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PubMed1999

Obesity in children.

The most common definition of obesity in childhood is weight in excess of 20% above ideal weight for age and gender and skinfold thickness in excess of the 85th percentile for age and gender. Any treatment plan for overweight children and adolescents should include three major components: diet, exercise and family-based behavior management. Children and adolescents should not be placed on restrictive diets because adequate calories are needed for proper growth and development. Aside from calorie excess and inactivity, genetics and environment predispose a child to be obese. Therefore, any program or treatment plan must include the caretakers, who in most cases are also overweight or obese.

Behavior Therapy↗
PubMed1993

Diet planning for humans using mixed-integer linear programming.

Human diet planning is generally carried out by selecting the food items or groups of food items to be used in the diet and then calculating the composition. If nutrient quantities do not reach the desired nutritional requirements, foods are exchanged or quantities altered and the composition recalculated. Iterations are repeated until a suitable diet is obtained. This procedure is cumbersome and slow and often leads to compromises in composition of the final diets. A computerized model, planning diets for humans at minimum cost while supplying all nutritional requirements, maintaining nutrient relationships and preserving eating practices is presented. This is based on a mixed-integer linear-programming algorithm. Linear equations were prepared for each nutritional requirement. To produce linear equations for relationships between nutrients, linear transformations were performed. Logical definitions for interactions such as the frequency of use of foods, relationships between exchange groups and the energy content of different meals were defined, and linear equations for these associations were written. Food items generally eaten in whole units were defined as integers. The use of this program is demonstrated for planning diets using a large selection of basic foods and for clinical situations where nutritional intervention is desirable. The system presented begins from a definition of the nutritional requirements and then plans the foods accordingly, and at minimum cost. This provides an accurate, efficient and versatile method of diet formulation.

Algorithms↗
PubMed1995

A recipe-based, diet-planning modelling system.

In a recent article in the British Journal of Nutrition, Sklan & Dariel (1993) presented a method for diet planning employing a mixed-integer programming algorithm for meeting nutritional requirements at minimum costs for institutions or individuals. They recognized that most food items are generally consumed in whole units and as such they are represented as integer variables. However, as in most previous studies, they derived the minimum cost diets by optimizing over purchased food items. The present paper presents a computer-assisted, diet-planning modelling system for individuals by optimizing over recipes instead of food items. This is accomplished by restricting the integer programming solutions to those bundles of food that represent reasonably popular meal recipes. The modelling system is composed of three main components: recipe data entry, database management, and the model. The recipe data entry component creates and stores recipes. It also provides nutritional analysis of the recipes. The database management component creates and maintains several databases necessary to build the modelling data file. The modelling component solves the user-specified model. Currently, the model component can solve for the optimal diet by minimizing cost or minimizing cooking and preparation time. The optimal diet is prepared to satisfy the recommended nutritional guidelines for a predefined group of individuals for 1 week. The system currently has 895 popular recipes found in Hawaii. Diet plans generated using this modelling system with differing objectives are discussed and compared.

Computer Simulation↗
PubMedDate not supplied

Understanding the use of the exchange lists for meal planning in diabetes management.

The Exchange Lists for Meal Planning has been in existence since 1950 and was updated in 1976 and 1986. The lists were designed to provide a universal system for the nutrition management of diabetes mellitus. The current edition emphasizes a high-carbohydrate, low-fat diet and is widely used by persons with diabetes and by diabetes educators. To use the exchange lists, the educator must understand how to develop a meal plan. The meal plan serves as the tool to help patients select appropriate foods and amounts. The necessary steps for establishing the meal plan are outlined, and a suggested sequence for educating persons with diabetes in the use of the lists is presented.

Diabetes Mellitus↗
PubMedDate not supplied

Composition of foods commonly used in diets for persons with diabetes.

Information on the carbohydrate, protein, fat, kilocalorie, and plant fiber content of 152 common foods has been collated. These data are based on information currently available and will need to be modified and updated as more information emerges. These data are presented in six tables that follow the format of the commonly used Exchange Lists for Meal Planning for patients with diabetes mellitus.

Calorimetry↗
PubMedDate not supplied

All our patients need to know about intensified diabetes management they learned in fourth grade.

It may be feasible for some patients using simplified meal-planning approaches and short-acting insulin regimens to use an insulin pump instead of 2 daily injections of 70/30 insulin. Although this approach may not be possible for everyone, the methods discussed in this article open the door for some individuals whose main stumbling blocks are calculating insulin dosing and grams of CHO. In our practice, we have seen repeatedly that simplified approaches for counting CHO intake and calculating insulin dose can work successfully even with intensive insulin management. It is our challenge as diabetes health professionals to continually search for creative ways to help our patients simplify their daily diabetes management tasks. In many cases, the patient is more likely to commit to healthful changes when the meal plan is simpler and more visual. It is not possible, however, to make patients proficient in CHO counting and insulin dosing in one visit. Referral to a registered dietitian who specializes in diabetes allows a tailored plan to be developed with each individual based on health parameters, treatment goals, lifestyle, and cognitive skills.

