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PubMed2001

Estimates of the effects of folic-acid fortification and folic-acid bioavailability for women.

OBJECTIVE: With the recent implementation of the folic-acid-fortification program, our objective was to estimate its benefits in adult women and account for the higher bioavailability of synthetic folic acid in fortification programs and supplements. METHODS: The study used a cross-sectional design. Dietary assessment data were collected with a quantitative food-frequency questionnaire, the Nutrition DISCovery program. Fortification was simulated with the use of fortification standards (140 microg/100 g of flour) and new bioavailability standards for synthetic folic acid. Data were collected from 289 women 18 to 89 y old. Subjects were recruited from participants in two health-screening events in autumn of 1997. Chi-square tests were used to estimate the differences between categoric variables, and F tests were used in analysis of variance for continuous outcome measures. Results were considered significant at P < 0.05. RESULTS: Estimated mean dietary intake of folate increased considerably with simulation of fortification (320 to 608 microg of dietary folate equivalents). Women in the lower quartiles for age (18 to 39 and 40 to 46 y) consumed more servings from the bread group than women did in the upper quartile (55 to 89 y). Thus, the improvement in folate intake with fortification was significantly greater for the younger than for the older women (P < 0.05). Despite the limitations of estimating folate intakes, these data suggest that most women met the new estimated average requirement. However, 61% of women of childbearing age had intakes of synthetic folic acid below the recommended level of 400 microg/d, and only those using supplements containing folic acid met the guideline. CONCLUSIONS: Based on this sample of well-educated, adult women, the current level of folic-acid fortification should improve the intakes of a large proportion of women, especially when accompanied by supplements containing folic acid. These improvements in folate intake might not be seen in groups with limited resources, however. Further, under existing standards and practices, many women will not meet current recommendations for prevention of neural-tube defects.

Adolescent↗
PubMed1997

Evaluation of doctors trained at Diarrhoea Training Unit of National Institute of Child Health, Karachi.

Diarrhoeal diseases are a major contributory factor for high infant mortality and morbidity in Pakistan. To overcome this, Government of Pakistan launched a National Programme for Control of Diarrhoeal Disease. A Diarrhoea Training Unit (DTU) was established at the National Institute of Child Health, Karachi, where apart from proper case management, 17 training workshops were held between July, 1989 to July, 1991. Eighty-five doctors from various facilities in Sindh were trained in proper management of diarrhoea and establishment of Oral Rehydration Therapy (ORT) units in their regions. Evaluation of DTU training, assessment of the knowledge of trained doctors, case management and function of ORT Units were done between September, 1992 and October, 1993. Two teams each consisting of a doctor and a lady health visitor, visited 30 such facilities. An observation check list was used for assessing the ORT unit and diarrhoea case management and a test questionnaire for the knowledge of facility physician and paramedic. Of the 29 facilities, 17 had DTU trained doctors. ORT corner had been established in 26, weighing scales were used in 21, record keeping in eight and soap and water was available for hand washing in seven centres. The presence of untrained doctors provided an opportunity to compare the two groups. Dehydration assessment was fairly good, weight was recorded in fewer cases than desirable, case management was similar in the two groups, except for infrequent use of antibiotics by the trained group. Prevention was poorly advised. Physicians' knowledge in both groups was similar but deficient in advising the use of ORS, feeding in diarrhoea and nutritional assessment. The trained ones had significantly better knowledge about drugs and this was reflected in their case management. Paramedic case management were similar to those in doctors. The study thus showed positive and beneficial effects of training.

Anti-Bacterial Agents↗
PubMed1993

Home parenteral and enteral nutrition in cancer patients.

The clinical outcomes of 2968 patients with active cancer receiving home nutrition support are described. Of these patients 1672 were receiving home parenteral nutrition and 1296 were receiving home enteral nutrition. The outcomes of these active cancer patients are compared to those of 123 radiation enteritis ("cured" cancer) and 480 Crohn's disease patients receiving home parenteral nutrition and 918 noncancer dysphagic patients receiving home enteral nutrition. This longitudinal clinical information was reported to the North American Home Parenteral and Enteral Nutrition Patient Registry between 1985 and 1990. Evidence indicates that the number of home parenteral and enteral nutrition patients has increased nationally by about 25% each year between 1989 and 1990. In a subsample of 37 home nutrition support programs that have consistently reported their data to the registry since 1985, more than 90% of their program growth was accounted for by new patients with active cancer. This is now the largest single diagnosis of patients starting home parenteral and enteral nutrition. The mean survival time of cancer patients is 6 months after starting home parenteral and enteral nutrition, but 25% live beyond a year and 20% resume full oral nutrition. Although most active cancer patients experience only partial rehabilitation, for those patients with longer survival, rehabilitation is more complete. The outcome is relatively better for children and for patients whose neoplasm is leukemia, lymphoma, small bowel, or liver. In comparison, 96% of home parenteral nutrition Crohn's patients, 80% of home parenteral nutrition radiation enteritis patients, and 60% of home enteral nutrition noncancer dysphagic patients survive at least 1 year. Adult active cancer home parenteral and enteral nutrition patients do not have a greater incidence of therapy-related readmissions than other patient groups, however, their overall rehospitalization rate is much more frequent. This article discusses factors that may have contributed to this growth in home nutrition support in active cancer patients. It attempts to clarify where this therapy is clearly justified and where more information is needed. It emphasizes some of the special issues that need to be addressed in treating these vulnerable patients.

