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PubMed2002

The interrelationship of nutritional risk factors, indicators of nutritional risk, and severity of disability among home-delivered meal participants.

PURPOSE: This study examines the direct and indirect relationships between individual components of nutritional risk and increased severity of disability among a large and diverse sample of homebound older adults. DESIGN AND METHODS: Using routinely collected nutrition and function data, structural equation modeling of recursive and nonrecursive models examined the interrelationships of nutritional risk factors, indicators of nutritional risk, and disability severity among 1,010 home-delivered meals program participants in Wake County, NC. RESULTS: The equally good fit for both the recursive and nonrecursive structural models revealed that specific nutritional risk factors were directly and indirectly associated with indicators of nutritional risk and increased severity of disability. The nonrecursive model also revealed significant reciprocal associations of increased disability with unintended weight change and medication use. IMPLICATIONS: The findings from this study acknowledge aspects of the complex direct and indirect relationships between nutrition and function among homebound older persons. This knowledge will help service providers with the development of effective elderly nutrition programs with nutritional and functional status outcomes.

Aged↗
PubMed2003

Changing practice in residential aged care using participatory methods.

BACKGROUND: Residential aged care staff play a significant role in the day-to-day lives of residents yet are faced with many barriers to providing care that promotes resident wellbeing. APPROACH: Action research is a useful approach for clarifying issues, identifying education and training needs, and identifying, and in some cases overcoming, organizational barriers to change. The Well for Life project aimed to enhance the social and physical health and well being of residents of aged care settings by empowering the staff of facilities to make change. The project had a particular focus on nutrition and physical activity. This paper reports on the action research group process undertaken during Phase I of the Well for Life project. Five residential aged care settings participated in the action research process facilitated by project staff independent of the facilities. The action plan and outcomes from one of these settings is used to illustrate the process and outcomes. FINDINGS: The main findings of the project indicate that using a process that encourages staff involvement in identification of issues and actions can facilitate change in the practice of resident care. The action research groups identified specific gaps in knowledge and skill leading to targeted education that addressed areas of need. The importance of presenting information and learning opportunities for staff in a variety of formats was also recognized, as was the importance of organizational context, management support and empowerment of staff to make change.

Aged↗
PubMed1990

Long-term effects of food supplementation and psychosocial intervention on the physical growth of Colombian infants at risk of malnutrition.

280 Colombian infants at risk of malnutrition were randomly assigned to 1 of 4 experimental groups formed by the presence/absence of 2 interventions: (1) food supplementation for the entire family, from mid-pregnancy until the target child was 3 years old, and (2) a twice-weekly home-visiting program to promote cognitive development, from birth until age 3. All families received free medical care and were studied prospectively. At 3 years of age, children who had received food supplementation averaged 2.6 cm and 642 grams larger than controls. Home visiting and supplementation together reduced the number of children with severe growth retardation. 3 years after intervention (age 6), supplementation effects remained. Children in the home visit condition had become larger than controls, by 1.7 cm and 448 grams. The interactive effect to reduce stunting was marginally significant at this age, and the overall distribution of scores was improved. Other results suggest that changes in family functioning as well as biological mechanisms account for the observed pattern of results.

Body Height↗
PubMed1979

A home program of long-term total parenteral nutrition in children.

Three children--ages 4 months, 5 months, and 14 years--have been on a program of total parenteral nutrition at home for ten, 23 and 44 months respectively, as of January, 1978. Using a specially designed silicone rubber catheter, placed in the right atrium, total nutritional needs of these children were delivered nightly by family members; the children carried out normal activity during the day with the catheter line maintained by a heparin lock. Normal skeletal development and weight gain have been achieved while allowing these children normal social and psychlogic development outside the hospital. During the course of the therapy the patients had multiple metabolic abnormalities which were successfully treated by replacement therapy. The duration of catheter patency ranged from three to 22 months. Catheter sepsis or mechanical failure occasionally required catheter removal and replacement.

Adolescent↗
PubMedDate not supplied

Personal attributes and job competencies needed by EFNEP paraprofessionals as perceived by EFNEP professionals.