Blood Glucose↗
PubMedDate not supplied

IT'S MINE: Initiating Treatment Success--My Individualized Nutrition and Exercise Plan.

The authors' class structure incorporates individual meal and exercise planning in the group setting. This study was conducted to (1) determine if class participants can create their own meal and exercise plans, (2) determine if class participants feel they will be able to adhere to their meal and exercise plans, and (3) assess adherence to the plans over time. Subjects were recruited from the classes offered at the Joslin Diabetes Center. Following completion of class, patients completed the evaluation questionnaire. Two and 6 months later, study participants received follow-up questionnaires by phone or mail. Among respondents, 63% were able to determine their own carbohydrate goals, with 95.9% indicating they could adhere to the plan, and 82.8% felt the plan would be easier than previous ones. At 2 and 6 months, respectively, 89% and 92% of the participants felt they were following the meal plan either some or most of the time. One hundred percent of the respondents were able to determine their own exercise plan, with 98% indicating they could adhere to the plan, and 85.7% felt the new plan would be easier than previous ones. At 2 and 6 months, respectively, 70% and 73% felt they were following their exercise plan either some or most of the time. Individualized meal and exercise plans can be successfully created in a group setting.

Adaptation, Psychological↗
PubMed1983

A computerized food management system for an extended care unit.

Burnaby Hospital recently implemented a computerized Food Management System. The system is fully operational in the Extended Care Unit (ECU) and now is being introduced in the Acute Care Unit (ACU). The main goals for the new program were: cost savings, more effective use of foodservice employee time and skills, and better patient care. To date, the total time saved by use of the computerized system has been equivalent to one full time employee. The ECU dietitian's and the dietary technician's duties have been upgraded. The technician has been relieved of clerical tasks and has taken over some responsibilities formerly performed by the dietitian; the dietitian is able to perform more administrative and planning tasks; and the former ECU coordinator is manager of patient services and responsible for coordinating changes in the computer system. Research indicates that this system, designed and developed for Burnaby Hospital by Rick Hepting & Associates and running on an MAI Basic Four min computer, model 210, is unique among North American hospitals. Current applications include manipulation of patient diet information for automatic menu processing, food tallying, and production of nourishment labels. Future enhancements will take care of production reporting, standard recipe printouts, food cost analysis, and nutrient analysis. The system has valuable potential for use in other hospitals.

British Columbia↗
PubMedDate not supplied

Nutrition strategies for adolescents with insulin-dependent diabetes mellitus.

Optimal metabolic control is a primary management objective for adolescents with insulin-dependent diabetes mellitus. Nutrition therapy plays an important role in meeting this challenging treatment goal. This article presents broad nutrition goals, makes macronutrient recommendations, and describes their effect on blood glucose levels. Various meal-planning techniques and other developmentally appropriate approaches to assist adolescents in meeting these nutrition objectives are described. Finally, challenges in implementing nutrition therapy in an adolescent population are discussed.

Adolescent↗
PubMed1991

Diabetes and nutrition recommendations: a practical perspective.

Nutritional management is a major therapeutic tool in the care of persons with diabetes. Goals for insulin-dependent and noninsulin-dependent diabetes mellitus (IDDM and NIDDM) differ due to the underlying pathophysiology of the conditions. This article discusses the nutrition management goals for IDDM and NIDDM and provides practical recommendations to achieve them. The authors supply a sample meal plan, a list of high-fiber and low-fat foods, a sample diet history, and a food record to facilitate assessment and patient behavior changes. NPs can use this information in practice when nutrition consultation is not available.

Diabetes Mellitus↗
PubMedDate not supplied

Recommendations of dietitians for overcoming barriers to dietary adherence in individuals with diabetes.

PURPOSE: The purposes of this research were to (1) identify factors that contribute to the barriers to dietary adherence in individuals with diabetes identified in a 1998 study and (2) obtain recommendations from registered dietitians for strategies to overcome these barriers. METHODS: A 10-item, open-ended telephone questionnaire was used to obtain information. The sample included 75 registered dietitians who participated in a previous survey to identify barriers and agreed to a follow-up telephone interview. RESULTS: Of the 75 participants, 28% reported spending 5 hours or less per week counseling individuals with diabetes, 64% spent between 6 and 30 hours, and 8% spent more than 31 hours per week. Almost half of the participants (47%) were certified diabetes educators. Factors identified as the greatest contributors to the barriers being evaluated included lack of time, lack of symptoms, lack of education (including follow-up), poor self-esteem/lack of empowerment, and misinformation from family/peers/others with diabetes. The primary recommendations for overcoming each of these barriers included individualizing meal plans and planning ahead, teaching about complications, and setting obtainable goals. CONCLUSIONS: The registered dietitians who were surveyed emphasized the importance of individualizing dietary counseling.

