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- Dahl, Wendy J PhD RD2
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- A pilot outpatient group for patients with anorexia nervosa was developed and co-led by a dietitian and a psychologist on a general hospital eating disorders team. The main goal of the short-term nutrition and behaviour change group was weight gain through normalization of eating. The first three groups conducted in the clinic were evaluated by monitoring group members’ weights, collecting pre-treatment and post-treatment scores on the Eating Attitudes Test-26, and comparing earlier and later food records. The mean (+/− standard deviation) patient weight gain per eight-week group cycle was 1.6 (+/− 1.9) kg (p<0.05) and the Eating Attitudes Test-26 score change was −17.1 (+/− 11.5) points (p<0.01). Statistically significant changes were found in consumption of calories (p<0.01), fat (p<0.005), and protein (p<0.02). This treatment approach warrants further refinement and investigation.
- A facilitated group discussion approach was used to explore how a group of eight low-income consumers perceive, understand, and use the current food label for food-shopping decisions. Meeting for one hour on three consecutive weeks in a community facility, the group discussed the total food package, the ingredient list alone and in combination with the nutritioninformation panel, and nutrition claims. All sessions were recorded and later transcribed verbatim. Through inductive analysis, three broad categories (brand name, package feature, and nutritionrelated information) and numerous underlying themes emerged from the data; a theoretical framework was proposed to explain the data and provide future direction. A number of barriers to effective use of the food label were identified, and some actionable tips for dietetic practice were suggested.
- This study included 305 children living in Ontario in 1993. Our objective was to determine the proportion of daily energy and macronutrient intake consumed at breakfast, and the major food groups contributing to this meal. Demographic data were obtained in a parent interview that was part of the prevention project Better Beginnings, Better Futures. A single 24-hour recall among parents indicated that breakfast provided a mean of 1,230 (± 607) kJ. Although only 4.9% (n=15) of children ate nothing at breakfast, 26.9% had <837 kJ. Many (59.7%) had a mid-morning snack; however, children who consumed <837 kJ at breakfast were not more likely to have a snack than were those who had a greater energy intake. The major sources of energy were foods from the milk (27.4%), cereals (22.1%), and breads (14.1%) groups. Energy intake at breakfast was no different in children whose household income was at or above the low-income cutoff than in children whose household income was below the cutoff. While few children missed breakfast, many needed more energy at this meal, and non-economic as well as economic influences on breakfast consumption need to be identified.
- While it is important that dietitians and other health or food professionals provide consistent messages to the public about food safety, it is equally important that the information be evidencebased. Conflicting recommendations are evident when reviewing consumer publications from food safety advisory groups and the scientific literature. In addition, caveats are attached to the various food-handling methods. Pathogens, spoilage microorganisms, and contamination of the work area are the major concerns in thawing turkey. While several methods, including thawing on the counter at ambient temperatures, can be employed for thawing turkey, cooking to an adequate internal temperature, validated with a meat thermometer, is the more critical step. The findings indicate that providing clients or consumers with clear, consistent, evidence-based messages is difficult for food and health professionals. Further research is required to corroborate best practices in a kitchen setting. This paper is of interest to professionals who counsel clients at high risk for foodborne illness, or who counsel consumers about safe preparation of foods such as turkey.
- The purpose of this exploratory study was to further our knowledge of how the concept of prior learning assessment is being operationalized within dietetic internship programs. We reasoned that such knowledge would allow us to determine if the profession is capitalizing on associated benefits. A six-item, multi-part, self-administered survey was faxed to all internship directors (n=42). Results indicate that although programs are aware of prior learning assessment, its application is not consistent. Barriers include procedural, implementation, and philosophical issues. The study results provide information for educators and policy-makers to understand better the factors that influence prior learning assessment implementation and usage. Information related to current usage and perceived barriers can assist in the development of a professional prior learning assessment philosophy, which can guide decision-making, development, implementation, and evaluation of new and existing prior learning assessment initiatives.
- In 1998, Dietitians of Canada and the team of registered dietitians at Kellogg Canada Inc. partnered to develop Mission Nutrition ®, a national bilingual nutrition education program that provides curriculum-based resources to teachers. The main objectives of this study were to measure the awareness and utility of the Mission Nutrition® program among elementary teachers, and to identify opportunities to enhance the Mission Nutrition ® resources to increase use. A ten-minute telephone survey was conducted with a representative sample of 203 elementary school teachers. A sub-sample of 20 teachers then participated in a more in-depth 30-minute telephone survey. A need for increased promotion of the Mission Nutrition® program was identified on the basis of the 22% awareness among teachers participating in the initial interview. All teachers who had used the educator guides and student activity sheets reported that they would use them again. Teachers found that the Mission Nutrition ® materials were wellresearched and contained useful activities relevant to students. The findings indicate that, to be most effective, nutrition education resources should be provided in a ready-to-use format and integrated with core curricula. Teachers also suggested that materials should include fresh ideas to engage students at different grade levels, and ways to involve parents. Dietitians are ideally positioned to work collaboratively with educators to develop these types of nutrition education resources.
