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- Willows, Noreen D PhD7
- Lordly, Daphne MA PDt4
- Buchholz, Andrea C PhD RD3
- Farmer, Anna PhD RD3
- Hammond, David PhD3
- Ball, Geoff D C PhD RD2
- Bell, Rhonda C PhD2
- Dahl, Wendy J PhD RD2
- Elliott, Sarah A PhD2
- Glanville, N Theresa PhD PDt2
- Hekmat, Sharareh PhD2
- MacLellan, Debbie PhD RD2
- Mager, Diana R PhD RD2
- Maximova, Katerina PhD2
- Mazurak, Vera C PhD2
- McCargar, Linda J PhD RD2
- Mudryj, Adriana PhD2
- Ricciuto, Laurie MHSc RD2
- Rioux, France M PhD2
- Slater, Joyce RD PhD2
- Suh, Miyoung RD PhD2
- Tyler, Robert T PhD2
- Vagianos, Kathy RD MSc2
- Whiting, Susan J PhD2
- Wismer, Wendy PhD2
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- Purpose: Dual energy X-ray absorptiometry (DXA) and air displacement plethysmography (ADP) are commonly used to assess body composition. Accurate body fat measures are valuable in a variety of populations. Because DXA, the reference standard, is expensive and labour-intensive, determining whether these two methods are interchangeable is important. Methods: Forty-five female undergraduate students aged 21 to 33 with body mass indexes of 18.3 to 28.6 kg/m2 were recruited from the University of Guelph. Each participant underwent one full-body DXA scan and one ADP assessment, to determine total percent fat mass (%FM). Results: The Pearson's correlation between %FMDXA (27.1 ± 4.8) and %FMADP (26.1 ± 5.5) indicated good association (r=0.88, p<0.01). While Bland–Altman analysis revealed no systematic bias between the two methods (R2=0.07, p=0.08), large intraindividual variation occurred (95% confidence interval: -5.86% to 4.11%); this was related to height, weight, body-surface area, and lung volume. Conclusions: The two methods were significantly correlated. Mean %FM was not significantly different and no systematic bias between methods was observed. These findings indicate that ADP and DXA may be used interchangeably for determining %FM at the group level in healthy young women; a large intraindividual variation between the methods precludes interchangeability at the individual level.
- Purpose: The study was undertaken to evaluate the education and training background of Canadian registered dietitians (RDs) practising in sport and exercise nutrition, as well as learning opportunities in the practice area. Methods: A secondary analysis of a 2009 Dietitians of Canada (DC) Sport Nutrition Network survey of members (n=70) was conducted to describe members’ educational background. Through the use of publicly available information, Canadian dietetic internship, undergraduate, and graduate sport nutrition educational opportunities were identified. Results: Most (72.9%) respondents indicated they had some type of formal education in sport nutrition; learning from undergraduate courses and conference sessions was cited most frequently. The majority (86.7%) of accredited universities offered undergraduate courses in sport/exercise nutrition. No DC-accredited internship program offered sport nutrition as a mandatory rotation, while 15.8% of graduate programs in Canada had faculty with research interests in the area. Among respondents, 91.4% felt sport nutrition education in Canada was inadequate; all expressed interest in participating in more formal learning experiences, and 97.1% were interested in a specialized credential. Conclusions: Canadian dietitians working in sport and exercise nutrition have diverse educational backgrounds and must direct their own learning. Improved career development pathways and more available formal education are desired and needed.
