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  • Influence of Cooking Workshops on Cooking Skills and Knowledge among Children Attending Summer Day Camps
    Canadian Journal of Dietetic Practice and Research • Vol. 81 • No. 2 • pp. 86 - 90
    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.
  • Participant Evaluation of a Prediabetes Intervention Program Designed for Rural Adults
    Canadian Journal of Dietetic Practice and Research • Vol. 81 • No. 2 • pp. 80 - 85
    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.
  • Knowledge Translation in Dietetics: A Survey of Dietitians’ Awareness and Confidence
    Canadian Journal of Dietetic Practice and Research • Vol. 81 • No. 1 • pp. 49 - 53
    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.
  • Barriers to Oral Food Intake for Children Admitted to Hospital
    Canadian Journal of Dietetic Practice and Research • Vol. 80 • No. 4 • pp. 195 - 199
    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.
  • Apprentissage par simulation : activité novatrice de formation interprofessionnelle sur la gestion de la dysphagie
    Canadian Journal of Dietetic Practice and Research • Vol. 81 • No. 1 • pp. 44 - 48
    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.
  • Implementing a Clinical Practice Change: Adopting the Nutrition Care Process
    Canadian Journal of Dietetic Practice and Research • Vol. 80 • No. 3 • pp. 127 - 130
    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.
  • The Relationship between Texture-Modified Diets, Mealtime Duration, and Dysphagia Risk in Long-Term Care
    Canadian Journal of Dietetic Practice and Research • Vol. 80 • No. 3 • pp. 122 - 126
    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.
  • Acceptability of Donor Human Milk in Muslim Populations in Canada
    Canadian Journal of Dietetic Practice and Research • Vol. 80 • No. 4 • pp. 186 - 189
    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.
  • Blenderized Tube Feeding: A Survey of Dietitians’ Perspectives, Education, and Perceived Competence
    Canadian Journal of Dietetic Practice and Research • Vol. 80 • No. 4 • pp. 190 - 194
    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.
  • Calorie Intake from Alcohol in Canada: Why New Labelling Requirements are Necessary
    Canadian Journal of Dietetic Practice and Research • Vol. 80 • No. 3 • pp. 111 - 115
    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.
  • “Detoxify or Die”: Qualitative Assessments of Ontario Nutritionists’ and Dietitians’ Blog Posts Related to Detoxification Diets
    Canadian Journal of Dietetic Practice and Research • Vol. 80 • No. 3 • pp. 116 - 121
    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.
  • Nutrition Care of Critically Ill Patients with Leukemia: A Retrospective Study
    Canadian Journal of Dietetic Practice and Research • Vol. 80 • No. 1 • pp. 34 - 38
    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.
  • Food Service Workers: Reliable Assessors of Food Intake in Hospitalized Patients
    Canadian Journal of Dietetic Practice and Research • Vol. 80 • No. 1 • pp. 30 - 33
    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.
  • Dietetic Staffing and Workforce Capacity Planning in Primary Health Care
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 4 • pp. 181 - 185
    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.
  • Improving Documentation of Pediatric Height, Weight, and Body Mass Index by Primary Care Providers
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 4 • pp. 186 - 190
    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.
  • Ingredients for Success: Strategies to Support Local Food Use in Health Care Institutions
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 3 • pp. 113 - 117
    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.
  • Dietary Intake and Micronutrient Supplementation in Youth with Celiac Disease with and without Type 1 Diabetes
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 3 • pp. 118 - 124
    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.
  • A Canadian University “Understanding Foods” Course Improves Confidence in Food Skills and Food Safety Knowledge
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 4 • pp. 170 - 175
    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.
  • Opportunities and Challenges for Practical Training in Public Health: Insights from Practicum Coordinators in Ontario
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 4 • pp. 176 - 180
    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.
  • The Development of a Provincial Food and Nutrition Strategy through Cross-Sector Collaboration
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 1 • pp. 28 - 34
    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.
