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- Lordly, Daphne MA PDt3
- Mager, Diana PhD RD3
- Baracos, Vickie E PhD2
- Black, Jennifer L PhD RD2
- Buccino, Jennifer MEd RD CDE2
- Buchholz, Andrea C PhD RD2
- Carrier, Natalie PhD RD2
- Duizer, Lisa PhD2
- Dworatzek, Paula PhD RD2
- Fraser, Valli RD2
- Gillis, Doris PhD PDt2
- Johnson, Frances MSc RD2
- Keller, Heather H PhD RD FDC2
- Keller, Heather H RD PhD FDC2
- Kirk, Sara F L PhD2
- Lengyel, Christina PhD RD2
- Lieffers, Jessica R MSc RD2
- Lordly, Daphne DEd PDt FDC2
- Lordly, Daphne MAHE PDt2
- Mager, Diana R PhD RD2
- Manafò, Elizabeth MHSc RD2
- Mann, Linda PDt MBA2
- McCargar, Linda J PhD RD2
- McQueen, Kay RD2
- Mourtzakis, Marina PhD2
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- Raphaëlle Jacob MSc,
- Annie Motard-Bélanger MSc,
- Véronique Provencher PhD,
- Melissa Anne Fernandez PhD,
- Hélène Gayraud MSc, and
- Vicky Drapeau PhD
This study aimed to measure the influence of the Chefs in Action program (3 cooking workshops) on cooking skills, nutrition knowledge, and attitudes towards healthy eating in children attending summer day camps and compare it with a single cooking workshop. Groups of children (8–12 years) were randomly assigned to the intervention group (n = 25) or to 1 of 3 comparison groups performing a single workshop (group 1, n = 16; group 2, n = 36; group 3, n = 24). Two dietitians evaluated cooking skills during the workshops. Nutrition knowledge and attitudes towards healthy eating were assessed before and after the intervention. No improvement in cooking skills was observed in the intervention group (P = 0.25). The intervention group’s cooking skills score was significantly higher than comparison group 1 (P < 0.001). Nutrition knowledge was significantly improved in the intervention group and the comparison group 3 (P < 0.0001) but no effect on attitudes towards healthy eating was observed (Pgroup × time = 0.36). In conclusion, the Chefs in Action program positively impacted nutrition knowledge in children. The results also suggest that the type of recipe may influence nutrition knowledge and cooking skills. Further studies are needed to better assess the degree of difficulty required in cooking workshop recipes to improve cooking skills in children.- Jayson L. Azzi BSc, MD(c),
- Sarita Azzi RD, MSc,
- Mathilde Lavigne-Robichaud RD, MSc,
- Adrienne Vermeer RD,
- Teresa Barresi RN, MHS,
- Sean Blaine MD, and
- Isabelle Giroux RD, PhD
The type 2 diabetes epidemic is a global crisis threatening the health and economies of many nations. This study aimed to evaluate a prediabetes intervention program designed for rural adults in southwestern Ontario based on the feedback of participants. Rural adults with prediabetes were referred by physicians to an intervention program developed to assist with unique barriers rural adults face related to the built environment and socioeconomic status when adopting a healthy lifestyle. After 6 monthly education sessions offered by a dietitian and a nurse, participants completed a questionnaire to share their program experience. In addition, 6 focus groups consisting of 5–9 participants were conducted to assess program acceptability, feasibility, and practicality. Of 49 enrolled, 35 participants aged 60.8 ± 7.1 (mean ± SD) evaluated the program. Participants reported finding the program to be acceptable, feasible, and practical due to the interactive nature of the sessions, the group setting and the availability of health professionals. This prediabetes lifestyle intervention program was perceived as successfully addressing rural adults’ needs in terms of adopting a healthy lifestyle. Feedback received through program evaluation, which included a participant experience survey and focus groups has helped improve this program and may benefit other prediabetes education intervention programs.- Adrienne M. Young PhD,
