Nutrition work in socioeconomic development agencies.
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Americas↗
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[Nutrition and economics: a simple analysis on the relationship between economic conditions and nutritional status].
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Asia↗
Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery.
BACKGROUND: Pancreatic exocrine dysfunction has been frequently recorded in protein energy malnutrition (PEM) because the pancreas requires optimal nutrition for enzyme synthesis. This pancreatic enzyme insufficiency may play a role in the continuation of PEM. OBJECTIVE: This study was designed to assess the pancreatic head size and exocrine pancreatic functions, namely serum amylase and lipase, in PEM and its subtypes and correlate any defect present with the various clinical and laboratory data of the PEM patients with special emphasis on the effect of nutritional rehabilitation. PATIENTS AND METHODS: A total of 33 cases of PEM; 15 marasmus, 10 kwashiorkor (KWO) and eight marasmic kwashiorkor (MKWO) were recruited from Ain Shams University children's hospital, together with 12 matched controls. The mean age of patients was 11.87 +/- 7.8 months and that of the controls was 14.83 +/- 7.7 months. Detailed history taking and thorough clinical examination with special emphasis on anthropometric measurements were taken for each studied infant as well as laboratory investigations which included; complete blood count, liver and kidney functions and serum amylase and lipase. Ultrasonographic assessment of pancreatic head size was performed for the cases and controls. Nutritional rehabilitation program was carried out for 3-6 months followed by reassessment of the cases. RESULTS: The pancreatic head size values were significantly lower in all subtypes of PEM (1.52 +/- 0.6, 2.73 +/- 0.12 and 3.00 +/- 0.54 cm(3) in the marasmus, KWO and MKWO respectively) compared to the controls (5.13 +/- 2.33 cm(3)). The serum amylase and lipase were also significantly lower in all subgroups of PEM when compared to the controls with significant improvement following nutritional rehabilitation coupled by a significant increase in pancreatic head size too. No significant differences were recorded when we compared the subgroups together except for a significant higher rate of change in serum amylase in edematous patients compared to nonedematous ones. The length of nutritional rehabilitation period, age of the patient, weight and serum albumin were the most determinant factors for pancreatic head size as evident from the multiple regression analysis study. CONCLUSION: The potentially correctable exocrine pancreatic insufficiency in cases of PEM should be carefully thought of when planning the nutritional rehabilitation program for such patients as it could be responsible for the serious continued morbidity issues that they face. We thus recommend that estimation of pancreatic head size and exocrine function should be included in the evaluation of PEM patients and they could also be used as a prognostic parameter. SPONSORSHIP: The patients enrolled were among those admitted and managed freely in the children's Hospital Faculty of Medicine Ain Shams University, including the use of the ultrasound apparatus, while the kits have been purchased by authors who contributed in financing the study.
Adolescent↗
Teaching medical students cancer risk reduction nutrition counseling using a multimedia program.
BACKGROUND AND OBJECTIVES: There are many barriers to medical students receiving education about the linkage between nutrition and cancer, including the lack of role models and teachers and insufficient curricular time. We tested the use of a multimedia program as a possible solution to teaching diet-risk assessment and counseling skills. METHODS: Images of Cancer Prevention, The Nutrition Link is a CD-ROM multimedia program that was developed and evaluated by 147 medical students. Pre-use and post-use surveys, computer log files, and recorded response sessions were used to determine the learner's 1) ease in using the program, 2) attitudes about the treatment of the content, 3) knowledge gain, and 4) attitudes about the role of physicians in nutrition assessment and counseling for cancer risk reduction. RESULTS: Students improved their knowledge of dietary guidelines for cancer risk reduction and made positive changes in their attitudes toward the role of physicians in dietary counseling. However, most students reported that they would not use the program unless it was required that they do so. CONCLUSIONS: The multimedia program was successful; it affected students' knowledge and attitudes concerning nutrition as a modifiable risk factor for some cancers. In addition, the design and delivery of the multimedia product was positively reviewed by the students for ease of access, message design, individualized instruction, and flexibility. Despite these favorable ratings, it was not clear that students would use the program unless required to do so.
Health Knowledge, Attitudes, Practice↗
Using goal setting as a strategy for dietary behavior change.