OBJECTIVE: To determine the personal attributes and job competencies that are necessary for the job success of Expanded Food and Nutrition Education Program (EFNEP) paraprofessionals as perceived by EFNEP professionals. DESIGN: A qualitative descriptive design and a 3-round modified Delphi methodology was used. PARTICIPANTS: A convenience sample of 14 state and 20 county EFNEP professionals participated in all 3 Delphi rounds. The response rates for state and county professionals for all 3 Delphi rounds were 70% and 91%, respectively. VARIABLES MEASURED: Personal attributes and job competencies were generated and the level of importance was determined. ANALYSIS: An independent t test was employed to determine differences between importance scores by professional position. RESULTS: Thirty-seven personal attributes, 18 job competencies prior to hire, and 43 job competencies after training were generated and the majority were very important to important. County EFNEP professionals tended to score personal attributes and job competencies as more important than state EFNEP professionals. IMPLICATIONS: These personal attributes and job competencies prior to hire can guide hiring decisions and initial training content. The job competencies after training can shape content for inservice training.

Adult↗
PubMed2003

A curriculum based on social learning theory emphasizing fruit exposure and positive parent child-feeding strategies: a pilot study.

This study examined the effectiveness of a nutrition intervention program to enhance children's knowledge, preference, and intake of whole fruit and to decrease parents' use of controlling child-feeding behaviors. Subjects were fifth- and sixth-grade students (children aged 10-12 years) from Cincinnati, Ohio. Nine parent-child pairs completed the study. Seventeen parent-child pairs who expressed interest but were unable to attend more than one session served as controls. Based on the Social Learning Theory, the curriculum combined child-focused interactive lessons and skill-building activities with parent-focused lessons on child-feeding strategies to increase the fruit intake of children. Change in children's knowledge, preference, and intake of fruit and parents' use of controlling child-feeding strategies were measured in a pretest/posttest manner using validated questionnaires. There was a significant increase in knowledge scores and fruit intake by children in the experimental vs the control group. Fruit preference scores were similar between groups. Additionally, there was a significant decrease in use of controlling child-feeding strategies by parents in the intervention vs the control group.

Adult↗
PubMed2001

High serum retinyl esters are not associated with reduced bone mineral density in the Third National Health And Nutrition Examination Survey, 1988-1994.

Hypervitaminosis A is sometimes associated with abnormalities of calcium metabolism and bone mineral status. A recent study found a negative association between reported dietary vitamin A intake and bone mineral density (BMD). Some segments of the U.S. population have high fasting serum retinyl ester concentrations, a physiological marker that may reflect high and possibly excessive vitamin A intake. We examined the association between fasting serum retinyl esters and BMD in the Third National Health and Nutrition Examination Survey, 1988-1994 (NHANES III), a large, nationally representative sample of the U.S. population. BMD was measured for the femoral neck, trochanter, intertrochanter, and total hip on all nonpregnant participants aged > or = 20 years; 5,790 participants also had complete data on fasting serum retinyl esters and covariates including age, body mass index (BMI), smoking, alcohol consumption, dietary supplement use, diabetes, physical activity, and, among women, parity, menopausal status, and the use of oral contraceptives or estrogen-replacement therapy. The sample included non-Hispanic white, non-Hispanic black, and Mexican American men and women. We examined the association between fasting serum retinyl esters and BMD at each site, controlling for covariates with multiple linear regression. We examined the association with osteopenia and osteoporosis with multiple logistic regression. Although the prevalences of high fasting serum retinyl esters concentration and low BMD were both substantial in this sample, there were no significant associations between fasting serum retinyl esters and any measure of bone mineral status.

Adult↗
PubMed1981

Major nutritional findings from the First Health and Nutrition Examination Survey in the United States of America, 1971-1974.

Some of the major findings from the First Health and Nutrition Examination Survey in the United States were presented related to the Nutritional Status of the American people. These findings cover a range from possible deficiencies to possible escesses. Among the deficiencies, iron is the most frequent, affecting particularly young children and women of childbearing age as reflected by relatively low intakes and relatively high prevalences of low hemoglobin values and percent transferrin saturations. Mean hemoglobin values of blacks were significantly lower than those of whites in spite of higher iron intakes in many black females. Low mean intakes of calcium in black women were found associated with higher prevalences of Chvostek's sign, and low mean vitamin A intakes in younger black men and women of all ages were associated with follicular hyperkeratosis. On the excess side of the range were total fat, saturated fat and cholesterol intakes which are among the highest known. These high intakes are associated with relatively high serum cholesterol levels and a high frequency of obesity. Obesity in white women aged 20-45 years was associated with a lower reported caloric intake and a lower exercise score.

Adolescent↗
PubMed1981

Overview of nutritional status in the United States.