Enteral Nutrition↗
PubMed1981

Nonphysician supervision of a very-low-calorie diet. Results in over 200 cases.

Nonphysician nutritional therapists treated 234 obese patients with a 12-week behavioral modification, nutrition education program followed by up to 12 weeks on a very-low-calorie diet (VLCD). Mean weight decreased from 104.5 kg to 85.8 kg after 12 weeks on VLCD. Mean maximal weight loss for all patients was 17.2 kg. Blood pressure decreased from 133/86 to a low of 111/70 during VLCD. In 91 hypertensive patients, blood pressure fell from 145/95 to 128/81 after 12 weeks of VLCD. No serious side effects of VLCD were noted, although two patients developed mild cases of gout and one patient was taken off the fast when premature ventricular contractions were noted on ECG. Cost analysis reveals that physician care is almost three times as expensive as care by non-physician nutritional therapists. We conclude that the treatment of obesity should be performed by nutritional therapists under physician supervision using a comprehensive program of behavioral modification and VLCD.

Adolescent↗
PubMed1984

National Nutrition Monitoring System.

This issue contains three articles and two related reports on the National Nutrition Monitoring System (NNMS), an umbrella designation for a variety of activities carried out primarily by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture. Uses of NNMS data are legion; some examples are provided. Full exploitation of NNMS data has been hampered by lack of coordination, delays in processing, and limited understanding on the part of the nutrition community. There has been recent progress in coordinating NNMS activities. Improved understanding among members of the nutrition community will require continued educational efforts.

Diet Surveys↗
PubMed2004

Evaluation of nutritional education using concept mapping.

UNLABELLED: The concept mapping method is presented in the current study as a new tool to assess the learning process taking part in the hallmark of a nutritional education program addressed to obese diabetic patients. POPULATION: eight patients were interviewed prior to and after completion of 1-week in-hospital stay during which concept maps were designed. Concept maps quantitative and qualitative analysis disclose both (i) the importance of previous knowledge among patients prior to nutritional education and (ii) the maintenance of misconceptions after it. Nutritional education allows patients to acquire and structure their knowledge while providing them with a certain amount of medical vocabulary. An underlying correlation between concept maps design and the results of psychological tests identifying eating behaviour troubles (EBT), depression or anxiety has not been clearly identified. However, the nutritional education is more beneficial to those patients with a higher degree of self-assertiveness and with a lesser degree of anxiety, depression and eating disorder.

Attitude to Health↗
PubMed2005

Nutrition and the chronically critically ill patient.

PURPOSE OF REVIEW: It has been recently recognized that patients of chronic critical illness (CCI) - those who have stabilized after an acute critical illness but remain dependent on life-support - manifest a distinct set of clinical attributes. This unique patient population is often dismissed as hopeless, with aggressive medical therapies considered futile. In fact, with meticulous care, many CCI patients can be liberated from mechanical ventilation and graduated to a rehabilitation program. The nutritional approach to CCI patients is presented here as part of a comprehensive metabolic program to increase their survival and quality of life. RECENT FINDINGS: Both theory-driven and data-driven advances to our knowledge of CCI syndrome have appeared in the literature over the past year. Recurrent activation of the immune-neuroendocrine axis may induce allostatic overload in CCI. Experimental studies with hypothalamic releasing factors and intensive insulin therapy demonstrate that mechanisms perpetuating the CCI state can be abrogated. Recent studies and consensus opinions support the use of aggressive nutrition support. SUMMARY: Nutritional assessment and support of the CCI patient must be implemented upon admission to the respiratory care unit (RCU). Enteral nutrition (EN) with semi-elemental formulas is preferred. Parenteral nutrition is used to supplement EN when necessary. Overfeeding is avoided and tight glycemic control maintained. Diarrhea is aggressively managed. By correcting proximal etiologic events (infection, inflammatory, injuries), avoiding iatrogenic complications and devoting careful attention to nutritional status, CCI patients can potentially overcome their pulmonary compromise and debilitated state, to fully recover.

Chronic Disease↗
PubMed1998

Outcomes of obese children and adolescents enrolled in a multidisciplinary health program.