- Carole Mayer PhD candidate, MSW,
- Kerri Loney RD, MEd, BASc,
- Suzanne Lamoureux RD, BSc, and
- Denise Gauthier-Frohlick PhD candidate, MA, BEd
Purpose: An oncology nutrition referral priority rating system (NRPRS) was developed and evaluated as a tool to classify patients into nutrition risk categories and allocate reasonable wait times. Methods: A retrospective chart audit (n=112), patient focus groups (n=14), and a prospective chart audit (n=179) were conducted to refine the tool. Using the NRPRS, the dietitians assigned a priority rating from the information on the referral and then compared it with a second rating after the first visit. Education to referring staff was provided to improve the completeness of referrals. Results: Patients rated at highest nutrition risk (priorities 1 and 2 [P1 and P2]) had a rating similar to the dietitian's after the first visit (P1, 97%; P2, 84%). Incomplete referrals were assigned a P3 rating. This may explain the discrepancy in ratings for P3 referrals (64%). After education, essential information on the referral form increased by 26%. Conclusions: The NRPRS is an effective tool for prioritizing high-risk patients when referrals are completed fully. The next step is to validate the NRPRS now that computerized order entry is implemented in the cancer clinic.- Kay Watson-Jarvis RD, MNS, FDC,
- Deborah McNeil RN, PhD,
- Tanis R. Fenton RD, PhD, and
- Kristina Campbell RD, MSc
Purpose: Identifying nutrition-related problems during the early years may provide an opportunity to enhance parents’ abilities to support healthy growth and development. The Nutrition Screening Tool for Every Preschooler (NutriSTEP®) is a validated, parent-administered questionnaire designed to identify preschool children at nutritional risk. Parents can complete NutriSTEP® in under five minutes. Parents’ and staff's views of NutriSTEP® implementation feasibility were assessed in two community health centres. Methods: Parents attending preschool immunization clinics were recruited. Parents, staff, and physicians were asked for their opinions on screening. Results: The 412 (34%) parent questionnaires completed indicated that parents found NutriSTEP® easy to complete and helpful for identifying areas of nutrition concern. Staff estimated screening distribution took one to three minutes. Clerks and nurses expressed concern about additional workload and demands on parents. Managers believed NutriSTEP® was easy to implement. Physicians considered nutrition screening of preschoolers important, and felt that health centres were the best location for screening. Conclusions: NutriSTEP® was relatively easy to implement in two community health clinics. While staff expressed concern about increased workload, parents found it easy to complete and helpful.- Purpose: Portion size measurement aids (PSMAs) are used extensively by dietitians. In this cross-sectional, descriptive study, we explored the degree of consistency and concordance between measured and putative volumes of selected household and sport-related PSMAs that are commonly used for nutrition education and dietary assessment. Methods: An online search of portion size resources yielded several governmental and academic descriptions of household PMSAs (e.g., a compact disc, a nine-volt battery) and sportrelated PMSAs (e.g., a golf ball) and their purported dimensions. The spherical items were purchased locally and measured using electronic digital calipers; measurements were then converted to volumes, in millilitres. Results: Overall, we observed a high degree of heterogeneity in how different educational resources related sport-related PSMAs to portion sizes of food. The mean percentage of error between the measured and putative volumes of PSMAs varied considerably. Conclusions: Our findings indicate that the inaccurate use of PSMAs can lead to systematic bias in nutrition education and misreporting of dietary intake during dietary assessment. Dietitians should exercise caution when using PSMAs because these may not reflect the true portion size they are meant to represent.
