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- Lordly, Daphne MA PDt3
- Mager, Diana PhD RD3
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- Buchholz, Andrea C PhD RD2
- Carrier, Natalie PhD RD2
- Duizer, Lisa PhD2
- Dworatzek, Paula PhD RD2
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- Keller, Heather H RD PhD FDC2
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- Lengyel, Christina PhD RD2
- Lieffers, Jessica R MSc RD2
- Lordly, Daphne DEd PDt FDC2
- Lordly, Daphne MAHE PDt2
- Mager, Diana R PhD RD2
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- Increased child and youth overweight and obesity, as well as significant health effects associated with obesity, have led to recommendations for multicomponent prevention programs. In 2005 to 2006, the former Calgary Health Region (now Alberta Health Services) had an opportunity to develop, deliver, and evaluate an early intervention service for families with children at risk for overweight and obesity. Using available evidence and with access to key advisors, core team members developed and implemented a curriculum for a family-focused, behaviour-based education program entitled Make It HAPPEN. A health-centred approach based on the physical, mental, and social well-being of the whole child was used. Physical, selfesteem, and quality-of-life measures were included in program evaluation. After the program, statistically significant reductions in body mass index (BMI) percentile and z-score were seen, as were increases in quality of life. Self-esteem improved significantly for children with initial BMI percentiles of at least 98. Evaluation results indicate that an effective program can be developed with limited resources to meet best practice needs. Potentially, such programs could be integrated into other community obesity prevention programs or within primary health services models.
- Kelly R.S. Fehr BSc (HNS),
- Kelsey D.H. Fehr BSc (HNS), and
- Jennifer Lisa Penner Protudjer PhD candidate, MSc
Folic acid reduces the risk of neural tube defects. As approximately 50% of pregnancies are unintended, women of reproductive age should be aware of the importance of folic acid. We reviewed the existing literature on these women’s knowledge of folic acid and neural tube defects. Databases searched were PubMed, CINAHL, and Health Reference Center Academic. We used terms such as “folic acid knowledge” and “folic acid awareness” to search articles published from 1998 to 2010. Awareness of the benefits of folic acid before conception and during pregnancy was low, although knowledge levels were associated with education and household income. Women who were already knowledgeable about folic acid cited health care professionals, magazines and newspapers, and radio and television as common sources of information. Effective knowledge translation is needed to ensure that women are informed about the benefits of folic acid during the reproductive years. This knowledge will allow them to make informed decisions about folic acid consumption. Health care professionals play an influential role in promoting folic acid knowledge among women of childbearing age. Lower levels of knowledge among women with lower levels of education and/or household income must be addressed.- To assess relationships among food intake, anthropometrics, and wound severity, we studied 31 home care clients with pressure ulcers (PUs) or venous stasis ulcers (VSUs). Anthropometric variables (weight, height, waist circumference [WC]) were measured according to standard methodologies. Risk for PU development was assessed using the Braden Pressure Ulcer Risk Assessment score and wound severity according to the National Pressure Ulcer Advisory Panel. Three-day food records were analyzed to assess dietary adequacy. Adults with VSUs (65.8 ± 18.4 years) had a higher body mass index (48.1 vs. 25.9), WC (146.6 vs. 98.4 cm), and Braden score (20.2 vs. 17.5) than did those with PUs (67.8 ± 17.9 years) (p <0.05). Energy, protein, and zinc intake by diet alone did not meet estimated requirements in 41%, 32%, and 54.5% of clients, respectively. Intake by diet alone met the Estimated Average Requirement/ Adequate Intake for all nutrients except fibre, vitamin D, vitamin E, vitamin K, folate, calcium, magnesium, and potassium. Nutrient supplementation resolved this for all nutrients except fibre, vitamin K, and potassium. In multivariate analysis, increasing wound severity was associated with decreased intakes of vitamin A, vitamin K, magnesium, and protein (r2=0.90, p<0.001). Optimizing nutrient intake may be an important strategy to promote wound healing and decrease wound severity in home care clients with chronic wounds.