  • Family-Based Obesity Prevention: Perceptions of Canadian Parents of Preschool-Age Children
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 1 • pp. 13 - 17
    Our objectives were to explore the perspectives of a community-based sample of Canadian parents with 2–5-year-old children on: (i) strategies to support the development of healthful weight-related behaviours and (ii) assessment approaches to measure weight-related behaviours and outcomes among children and families. We conducted 4 focus groups with 28 parents (89% mothers and 68% identified as White). Transcripts were analyzed using conventional content analysis. Regarding parent’s perceptions of strategies to support healthful behaviours, we found that parents largely valued: home-based interventions, expert opinion, practical health behaviour strategies delivered in a nonjudgmental manner, and opportunities for social support. Regarding perceptions of assessment procedures, parents had mixed views on children providing blood samples, but looked upon it more favourably if it would contribute to research on child health. Our results suggest that to increase parental engagement interventions focused on improving weight-related behaviours among families with young children should be delivered within the home and include easy-to-implement behaviour change strategies communicated by experts, such as dietitians working in the clinical or public health setting. Using social media to share information and provide a platform for social support may also be an effective way to engage parents of young children.
  • Reproducing or Reducing Inequity? Considerations for School Food Programs
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 1 • pp. 18 - 22
    It is important to consider health inequities when exploring the extent to which school food programs may contribute to the stigmatization and social exclusion of families experiencing food insecurity. As part of a broader school-based project, this paper considers evidence derived from a secondary analysis of research in Nova Scotia (NS). In the original research, interviews were conducted with key stakeholders involved in supporting health promotion activities across NS elementary schools. For this article, data were re-examined using tenets of critical discourse analysis to evaluate if school practices were addressing the root social issues by identifying patterns in language and institutional norms. Our findings suggested that further illumination of programs may be needed to ensure that they do not contribute to the stigmatization and social exclusion of families experiencing food insecurity. Nutrition professionals are in a position to engage families experiencing food insecurity in policy action that will shift from a focus on individual determinants towards the social–structural conditions that underlie the complex issue of food insecurity.
  • Les caroténoïdes sériques comme biomarqueurs : une stratégie pour améliorer la validité de l’évaluation alimentaire
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 1 • pp. 23 - 27
    La marge d’erreur dans l’évaluation de la prise alimentaire au moyen des outils traditionnels comme le rappel de 24 h, le questionnaire de fréquence et le journal alimentaire est grande et peut conduire à l’interprétation erronée de résultats de recherche. La recherche sur des biomarqueurs associés à la consommation de fruits et de légumes a le potentiel d’améliorer sensiblement la validité de l’évaluation de la prise alimentaire ainsi que la mesure des associations entre la qualité nutritionnelle et la santé. Les caroténoïdes, des pigments issus presque exclusivement du monde végétal, présentent un intérêt grandissant dans ce domaine. Les caractéristiques des caroténoïdes ainsi que les avantages et les défis que pose leur utilisation dans l’évaluation nutritionnelle seront explorés dans la présente revue.
  • Gluten-Free Foods in Rural Maritime Provinces: Limited Availability, High Price, and Low Iron Content
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 4 • pp. 192 - 196
    We investigated the price difference between gluten-free (GF) and gluten-containing (GC) foods available in rural Maritime stores. GF foods and comparable GC items were sampled through random visits to 21 grocery stores in nonurban areas of Nova Scotia, New Brunswick, and Prince Edward Island, Canada. Wilcoxon rank tests were conducted on price per 100 g of product, and on the price relative to iron content; 2226 GF foods (27.2% staple items, defined as breads, cereals, flours, and pastas) and 1625 GC foods were sampled, with an average ± SD of 66 ± 2.7 GF items per store in rural areas and 331 ± 12 in towns. The median price of GF items ($1.76/100 g) was more expensive than GC counterparts ($1.05/100 g) and iron density was approximately 50% less. GF staple foods were priced 5% higher in rural stores than in town stores. Although the variety of GF products available to consumers has improved, higher cost and lower nutrient density remain issues in nonurban Maritime regions. Dietitians working in nonurban areas should consider the relative high price, difficult access, and low iron density of key GF items, and work together with clients to find alternatives and enhance their food literacy.
  • Creation of University Wellness Program Healthy Eating and Active Lifestyle Supports: A Knowledge-to-Action Process
    Canadian Journal of Dietetic Practice and Research • Vol. 79 • No. 1 • pp. 7 - 12
    With the burdens that preventable health conditions place on individuals, workplaces, and society, workplace wellness programs (WWP) are critical to ensuring employees have access to health promotion supports tailored to their work environments. Such programs are best guided by a knowledge-to-action (KTA) framework; a theoretically grounded, systematic process that considers the ongoing exchange of knowledge with employees to engage them in health behaviour change and to garner employers’ support for the interventions. Therefore the purpose of this project was to develop, implement, and evaluate WWP healthy eating and active lifestyle supports at a university. A KTA process guided the consultations with employees and stakeholders that led to the development and implementation of a range of resource effective supports and the incorporation of wellness in the organization culture. A key support was the Wellness Passport that encouraged participation in scheduled WWP activities, as well as allowing for self-identified ones. Quality assurance assessments demonstrated a desire for a continuation of these WWP supports and activities. Dietitians, as health promotion leaders, can play key roles in the emerging field of WWPs. University dietetic and internship programs should consider adding WWP and KTA training components.