Attitude of Health Personnel↗
PubMed1980

Diets for children and adolescents that meet the dietary goals.

The parents of many elementary and secondary schoolchildren ask pediatricians for advice on how to feed diets that are in line with the US Dietary Goals or the Dietary Guidelines for Americans. This article outlines an approach for planning diets that fit these recommendations while also assuring that intakes approximate the recommended dietary allowances and the estimated safe and adequate intakes of nutrients provided by the Food and Nutrition Board, National Research Council.

Adolescent↗
PubMedDate not supplied

Predicting serum gastrin levels among men during Ramadan fasting.

Increased gastric acidity is common when fasting during Ramadan. Our study aimed to develop a regression equation to predict fasting serum gastrin levels using parameters commonly analysed in clinical laboratories. Fasting blood samples from six men were taken on days 1, 10, 19, 26 and 28 of Ramadan. Serum gastrin, total cholesterol, urea and uric acid were analysed. All 5 samples from each man were included in multiple regression analysis and the prediction equation obtained was: serum gastrin, pg/mL = 198.27-0.199 total cholesterol (mg/dL) + 2.525 urea (mg/dL)--103.238 uric acid (mg/dL) + 10.923 uric acid (mg/dL)2 + 3.683 body mass index, r2 = 0.75, P < 0.001. This equation might be used to estimate gastrin levels and plan dietary and medicinal measures to avoid high gastric acidity during Ramadan.

Adult↗
PubMedDate not supplied

The challenge of obtaining continence in a child with a neurogenic bowel disorder.

Fecal incontinence in pediatrics can occur from an array of conditions. A challenging group of pediatric patients are those with a neurogenic bowel disorder who can face a lifelong struggle with attaining and maintaining continence. It is difficult to develop a "cookbook approach" to care, particularly because these children's unique physical needs change as they develop. In addition to addressing physical needs, children's emotional and developmental needs must also be incorporated into the plan of care. This article provides an overview of the common congenital conditions in children with a neurogenic bowel, reviews assessment, and addresses treatment options that should be considered when developing a bowel management program.

Anus, Imperforate↗
PubMedDate not supplied

Using the nondiet approach to diabetes meal planning.

Diabetes educators can present the best alternatives for individuals to achieve their health goals. We need to be open to less structure when the situation allows or when it is necessary to do so. By opening our minds to new possibilities, we can help patients create the best scenario for their lives to be as normal as possible while achieving glycemic control.

Adult↗
PubMed1998

Guess who's cooking? The role of men in meal planning, shopping, and preparation in US families.

OBJECTIVES: To determine the role of men in meal-related tasks in households with both a male and female head, and to identify households in which the man is more likely to be involved in these tasks. DESIGN: Data collected as part of the US Department of Agriculture's 1994 Continuing Survey of Food Intakes of Individuals were analyzed. SUBJECTS/SETTING: All analyses were restricted to sampled persons who were identified as a male head of household residing in a household that also had a female head (N = 1,204). STATISTICAL ANALYSES: Frequency distributions were calculated and logistic regression analyses were conducted. RESULTS: Approximately 23%, 36%, and 27% of men reportedly were involved in meal planning, shopping, and preparation, respectively. Men in lower income and smaller households were more likely to be involved in each of the meal activities. Younger men and men in households in which the female head of household worked full-time were more likely to be involved in meal planning and preparation. IMPLICATIONS: Current education efforts to improve family nutrition tend to target the female rather than the male head of household. Our findings confirm that this focus is appropriate for most dual-headed households.

Adult↗
PubMed2004

Industry-sponsored weight loss programs: description, cost, and effectiveness.

PURPOSE: To describe three commercial weight loss programs (Jenny Craig, LA Weight Loss, and Weight Watchers), including efficacy data when available, and to provide clinicians with information for patient counseling. DATA SOURCES: Personal interviews, journal articles, and Web site information. CONCLUSIONS: Commercial weight loss programs provide weight loss services. Benefits are experience, planned menus, and psychological support. Limitations are cost, sales promotions that encourage on-the-spot commitment to prepaid contracts, and the cost of program food and additional vitamins. IMPLICATIONS FOR PRACTICE: Weight loss is a necessary goal for many patients. Clinicians are mandated to provide counseling regarding weight loss.

Cost-Benefit Analysis↗