- Factors that influence the menu planning process in Ontario long-term care (LTC) homes were studied, as were key informants’ perspectives on how this process could be improved to promote resident-centred menus. Key informants were interviewed by telephone to obtain qualitative data through standardized open-ended questions. The key informants (n=35) were randomly selected nutrition managers of Ontario LTC homes. Selected registered dietitians from the Ontario Long-Term Care Action Group also participated (n=5). Descriptive thematic analysis was completed on data provided. Three overarching themes emerged from the data as drivers in the menu planning process: resource limitations, Ontario Ministry of Health and Long-Term Care standards, and the accommodation of diverse and evolving preferences. Challenges involving resources include insufficient food labour and raw food funding, the workload involved with altering menus, and providing food items for special diets or preferences. In terms of ministry standards, participants reported barriers to complying with rotation and portion standards. Other common obstacles within LTC homes include accommodating personal preferences, cultural preferences, and therapeutic diets. Ontario LTC homes face numerous challenges in the planning of menus for residents, regardless of a home's size, location, or profit status. Suggestions are aimed at improving the menu planning process and providing high-quality, palatable, and culturally appropriate food in these homes so that menus are resident-centred.
- We explored the effect of relocating to a personal care home (PCH) on older adults’ nutritional status and eating habits. Fourteen Caucasian older adults (F=57%) with a mean age of 83 years (standard deviation = 9.79) consented to participate. Anthropometric information (height, weight, bioelectrical impedance analysis), biochemical and clinical information (diagnoses, data from scales measuring risk or function), and dietary information (three-day plate waste analysis) were collected at time points A (two to three months after relocation) and B (six to seven months after relocation) through face-to-face interviews and medical chart reviews, and from nursing staff. At time B, cognitive function declined (z = -2.185, p<0.05) and the number of medications prescribed increased (z = -2.00, p<0.05). Levels of 25-hydroxyvitamin D were insufficient among 83% of participants at both time points. Mean serum albumin was 34.4 ± 7.2 g/L at time B, and the prevalence of potential nutritional risk increased from 57% to 77%. Dietary intake was inadequate at both time points. Nutritional risk became more prevalent at time B. Protein–energy malnutrition and other nutritional inadequacies may result if dietary intakes do not improve. Strategies to improve dietary intakes should be implemented within PCHs to reduce potential malnutrition.
- Élodie Gelin Dt.P.,
- Marie Marquis Dt.P., Ph. D.,
- Stéphanie Côté Dt.P., M. Sc.,
- Julie Deschamps Dt.P.,
- Mylène Duplessis Brochu Dt.P.,
- Philippe Grand Dt.P., and
- Marie-Josée Leblanc Dt.P., Ph. D.
Une recension des écrits révèle l'absence d'outil servant à analyser la qualité des menus offerts en services de garde. Une grille d'analyse a été élaborée à cet effet, laquelle cible particulièrement l'offre alimentaire faite aux enfants d’âge préscolaire de plus de 18 mois. Cette grille a été développée à partir de la littérature scientifique récente. La version définitive de la grille d'analyse comprend 25 énoncés abordant: les types de menus, les groupes et recommandations du Guide alimentaire canadien, les sources de protéines, l'offre de boissons, les mets transformés, les produits cariogènes, la variété alimentaire, les allergènes et les propriétés organoleptiques des aliments. Les données recueillies à l'aide de cette grille serviront à l’élaboration de recommandations à formuler aux directions et aux responsables de cuisine des services de garde relativement à plusieurs composantes importantes dans la promotion de saines habitudes alimentaires à la petite enfance. Les limites de son utilisation sont associées à la nécessité de compléter les recommandations par l'analyse des recettes et ingrédients utilisés, des boissons offertes et de la taille des portions.- Primary health care aims to provide timely treatment of serious illness, teach health promotion, and maintain health for patients with chronic diseases. In partnership with the primary care network at Vancouver Coastal Health (VCH), family physicians (FPs), and dietitians, this practice needs assessment was undertaken to explore how VCH could support access to primary care nutrition services. Both qualitative and quantitative approaches were used. Data from two focus groups, one for dietitians and the other for physicians, were compiled and formed the questions for the survey. The data were analyzed using the inductive approach, to consider the messages or themes that appeared from the focus groups and the survey. A review of information from the focus groups, surveys, and literature revealed four common themes of findings: accessibility, collaboration in chronic disease management, health promotion, and information sharing. Sixty-six percent of FPs perceived that primary health nutrition services were fair to poor. Both dietitian and physician groups recognized that collaboration in the areas of chronic diseases and health promotion was essential, and that sharing of information among providers could improve this service.