  • Qualitative Assessment of Key Messages about Nutrition and Weight Gain in Pregnancy in Printed Educational Materials in Alberta
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 4 • pp. 182 - 186
    Printed educational materials are a common source of health information, although their effectiveness in improving women’s knowledge or self-care in pregnancy has been questioned. This study describes the information in printed educational materials that address healthy eating during pregnancy and gestational weight gain (GWG) that are currently used in Alberta, Canada. Content of 6 resources was analyzed using a constant comparison qualitative approach. Resources emphasized healthy eating, prenatal supplements, folate supplementation, and healthy weight gain. More resources discussed the importance of “eating enough” than provided guidance on avoiding excessive GWG. Themes identified were: “everything is important” meaning that all healthy behaviours are important, making prioritization difficult; “more is more” emphasized eating more over moderation; “everyone is individual” suggests women seek individualized care through the care provider; and “contradictions” describes differences in content and recommendations within and between resources. New or revised versions of resources should provide congruent information with up-to-date recommendations that are easily prioritized. Care providers should be aware of contradictory information or information that does not align with current recommendations within printed educational materials and be ready to help women address the areas important for her personal behaviour change.
  • Bringing Menu Labelling to Independent Restaurants: Findings from a Voluntary Pilot Project in Toronto
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 4 • pp. 177 - 181
    Toronto Public Health conducted a pilot project to assess the feasibility of menu labelling by independent restaurants. The pilot project was informed by consultations with the industry and other jurisdictions that have implemented a similar initiative. Public Health Dietitians worked closely with these restaurants to help them work toward posting calories and sodium on their menus. This paper reports on the findings of a feasibility assessment that took a mixed-methods approach resulting in a comprehensive process evaluation. Results showed that having highly motivated restaurants and early adopters of menu labelling is a necessary starting point. However, this alone is not sufficient to make voluntary menu labelling successful. It may be feasible only for select independent restaurants who: (i) are highly motivated and ready to make a substantial time commitment; (ii) value offering healthy food choices; (iii) have fairly standardized recipes to begin with; (iv) receive extensive specialized, individualized support; and (v) receive incentives, cost offsetting, and recognition. Full-scale implementation of a menu labelling program with Toronto independent restaurants was not justified given the current level of interest and capacity.
  • Feasibility and Tolerability of Daily Pulse Consumption in Individuals with Peripheral Artery Disease
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 4 • pp. 187 - 191
    The present study investigated the feasibility, tolerability, and adherence of daily consumption of whole pulses (dried beans, peas, lentils, chickpeas) by individuals with peripheral artery disease participating in an 8-week study. Study questionnaires and semi-structured interviews for 26 participants were used to determine prestudy pulse consumption and participants’ experiences with respect to adherence, positive and negative effects, bowel routine, satiety, and enjoyment of the foods. Although the majority of participants rarely consumed pulses prior to the study, there was a high rate of adherence to daily consumption of the study foods for 8 weeks despite comments regarding study fatigue during the latter part of the study. Participants had no gastrointestinal side effects (42%) or experienced flatulence that resolved by week 4 (23%), whereas 62% reported improvements in their bowel pattern. By week 8 greater satiety was noted by some participants (19%), with the categories “less afternoon snacking” and “not snacking” receiving more responses. The key finding of this study was that consumption of pulses is a viable approach for this population; however, the frequency of consumption that is tolerable in the long term should be integrated with the dose and timeframe required to achieve and maintain health benefits.