- Cédée-Anne LeClair PhD, RD,
- Marie Marquis PhD, RD,
- Lita Villalon PhD, RD, and
- Irene Strychar EdD, RD
Purpose: Healthy adolescents’ awareness of diabetes was explored, and gender and grade-level differences in understanding were determined. Methods: Adolescents without diabetes in grades five, eight, and 10 (n=128) at four New Brunswick schools wrote down all words/expressions that came to mind when they heard the word “diabetes” (i.e., they used the free association technique). Answers were classified into categories using content analysis. Results: Eighty-eight girls and 40 boys completed the activity (n=44, 52, and 32 in grades five, eight, and 10, respectively). Nine principal categories were identified: 66% of the adolescents cited sugar (e.g., eating too much sugar, not enough sugar), 48% treatment (e.g., needles, injections), 45% the nature of diabetes (e.g., a disease, types of diabetes, heredity), 41% nutrition (e.g., diet, sugar-containing foods, other foods), 38% blood (e.g., too much/not enough sugar in blood), 18% complications (e.g., death), 11% physiological manifestations/ symptoms (e.g., fainting), 6% obesity, and 6% physical activity. No differences were found in category citation frequency between boys and girls and grade levels, except that grade 10 students more frequently cited the categories of treatment, blood, and obesity (p≤0.05). Conclusions: Students thought of diabetes in terms of sugar and injections. Words related to obesity, prevention, and complications were cited infrequently.- Purpose: The likelihood of experiencing poor nutrition status increases as people age. Sampling new foods may promote a continued interest in food and enjoyment of eating. This pilot study was designed to describe and provide a preliminary evaluation of food-tasting activities integrated into nutrition displays directed at community-living older adults. Methods: Three consecutivemonthly nutrition displays incorporating a food-tasting activity were presented at a Guelph, Ontario, recreation centre for seniors. Seniors had an opportunity to taste two recipes at each of three displays; 226 food samples and 155 copies of recipes were taken. Feedback forms were used to determine participants’ interest inmaking the recipes, and whether tasting influenced their interest in preparing the food. Results: Among 54 participants who completed feedback forms about the program, 75.9%indicated that they intended to prepare one or both of the recipes tasted at the display; 70.4%indicated that they would not ormay not havemade the recipe without tasting it beforehand. Conclusions:Dietitians working with community-living older adults could use food tastings to help translate key educational messages into practice, and to encourage eating enjoyment as people age.
- Purpose: Few authors have investigated the institutional character of charitable food programs and their capacity to address food security in Canada. Methods:We surveyed food programmanagers at charitable agencies in Greater Victoria, British Columbia.We discuss the structure of the “system” of charitable food provision, the value of sourced food, types of services provided, clients’ demographic profile, and the estimated healthfulness ofmeals served.We also describe the proportion ofmajor food types purchased and donated to agencies. Results: Thirty-six agencies served approximately 20,000meals a week to about 17,000 people. Food valued at $3.2million was purchased or donated; approximately 50%was donated,mainly by corporations. The largest value of food purchased and donated was frommeat and alternatives (40.9%) and nonperishable food items (16%). Dairy productsmade up the smallest share of donated foods. Conclusions: Charitable food programs in Victoria depend on food donations. The proportion of dairy products and produce is low, which raises questions about the healthfulness of foods currently fed to homeless and poor people in the city.
- Purpose: Dietary vitamin D intake was assessed among residents in a long-term care (LTC) facility, so that recommendations could be made about vitamin D supplementation. Methods: Three-day tray audits were completed for allmeals and snacks, including nutritional supplements (Boost™and/or high-protein pudding). Total daily and three-day vitamin D intake was calculated for each resident, and the total sample was compared with the recommended Adequate Intake (AI) of 600 IU. Vitamin D content was calculated using the Canadian Nutrient File and product labels. Resident charts were reviewed for micronutrient supplements and diagnoses. Results: The daily average vitamin D available to and consumed by 30 residents was 414 IU and 295 IU, respectively. Those provided with nutritional supplements received an average of 480 IU and consumed 357 IU, while those without received an average of 245 IU and consumed 207 IU. Thirty-three percent of residents were diagnosed with osteoporosis, osteoarthritis, and falls and/or fractures. Vitamin Dmicronutrient supplementation varied from above 600 IU (43%) to below 600 IU (30%) to no supplementation (27%). Conclusions:None of the study participantsmet the recommended AI of 600 IU through dietary sources alone. Study results suggest that all LTC residents require vitamin Dmicronutrient supplementation of at least 400 IU to achieve the recommended AI of 600 IU.
