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PubMed1996

Nutrition measures for managed care report cards.

Health plan "report cards," that is, published summaries of health plan performance, are a new way to help consumers select a health plan on the basis of cost and quality. The Health Plan Employer Data and Information Set (HEDIS) includes a set of health plan performance measures, standardized definitions, and methods for data collection. HEDIS is used as the basis for many report card initiatives and is the preferred tool of the managed care industry for measuring health plan performance. Nevertheless, the current list of HEDIS performance measures omits many health services, including medical nutrition therapy. Nutrition measures have the potential for wide appeal among health care stakeholders (ie, payers, consumers, and providers). Four measures related to medical nutrition therapy are proposed for managed care report cards: staffing for nutrition services and medical nutrition therapy for high cholesterol level, gestational diabetes, and cardiovascular disease. Barriers to adopting medical nutrition therapy measures in HEDIS include the need to address technical issues before considering new measures and competition from other potential measures. Steps to create support for medical nutrition therapy measures in HEDIS should focus on influencing representatives of health plans and employers to include these measures. The involvement of registered dietitians in the dynamic process of health plan evaluation is an important extension of ongoing efforts for strategic positioning in the managed care market.

Dietary Services↗
PubMed1996

[Immunologic characteristics of undernutrition. I. The undernourished patient in nutritional recovery].

Malnutrition in children is a well known critical factor that determines immunocompetence changes with altered immune response and higher risk to many diseases, especially in developing countries. Moreover, it is related to increased morbi-mortality rates mainly due to infections. For those reasons, 12 undernourished children, age 5 to 24 months were studied along 8 weeks at the Nutritional Recovery Center of Chiquinquira Hospital in Maracaibo, Venezuela. There were 5 cases of kwashiorkor, 5 marasmatics, 1 mixed marasmus/kwashiorkor and 1 case with moderate malnutrition. After a control blood sample was taken and cutaneous tests were done, a nutritional recovery program was began. At regular time intervals and at the end of the study, tests were done again by measuring seric immunoglobulins (IgG, IgA, IgM), secretory IgA (IgAs), C3 and C4 complement, lymphocytic sub-populations, and auto antibodies; cutaneous hipersensitivity tests were also done. As a control group, 10 apparently healthy children of matching age and sex were also studied with the same parameters. Results show that basal seric Igs did not differ significantly from the control group and did not change along the recovery program period, but there was a significant decrease in IgAs at all times of the study. C4 did not change and C3 was lower than control (p < 0.05) but returned to normal value at the end of the recovery period. CD3 and CD4 lymphocytes showed the same pattern. Only two patients showed positive skin tests and auto antibodies were not detected. It is concluded that there is indeed an altered immune competence with low levels of C3, IgAs, and CD3-CD4 lymphocytes that is reversible after nutritional recovery.

Antigens, CD↗
PubMed1985

Modifying the eating behavior of young children.

A nutrition education curriculum was developed, based on a social learning model, that emphasized the importance of a low-salt, low-fat, and increased complex carbohydrate diet for cardiovascular health. The curriculum was pilot-tested in eight third and fourth grade classrooms. Students were exposed to cartoon character role models, were reinforced for dietary changes, and practiced relevant behavioral skills. Students in eight other third and fourth grade classrooms served as controls. At posttest, students participating in the nutrition education program reported a significant reduction in consumption of foods high in fat and salt and an increase in consumption of complex carbohydrates. These assessments were confirmed by food selection measures and by 24-hour food recalls. Students in the control classrooms did not report these eating pattern changes.

Child↗
PubMed2004

Men can cook! Development, implementation, and evaluation of a senior men's cooking group.

This study reports on the process and outcome evaluation of a community-based nutrition and cooking education program for senior men. As part of Evergreen Action Nutrition, a community-organized, nutrition education program, a registered dietitian led a Men's Cooking Group in a seniors' recreation facility. Written questionnaires were completed by most of the men (n = 19) at the beginning and end of the evaluation year, and ten men participated in personal key informant interviews. The majority of participants gained cooking confidence, increased their cooking activities at home, developed healthy cooking skills, and improved cooking variety through the program. The men also identified social benefits to the program. Overall, this preliminary evaluation suggests that community-based nutrition and cooking education for older men is a beneficial nutrition education activity.

Aged↗
PubMed1989

Food group contributions to nutrient intake in whites, blacks, and Mexican Americans in Texas.