- Two education interventions involving personalized messages after nutrition screening in older adults were compared to determine changes in nutrition knowledge and risk behaviour. Of 150 older adults randomly selected from a local seniors’ centre, 61 completed baseline screening and a demographic and nutrition knowledge questionnaire and were randomized to one of two groups. Group A received personalized letters plus an educational booklet, and Group B received personalized letters only. All materials were sent through the mail. Forty-four participants completed post-test questionnaires to determine change in knowledge and risk behaviour. Both groups had reduced nutrition risk scores and increased knowledge scores at post-test. After the intervention, a significant difference was observed in knowledge change by treatment group. Group A participants experienced greater gains in knowledge, with a mean gain of 5.43 points, than did those in Group B, who had a mean gain of 1.36 points (p=0.018). Screening and education with print materials have the potential to change risk behaviour and nutrition knowledge in older adults. A specially designed booklet on older adults’ nutrition risk factors plus a personalized letter provide an effective education strategy for older adults after screening.
- Anne-Marie Hamelin PhD,
- Caroline Lamontagne,
- Denise Ouellet PhD,
- Nathalie Pouliot MSc, and
- Huguette Turgeon O'brien PhD
Producing a definition of healthful eating that expresses adequately the richness and the complexity of the eating experience is challenging. Still, the effort is crucial if one wants to promote behavioural change in the population, as well as a transformation of interventional practices, programs, and policies, and even the agri-food system. We explain that the biological, social, and environmental dimensions of healthful eating, along with the interactions among them, must be addressed. Once these dimensions are considered as a whole, the definition of healthful eating allows the identification of a wide range of strategic interventions to implement such eating. We suggest a continuum of eating quality that could be used to identify, in general, the food habits of persons or groups.- A web-based cross-country survey of renal registered dietitians (RRDs) was launched. It was used to assess whether or not their clinical practice in identifying and treating proteinenergy malnutrition (PEM) in adults with end-stage renal disease (ESRD) and dialysis was based on current nutrition practice guidelines (NPGs). The survey included questions on strategies, timelines, and markers used for the identification and treatment of PEM. Fifty-nine RRDs responded (21%). Sixty-seven percent did not base clinical practice on NPGs, while 33% indicated they followed the guidelines. Of those who followed guidelines, 76% use the National Kidney Foundation— Kidney Disease Outcomes Quality Initiative nutrition guidelines. Strategies used to identify and treat PEM were not related to duration of RRD experience in nephrology, but were significantly different between guidelines users and non-users. Guideline users commonly used key nutrition treatment strategies that included enteral/parenteral nutrition and medication therapy. The clinical practice of RRD is typically based on expert opinion/consensus, rather than on evidence-based practice guidelines (EBPG). It remains unclear if differences in RRDs’ adoption of clinical guidelines influences patient outcomes, particularly in the treatment of PEM. Up-to-date EBPG need to be developed for the identification and treatment of PEM in patients with ESRD.
- Evaluation of university-run dietetic internship programs will improve preceptors’ experience and, ultimately, increase the capacity for training future dietitians. We attempted to identify preceptors’ perceptions of their roles, benefits, and supports, as well as of the skills/traits that students need for internship, and suggested improvements for the internship program. Fifteen of 39 current program preceptors who had supervised more than one intern consented to participate in an ethics-approved research methodology. They responded anonymously to a series of questions posted in an online discussion group, and provided feedback on the subsequent reports. While no consensus emerged, more than 50% of participants perceived their role as providing a supportive learning experience for interns. Benefits noted most frequently were personal academic growth and contributions to their organizations from intern research projects. Effective supports included conventional communication methods and website materials. Participants identified self-motivation, independence, and communication skills as most important for interns. They also provided several suggestions for program improvements. The study methods and results could be helpful to other universityrun internship programs seeking improvement and growth.