- Objectif: Étudier l’association entre la pneumonie d’aspiration (PA) et la dénutrition chez des patients d’unités gériatriques actives (UGA) et décrire le profil des patients ayant développé une PA. Méthodes: Les cas de PA ont été repérés parmi les patients radiés de deux UGA entre 2001 et 2007 (n=2238). La prévalence des atteintes neurologiques, de la dysphagie et de la dénutrition a été comparée chez les patients selon qu’ils aient développé ou non une PA. Le profil des cas de PA a été déterminé à partir des dossiersmédicaux. Résultats: L’incidence cumulée des PA est faible dans les deux unités (1,1%). La PA était fortement associée aux atteintes neurologiques (accident vasculaire cérébral etmaladie de Parkinson) et à la dysphagie (p<0,01), et tendait à être plus prévalente parmi les patients dénutris (p<0,10). Selon l’évaluation diététique, environ 80%des cas de PA étaient dénutris, résultat appuyé par une prévalence élevée d’indicateurs du risque nutritionnel. Conclusions: Les résultats obtenus soutiennent l’hypothèse d’un rôle possible de la dénutrition dans le développement des PA chez les patients âgés hospitalisés. La prévention et la prise en charge de la dénutrition, particulièrement chez les personnes dysphagiques, pourraient contribuer à la prévention des PA dans cette population.
- Purpose: The Healthy Eating Champions Award for Elementary Schools (HEC) is a public health initiative that recognizes and rewards schools for their outstanding commitment to the promotion of nutrition, for nutrition education, and for making healthy foods and beverages available. This process evaluation assessed HEC implementation, identified benefits and barriers, and solicited suggestions for program improvement. Methods: In-person interviews with principals or their designates from 28 HEC participating schools were conducted in fall 2006. Results: Participants had positive feelings about the HEC program and shared many success stories. Perceived program benefits included increased student awareness about healthy eating, more student involvement in healthy eating initiatives, the creation of opportunities for goal setting and spirit boosting, and improved hygiene practices. The challenge of getting parents and teachers involved and the significant financial needs of schools in low-income areas were identified as challenges. Conclusions: Participants view the HEC program as having a positive impact on the healthy eating environment in schools.
- Purpose: Obesity in childhood has become a major public health concern because of increasing rates of overweight and obesity. To address this epidemic, effective dietetic interventions must be developed. We examined parent/caregiver and/or patient reasons for not returning for follow-up clinical care in the Alberta Health Services, Edmonton Area's Nutrition Services Pediatric Weight Management Program (NS PWMP) in Edmonton, Alberta. Methods: A qualitative telephone survey was developed to identify reasons for non-return to the NS PWMP. Face validity was evaluated by five pediatric registered dietitians (RDs). Results: The survey was administered to parents/caregivers of children or adolescents aged 2.5 to 14.2 years (n=21) who attended fewer than two appointments in the NS PWMP. The major reasons for non-return included physical barriers (scheduling, parking, location), organizational barriers (clinic environment), and program educational content (type of educational tools, the focus of lifestyle education on the individual rather than the family, physical activity interventions, and appropriateness of information for the parent or child). Conclusions: Development and delivery of effective dietetic interventions for children and adolescents at risk of overweight and obesity may be achieved by emphasizing skill building within the child and the family. Analysis of child and family feedback on clinical RD services is critical to optimization of care in a pediatric weight management program.
- Purpose: Beverage consumption by poor, lone mother-led, “milk-friendly” families living in Atlantic Canada was characterized over a one-month income cycle. Methods: Beverage intake and food security status were assessed weekly, using a 24-hour dietary recall and the Cornell- Radimer food insecurity questionnaire. Families were classified as “milk friendly” if total consumption of milk was 720 mL on a single day during the month. Beverage intake was assessed using t-tests, analysis of variance (ANOVA), repeated measures ANOVA with post hoc comparisons, and chi-square analysis. Results: Milk consumption by milk-friendly families (76; total sample, 129) was highest at the time of the month when they had the most money to spend. During all time intervals, mothers consumed the least amount of milk and children aged one to three years consumed the most. Mothers consumed carbonated beverages disproportionately, while children of all ages consumed more fruit juice/drink. Mothers’ coffee consumption was profoundly increased when either they or their children were hungry. Conclusions: The quality of beverage intake by members of low-income households fluctuates in accordance with financial resources available to purchase foods. Mothers’ beverage intake is compromised by the degree of food insecurity the family experiences.