- Samantha Olenski PhD,
- Shelley A. Wilkinson PhD,
- Katrina Campbell PhD,
- Rhiannon Barnes BHlthSci(NutDiet),
- Ashley Cameron PhD, and
- Ingrid Hickman PhD
This study aimed to determine dietitians’ familiarity with knowledge translation (KT), confidence in undertaking KT, and preferences for receiving KT training. An online questionnaire was designed and disseminated to all dietitians working across hospital and health services in Queensland, Australia, for completion over a 6-week period (April–May 2018). Of the 124 respondents, 69% (n = 85) reported being familiar with KT, but only 28% (n = 35) reported being confident in applying KT to their practice. Higher confidence was reported with problem identification, evidence appraisal, and adapting evidence to local context, compared with implementation, evaluation, and dissemination. Almost all respondents reported an interest in learning more about KT (n = 121, 98%), with a preference for easily accessible and short “snippets” of training aimed at beginner–intermediate level. Lack of management support, difficulty attending multi-day courses, cost, travel requirements, and lack of quarantined time were reported barriers to attending KT training. There is a high awareness and interest but low confidence in undertaking KT amongst dietitians. This highlights an opportunity for workforce development to prepare dietitians to be skilled and confident in KT. Training and support needs to be low-cost and multi-modal to meet diverse needs.- Laura E. Carter MSc, RD,
- Natalie Klatchuk BSc, RD,
- Kyla Sherman BSc, RD,
- Paige Thomsen BSc, RD,
- Vera C. Mazurak PhD, and
- M. Kim Brunetwood MSc, RD
Children are at risk for malnutrition in hospital, and a contributing factor may be poor oral intake. Barriers to intake have been studied in adults, but there is a lack of research in children. The purpose of this study was to identify the potential barriers to oral intake for children in hospital. Patients and families (n = 58) admitted to surgery and medicine units at the Stollery Children’s Hospital completed a survey on barriers to oral food intake. Barriers were classified into 6 domains and major barriers were those identified by at least 30% of the population. On average each patient was affected by 22% of the barriers. Within each domain, the proportion of patients identifying at least 1 barrier was as follows: organization (74%), hunger (67%), quality (60%), effects of illness (53%), choice (38%), and physical limitations (29%). Having food brought in from home due to hunger, not wanting what was ordered once it arrives, food quality, decreased appetite, sickness, fatigue, and pain were identified as major barriers. Children have unique barriers to oral food intake in hospital which have not been previously identified. Food service models should consider these barriers to better meet the needs of this population.- Les simulations interprofessionnelles sont une approche pédagogique émergente de plus en plus utilisée dans la formation des professionnels de la santé. Bien que les avantages des simulations soient documentés exhaustivement dans le domaine de la médecine et des sciences infirmières, peu d’études ont exploré le potentiel de cette approche dans la formation des futurs diététistes. Cet article décrit quatre simulations, dont deux interprofessionnelles, axées sur la gestion des soins de la dysphagie qui ont été réalisées dans le cadre d’un programme de baccalauréat spécialisé en sciences de la nutrition et discute les mérites potentiels de cette approche pédagogique dans la formation des futurs diététistes.