The existence of three different ethnic groups, living within a defined geographic area in Texas and maintaining fairly distinct life-styles, provided an excellent opportunity to compare their dietary behaviors. Information about food consumption was obtained by 24-hour dietary recall from a group of 431 whites, blacks, and Mexican Americans residing in two counties in southeast Texas. Food group and subgroup contributions to 11 nutrients were calculated. The intake patterns of Mexican Americans demonstrated both an adherence to traditional or familiar Mexican food items, such as beans and tortillas, and a preference for foods not previously reported to be commonly consumed by that ethnic group, specifically beef. The current study provides a base of information necessary to implement dietary changes acceptable within the context of a particular culture's world view. Results revealed differences in food intake patterns that would be helpful in designing practical nutrition education programs specifically targeted toward these ethnic groups. For example, inadequate sources of nutrients were identified, as were sources of excess fat.

Adult↗
PubMed1979

Vietnam, 1978: crisis in food, nutrition, and health.

Evidence of shortages of food, medical equipment, and supplies and indications of malnutrition were observed by an American Study Mission to Vietnam in the summer of 1978. Recommendations of humanitarian aid were made by the study team and presented as promoting peace and stability in Southeast Asia.

Adult↗
PubMed1999

Intestinal adaptation in pediatric patients with short-bowel syndrome.

The purpose of this study is to evaluate 12 pediatric short-bowel syndrome (SBS) patients experienced at Osaka University Hospital and its affiliated hospitals and to study the intestinal length for achieving intestinal adaptation and the metabolic characteristics. The length of the residual small intestine ranged from 0 to 75 cm with an average of 47 cm and an ileocecal valve had been resected in five cases. Total parenteral nutrition (TPN) was started immediately after operation and was gradually substituted by enteral nutrition. No patient died during the follow-up period. Eight of 12 patients could be weaned from TPN with residual intestinal length of 27 to 75 cm (mean 57 cm). Four patients with the residual intestine of 0 to 45 cm (mean 22 cm) were unable to achieve intestinal adaptation. The rate of catheter-related sepsis per 1000 catheter days was 0.63. Fatty liver was detected in two cases, but no patient developed progressive liver failure. Plasma arginine and citrulline were decreased in patients who were unable to achieve intestinal adaptation. Our nutritional support program provided excellent survival for pediatric SBS patients primarily due to the low incidence of catheter-related sepsis and no episode of severe liver disease. Patients with more than 16 cm of residual intestinal length can be expected to be weaned from TPN.

Adaptation, Physiological↗
PubMedDate not supplied

[Anthropometric nutritional status and food habits of students of the secondary schools of Umbertide (author's transl)].

A survey has been carried out on anthropometric nutritional status and food habits of students of the secondary schools of a little town of Umbria that is now in an economic development. The anthropometric data (body weight and height, skinfolds, diameters, muscle and fat areas and body mass index) show that in the girls the body fat mass is higher than in boys and american girls of the same age. The boys of professional men are fatter than the boys of workmen. The survey of food habits (using the method of frequency of occurrence for three days) shows that milk, eggs, legumes and cheese are not frequently consumed, while meat (particularly beef and veal), alcoholic beverages, animal fats and sucrose occur rather frequently in the diet. The excess of body fat mass and the biological and economic errors in the diet of these children need to be corrected with a nutrition education program. It is well recognized that both diet and physical activity play an important role in the prevention of metabolic degenerative disease and this prevention has to be started as early as possible.

Adolescent↗
PubMedDate not supplied

Vitamin D deficiency in a Manitoba community.

OBJECTIVE: Using a cross-sectional survey, to investigate the vitamin D status of a random sample of 80 mother-child pairs (child age 3-24 months) in a Manitoba community with a high incidence of rickets. METHOD: A questionnaire on feeding habits, gestational history, maternal diet and vitamin supplements was administered to mothers in their homes with the assistance of a local interpreter. Venous blood was collected from both mother and child for serum 25-hydroxyvitamin D levels. RESULTS: Of 91% babies initially breastfed, 36% received no formula or milk after weaning and 40% received no vitamin supplements. 24% of mothers took no vitamin supplements during pregnancy and lactation. Knowledge about rickets was poor. In 43% of children and 76% of mothers, serum 25-hydroxyvitamin D levels were below normal range. CONCLUSIONS: Vitamin D levels are low in this population due to lack of fortified dairy products and vitamin D supplements. A public health program should include counseling on rickets and vitamin D supplementation for all infants and pregnant or lactating women.

Adult↗
PubMed2002

Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme--experiences from Finland.