- Adolescents need good nutrition, both to grow to their full potential and to decrease their risk of obesity and chronic diseases in adolescence and later life. The Food Habits of Canadians study provides data on the important food sources of energy and nutrients in a sample of Canadian teenagers. One 24-hour recall was obtained for 178 teenagers living in households participating in a national survey of 1,543 adults. Foods were categorized into 51 groups, and ranked according to contribution of key nutrients, energy, and fibre. Top contributors to energy and other nutrients included foods of low nutrient density (cakes/cookies/pastries, carbonated beverages, sugars/jams/syrups, and salty snacks). A high intake of nutrient-poor foods, particularly high-sugar beverages, is a concern for this sample of Canadian teenagers.
- According to recent literature, delivering chilled Meals on Wheels to seniors increases food quality and safety. The purpose of this study was to determine the acceptability and/or feasibility of a cook-chill delivery system for participants in the Maimonides Geriatric Centre Meals on Wheels program in Montreal, Quebec. The authors also evaluated whether the meal was eaten upon delivery, documented where the meal was stored if consumption was delayed, determined what cooking/heating appliances were used and if the recipients were capable of heating up their meals, and assessed preferences for receiving chilled versus hot meals. Upon receiving the meal, 89% of the 60 seniors did not eat it immediately. Those who ate the meal later stored it in the refrigerator. All had some appliance available to heat the delivered meal; 55% used a microwave. Approximately 75% did not object to receiving meals chilled. The majority of recipients did not require delivery of hot meals, as most delayed consuming the meal until later in the day. Other meal-delivery program planners can use these findings when deciding if a cook-chill system is appropriate for their client populations.
- The benefits of nutrition assessment and support of the high-risk infant are well established. The premature infant remains vulnerable for poor growth and developmental disabilities, thus requiring consistent monitoring, intervention, and follow-up care. The purpose of this study was to determine the registered dietitian’s role in neonatal/perinatal follow-up programs. A survey was sent to the 26 follow-up programs in Canada. The questionnaire response rate was 81%. Registered dietitians were involved in 67% of these programs. Of these dietitians, 43% were assigned to neonatal/perinatal follow-up programs while 57% were involved only by consult. The average time that assigned registered dietitians devoted to programs was 0.35 full-time equivalents. Over 80% of the dietitians did ongoing development, evaluation, and modification of nutrition care plans; 71% screened new patients for nutritional risk, and 100% instructed patient families and developed teaching materials. The study findings will assist program planners who wish to establish a dietitian position in a neonatal/ perinatal follow-up program. For registered dietitians already working in such programs, the results may provide some guidance on role definition and expansion.
- The prevalence of anemia in Aboriginal children is high, but, given the high burden of infection in these children, the extent to which anemia is due to iron deficiency and/or infection is unclear. To determine the contribution of iron deficiency to anemia, we screened 144 Aboriginal infants (70 boys, 74 girls) who were free from infection. The prevalence of anemia (hemoglobin <105 g/L) was 18.8%; caregivers reported that 53.5% of infants had had an infection in the two weeks before screening. Anemic infants were more likely than non-anemic infants to have had an infection before screening (74.1% versus 48.7%, p = 0.02), and anemic infants had a higher prevalence of iron deficiency revealed by low serum iron concentrations (< μ7 mol/L) (73.7% versus 38.3%, p <0.01). Iron deficiency measured using serum ferritin concentration tended to be less marked in infants who had had an infection (13% versus 30.3%, p = 0.06); this is probably because serum ferritin is a positive acute-phase protein. This study indicates the difficulty of isolating the contribution of infection to anemia from the separate effects of dietary iron deficiency.