- Andrea Carpenter RD,
- Jordan Mann RD,
- Dianna Yanchis RD,
- Alison Campbell RD, CDE,
- Louise Bannister MSc, RD, and
- Laura Vresk MSc, RD
The Nutrition Care Process (NCP), created by the Academy of Nutrition and Dietetics, provides a framework that encourages critical thinking and promotes uniform documentation by Registered Dietitians (RD). Additionally, it creates a link between the nutrition assessment, nutrition intervention, and the predicted or actual nutrition outcome. NCP has been integrated into a number of institutions in Canada and internationally. A committee of nonmanagement RDs at the Hospital for Sick Children led the Department of Clinical Dietetics in adopting the NCP. The committee developed and consecutively delivered a tailored education plan to 5 groups of RDs within the department. Additional resources were developed to complement the learning plan. The committee administered informal pre- and post-education surveys to measure outcomes. RDs reported receiving adequate training and felt confident implementing NCP into their practice. Adopting the NCP was well-received and RDs within the department continue to integrate it into their current practice.- Ashwini M. Namasivayam-Macdonald PhD, CCC-SLP, SLP(C), Reg. CASLPO,
- Catriona M. Steele PhD, CCC-SLP, SLP(C), Reg. CASLPO,
- Natalie Carrier PhD, RD,
- Christina Lengyel PhD, RD, and
- Heather H. Keller PhD, RD, FDC
Many long-term care (LTC) residents have an increased risk for dysphagia and receive texture-modified diets. Dysphagia has been shown to be associated with longer mealtime duration, and the use of texture-modified diets has been associated with reduced nutritional intake. The current study aimed to determine if the degree of diet modification affected mealtime duration and to examine the correlation between texture-modified diets and dysphagia risk. Data were collected from 639 LTC residents, aged 62–102 years. Nine meal observations per resident provided measures of meal duration, consistencies consumed, coughing and choking, and assistance provided. Dysphagia risk was determined by identifying residents who coughed/choked at meals, were prescribed thickened fluids, and/or failed a formal screening protocol. Degree of texture modification was derived using the International Dysphagia Diet Standardization Initiative Functional Diet Scale. There was a significant association between degree of diet modification and dysphagia risk (P < 0.001). However, there was no association between diet modifications and mealtime duration, even when the provision of physical assistance was considered. Some residents who presented with signs of swallowing difficulties were not prescribed a texture-modified diet. Swallowing screening should be performed routinely in LTC to monitor swallowing status and appropriateness of diet prescription. Physical assistance during meals should be increased.- Human milk is considered to be the best nutritional option for newborns. When a mother gives birth prematurely, she may have difficulty providing breast milk for her child. Pasteurized donor human milk (DM) is a better feeding alternative than preterm formula. Human milk banks in North America pool the milk from up to 5 women before distribution, a concept which does not pose a problem for most living in the Western world. Muslim families living in North America may reject the use of DM due to the idea of milk kinship and the anonymity of the donor. This paper aims to provide knowledge to Canadian clinicians on these Islamic religious beliefs relevant to DM and how they may impact their practice. Additionally, this paper provides Canadian clinicians with information to alleviate concerns Muslim families may have regarding the use of DM for their preterm infant.
- Claire Kariya BSc, RD, CNSC,
- Katherine Bell BSc, RD,
- Celise Bellamy BSc, RD,
- Jason Lau BSc, RD, and
- Kristy Yee BSc, RD
Increasingly, patients and their caregivers desire blenderized tube feeding (BTF) as an alternative or adjunct to commercial enteral formula. Although dietitians are central in the care of tube fed patients, they do not necessarily have training or experience with BTF and may therefore find it challenging to manage the nutrition of patients who opt for this enteral nutrition approach. To describe dietitians’ perspectives, perceived competence, and education on BTF, a cross-sectional survey was conducted by use of an original questionnaire. Dietitians with the authority to practice enteral nutrition in the province of British Columbia, Canada, were included in the study (n = 715). Of the 221 respondents (31% response rate), 28% reported being knowledgeable about BTF, and 24% reported confidence managing patients on BTF. Few agreed they had the expertise to design, administer, or teach administration of BTF (29%, 15%, and 24%, respectively). In regards to education, 27% of respondents did not have BTF education of any kind, and those with BTF education reported it to be primarily derived from informal sources such as self-directed study and learning from colleagues or patients. These results indicate that among dietitians, formal BTF education is uncommon, and there is limited perceived competence on BTF practice.- We estimated calorie intake from alcohol in Canada, overall and by gender, age, and province, and provide evidence to advocate for mandatory alcohol labelling requirements. Annual per capita (aged 15+) alcohol sales data in litres of pure ethanol by beverage type were taken from Statistics Canada’s CANSIM database and converted into calories. The apportionment of consumption by gender, age, and province was based on data from the Canadian Tobacco, Alcohol and Drug Survey. Estimated energy requirements (EER) were from Canada’s Food Guide. The average drinker consumed 250 calories, or 11.2% of their daily EER in the form of alcohol, with men (13.3%) consuming a higher proportion of their EER from alcohol than women (8.2%). Drinkers consumed more than one-tenth of their EER from alcohol in all but one province. By beverage type, beer contributes 52.7% of all calories derived from alcohol, while wine (20.8%); spirits (19.8%); and ciders, coolers, and other alcohol (6.7%) also contribute substantially. The substantial caloric impact of alcoholic drinks in the Canadian diet suggests that the addition of caloric labelling on these drinks is a necessary step.