Recent reviews have noted that behavioral theory-based nutrition education programs are more successful at achieving food behavior change than knowledge-based programs and that a clear understanding of the mechanisms of behavior change procedures enable dietetics professionals to more effectively promote change. Successful dietary behavior change programs target 1 or more of the personal, behavioral, or environmental factors that influence the behavior of interest and apply theory-based strategies to influence or change those factors. Goal setting is a strategy that is frequently used to help people change. A 4-step goal-setting process has been identified: recognizing a need for change; establishing a goal; adopting a goal-directed activity and self-monitoring it; and self-rewarding goal attainment. The applications of goal setting in dietary interventions for adults and children are reviewed here. Because interventions using goal setting appear to promote dietary change, dietitians should consider incorporating the goal-setting strategies to enhance the behavior change process in nutrition education programs.
Adult↗
Nutrition education is positively associated with substance abuse treatment program outcomes.
The scope and types of nutrition services provided in substance abuse treatment programs has not been well defined nor has there been an attempt to determine if associations exist between the provision of nutrition services and substance abuse treatment outcomes. The objectives of this study were to assess the provision (use and extent) of nutrition education in substance abuse treatment programs in facilities that provide a single or two or more substance abuse treatment programs, and to determine the possible association between nutrition intervention and substance abuse treatment program outcome measures (defined as changes in Addiction Severity Index [ASI] composite scores). A descriptive, single, cross-sectional survey of registered dietitians with clinical nutrition program management responsibility (n=152) was used to define the use and extent of nutrition services in substance abuse treatment programs. Positive associations between nutrition services provided, particularly nutrition education services and substance abuse treatment program outcome measures, were detected. When group nutrition/substance abuse education was offered, ASI psychological and medical domain scores improved by 68% and 56%, respectively (P<.05). Individual nutrition/substance abuse education was a predictor of ASI family/social domain change scores improving by 99% (P<.05). In those programs where group nutrition/substance abuse education was offered, moderate to strong correlations with various nutrition education services were observed, specifically in individual nutrition/substance abuse education (r=0.51; P<.05), group normal/nutrition education (r=0.64; P<.01), and individual normal/nutrition education (r=0.46; P<.05). Substance abuse treatment programs offering group nutrition/substance abuse education offered significantly (P<.05) more nutrition services overall. Findings support the position that nutrition education is an essential component of substance abuse treatment programs and can enhance substance abuse treatment outcomes. Dietitians should promote and encourage the inclusion of nutrition education into substance abuse treatment programs.
Cross-Sectional Studies↗
Position of the American Dietetic Association: nutrition standards for child care programs.
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Child Day Care Centers↗
Seek support for nutrition policy.
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Consumer Organizations↗
Symposium on "Strategy for nutrition research".
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Animals↗
The practice of clinical nutrition in a developing nation.
Recently the academic community has been charged with nutrition malpractice for allegedly spending billions of dollars in international nutrition research and failing to make a difference. Looking at this issue from a field perspective one would conclude that notable progress has been made and is being made on a daily basis. The analysis presented is based on my experience as a clinical nutritionist in Chile, a developing country in transition. It points out the issues and some of the answers by using selected examples of what can be accomplished by integrated health, nutrition, and educational interventions. The results have been a dramatic decline in infant and childhood malnutrition and mortality rates and the emergence of a pattern of mortality that closely resembles that of developed countries. The specific nutritional problems of hospitalized patients are discussed and the benefits of enteral nutritional support are presented. Preventive strategies are emphasized; they require wide coverage of basic human needs and community participation. Nutritional improvement is a prerequisite for economic development and is only possible if individuals and institutions are committed to making this happen. Critical dilemmas facing clinical nutritionists in developing countries are addressed.
Chile↗
GO GIRLS!: results from a nutrition and physical activity program for low-income, overweight African American adolescent females.
This article describes the development, implementation, and results of an intervention designed for inner-city, overweight African American adolescent women. Fifty-seven participants were recruited from four public housing developments. Participants were administered physiologic, dietary, and cognitive assessments at baseline and immediately postintervention. Each session comprised three elements: (1) an educational/behavioral activity, (2) 30 to 60 minutes of physical activity, and (3) preparation and tasting of low-fat meals. In the absence of a control group, results were compared for high and low attenders, the former defined as attending at least 50% of the sessions. High attenders (n = 26) showed more favorable 6-month posttest values for most outcomes compared with low attenders (n = 31). These effects achieved statistical significance for nutrition knowledge, low-fat practices, perceived changes in low-fat practices, and social support.
Adolescent↗
Behavioral variables and education are predictors of dietary change in the Women's Health Trial: Feasibility Study in Minority Populations.