Nutritional surveys attempt to estimate the nutritional status of people from various physical (clinical, anthropometric) and biochemical (with respect to nutrients) measurements, whereas dietary surveys attempt to measure what people eat. Although dietary surveys help explain possible reasons for clinical and laboratory findings, the nutritional status of people cannot be inferred from the diet alone. The determinants of nutritional status and, for that matter, the health of the individual and the population as a whole, include a variety of factors, biologic (genetic), behavioral, sociocultural, economic, and environmental. Diet is one environmental factor of great importance in determining man's level of health and well-being. The 1971-1974 HANES showed that excessive weight or obesity is a major health problem affecting people at all age and economic levels. At the same time, the survey showed a trend toward low calorie intake among certain adults over age 45, particularly women over age 60. The data also indicate that iron deficiency occurs among young children, pregnant women, and the elderly and that dental caries is a prevalent condition. Vitamin and iodine deficiencies, for practical purposes, do not exist in the U.S. population, although several surveys have uncovered certain vitamin deficiencies among the elderly. Dietary deficiencies, where they occur, are related to socioeconomic and cultural factors, specific conditions, and disease states. Reliable data do not exist to estimate the extent of malnutrition among the hospitalized and institutionalized population.

Adolescent↗
PubMed2005

Subsidized housing and children's nutritional status: data from a multisite surveillance study.

BACKGROUND: A critical shortage of affordable housing for low-income families continues in the United States. Children in households that are food insecure are at high risk for adverse nutritional and health outcomes and thus may be more vulnerable to the economic pressures exerted by high housing costs. Only about one fourth of eligible families receive a federally financed housing subsidy. Few studies have examined the effects of such housing subsidies on the health and nutritional status of low-income children. OBJECTIVE: To examine the relationship between receiving housing subsidies and nutritional and health status among young children in low-income families, especially those that are food insecure. DESIGN: Cross-sectional observational study. SETTING AND PARTICIPANTS: From August 1998 to June 2003, the Children's Sentinel Nutrition Assessment Program interviewed caregivers of children younger than 3 years in pediatric clinics and emergency departments in 6 sites (Arkansas, California, Maryland, Massachusetts, Minnesota, and Washington, DC). Interviews included demographics, perceived child health, the US Household Food Security Scale, and public assistance program participation. Children's weight at the time of the visit was documented. The study sample consisted of all renter households identified as low income by their participation in at least 1 means-tested program. MAIN OUTCOME MEASURES: Weight for age, self-reported child health status, and history of hospitalization. RESULTS: Data were available for 11 723 low-income renter families; 27% were receiving a public housing subsidy, and 24% were food insecure. In multivariable analyses, stratified by household food security status and adjusted for potential confounding variables, children of food-insecure families not receiving housing subsidies had lower weight for age (adjusted mean z score, -0.025 vs 0.205; P<.001) compared with children of food-insecure families receiving housing subsidies. Compared with children in food-insecure, subsidized families, the adjusted odds ratio (95% confidence interval) for weight-for-age z score more than 2 SDs below the mean was 2.11 (1.34-3.32) for children in food-insecure, nonsubsidized families. CONCLUSIONS: In a large convenience sentinel sample, the children of low-income renter families who receive public housing subsidies are less likely to have anthropometric indications of undernutrition than those of comparable families not receiving housing subsidies, especially if the family is not only low income but also food insecure.

Body Weight↗
PubMed1998

[Estimating the prevalence of height for age deficits based on the prevalence of weight for age deficits among Brazilian children].

INTRODUCTION: Anthropometry is frequently used for evaluating nutritional status of individuals and populations. In recent years, community surveys have been conducted by health professionals in various regions of Brazil with the objective of complementing the data obtained through nutritional surveillance programs. One important difficulty in conducting these assessments has been measuring height during visits to the homes of survey participants. METHODS: Thirty-eight anthropometric surveys of Brazilian children aged up to 5 years using the National Center for Health Statistics (NCHS) reference were identified. The percentage of children with a Z-score below standard deviations was used to define deficits of weight for age and height for age. RESULTS: Correlation between prevalences of height for age and weight for age deficits were examined. Due to the low prevalence of deficits in weight for height in all surveys, there was a strong correlation between weight for age and height for age at the population level. Approximately 90% of the height for age (H/A) variation was accounted for by that of weight for age (W/A). CONCLUSIONS: Using the equation, (Prevalence H/A) = 0.74 + 2.34 (Prevalence W/A) -0.03 (Prevalence W/A)2 it is possible to estimate the prevalence of height deficits on the basis of prevalence of weight deficits. These results suggest that anthropometric surveys as conducted in Brazil, in the context of health services, can be simplified by measuring weight only, instead of both weight and height.