A global health transition is currently underway. The burden of non-communicable diseases (NCDs) is increasing rapidly in the developing world, very much as a result of changes in lifestyles. In addition to changes in tobacco use and physical activity, major changes are taking place in diets, contributing greatly to the growing epidemic of NCD. Thus, a huge global public health challenge is how to influence the trends in diet and nutrition for effective global NCD prevention. The health transition took place rapidly in Finland after World War II and mortality from cardiovascular disease (CVD) was exceptionally high. The North Karelia Project was launched in 1972 as a community-based, and later as a national, programme to influence diet and other lifestyles that are crucial in the prevention of CVD. The intervention had a strong theory base and it employed comprehensive strategies. Broad community organisation and the strong participation of people were the key elements. Evaluation has shown how the diet (particularly fat consumption) has changed and how these changes have led to a major reduction in population serum cholesterol and blood pressure levels. It has also shown how ischaemic heart disease mortality in a working-age population has declined by 73% in North Karelia and by 65% in the whole country from 1971 to 1995. Although Finland is an industrialised country, North Karelia was rural, of rather low socio-economic level and with many social problems in the 1970s and 1980s. The project was based on low-cost intervention activities, where people's participation and community organisations played a key role. Comprehensive interventions in the community were eventually supported by national activities--from expert guidelines and media activities to industry collaboration and policy. Similar principles for nutrition intervention programmes could be used in developing countries, obviously tailored to the local conditions. This paper discusses the experiences of the North Karelia Project in the light of needs from the less-industrialised countries and makes some general recommendations.

Cardiovascular Diseases↗
PubMed2001

[Physical and chemical characterization of industrial nixtamalized corn flour for human consumption in Central America].

The objective of this study was the characterization of industrial nixtamalized maize flour for human consumption and which are marketed in Central America for some selected physical and chemical properties which may contribute to food composition information and help nutrition and micronutrient fortification programs. A total of 12 brands purchased in triplicate were obtained from supermarkets in Guatemala, El Salvador and Honduras. These samples were kept under refrigeration until analyzed. The physical parameters measured and results were the following: particle size with most samples having a high percentage of particles greater than 60 mesh, pH (5.4-7.5), water absorption index (WAI) (3.4-4.0 g gel/g sample), water soluble index (WSI) (4.8-7.8 g/100 g) and flour density (0.410-0.547 g/ml). The differences were statistically significant for all parameters measured, except for WAI. The chemical characteristics included, moisture, protein, fat, ash and dietetic fiber. Differences between flour samples were statistically significant except for fat content. Protein content was low, ranging between 6.7-8.1 g/100 g and total dietary fiber varied between 7.7-12.0 g/100 g. The samples were analyzed for phytic acid with a variation from 632 to 903 mg/100 g, with statistical significant differences. The samples were also analyzed for total and soluble (pH 7.5) iron, phosphorus, calcium, potassium, zinc, copper, manganese, and magnesium. The difference in the iron and calcium content between flour samples were statistically significant. The physical and chemical variability found between flour samples of nixtamalized maize was relatively high and it is recommended to establish quality standards through raw material and process standardization for greater effectiveness of nutrition programs and activities on micronutrient fortification which may be pursued in the future.

Central America↗
PubMed1990

[Digestive parasitic diseases in young children in a tropical outpatient setting].

Parasites were looked for in stools of infants aged 6 months to 3 years living in a village in the south of Togo. These children were enrolled in a nutritional surveillance program. 42.5% of children harboured at least one parasite and 12.1% had more than one parasite: The most common parasites found included Giardia (21%), Ancylostoma (13%), and Ascaris (12.5%). Infection with a single parasite and infection with several parasites were observed from the age of nine months and 18 months, respectively; the incidence of these infections increased with advancing age. The incidence of diarrheal stools decreased with advancing age and no particular parasite seemed to be directly and exclusively responsible for diarrhea. The distribution of parasites and diarrheal symptoms were not influenced by sex. No correlation was found between nutritional status and presence of a parasitic infection or diarrhea. After treatment, reinfection with Ancylostoma (65%), whipworm (50%), and Giardia (34.2%) were common.

Ascariasis↗
PubMed1985

Self-management of nutrition.

Eleven overweight subjects received a behavioral treatment program for weight loss and a nutritional self-management program during a 10-week treatment period. The nutritional self-management program was evaluated using a multiple-baseline across-groups design. The results indicated that caloric restriction without the nutritional self-management program did not result in the consumption of a well-balanced diet. Introduction of the nutritional self-management program led to improvement of nutritional consumption across six food groups. Self-control of caloric intake within certain food groups, i.e., fruit and vegetable, was better than for others. These findings are discussed in terms of the methodological difficulties involved in managing nutrition and the significance of nutritional self-management for health problems other than obesity.

Behavior Therapy↗
PubMed1997

Random-effects models for analyzing clustered data from a nutrition education intervention.

When evaluating the effects of public health intervention, larger units, or clusters, of individuals are often the unit of randomization and implementation. Ignoring dependency in the data due to clustering can misrepresent intervention effects. Random-effects models (REMs) may be a useful way to analyze such data. The present study compares results of analyses of data from a nutrition intervention program using four different methods: (a) usual multiple regression analysis using individual subject data, (b) usual multiple regression analysis using the classroom cluster as the unit of analysis, (c) two-level REM model with subjects clustered within classrooms, and (d) two-level REM model with subjects clustered within sites.