BACKGROUND: Reducing the intakes of fats and increasing consumption of fruits and vegetables are an important goal for improving population health. Analyzing the effects of nutrition education programs on subjects' dietary intakes incorporating factors such as habit persistence in diets, unhealthy eating habits, perceptions of health risks, participation motivation, and expectancies can yield useful insights. METHODS: A Food Frequency Questionnaire (FFQ) was used to measure intakes at baseline, 6 and 12 months, by 318 and 548 postmenopausal women in, respectively, the Control and Intervention groups of the Women's Health Trial: Feasibility Study in Minority Populations (WHTFSMP). Information on background, behavioral, and anthropometric variables was collected. The Intervention group met in classes led by nutritionists. Dynamic random effects models were estimated for the two groups using the data at baseline, 6 and 12 months on the intakes of carbohydrate, saturated, monounsaturated, and polyunsaturated fats, fiber, beta-carotene, ascorbic acid, and calcium. RESULTS: The nutrition education program lowered the intakes of fats while increasing fiber, beta-carotene, and ascorbic acid intakes especially in subjects scoring high on indices reflecting concerns about health, desirability of change, and participation motivation. In addition, subjects' education was a predictor of dietary intakes in the Intervention group. CONCLUSIONS: Nutrition education can be an effective tool for improving diets, but behavioral characteristics deserve greater attention in helping to design the most effective approaches for various target groups.
Black or African American↗
[Levels of oligo-elements and trace elements in patients at the time of admission in intensive care units].
Routinely, the macronutrient contribution is thoroughly studied when a patient is included in a total parenteral nutrition (TPN) program. However, it must be kept in mind that along with macronutrients, micronutrients, oligoelements and vitamins are also administered, and these must be taken into account. At present, for instance, the importance of oligoelements has become evident, and clinical conditions of oligoelement deficiency have been described in many cases even when the minimum daily requirements had been met. This study centers on the importance of evaluating oligoelement and trace element levels when patients are admitted into the ICU and were included into a total parenteral nutrition (TPN) program. An assessment of the serum calcium (Ca), phosphorus (P), magnesium (Mg), zinc (Zn), copper (Cu), iron (Fe) and transferrin (Tfe) levels was done on 55 septic patients who underwent abdominal surgery was done on admission to the ICU. Transferrin was measured of serve as an indicator of metabolic damage. A description of the methods used in analytical assessment, a presentation of normal values, the statistical management of each of the elements under study and the interpretation of the results obtained has been done. The discussion is based on the changes detected in the patients' serum levels on admission to the unit, showing low iron, transferrin, zinc and calcium values and normal magnesium, phosphorus and copper figures. The conclusion arrived at suggests that the daily parenteral supplements of these elements should be higher than those recommended by the American Medical Association (AMA) and by other authors.
Female↗
A survey of undergraduate programs for the community practitioner.
The purpose of the survey of college and university undergraduate programs in community nutrition, community dietetics, and public health nutrition was to characterize undergraduate programs which prepared entry-level practitioners in order to facilitate planning at the graduate level. The survey, which sampled known problems areas, revealed the diversity, confusion, and accomplishments of a field of study that is changing. The rapid growth and early stage of development of many of the undergraduate programs suggested that measures may be taken to promote excellence in both undergraduate and graduate education. Specific problems in the organization, administration, and curricula of the programs surveyed were identified. Recommendations were made to the Association of Faculties of Graduate Programs in Public Health Nutrition and the State and Territorial Public Health Nutrition Directors to promote surveillance of these programs, to encourage problem-solving communications, and to conduct educational research. The report and the recommendations have been referred to the newly formed ad hoc committee of the joint associations for further action.
Adolescent↗
Research challenges to recruitment and retention in a study of homebound older adults: lessons learned from the nutritional and dental screening program.
This paper attempts to describe the many reasons why it is difficult to recruit homebound older adults to participate in research studies. The reasons, not surprisingly, are more practical than theoretical. Complicated procedures for participants to follow, cross-cultural communication, fear of the medical establishment, convoluted consent forms, making contact on the telephone, finding the participants' homes, and a host of other nagging problems combine to erect enormous barriers to running successful studies. It is our hope that in identifying these difficulties we will also shed light on how to design studies that minimize their impact.
Aged↗
[Assessment of the nutritional impact of the complementary feeding program of Panama in children under five years old].