- Jill Toth BSc, RD,
- Colleen O’connor PhD, RD,
- Brenda Hartman PhD, RD,
- Paula Dworatzek PhD, RD, and
- Justine Horne MScFN, RD, PhD (Candidate)
While the title Registered Dietitian (RD) is regulated under provincial legislation in Ontario and other Canadian provinces, the title “nutritionist” is not regulated in Ontario, which poses potential risks to consumers who place misguided trust in those proclaiming to be nutrition experts. This is concerning as nutrition is a complex health care discipline and RDs, the recognized providers of credible nutrition information, must be registered with an accredited regulatory college that requires them to have undergone rigorous training, practicum placements, entrance examinations, and continuous professional development. The purpose of this study was to determine if Ontario-based unregulated nutritionists and RDs are providing safe, evidence-based, information regarding detoxification diets. Content from 10 blog posts were qualitatively analyzed using deductive content analysis with predetermined categorization matrices. The results revealed that Ontario nutritionists promoted detox diets and provided unproven, misleading, and potentially harmful information, whereas Ontario RDs did not promote detox diets and provided evidence-based, harm-reducing information. Additionally, conflicts of interest arose only in nutritionists’ blog posts. RDs provided credible references for their information while nutritionists did not. Protecting the term “nutritionist” for use exclusively by RDs under provincial legislation would be a positive step towards ensuring Ontarians are receiving the highest quality evidence-based nutrition information.- Adults with acute leukemia (AL) are at high risk of malnutrition due to their disease and treatment side effects and may be admitted to the intensive care unit (ICU), further increasing the risk of malnutrition. Although ICU care includes some form of nutrition, patients typically receive less than prescribed energy and protein. Our objective was to characterize the nutrition care for critically ill patients with AL. We completed a retrospective review of adults with AL admitted to the Medical/Surgical ICU >24 hours. Descriptive statistics were performed on collected data including: demographics, APACHE II and Nutric scores, nutrition therapy, reasons for withholding nutrition, and mortality status at discharge. Data were collected on 154 AL patients with an average APACHE II score of 27 and Nutric score of 5.96. ICU mortality was 36%. Enteral nutrition (EN) was most commonly prescribed. Patients on EN received 55% of energy and 51% of protein prescribed. EN was commonly withheld for airway management and gastrointestinal impairment. Patients with AL received low amounts of energy and protein in the ICU and had a high Nutric score. Strategies and barriers to improve protein intake in this population are identified.
