developmentally disabled residents living at the Western Carolina Center, Morganton, NC, were assessed for anthropometric measurements and for dietary intake, with a 3-day plate waste study. Seventy paraprofessionals/feeders working at the same center were assessed for knowledge of nutrition and food practices and participated in a series of inservice programs on nutrition. Pretest and post-test scores for knowledge of nutrition and food practices were determined. For the paraprofessionals/feeders, inservice programs on nutrition resulted in increased knowledge of nutrition but did not increase the nutritional quality of their own diets. However, statistically significant differences were noted in residents' diets for calories (p less than .05), iron (p less than .05), and niacin (p less than .05) attributable to the inservice programs on nutrition.

Adolescent↗
PubMed1994

Reaching out to all America: coordinated nutrition education across USDA programs.

This presentation briefly discusses how the USDA agencies work together to meet the nutrition education needs of our diverse population. Atwater's work in nutrition was characterized by an extensive cooperative program and this legacy has continued in USDA nutrition education efforts. Our challenge is not only to provide the consumer with accurate, appropriate, and effective nutrition education, but to also ensure that our efforts are in harmony with those of other agencies within and outside of the Department. The complexity of the needs of society, the present awareness of social problems, and the scrutiny being applied to the use of public and private funds for these purposes dictates that viable interagency relationships must become the rule rather than the exception. Since the late 1970's USDA agencies have worked to expand cooperative efforts and establish mechanisms that facilitate coordination. This presentation will highlight the diversity of consumer needs for nutrition education, give examples of how the unique contributions of each USDA agency combine to meet consumer needs and discuss the major organizational structures which support interagency coordination.

Child↗
PubMedDate not supplied

Consumption and perceptions of soy among low-income adults.

OBJECTIVE: To assess the consumption and perceptions of soy among low-income adults. DESIGN: A survey, which included demographic items, Likert scales for items on perceived benefits and barriers to soy consumption and factors that may increase soy consumption, and a soy food consumption frequency questionnaire. SUBJECTS/SETTING: A convenience sample of 353 adults enrolled in either the Pennsylvania Expanded Food and Nutrition Education Program or the Pennsylvania Food Stamp Nutrition Education Program. STATISTICAL ANALYSES: Descriptive statistics. RESULTS: Few participants (13%; n = 44) reported currently consuming soy foods. The percentage of respondents recognizing potential health benefits of soy ranged from 53% to 57%. The major barriers to soy consumption were a lack of knowledge on how to use soy (87%), cost (55%), and unavailability (45%). Participants indicated that education on how to use and incorporate soy into the diet (88%) and addition of soy into familiar foods (82%) may increase their soy consumption. APPLICATIONS/CONCLUSIONS: The findings suggest that this population would benefit from exposure to soy foods and instruction on preparing low-cost soy foods that can easily be included in their diet, in addition to education on the potential health benefits of soy foods. The results may provide direction for the development of curricula that educate this population on the potential benefits and uses of soy.

Cooking↗
PubMed1994

Sports and nutrition--an out-patient program for adipose children (long-term experience).

Sports activity (3 times per week), nutritional changes and modification of behavior are the basic tenets of an outpatient program run for 9- to 12-year-old adipose children since 1987. The following goals are to be attained: increase in physical performance capacity and body awareness, long-lasting change in eating habits, weight loss to under 20% overweight compared to the age-normal (height/normal weight), and understanding of the permanence of body weight problems. Individual nutritional consultation is offered in addition to the initial examination consisting of physical examination, skin fat-fold measurement, blood chemical parameters, spiroergometry and a detailed consultation with parents and children. The eating habits of the children are recorded in a dietary history (3-day dietary protocol, questionnaire) and discussed in individual meetings with the parents and children. Moreover, the nutritional program includes regular nutritional consultations and parents' meetings every month. Cooking instructions for children and parents provide practical knowledge of food preparation to preserve nutrients in an energy-reduced, tasty diet, as well as theoretical basics of nutrition. The control examinations show individual weight loss or stability and improvement in blood lipid parameters. Awareness and controlled nutritional habits were learned especially by the children of parents who, for their part, tried to tailor their nutrition to be better balanced, more nutritional and more need-oriented. Children who maintain the learned nutritional habits after completion of the outpatient program, and who remain active in sports, show long-lasting constant weight. Prevention must begin in childhood. Intensive nutritional support combined with an appropriate sports program should be offered as a preventive measure.

Ambulatory Care↗
PubMed2005

Long-term programming effects of early nutrition -- implications for the preterm infant.

The current focus of nutritional science has shifted from meeting needs to determining the biological effects that nutrition has on immediate and lifetime health. Of particular interest is the concept of programming, the idea that "a stimulus or insult during a critical or sensitive period of development can have long-term or lifetime effects on an organism." Evidence that early nutrition has such "programming" effects in animals is overwhelming. In humans, retrospective observations show a relationship between adult disease and size in early life, though it is difficult to prove nutritional cause from observational associations and therefore difficult to use such data to underpin health policy. However, the results of randomized intervention trials of early nutrition with long-term follow-up are emerging. These experimental studies show that nutrition in early life has a major impact on health into early adulthood, notably on cardiovascular disease risk, bone health and cognitive function. These new findings have major biological, social and medical implications and should increasingly underpin health practices.