- Purpose: Middle-aged women have the highest levels of obesity and comprise the largest group of dieters. Few investigators have examined how women apply weight-loss diet principles in an unsupervised setting. Dietary intakes and attitudes toward carbohydrates were examined in women who were selfreported low carbohydrate dieters (SRLCDs); these intakes and attitudes were compared with those of women who were following their normal diet (non-dieters [NDs]). Methods: A convenience sample of 29 postmenopausal women aged 45 to 65 was recruited. Data were obtained by interview, questionnaire, and direct anthropometric measurement. Descriptive statistics, chi-square analysis, and analysis of variance were used to compare groups. Results: Although total energy and protein intakes were similar, SRLCDs consumed significantly more fat and less carbohydrate (expressed as a percentage of total energy) and more cholesterol and less fibre than did NDs. Both groups had unfavourable attitudes toward carbohydrates. Conclusions: The SRLCDs ate more fat than recommended. Women who are considering following a low carbohydrate diet need to know the nutritional risks of unbalanced self-designed low carbohydrate diets. Negative attitudes toward carbohydrates were not confined to dieters. Nutrition education is necessary to help consumers understand basic nutrition principles and to be more skeptical of fad diets.
- Purpose: Current prevention-focused nutrition policy for community-dwelling older adults in Canada is discussed. Methods: Government websites were searched and key informants asked to identify relevant documents and policies specific to older adults. These were reviewed to find specific legislation on community nutrition programs for older adults. Results: Despite this population’s known nutritional risk, policies guiding community nutrition programs are extremely limited. Current policies and significant documents and organizations that could influence legislation are acknowledged. Conclusions: Dietitians in diverse settings need to advocate for specific policy concerning preventive nutrition programs for older adults in Canada.
- Purpose: An n-3 polyunsaturated fatty acid (PUFA) supplement was incorporated into three food products previously determined to be preferred by cancer patients, and overall acceptability of these foods was evaluated. Methods: Preliminary testing was performed; an internal panel determined initial acceptability of foods with the supplement added. Taste panel evaluations were held at the Cross Cancer Institute in Edmonton, Alberta. Each participant completed a questionnaire rating aroma, flavour, and overall acceptance on a seven-point hedonic scale (1 = dislike extremely, 7 = like extremely), as well as ability to consume each food daily. Results: Foods were well-liked by patients and non-patients. Mean ± standard deviation acceptance scores for the three foods were pasta sauce 5.9 ± 0.94 (n = 90), oatmeal 6.1 ± 0.88 (n = 79), and smoothie 5.9 ± 1.12 (n = 126). Overall, 94% of patients and non-patients gave tomato pasta sauce, oatmeal, and the smoothie an acceptance score of at least 5. Conclusions: The supplement was incorporated successfully into three foods, which were highly accepted by patients with cancer. Further research should focus on incorporating the supplement into flavoured or sweet foods, as these appear most effective. Microencapsulated fish oil in food products may be used as an alternative to fish oil capsules for delivering n-3 PUFA in clinical trials.