- To respond to a need to develop a national fee guideline, the Consulting Dietitians Network conducted a membership fee survey. A questionnaire requesting fee information for various nutrition consulting services was distributed to members as an insert with the Consulting Dietitians Network quarterly newsletter and by electronic mail. The response rate was 38.4% (98 respondents) and most respondents (74.5%) had urban practices. The most frequently charged fees (mode) for individual counselling ($75/hour), industry and commercial firm consultations ($150/hour), group facilitation ($150/hour), and media consultations ($150/ article) were highest in the region of Ontario, Quebec, and the Atlantic provinces. The most frequently charged fees (mode) for home visits ($100/hour), writing for newspapers ($250/hour), and menu reviews ($60/hour) were highest in the region of Saskatchewan and Manitoba. The minimum and maximum fees were significantly different for the three regions (Ontario, Quebec, and the Atlantic provinces; Manitoba and Saskatchewan; and Alberta, British Columbia, and Yukon Territory) studied for initial client consultations, industry and commercial firm consultations, and menu reviews (p<0.05). For home visits, teaching in an institution, seminar presentations, group facilitation, media consultations, and writing media articles, the differences in the minimum and maximum fees charged were highly significant (p<0.001). Entrepreneurial dietitians may use these data as a reference to establish and negotiate consultation fees.
- Research indicates that the ability to perform a task can be affected by the composition of the meal preceding the task. This study investigated the effect of shift workers’ consumption of a medium-fat, medium-carbohydrate meal on alertness scores. Six subjects (four men, two women) aged 19 to 44 recorded food intake, sleep, and quality of sleep for two weeks, and measured their body temperature and performed cognitive tests during two night shifts at baseline and in test periods. The Stanford Sleepiness Scale (SSS) was used to quantify sleepiness, and a Paced Auditory Serial Addition Test (PASAT) was used to measure cognitive performance. In comparison with the score at baseline, when subjects had a low-fat, high-carbohydrate dietary intake (1,335 kcal/5,588 kJ, 56% carbohydrate, 28% fat), the 1.6-second PASAT score improved significantly (p=0.042) during night shifts when subjects consumed a test meal (987 kcal/4,131 kJ, 46% carbohydrate, 42% fat). No statistically significant difference in SSS was found between baseline and test periods. The reduced body temperature between 2400 hours and 0530 hours was similar for both baseline and test periods. Meal composition and size during night shifts may affect cognitive performance.
- The psychosocial correlates of nutritional risk among older adults were examined in a study involving 54 people over age 65 (range, 65 to 98; average, 81), who were selected through a convenience sampling strategy. Measures included a background questionnaire, Mini Nutritional Assessment, Life Satisfaction Index Form Z, Geriatric Depression Scale, and Lubben's Social Network Scale. Seventeen percent of participants were found to be at risk of malnutrition. Compared with those who had adequate nutrition, at-risk participants had lower levels of social support (approaching statistical significance, p=0.08) and life satisfaction (not significant), and significantly higher levels of depression (p=0.04). Hierarchical multiple regression analysis showed that depression and social support were significant correlates of nutritional risk (p=0.01). Nutrition professionals should have a multidisciplinary perspective when they assess older adults’ nutritional status.
- Food banks mitigate immediate food insecurity, but their ability to promote healthy nutrition is constrained by how often recipients may visit and the range of foods available. In a descriptive study, a formative evaluation was completed of a combined heart-healthy recipe-tasting and education program that aims to promote healthy eating knowledge and skills in a group of food bank recipients in Hamilton, Ontario. Fifty-five adults were surveyed about food bank attendance, program awareness, perceived enhancement of knowledge and skills, and suggestions for program improvement. Most participants (73%) were positive about the program, and 91% wanted the program to continue. In addition, 78% would prepare the recipes sampled. In contrast, program awareness and planning food bank visits to coincide with the program were generally low. Food banks are potential sites for effective nutrition promotion programs. To reach more recipients, more frequent implementation and seeking the use of a designated room are suggested for the current program. The findings also suggest that the sampling approach to promoting healthy eating to food bank recipients deserves further study. For example, monitoring the selection of featured recipe ingredients would be a useful indicator of behaviour.