- Heather Tulloch MSc, RD,
- Stephanie Cook MSc, RD,
- Roseann Nasser MSc, RD,
- Gina Guo BSc, and
- Adam Clay MSc
Early detection of malnutrition in hospitalized patients is of paramount importance. As poor food intake is a marker of malnutrition risk, a simple and accurate method to monitor intake is valuable. This quality assurance project aimed to determine if food service workers (FSW) were able to provide accurate estimates of patient intakes through visually assessing meal trays at an acute care hospital. FSW conducted visual estimates of patient trays after meals using the meal plate pictorial rating scale adapted from the My Meal Intake Tool and translated their estimates into one of 5 consumption levels (0%, 25%, 50%, 75%, or 100%). A total of 401 patient meal estimates were validated using the food weighing method. Spearman’s correlations between percent calories consumed (determined by weight) and estimates by FSW were 0.624 (n = 137, P < 0.001), 0.771 (n = 134, P < 0.001), and 0.829 (n = 130, P < 0.001), for breakfast, lunch, and supper, respectively. Paired Wilcoxon tests and the Kruskal–Wallis H test showed that accuracy varied for breakfast, lunch, and supper. The overall sensitivity and specificity of FSW for detecting patient intake ≤50% was 81% and 88%, respectively. These findings identify that FSW can accurately estimate patient intake, contributing an important marker for the detection of malnutrition.- The addition of Registered Dietitians (RD) to primary health care (PHC) teams has been shown to be effective in improving health and economic outcomes with reported savings of $5 to $99 New Zealand dollars for every $1 spent on nutrition interventions. Despite proven benefits, very few Canadians have access to dietitians in PHC. This paper summarizes the literature on dietetic staffing ratios in PHC in Canada and other countries with similar PHC systems. Examples are shared to demonstrate how dietitians and others can utilize published staffing ratios to review dietitian services within their settings, identify gaps, and advocate for additional positions to meet population needs. The majority of published dietetic staffing ratios describe ranges of 1 RD: 15 000–18 500 patients, 1 RD for every 4–14 family physicians, or 1 RD for every 300–500 patients with diabetes. These staffing ratios may be inadequate as surveys report ongoing issues of limited access to dietetic counseling, under-serviced populations, and a shortage of dietitians to meet current population needs in PHC. Newer projection models based on specific population needs and ongoing workforce data are required to identify professional practice issues and accurately estimate dietetic staffing requirements in PHC.
- Coraine V. Wray BSc, MS, RD,
- Paula M. Brauer PhD, RD, FDC,
- Roschelle A. Heuberger PhD, RD, and
- John V. Logomarsino PhD, RD, LD/N
The regular documentation of anthropometric data in an electronic medical record (EMR) is one tracking method used by primary care providers to follow the growth trajectory and development of children in their health care practices. EMR reminders have been proposed as a method to increase recording of pediatric height and weight by primary care providers, leading to potentially better detection and management of children classified as overweight or obese. The aim of this pre–post study was to improve a Family Health Team’s physician documentation of pediatric height and weight through the implementation of an EMR reminder alert tool. The documentation rate for children 4–7 years old in the 6 months before intervention was 36% of children seen. After implementation of EMR reminder alerts, primary care physicians’ documentation rate rose to 45% (9% increase; P < 0.01), but it was below the 15% target increase. Better documentation of pediatric height and weight by family physicians is needed to improve monitoring of children’s growth trajectories. Additional strategies to increase documentation rates are needed.- There is growing interest in use of local food within health care institutions such as hospitals and long-term care homes. This study explored stakeholder perspectives on (i) influences on local food use and (ii) strategies that support success and sustainability of use in health care institutions. Fifteen participants who were institutional leaders with experience in implementing or supporting local food use in health care institutions in Ontario were recruited through purposeful and snowball sampling. A semi-structured interview was conducted by telephone and audio-recorded. Qualitative content analysis identified that influences on local food use were: product availability, staff and management engagement, and legislation and resources (e.g., funding, labour). Several strategies were offered for building and sustaining success including: setting goals, requesting local food availability from suppliers, and more clearly identifying local foods in product lists. The influences and potential strategies highlighted in this paper provide a greater understanding for dietitians and food service managers on how local foods can be incorporated into health care institutions.