  • A Comparative Content Analysis of Vegetarian Food Blogs Written by Registered Dietitians and Non-Registered Dietitians
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 2 • pp. 86 - 91
    This purpose of this study was to compare the nutritional content of vegetarian recipes published in food blogs written by registered dietitians (RDs) and by non-registered dietitians (non-RDs). Twelve food blogs written by RDs and 12 written by non-RDs were selected using a systematic approach. For each food blog, 2 vegetarian entrée recipes per season were selected (n = 192 recipes). Descriptive analyses were performed using Fisher’s exact test. Median nutritional values per serving between RDs’ and non-RDs’ recipes were compared using Wilcoxon–Mann–Whitney tests. RDs’ recipes were significantly lower in energy, non-heme iron, vitamin C, and sodium, contained significantly more vitamin D and had a higher protein proportion than non-RDs’ recipes. Disparities were also observed across type of entrée and vegetarian dietary pattern. In conclusion, this study showed that RD and non-RD food bloggers provided vegetarian recipes with few nutritional differences. Whether expanding the comparative analysis between RDs and non-RDs’ blogs targeting different nutrition-related topics would yield different results remains to be investigated.
  • Food and Mood: Diet Quality is Inversely Associated with Depressive Symptoms in Female University Students
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 3 • pp. 124 - 128
    Researchers have found support for an inverse association between diet quality and depressive symptoms in middle-aged adults. This association has not been well examined among university students, a population at risk of developing both depression and unhealthy lifestyle habits. We sought to examine the cross-sectional association between depressive symptoms and diet quality in female university students. One hundred and forty-one females (19.1 ± 1.5 years, 22.3 ± 3.4 kg/m2) were recruited from a Canadian university in 2012 and 2013. Dietary intake data were collected using 3-day food records and analysed using the Canadian Healthy Eating Index. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Results of a linear regression demonstrated an inverse association between depressive symptoms and diet quality score (β = −0.016, 95% CI = −0.029 to −0.003, P = 0.017). Elevated depressive symptoms were associated with consumption of diets of poor nutritional quality in our female university student sample. Thus, healthy eating may correspond with lower levels of depression in young adult females.
  • Aboriginal Cultural Competency in Dietetics: A National Survey of Canadian Registered Dietitians
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 4 • pp. 172 - 176
    Little has been published on cultural competency curriculum and dietetics considering the impact of food-related beliefs and behaviours on health. A 14-item online survey was administered in January 2016 to 145 participants (125 members of Dietitians of Canada Aboriginal Nutrition Network and 20 dietitians with an interest in Aboriginal nutrition). Questions included multiple choice and ranking responses and were pretested by 4 preceptors with the Northern Ontario Dietetic Internship Program (NODIP). Quantitative data analysis included frequencies, pivot tables, and averaging/grouping of ranking scores. A total of 42 individuals (29%) completed the survey. The majority rated the 5 health and cultural competencies and 6 food and nutrition competencies as “important” (90%–98% and 86%–100%, respectively). Overall, the competency related to identifying health status was ranked highest (78%), whereas developing culturally appropriate recipes was ranked lowest (83%). Most participants (95%) believed that all dietitians and graduating dietetic interns should be minimally competent in Aboriginal health and culture. The initial 11 draft competencies for dietetic interns were condensed to 6 minimum and 2 advanced competencies. Results will inform dietitians working with Aboriginal peoples and refinement of NODIP intern and preceptor tools, with the potential to integrate across Canadian dietetic internship programs.
  • Influence of a School-Based Cooking Course on Students’ Food Preferences, Cooking Skills, and Confidence
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 1 • pp. 37 - 41
    A quasi-experimental study was conducted to evaluate the influence of Project CHEF, a hands-on cooking and tasting program offered in Vancouver public schools, on students’ food preferences, cooking skills, and confidence. Grade 4 and 5 students in an intervention group (n = 68) and a comparison group (n = 32) completed a survey at baseline and 2 to 3 weeks later. Students who participated in Project CHEF reported an increased familiarity and preference for the foods introduced through the program. This was statistically significant (P ≤ 0.05) for broccoli, swiss chard, carrots, and quinoa. A higher percentage of students exposed to Project CHEF reported a statistically significant increase (P ≤ 0.05) in: cutting vegetables and fruit (97% vs 81%), measuring ingredients (67% vs 44%), using a knife (94% vs 82%), and making a balanced meal on their own (69% vs 34%). They also reported a statistically significant increase (P ≤ 0.05) in confidence making the recipes introduced in the program: fruit salad (85% vs 81%), minestrone soup (25% vs 10%), and vegetable tofu stir fry (39% vs 26%). Involving students in hands-on cooking and tasting programs can increase their preferences for unpopular or unfamiliar foods and provide them with the skills and cooking confidence they need to prepare balanced meals.