OBJECTIVE: The study was designed to evaluate the impact of a multidisciplinary program on children and adolescents' weight control. DESIGN: Retrospective study regarding changes in relative weight of all patients treated regularly in an out-patient care public service between January 1992 and December 1993. SUBJECTS: 198 children and adolescents (108 girls and 90 boys; mean age: 9.25y; mean body mass index (BMI): 24.26 kg/m2, range 19.1-40.31). MEASUREMENTS: Anthropometric data collected at the visits were obtained until June 30 1994. BMI compared to reference data was used. Dual Photon X-ray Absorptiometry (DEXA) was used for 64 patients, to determine percent body fat. RESULTS: Relative weight at the last visit was significantly lower when compared with initial relative weight for the whole sample. Significantly better outcome of relative weight was obtained when six or more visits occurred for the whole sample, and for girls when the days' interval between visits was shorter than 52 d. Variables such as percent body fat, body shape at the first visit, family obesity pattern, length of obesity and pubertal stage, did not significantly influence the outcome of relative weight for the subjects during the treatment. CONCLUSION: Results obtained indicated that good outcomes can be obtained in a program using nutrition education focused on small modifications of eating habits in order to avoid excess energy intake. The best predictors of weight improvement for children and adolescents participating in the program were the higher frequency of visits and shorter intervals between them.

Adolescent↗
PubMedDate not supplied

Worksite cancer screening and nutrition intervention for high-risk auto workers: design and baseline findings of the Next Step Trial.

BACKGROUND: This article describes the design and baseline findings of The Next Step Trial, a health promotion intervention targeting automobile industry employees at increased colorectal cancer risk. The intervention encouraged colorectal cancer screening participation and adoption of low-fat, high-fiber diets. METHODS: Twenty-eight worksites (n = 5,042) were randomized to control (a company-sponsored screening program) or intervention (an enhanced screening program including a personalized educational booklet and motivational telephone call and diet-change program including nutrition classes, self-help materials, and computer-generated personalized feedback). Outcomes included screening compliance and fat and fiber intake. RESULTS: Pretrial data indicated targeted employees were predominantly older, well educated, married, Caucasian men. Sixty-one percent (SE = 2) participated in the screening program in the preceding 2 years, and 24% (SE = 1) reported a history of colorectal polyps or cancer. Fifty-eight percent of the cohort responded to the baseline questionnaire; respondents were older and more educated; more were married, retired, and Caucasian than nonrespondents. Mean dietary intakes were 36.9% energy from fat (SE = 0.21), 8.8 g fiber/1000 kcal (SE = 0.07), and 3.4 servings of fruits and vegetables per day (SE = 0.04). CONCLUSIONS: Baseline data show moderate screening participation and dietary intakes that did not meet guidelines; hence intervention efforts were warranted. Data from this trial will support a rigorous test of whether this high-risk employee population is responsive to targeted health promotion, early cancer detection, and prevention interventions.

Automobiles↗
PubMed2000

Community Participation in Nutrition Communication: Models and Linkage Systems for Management.

New models of community participation, nutrition communication, and management linkages have been proposed. Changes in the health care sector have forced a major restructuring of facilities and a shifting of focus from traditional institution-based health care to a more community-based delivery of services, and from treatment to health promotion and disease prevention. These changes have also led to a redefinition of community clients and a review of the social processes whereby community members can participate actively in their health care. Challenges for health and nutrition professionals are to create manageable environments for meaningful dialogues, and to communicate action-oriented nutrition messages that reflect the community's values and realities. Some theories on learning and behaviour change can be applied to and aid in nutrition communication. At the same time, facilitators of and barriers to community participation in nutrition communication programs must be identified and addressed. In addition, during this time of health care transition, dietitians and nutritionists must position themselves as leaders in health and nutrition communication so that the community will act on their messages. Partnerships or linkages between organizations at the local, national, and international levels can assist in the effective delivery of nutrition information.

Journal Article↗
PubMedDate not supplied

Nutrition education and mega-dose vitamin A supplementation in Nepal.

Two approaches to improve vitamin A nutriture are compared: nutrition education and mega-dose capsule distribution. The impact of these programmes on vitamin A deficiency (VAD), wasting malnutrition, and excessive childhood mortality are compared for approximately 40,000 children who were assigned to either intervention cohorts or a control group from 75 sites within seven districts in two ecological settings (Terai, or lowland, and hills) of Nepal. Twenty-four months after the implementation of the project, the reduction of risk of xerophthalmia was greater among children of mothers who were able to identify vitamin A-rich foods [relative risk (RR) = 0.25; 95% CI = 0.10-0.62] than among children who received mega-dose capsules (RR = 0.59; 95% CI = 0.41-0.84). The risk of mortality at two years was reduced for both the nutrition education cohort (RR = 0.64; 95% CI = 0.48-0.86) and capsule distribution cohort (RR = 0.57; 95% CI = 0.42-0.77). The nutrition education program, however, was more expensive to deliver than the capsule distribution programme. High rates of participation in the supplementation programme were achieved within a short period. The nutrition education message spread rapidly throughout the study population, although practice was slower to change. Where maternal literacy was low and channels of communication were limited, the capsule programme appeared to be more cost-effective. However, economies of scale for nationwide programmes exist for nutrition education programmes that do not exist for capsule distribution programmes. A comprehensive national programme requires both dietary supplementation and nutrition education.

Child↗
PubMed1982

Classifying cultural food habits and meanings.

Old ideas and themes need to be challenged. Fresh approaches are needed in dealing with problems of food habits so that ultimately scientific knowledge of cultural food habits can produce greater success in nutrition education programs.

Cultural Characteristics↗