- Amanda Liu BASc,
- Margaret Marcon FRCPC, MD,
- Esther Assor RD,
- Farid H. Mahmud FRCPC, MD,
- Justine Turner PhD, FRACP, MD, and
- Diana Mager PhD, RD
The study purpose was to describe dietary intake and the factors influencing micronutrient supplements (MS) use in Celiac Disease (CD) ± Type 1 Diabetes (T1D). Three-day food records collected from parents of youth (3–18 years) with CD (n = 14) ± T1D (n = 10) were assessed for macro and micronutrient intake, diet quality (DQ), glycemic index (GI), glycemic load (GL), and food group intake. Focus group methodology and thematic concept analysis were conducted to determine factors influencing adolescent MS use. Mean ± SD age was 11 ± 4.4 (CD) and 13 ± 3.7 (CD + T1D) (P = 0.32). Body mass index was within healthy reference ranges (17.9 ± 2.5 [CD]; 19.3 ± 3.8 [CD + T1D] kg/m2; P = 0.61). The majority of youth with CD ± T1D (>90%) had high intakes of sugar and saturated fat, had high GI and GL, and met food serving recommendations and DQs that were indicative of “needs improvement.” With the exception of vitamin D, vitamin E, folate, calcium, and potassium, youth in both groups met the estimated average requirements (EAR) for most micronutrients. MS use corrected suboptimal vitamin D intake; however, vitamin E, folate, calcium, and potassium intake remained below the EAR. Variables influencing adolescent MS use included daily routine, health professional influence, disease management (CD + T1D), and lack of knowledge about the need for MS. Strategies to elicit adolescent MS use varied between parent and adolescents.- The impact of a hands-on foods course on undergraduate students’ food skills was examined at the University of Guelph. For a convenience sample, first- and second-year students (n = 47, 87% female) registered in the “Understanding Foods” course were recruited to participate in a survey administered on Qualtrics at the beginning of the semester and again at the end of the semester. Participants were asked questions related to demographics and food habits; additional questions on food skills, in Likert-scale format, included confidence in food preparation, food safety knowledge, and grocery shopping habits. Subscales were combined for an overall Food Skills Questions (FSQ) score and differences were determined by paired t tests. Overall, significant (P < 0.05) improvements were observed related to students’ confidence and food safety knowledge scores as well as the overall FSQ score. Students, however, rated their personal eating habits more poorly (P < 0.05) at the end of the semester. As a lack of food skills is often considered a barrier for healthy eating among students, these results signify the importance of a hands-on introductory cooking course at the undergraduate level.
- Dietetic educators and practicum coordinators (PC) play critical roles in preparing students for practice. Dietitians have made significant progress in the development of educational curricula, competencies, and other resources to support knowledge and skill attainment in public health. There are identified gaps in the literature concerning practical training in sustainable food systems and public health, creating barriers in knowledge exchange and improvements in practicum programs in Canada. This paper discusses the potential opportunities and challenges associated with the number of placements for practical training in public health based on interviews with PCs in Ontario. The findings are limited to the perspectives of 7 PCs with experience in practical training and are a starting point for ongoing evaluation. Identified opportunities within traditional and “emerging settings” for practical training in public health included: the uniqueness of the experience, the potential for students to learn outside their comfort zones, and greater possibilities for dietitians in new roles and settings. Challenges included the need for significant PC engagement with nondietetic preceptors and a narrow view of dietetic practice among some dietitians. Interprofessional teams, emerging settings, and flexible learning approaches may create and support practical training opportunities in food systems and public health going forward.
- A whole-system perspective is critical in efforts to create a healthy population and a productive, equitable, and sustainable food system. In 2009, the Ontario Collaborative Group on Healthy Eating and Physical Activity undertook a bold initiative to develop a comprehensive provincial strategy encompassing the entire food system. The Ontario Food and Nutrition Strategy was shaped through extensive consultation with diverse stakeholders. This strategy identified strategic directions and priority actions for productive, equitable, and sustainable food systems intended to promote the health and well-being of all Ontarians. Paramount to the strategy is a collaborative governance mechanism allowing for a cross-government, multistakeholder coordinated approach to food policy development. Key actors participated in a collective impact process to develop a theory of change and potential governance model. Different models for collaborative work were examined and a governance model for a multistakeholder coordinated provincial mechanism was proposed. Lessons learned from this process will inform others involved in food systems work at the provincial, regional, or local level and may pave the way towards successful inter-sectoral action on priority recommendations geared towards improved nutrition-related and food systems outcomes.