Animals↗
PubMedDate not supplied

Randomized trial of a tailored nutrition education CD-ROM program for women receiving food assistance.

OBJECTIVE: This article describes the development and randomized evaluation of a tailored nutrition education CD-ROM program for participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in North Carolina. DESIGN: After randomization to intervention or control groups, participants completed a baseline survey and were resurveyed immediately after program use and 1 to 2 months postintervention. SETTING: Two WIC clinics in central North Carolina. PARTICIPANTS: A total of 307 respondents to the follow-up survey (response rate 74.8%) comprised the study sample. Participants were female (96%), 20% were pregnant, and 50% were minorities (African American and other). INTERVENTION: The interactive CD-ROM consisted of a targeted video soap opera, dietary assessment, and individually tailored dietary feedback and strategies for change. MAIN OUTCOME MEASURES: Measures included total fat and fruit and vegetable intake, knowledge of low-fat and infant feeding choices, self-efficacy, and stages of change. ANALYSIS: Descriptive statistics assessed baseline comparability of study groups; analysis of covariance and F tests were used to assess program effects at follow-up. RESULTS: INTERVENTION group members increased self-efficacy (P <.01) and scored significantly higher (P <.05) on both low-fat and infant feeding knowledge compared with controls. No differential effect was observed for dietary intake variables. CONCLUSIONS AND IMPLICATIONS: The findings suggest that one dose of an interactive CD-ROM program can impact mediators of dietary change but may be insufficient to change behavior.

Adult↗
PubMed1982

A school-based behavior modification, nutrition education, and physical activity program for obese children.

Sixty-three obese children, ages 5 to 12 yr, participated in a school-based program of behavior modification, nutrition education, and physical activity. The 10-wk program involved educating the children and those in the children's social network (parents, teachers, physical education instructor, food service personnel, school administrators, and the nurse's aide). Two methods were used to evaluate weight loss: the children were compared to a control group of obese children who did not receive the program, and the children in the program were used as their own controls by analyzing weight records for the 3 yr before the program. Sixty (95%) of the 63 children in the program lost weight, compared to only three (21%) of the 14 control children. The program children showed a mean decrease of 15.4% in their percentage overweight, and lost an average of 4.4 kg. These children also reversed the steady weight gain that had occurred before the program. These results suggest that a comprehensive program in the schools can produce significant weight losses, and that children left untreated tend to increase their degree of obesity.

Behavior Therapy↗
PubMed1982

Food behavior of elementary school students after receiving nutrition education.

A nine-week nutrition education program for kindergarten through sixth grade was implemented and its influence on children's food behavior assessed using a pretest/post-test design involving children who were and were not exposed to the program. The food behavior response was mixed. Consumption of some food items, at post-test time, was higher among pupils exposed to the program, but that of other items was lower, and consumption of some items was unaffected. Responses to questionnaires by parents indicated that they perceived a favorable effect of the nutrition education program on their children's food behavior.

Child↗
PubMed1991

Nutrition training in graduate medical (residency) education: a survey of selected training programs.

Because limited information exists about nutrition training of residents, we studied the teaching practices of nationally recognized nutrition programs. Two hundred thirty-eight nutrition educators and 787 residency-program directors identified 160 institutions with strong nutrition training. The 23 highest-ranked programs were surveyed and 7 were visited. The results showed that 1) clinically active physician-nutritionist role models are the key elements in teaching residents clinical nutrition; 2) multidisciplinary nutrition support teams are valuable learning resources unless they function primarily as technical support services; 3) nutrition elective rotations, although highly effective, are taken by a minority of residents; 4) the nutrition curriculum should include practical learning materials and conferences; and 5) a research environment is important to attract qualified physician-nutritionist role models. A major deficit is teaching nutritionally based approaches to disease prevention in the ambulatory setting. Finally, a shortage of nutrition-oriented physician role models is probably the major constraint in teaching nutrition to residents.

Curriculum↗
PubMed1991

Program for training staff pharmacists in total parenteral nutrition.

A staff development program in total parenteral nutrition (TPN) is described. A 12-week education and training program was developed at a community hospital to enable staff pharmacists (those with B.S. degrees) to become involved in the pharmacy-based TPN service that has been in effect at the institution since 1978. Before 1987, the TPN pharmacist had always held a Pharm.D. degree. In the first four weeks of the program the trainee is allotted two hours per day for required reading. During the final eight weeks, the trainee accompanies a TPN pharmacist on daily rounds. A proficiency examination is given after week 10. Upon successful completion of the program, the pharmacist serves as a nutritional support therapy consultant to physicians who wish to have their patients evaluated, treated, and monitored by the TPN service. A quality assurance program was developed to enable the clinical coordinator in charge of the service to identify areas where further inservice education might be indicated and to satisfy requirements of the Joint Commission. Six staff pharmacists have completed the training program and are allowed to write TPN orders and conduct TPN rounds. The program has expanded the clinical roles of the staff pharmacists and has been well received by the medical staff. The quality assurance monitoring indicates that the service is excellent. A staff development program was successful in training staff pharmacists to participate in TPN therapy.

Education, Pharmacy, Continuing↗