- Vera C. Mazurak PhD,
- Ellen Whybrow BA, BEd, MEd,
- Stanley Varnhagen PhD, and
- Catherine J. Field PhD, RD
Questions often arise about the quality of an educational experience in a distance format. Debate exists as to whether the relatively new format of on-line education can offer an equivalent learning experience for students, and the perception remains that virtual learning is impersonal. We examined students’ experience in an introductory undergraduate nutrition course that had been remodelled as an asynchronous, active-learning, student-centred model. The investigation used the framework of instructional message design, a concept based on cognitive science principles, to highlight themes in student survey and focus group data. Results indicate that a motivating and accessible quality educational experience is possible in an on-line format through a student-centred model. Such a model provides a means to offer education to a diverse and larger audience. Further investigation is needed to determine faculty professional development needs and cost-effective ways to expand the model. Such a model provides alternatives to expand delivery to encourage interest in the field, and to provide continuing education for allied professionals and the general public.- Purpose: Modifications to the amount and type of fat in the diet are recommended as strategies to help reduce heart disease risk. Individuals can choose from a variety of margarines and oils to alter their intakes of different types of fats, and nutrient content claims on product labels (e.g., ‘low in saturated fat’) can help them quickly identify healthful products. However, margarines and oils vary in price. Methods: To examine the relationship between the price and amounts of saturated and trans fats in margarines and oils, and the relationship between price and the presence of nutrient content claims, price and label information were recorded for margarines (n=229) and oils (n=342) sold in the major supermarkets within the Greater Toronto Area. Results: Linear regression analysis revealed a negative relationship between the price and amounts of saturated fat and trans fats in margarines, but not in oils. Margarines with a nutrient content claim were significantly more expensive than were those without a claim. Conclusions: The findings for margarines are of particular concern for lower income groups for whom budgetary constraints result in the purchase of lower priced foods, and also raise important questions about the usefulness of nutrient content claims in guiding food selections.
- Purpose: Food avoidance is central to the treatment of environmental sensitivity (ES), a chronic, often debilitating, multisystem disorder characterized by adverse reactions to non-noxious levels of environmental substances. Because prolonged food avoidance could impact nutritional health, the purpose of this research was to assess adequacy and quality of diets consumed by women diagnosed with ES. Methods: Twelve women aged 37 to 50 recruited from the Nova Scotia Environmental Health Clinic completed a fourday food record during the spring and summer of 1998. Results: When adequacy of nutrient intake was assessed by comparison to the Estimated Average Requirement, the most limited nutrients in the diet were folate, vitamin B6, vitamin B12, and magnesium. Only one woman exceeded the Adequate Intake for calcium. When diet quality was assessed using the Healthy Eating Index, the majority of women (75%) scored in the “needs improvement” category; intake of milk and dietary variety scored the lowest. Women consumed very few servings from “other foods”, defined in the food guide as foods containing mostly sugar and mostly fat. Conclusions: The results of this study suggest that women diagnosed with ES would benefit from counselling on ways to increase dietary variety, which would lead to improved nutrient intake, and ways to increase calcium intake.
- Purpose: Primary health care (PHC) reform, especially efforts to implement interdisciplinary teams, has implications for dietetic practice. A consistent, clear vision of the registered dietitian’s (RD’s) role in PHC is needed to develop a successful advocacy agenda. Methods: The Dietitians of Canada (DC) Central and Southern Ontario Primary Health Care Action Group organized a four-step process to engage dietitians in developing an advocacy agenda for RD PHC services in Ontario. Two facilitated workshops brought together dietitian opinion leaders to enhance the understanding of current roles, find common ground, and develop a shared vision. All DC members were invited to review the draft vision, and feedback was integrated into a revised vision. Results: Registered dietitians saw PHC reform through many lenses, and were uncertain about how reforms would affect their practices. In a national review, the majority of reviewers (approximately 85% of 270) supported the draft vision; additional clarity was needed on resources and the breadth of services that RDs would provide. Conclusion: Development of a PHC vision for RDs should be helpful in advocating for dietitian services in PHC.
- Purpose: To evaluate the adequacy of loans funding and the risk for food insecurity in students living away from home and receiving loans at the University of Alberta. Methods: A nutritious seven-day menu was developed. The menu was priced for skilled and unskilled shoppers at a grocery store near to campus and a discount-style grocery store further away. Results: The menu was more costly for males, unskilled shoppers and those students who shopped near to campus. The menu cost was as high as $296/month and often exceeded the $196 allocated by the Canada Student Loans Program for food each month. Conclusions: Based on the findings from this study, students reliant on financial assistance likely have insufficient money for a nutritionally adequate diet and are at risk for food insecurity. Shopping skills and budgeting, while important, would be insufficient to alleviate food insecurity for many students who require financial aid. Increased funding for food in student loans is necessary.
- Purpose: The use of solution-focused counselling (SFC) in dietetics was examined to determine the demand for an SFC teaching tool for registered dietitians. Methods: A cross-sectional web-based survey was conducted within the Dietitians of Canada cardiology, eating disorders, and consulting networks, with dietitians who practised in an outpatient setting. Dietitians were surveyed on the seven core components of SFC. Results: Responses (n=58) were received from dietitians practising in seven provinces, who tended to be younger (mean age=44) and who had practised for a mean of 15 years. The entire sample reported use of at least four of the seven core components of SFC. All respondents were interested in receiving a counselling teaching tool for dietitians. Conclusions: All respondents were using components of SFC in their outpatient practices. The efficaciousness of SFC in dietetic practice has yet to be determined.