- Liana C. Del Gobbo MSc,
- Josephine A. Archbold MSc,
- Loren D. Vanderlinden PhD,
- Chris S. Eckley PhD,
- Miriam L. Diamond PhD, and
- Matthew Robson PhD
Pregnant women's fish consumption provides both benefits and risks to the developing fetus. Docosahexaenoic acid (DHA) from fish may enhance fetal neurodevelopment, while methylmercury (MeHg) can have detrimental effects. Dietitians would benefit from information on the frequency with which fish species may be consumed to increase DHA intake among Canadian women of childbearing age, and on minimizing the risks from MeHg, especially for those who consume fish frequently. Eighteen fish species were selected for DHA and mercury analysis from retail markets in the Toronto area. Consumption scenarios using analytical results for these fish species indicate that women of childbearing age can consume nine of 18 fish species every day (14 servings a week) or often (up to four servings a week) and remain below toxicological benchmarks for mercury. Moreover, women can also attain the recommended DHA level by consuming six of those nine fish: four 75-g servings of smelt, porgie, or bluefish a week, or two 75-g servings of milkfish, silver pomfret, or tilapia a day. Our analysis indicates that the DHA level recommended for childbearing women can be attained through fish consumption alone, without the need for supplementation and without posing a risk to the woman (or the fetus) from mercury.- Patient food service is an important component in the nutritional management of hospitalized children. The previous meal delivery system at The Hospital for Sick Children in Toronto was a cold-plating re-thermalized system. Issues related to this model included order lead time, the reheating process, menu selection, and service style. Research into other systems led us toward room service, an innovative and flexible mode of meal delivery. Transformation to room service occurred over one year, and included implementation of a new computer system, kitchen renovation, redesign of menus and a new meal delivery system called Meal Train, and changes to human resource allocations. Throughout the transformation, consultations were held with key stakeholders, including the children’s council, the family advisory, the nursing council, and a multidisciplinary committee involving nursing staff, dietitians, patient service aides, infection control personnel, occupational health employees, patient representatives, and food services staff. Now, Meal Train is running smoothly, and meal days and food costs have been reduced. Others considering a project like this must know their clients’ needs and be willing to think outside the box. They should familiarize themselves with current information on systems and equipment, consult with key stakeholders within their organization, and then create the system that will work for them.
- Zinc deficiency has been reported in individuals with eating disorders, the risks of which increase during the adolescent and early adult years. A food frequency questionnaire (FFQ) specific for zinc-rich foods was tested for its usefulness in identifying problematic eating behaviour tendencies in college-age women. Ninety-two female students enrolled in a university introductory psychology course volunteered to complete demographic information, the Eating Attitudes Test (EAT-26), and a zinc-specific FFQ (ZnFFQ). Relationships among estimated zinc intakes, food/lifestyle habits, and eating attitude variables were examined. Twenty-five women had estimated intakes below the Recommended Dietary Allowance (RDA) for zinc. Individuals in the highest zinc intake group (over twice the RDA) had a tendency to score higher on the EAT-26 and the bulimia subscale. Vegetarians also scored high on the EAT-26. Although our data are limited, the ZnFFQ should be studied further to determine whether it could play a useful role in identifying individuals at risk for bulimia. The ZnFFQ is a simple, non-confrontational assessment tool and may be a helpful starting point for identifying women with unhealthy eating habits.
- Several health disciplines have incorporated the arts into professional education programs; however, little work has been done in the field of dietetics. A pilot arts module was implemented as part of a graduate education program in community nutrition. The course instructor developed a structured, open-ended questionnaire, which was administered to participating students before the educational module. The same students completed a similar questionnaire at the end of the module. Responses were compared and analyzed thematically so that changes could be noted in perspectives on the arts and health upon module completion. Findings suggested that students' understanding of “art” and “science” changed during the module, that they recognized benefits of incorporating the arts into community nutrition practice, and that they could identify resources that would support their efforts to do so. The positive student responses to this pilot project support the further development of arts initiatives within dietetic education.