Age Factors↗
PubMed1989

Community-based health care in Kibwezi, Kenya: 10 years in retrospect.

In response to the interest of the Kenya government in community-based health care, the Kibwezi Rural Health Scheme was developed by the African Medical and Research Foundation (AMREF) in a semi-arid district in eastern Kenya. Based on a community co-operative philosophy and focussing on health promotion and prevention, the scheme includes the following: a health centre with a 15-bed in-patient unit including four maternity beds, out-patient services, and a 15-bed nutrition rehabilitation unit; a cadre of volunteer community health workers, trained by AMREF, who form the backbone of the project; maternal child health/family planning and nutrition services including an applied nutrition programme, a water project; and a mobile health unit. Designed as a replicable model health programme, the intention was that services would be gradually taken over by the Ministry of Health of Kenya. Much has been learned in the development of the project which should be meaningful to others considering similar endeavours. One of the first lessons learned was that the time taken to sensitize the community to community-based health care is critical to the success of the project and may need to be as long as 1-2 years. Another was that gaining the support of the community for the community health workers (CHW) requires a considerable effort on the part of project staff, but seems to be the only viable solution to the remuneration and recognition of the CHW's work. It also became apparent that preventive and promotive health services should be integrated structurally and operationally with curative health services to provide the most benefits for the community served. Finally, although there are some differences of opinion, it is felt that with some refinements, the project could be replicated in other parts of Kenya.

Child Health Services↗
PubMedDate not supplied

Serum lipoproteins in home total parenteral nutrition patients.

Patients maintained in our home total parenteral nutrition (HTPN) program receive very small amounts of cholesterol in their solutions. Because of the severe intestinal insufficiency which is characteristic of this group, they do not absorb significant amounts of cholesterol or bile salts from their intestines. We investigated the serum lipoproteins in nine patients maintained on HTPN for 36 +/- 4 (mean +/- SEM) months. Fat emulsions were given twice a week as a source of essential fatty acids. Mean serum cholesterol 110 +/- 6.5 mg/dl, LDL-cholesterol 75 +/- 6 mg/dl, and HDL-cholesterol 29 +/- 1 mg/dl, were at or below the 5th percentile compared with age- and sex-matched Lipid Research Clinic controls. HDL-cholesterol to serum cholesterol ratio was in the normal range (0.25 +/- 0.30). The mean serum cholesterol did not rise, but the mean serum triglyceride rose significantly from 72 +/- 4 to 104 +/- 16 mg/dl (p less than 0.05) immediately after completion of TPN infusions with fat emulsions. There was a negative correlation between the length of HTPN therapy and the total serum cholesterol (r = 0.43, p less than 0.05). Thus, HTPN patients have markedly depressed concentrations of total serum cholesterol, LDL-cholesterol, and HDL-cholesterol, but the ratio of HDL cholesterol to total serum cholesterol is in the normal range.

Adult↗
PubMed2001

Bone mineral density and fracture among prevalent kidney stone cases in the Third National Health and Nutrition Examination Survey.

Concern that people who form kidney stones may have reduced bone mineral density (BMD) and increased fracture risk has motivated clinical and population-based studies, but findings are inconsistent. In this cross-sectional study, we use the Third National Health and Nutrition Examination Survey (NHANES III) to determine whether a history of kidney stones (n = 793) is associated with lower femoral neck BMD and whether the association is similar for men and women. We further ask whether dietary calcium modifies the association between kidney stone history and BMD and whether there is an association between kidney stone history and prevalent spine or wrist fracture. We find that men with kidney stone history have lower femoral neck BMD than men without kidney stone history after adjusting for age, body mass index (BMI), race/ethnicity, and other potential confounders. The effect of kidney stone history on BMD is weaker for women. Men with kidney stone history also are more likely to report prevalent wrist and spine fractures. Dietary calcium, represented by usual milk consumption, is associated positively with BMD for both men and women and modifies the effect of kidney stone history on BMD for men. For men who form kidney stones, milk consumption is associated more strongly with femoral neck BMD than for men without such a history. The effect modification is such that the difference in BMD between men with and without kidney stone history is observed only at lower levels of milk consumption.