To evaluate the nutritional impact of the Complementary Feeding Program of Panama in children under 5 years old. A retrospective cohort of children beneficiaries of the program was studied and compared with others of the same age and districts not involved in this intervention. Weight for age (W-A), height for age (H-A), and weight for height (W-H) was calculated in each control and the nutritional status determined according to Ministry of Health norms. Every beneficiary received six pounds/month of a food supplement containing cereals, legumes, calcium, iron and vitamin A (350 Kcal and 12 g of protein by 100 grams). Most of the children enter into the program in their second year of life with an average W-A and W-H of -1.5 +/- 1.2 and -0.6 +/- 0.9 respectively; both indicators were declining before the intervention (-0.6 +/- 1.2 y -0.3 +/- 1.3 respectively, p < 0.01). In 9 months of intervention an average change in W-A of 0.0 +/- 1.1 and H-A of - 0.1 +/- 1.1 was observed (NS). Weight gain was higher in children with lower W-A, in families with less children or mother with better education level (p < 0.05). In 35% of malnourished children and 24% of children at risk nutritional status improved during the intervention. Children with higher nutritional deficit at the beginning of the program have significantly better nutritional improvement (p < 0.001), encouraging the importance on focusing this program in malnourished children.
Anthropometry↗
[Prevention strategies of childhood obesity].
Considering the high prevalence and the increasing trends, obesity is now considered as a public health problem in numerous countries. The main aim of the National Program of Nutrition and Health is to stop the increasing prevalence of childhood obesity. In this frame work, a group of experts has established a new presentation of the corpulence curves, adapted for clinical practice, to define normal weight and obesity. Weight status is now currently assessed on the basis of weight and height measurements, after computing the Quetelet index or body mass index (BMI) corresponding to weight (m) divided by square of height (weight/height2). As body proportion varies during growth, age must be taken into account. Various curves were published. In 1982, based on the French sample of the international growth study, BMI curves were published. They were revised in 1991. The third and 97th centiles define the normal weight range. Overweight is defined by BMI values greater than the 97th centile. In the year 2000, a new international definition was established. Two centiles were constructed to define overweight and obesity. The new BMI charts adapted for clinical practice, proposed by the French National program of nutrition and health, include the French reference curves plus the centile defining obesity in the international definition. Thus, in the new French charts, the area above the 97th centile is split in two levels (degree 1 obesity and degree 2 obesity). Drawing the BMI curve for each child, like drawing weight and height curves, is a simple act which can be done routinely. The age at adiposity rebound (an indicator predicting the risk of adult obesity) can be read from the curve. It allows to identify an early phase of obesity development, even at the time when overweight is not yet clinically visible. When obesity appears clearly, the identification is easy. The use of BMI curves is particularly useful in two situations: (1) in very young overweight children, the curves allow to identify children who have a real risk of developing obesity. (2) By the age of 6 years, when due to normal physiological variations, clinical assessment can be misleading. The BMI curves allow to identify children at risk. When a child is identified as having a real risk of obesity, simple preventive measures, adapted for each subject, could avoid a development toward massive obesity, which may become difficult to reduce if managed too late.
Adolescent↗
[Patients with chronic airflow limitation: effects of the inspiratory muscle training with threshold load valve, built with appropriate technology, associated to nutritional support].
AIM: To assess prospectively the effects of a controlled program of inspiratory muscle training program and nutritional support in patients with chronic obstructive lung disease (COPD). PATIENTS AND METHODS: Twenty-three patients with COPD were randomly assigned into four groups. Group I received a 1000 kcal/day nutritional supplement, given as a casein based enteral nutritional formula; group III was subjected to inspiratory muscle training, using an inexpensive pressure threshold load valve constructed according to the Appropriate Technology principles of the WHO, adjusted at 30% of Maximal Inspiratory Mouth Pressure and received also the nutritional supplement; group IV was trained but did not receive the nutritional supplement and group II was not trained nor supplemented. Patients were studied during three months and monthly, inspiratory muscle function, exercise capacity and anthropometry were measured. RESULTS: A significant improvement in exercise capacity, maximal inspiratory pressure and inspiratory muscle endurance was observed in the four groups throughout the study. Trained subjects had greater improvement in their inspiratory muscle endurance, compared to untrained subjects. Nutritional support had no effect in inspiratory muscle function or exercise capacity. No changes in anthropometric measures were observed. CONCLUSIONS: The pressure threshold load valve used in this study, improved inspiratory muscle endurance and nutritional support had no effect in patients with COPD.
Aged↗