Adult↗
PubMed2003

Effect of a nutritional intervention promoting the Mediterranean food pattern on plasma lipids, lipoproteins and body weight in healthy French-Canadian women.

The present study examined the effect of a nutritional intervention promoting the Mediterranean food pattern in uncontrolled 'real life' conditions among a group of 77 French-Canadian women. The principal objective was to document changes in the plasma lipid-lipoprotein profile and in body weight that occurred in response to the intervention. The 12-week nutritional intervention included two group sessions, three individual sessions and four 24-h recalls (phone interview) with a registered dietitian. A score based on the 11 components of the Mediterranean pyramid, ranging from 0 to 44 points, was established to evaluate the adhesion to the Mediterranean food pattern. The Mediterranean score increased from 21.1+/-3.6 at baseline to 28.6+/-4.4 after 6 weeks of intervention (P<0.0001) with no further increase at week 12. Small but significant decreases in total cholesterol and apolipoprotein B (apoB) as well as in body mass index (BMI) were observed after 6 weeks of intervention. No significant change in plasma concentrations of high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and triglycerides (TG) were observed in response to the nutritional intervention. In conclusion, a nutritional intervention program promoting the Mediterranean food pattern was effective in modifying food habits of healthy women from the Québec City metropolitan area and resulted in small but significant effects on specific cardiovascular risk factors.

Adult↗
PubMed2003

Nutrition guidance in Dutch family practice: behavioral determinants of reduction of fat consumption.

BACKGROUND: Studies have shown that the psychosocial determinants attitude, self-efficacy, subjective norm, and health threat are important in predicting intention to change fat consumption. However, the role of habit in relation to these determinants is still largely unknown. OBJECTIVE: We aimed to assess whether and how habit influences intention in relation to attitude, self-efficacy, subjective norm, and health threat. DESIGN: Cross-sectionally, we studied the self-reported psychosocial determinants and intention of 105 (52 intervention, 53 control) patients who participated in a family practice-based tailored nutrition counseling intervention study for lowering cardiovascular risk. Fat intake 15 mo before the assessment of psychosocial determinants was used as a measure of habit. We used logistic regression analyses to develop a model predicting intention to change fat consumption. RESULTS: Our regression model explained 43% of the variance in intention. Patients who perceived higher subjective norm or more social support had a higher intention. Habit was a significant predictor of intention in interaction with self-efficacy and health threat. Attitude, health threat, age, and group membership (ie, whether patients had been in the intervention group or the control group of the intervention study) were also included in the regression model. CONCLUSIONS: The results suggest that habit in addition to subjective norm and the other more frequently investigated psychosocial determinants are important in predicting intention to change fat consumption. To achieve sustainable health improvement through nutrition education programs, these programs should therefore start focusing more on subjective norm and habit.

Attitude to Health↗
PubMed1978

Nutritional status of main food preparers and of nutrition education assistants.

The dietary habits and nutritional status of nutrition education assistants (NEAS) in the Expanded Food and Nutrition Education Program in Missouri were compared with a representative population of Missouri main food preparers (MFPs) from the same regions of the state. Dietary histories indicated that the NEAs tended to have better habits than the MFPs. Using biochemical parameters for determining status for iron, vitamin A, ascorbic acid, and riboflavin, the differences between the two groups were not as great as for the dietary intakes. However, almost half of the MFPs were taking at least one vitamin or mineral supplement compared with 17 per cent of the NEAs. A low dietary intake, coupled with some anemia, probably relating to a low iron intake, was a major nutritional problem for both groups of subjects. Low plasma vitamin A values were also observed among a large proportion of both groups, and obesity was a widespread problem for both groups.

Adult↗
PubMedDate not supplied

Inadequate dietary intake and altered nutrition status in early HIV-1 infection.

Recent studies indicate that multiple nutritional abnormalities occur relatively early in the course of human immunodeficiency virus (HIV-1) infection. Decreased plasma levels of vitamins B6, B12, A, and E and zinc have been correlated with dietary intake and associated with significant alterations in immune response and cognitive function. To determine the level of intake consistent with normal plasma nutrient levels, we examined nutrition status in relation to food consumption and nutrient supplementation in HIV-1-seropositive (HIV+) and -seronegative (HIV-) homosexual men. The mean level of total intake (diet plus supplements) for all nutrients was significantly higher in HIV+ men. To achieve normal plasma nutrient values, the HIV+ men appeared to require intake in multiples of the recommended dietary allowance (RDA) for vitamins A, E, B6, and B12 and zinc. For the HIV+ men, a relatively high proportion of biochemical deficiency was associated with consumption of vitamin B6 and zinc at the RDA level. Because little evidence of deficiency was observed with elevated intake in both groups, an effective program of nutritional supplementation may be beneficial in maintaining adequate plasma nutrient levels.

Adult↗