Adult↗
PubMedDate not supplied

Total parenteral nutrition in germfree colostrum-deprived neonatal miniature piglets: a unique model to study the ontogeny of the immune system.

In order to investigate the regulatory role of the immune system on gastrointestinal macromolecular permeability in neonates, and ontogeny of the neonatal immune system, we have developed a total parenteral nutrition (TPN) program capable of maintaining immunologically "virgin" germfree (GF) neonatal piglets. GF colostrum-deprived piglets obtained by aseptic hysterectomy 3-5 days prior to term were denied any oral feeding and maintained on central venous hyperalimentation in the GF isolators. GF piglets were anesthetized and 20-gauge silicone tubing was inserted into the external jugular vein and advanced to the level of right auricle of the heart. The distal end of the cannula was subcutaneously tunneled out between the shoulders and attached to a light jacket, tether, and swivel assembly that allowed the piglet to move freely inside the cage in a germfree unit. The TPN formula provided 60 Cal/kg/day for the first day and gradually increased up to 165 Cal/kg/day for day-7 and older piglets. The GF piglets were maintained on the TPN formula for 21 days and weight gain of the GF-TPN piglets averaged 23 g/day. The hematologic and serum biochemical parameters of GF-TPN piglets were within the normal range of gnotobiotic animals of their age group. The serum levels of total protein and albumin in the GF-TPN piglets were significantly less than those of colostrum-fed piglets, who absorbed a large quantity of the colostral macromolecules through their gastrointestinal tract into the blood stream.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Prevalence of liver complications in pediatric patients on home parenteral nutrition: indications for intestinal or combined liver-intestinal transplantation.

Parenteral nutrition (PN) is the only treatment for patients affected by chronic intestinal failure (CIF). Home parenteral nutrition (HPN) programs are started when patients need prolonged PN. Unfortunately, many patients on prolonged PN develop liver disease (LD). The aim of our study was to assess the prevalence of LD in our series of patients on HPN. We reviewed our records of patients discharged from the hospital on HPN for CIF. HPN was started when one parent was fully trained in the use of this treatment and if the social and familial home environment was reliable. All patients received total PN by a central venous catheter. All patients with abnormal AST, ALT, ALK, gammaGT, and bilirubin values for more than 3 months were considered affected by PN-related LD. Thirty-six patients (23 of whom were boys and 13 girls) were discharged on HPN. During the study period, for CIF, 16 were affected by short bowel syndrome (SBS), of whom 6 had ultra-short bowel; 16 with functional intestinal failure, and 4 with chronic intestinal pseudobstruction (CIPO). Mean duration of HPN was 2.1 years/patient. Nine of 36 patients (25%) on HPN for CIF showed LD. Seven of the 16 patients (43%) with LD were affected by SBS and 2 (12.5%) patients by functional intestinal failure. No patients with CIPO developed LD. In patients affected by SBS, the onset of LD was very earlier than in patients with ID.

Adult↗
PubMed2002

Demonstrating the impact of nutrition intervention in a heart failure program.

Outpatient heart failure centers using a multidisciplinary approach to management of heart failure are recognized as essential to decreasing costs of treating heart failure. These centers do not typically employ registered dietitians. With hospital foundation funding, our objective was to develop the role of the dietitian and to evaluate the impact of nutrition intervention in a multidisciplinary heart failure program. Based on a needs assessment, the dietitian developed and tested a medical nutrition therapy protocol, education materials, and special education projects. Unannounced 24-hour recalls at 3 points in time were used to determine changes in sodium and fluid intakes. An outcome tracking system was implemented. Intake data were analyzed for patients who were in the program 9 or more months (n = 79). Patients' sodium and fluid intakes at 2 to 3 months and 6 to 9 months were compared with their baseline intakes using paired t test. The sodium decrease of 0.5 g at 2 to 3 months and 6 to 9 months and the fluid decrease of 15 oz at 2 to 3 months and 12 oz at 6 to 9 months were all highly significant (P < .001). Patients active in year 3 (n = 82) completed the Minnesota Quality of Life Questionnaire. Compared with baseline, quality of life scores improved by 6.7 points (P < .003) at 3 months and by 5.9 points (P < .04) at 6 months. Of 83 patients hospitalized over 3 years, 6 hospitalizations were the result of an excessive sodium intake. At the completion of the project, the center provided funding for the dietitian to become a permanent team member. These positive findings indicate dietitians should seek involvement in heart failure centers.

Ambulatory Care↗