- Purpose: The relationship between body composition and resting energy expenditure (REE) was investigated in two boys and two men with Duchenne muscular dystrophy (DMD) (ages 11 to 22.4 years) and two boys with Becker muscular dystrophy (BMD) (ages 7.75 and 13.75 years). Methods: The REE was assessed by indirect calorimetry; body composition indices (weight, height, skinfolds, and mid-arm circumference) were measured using standardized techniques and compared with healthy reference data. Results: Those with DMD had reduced corrected mid-upperarm muscle area (C-MUMA) in comparison with healthy peers, and approximately twice the subcutaneous fat levels of subjects with BMD and healthy peers. Boys with BMD had remarkably lower muscle status than did boys with DMD and healthy peers. In both groups, REE was lower than in healthy peers; REE was associated with body weight (r=0.85), height (r=0.92), mid-upper arm fat area (MUFA) (r=0.97), and C-MUMA (r=0.65). Conclusions: Individuals with muscular dystrophy (MD) exhibit considerable disease-specific alterations in body composition. The REE had a stronger relationship with growth (weight and height) and subcutaneous body fat composition and a weaker association with C-MUMA. Understanding the effect of MD on body composition and REE will allow dietitians to individualize energy recommendations.
- Purpose: A food frequency questionnaire (FFQ) and an attitude/behaviour questionnaire (ABQ) were developed, and their validity and reliability were tested to determine adolescents’ vegetable and fruit (VF) intakes and factors influencing their food choices. Methods: High school students living in the lower mainland of British Columbia participated. The FFQ was adapted from the National Cancer Institute VF By-Meal screener, which was designed to be used with adults. After several focus groups with adolescents, the FFQ was revised to make it more user-friendly. The ABQ was developed after a literature review of factors influencing youth VF intake, and was based on the constructs within the Health Belief Model. Results: The FFQ was validated against a written 24-hour dietary record (correlation coefficient = 0.52). The test-retest reliability coefficient for the FFQ was 0.46. A panel of experts tested the ABQ construct validity, and changes were made as a result of the recommendations. Internal consistency reliability and test-retest reliability of the ABQ were 0.71 and 0.59, respectively. Both questionnaires were tested for face validity with students and revised accordingly. Conclusions: Further validation of these two questionnaires against other standardized tools is required. Future studies with adolescents using these tools can guide program and resource development.
- Purpose: Prince Edward Island adolescents’ food use was examined, as were possible associations between food use and grade, sex, and academic performance. Methods: Participants (n=325) were purposively selected from four junior high schools. Dietary data were collected using an adaptation of the 2003 Youth Risk Behavior Survey. Demographic information and self-reported academic performance were also assessed. Vegetable and fruit (VF) and milk scores were created, and multivariate analysis was performed to identify which combination of grade, sex, VF score, and milk score predicted academic performance best. Results: Mean daily intakes of VF (4.3 ± 2.9 servings) and milk (1.7 ± 1.4 servings) were below recommended levels. Students with higher academic performance (average grades above 90%) were more likely to consume milk, vegetables, and fruit daily than were those who reported lower grades. There was no significant difference in the proportion of adequate milk intakes between students reporting higher and lower academic performance. Conclusions: The association between VF intake and academic performance supports the need for further research with a larger, more representative sample.
- Purpose: The treatment of celiac disease is a strict gluten-free diet for life. This diet is assumed to be more expensive, although no studies confirm this assumption. In the current study, the prices of gluten-free foods and regular (gluten-containing) foods were compared to determine if and to what extent gluten-free products are more expensive. Methods: Prices were compared for all food products labelled “gluten-free” and comparable gluten-containing food items in the same group available at two large-chain general grocery stores. The unit cost of each food, calculated as the price in dollars per 100 grams of each product, was calculated for purposes of comparison. Results: All 56 gluten-free products were more expensive than regular products. The mean (± standard deviation) unit price for gluten-free products was $1.71 (± 0.93) compared with $0.61 (± 0.38) for regular products (p<0.0001). On average, gluten-free products were 242% more expensive than regular products (± 212; range, 5% to 1,000%). Conclusions: All the commercially available products labelled gluten-free were significantly more expensive than comparable products. This information will be useful to dietitians who counsel individuals and families with celiac disease, and to celiac advocacy groups for lobbying the government about financial compensation.