- The increased prevalence of childhood obesity has led to rising rates of type 2 diabetes mellitus (T2DM) in youth. Recommended nutrition strategies for children with T2DM are not well delineated. Adult recommendations for T2DM do not take into account different stages of physical and psychological growth. Nutrition recommendations for children with type 1 diabetes (T1DM) also are not applicable to youth with T2DM, who generally require interventions to promote weight loss. A nutrition education program was developed for youth with T2DM, with attention to current nutrition recommendations and the delivery of nutrition education to obese children, children with T1DM, adults with T2DM, and children with T2DM. Together with program development strategies, a summary of relevant content and mode of delivery is presented for a nutrition education program intended specifically for youth with T2DM at The Hospital for Sick Children.
- A nutritional screening and early intervention program was administered to older adults in a subacute care facility. The study group was recruited among patients aged 65 or older, who were admitted to the geriatric and rehabilitation units of two hospitals. Two simple, reliable, and valid tools were used to screen subjects for the risk or presence of malnutrition. Those determined to be at high nutritional risk (n=62) were included in the study. Dietitians then conducted a full nutritional assessment and implemented a nutritional care plan for these subjects. Weekly follow-up was completed to measure oral intake, weight, and biochemical indices. A Short-Form 36 Health Survey was administered upon admission and discharge. Results showed significant increases in energy (p=0.0001) and protein (p=0.01) intakes, and in serum albumin (p=0.001), prealbumin (p=0.003), transferrin (p=0.024), and hematocrit (p=0.026) levels. There was also a significant increase in seven of the eight dimensions of the healthrelated quality of life questionnaire (p<0.05). Outcomes improve when older adults are screened for the risk or presence of malnutrition and receive an early nutritional care program.
- This innovative, self-directed diet and physical activity program was designed to achieve moderate weight loss in women. Thirty-five overweight or obese hyperlipidemic women completed a 20-week weight loss study. The weight loss intervention consisted of a 20% decrease in energy intake through diet and a 10% increase in energy expenditure through physical activity. The diet consisted of 50-60% carbohydrates, 20% protein, and 20-30% fat. A personal trainer prescribed physical activity regimens. A progress-tracking system and monthly group sessions were used to maintain participant motivation throughout the weight loss period. Participants lost an average of 11.7 ± 2.5 kg (p<0.001). The pattern of weight loss was linear (p<0.001) throughout the study period. Average weight loss per week was 0.59 ± 0.55 kg. This 20-week program, combining a structured self-selected diet and independent preplanned physical activity with motivational strategies, resulted in weight loss comparable to that observed in more controlled interventions. The lower cost, ease of use, and outcome success make this approach potentially useful in a clinical setting.
- The Health Canada recommendation of 600 IU of vitamin D daily for those over age 70 may be inadequate to prevent deficiencies. A literature search was conducted to examine whether older people living in long-term care (LTC) facilities are at high risk for vitamin D deficiency and therefore should receive a minimum daily supplement of 800 IU. The search included the major databases; the search terms “elderly” and “vitamin D” were used. Articles primarily related to calcium were excluded. The results show that North American seniors generally consume a diet low in vitamin D and have limited sun exposure. The majority, particularly those living in LTC facilities, may have a vitamin D deficiency. Also contributing to deficiencies is an age-related decline in cutaneous production of vitamin D and altered metabolic processes responsible for converting vitamin D to its active form. In summary, research conducted in both Canada and the United States provides sufficient evidence to indicate that older people living in LTC facilities are at high risk for vitamin D deficiency and should receive a minimum daily supplement of 800 IU.
- Traditionally, an emphasis has been placed on dietetic interns’ attainment of entry-level clinical competence in acute care facilities. The perceived risks and benefits of acquiring entry-level clinical competence within long-term and acute care clinical environments were examined. The study included a purposive sample of recent graduates and dietitians (n=14) involved in an integrated internship program. Study subjects participated in in-depth individual interviews. Data were thematically analyzed with the support of data management software QSR N6. Perceived risks and benefits were associated with receiving clinical training exclusively in either environment; risks in one area surfaced as benefits in the other. Themes that emerged included philosophy of care, approach to practice, working environment, depth and breadth of experience, relationships (both client and professional), practice outcomes, employment opportunities, and attitude. Entry-level clinical competence is achievable in both acute and long-term care environments; however, attention must be paid to identified risks. Interns who consider gaining clinical competence exclusively in one area can reduce risks and better position themselves for employment in either practice area by incorporating an affiliation in the other area into their internship program.