  • Evaluation of Dietitian Counselling Access Revealed Reduced Pediatrician-Reported Hospital Admissions and Increased Parental Knowledge and Confidence
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 2 • pp. 81 - 85
    Based on a 1999 needs assessment a pediatric community-based outpatient dietitian counselling service was created. By 2010 annual referrals had grown to almost 1500 (62% from physicians; 38% from public health nurses). An evaluation was undertaken to gather perspectives of practitioners and parents about access, satisfaction, referral practices, and changes in knowledge, attitudes, behaviour, and child well-being. Health professionals surveyed via email were 62 pediatricians (response rate 71%), 25 family physicians (21%), 87 public health nurses (31%), and 7 dietitian providers (100%). Parents (n = 93, response rate 75% of those contacted) were interviewed by telephone. Pediatricians reported a significantly lower rate of 7% (95% confidence interval (CI), 0.8%–23%) for admitting children to hospital to access a dietitian, compared to 1999 of 39% (95% CI, 22%–59%) (P = 0.005). Health professionals reported a high degree of agreement on benefits of the service to their practice and on child health problems and a high degree of satisfaction with the service. Parents reported gaining knowledge (76%), confidence (93%), and making behaviour changes in foods offered (77%). Our evaluation demonstrated health practitioners saw a need for access to dietitians for pediatric dietitian counselling and parents reported more confidence and improved child feeding practices after dietitian counselling.
  • Examining Diet-Related Care Practices Among Adults with Type 2 Diabetes: A Focus on Glycemic Index Choices
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 1 • pp. 26 - 31
    We examined self-care dietary practices and usual intakes among adults with Type 2 diabetes in Alberta, Canada, using data from the Healthy Eating and Active Living for Diabetes study. Participants completed a modified Fat/Sugar/Fruit/Vegetable Screener and answered questions about the number of days per week they followed specific diabetes self-care dietary recommendations. Capillary blood samples were collected to assess glycemic control measured by hemoglobin A1c (HbA1c). ANOVA was used to examine differences in dietary self-care, intakes, and glycemic control across categories of days/week of practicing recommended dietary behaviour. Participants (n = 196) were 51% women, mean ± SD age 59.6 ± 8.5 years, with BMI 33.6 ± 6.5 kg/m2, and diabetes duration of 5.1 ± 6.3 years. Sixteen percent of participants were unfamiliar with low-GI eating and 28% did not include low-GI foods in their diet. Overall, lower mean intake of saturated fat, trans fat, added sugars, higher fibre, and greater GI were each associated with meeting diabetes-related dietary behaviours including: eating ≥5 servings of vegetables and fruit; avoiding processed high fat foods; and replacing high with low-GI foods (P < 0.05). No clear pattern was observed for low-GI eating and HbA1c.
  • Stronger Together: Use of Storytelling at a Dietetics Conference to Promote Professional Collaboration
    Canadian Journal of Dietetic Practice and Research • Vol. 78 • No. 1 • pp. 32 - 36
    During a Dietitians of Canada conference session (2015), 4 facilitators drew upon “Alice’s Adventures in Wonderland” (Alice) to engage participants in discussing the future of dietetic education. The aim was to feature Nova Scotia (NS) collaborative experiences as an example of dietetic education planning that could be implemented elsewhere. Three vignettes from the Alice story were chosen as metaphoric representations of dilemmas and assumptions commonly faced by dietetic educators. Story quotations and facilitator questions related to each vignette-guided discussion. The 3-part story-based arts approach of hearing stories, recognizing stories, and telling stories enabled participants to reflect on their own practice, relate to the challenges of others, and question conventional wisdom. Participants heard the Alice stories, recognized their experiences through the NS examples and had an opportunity to tell their own stories during discussions. Participants identified barriers to and strategies for collaborative planning in their own regions. Evaluation suggests most participants were positively engaged by the storytelling approach. Participants recommended that future offerings allow more time for orientation and for completion of planned activities. Bilingual programming should also be considered. Participants valued the unconventional approach to workshop engagement and planned to implement it in their own workplaces.
  • Participation in School Food and Nutrition Activities among Grade 6–8 Students in Vancouver
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 3 • pp. 148 - 153
    This study examined student-reported participation in school food and nutrition activities in Vancouver, British Columbia (BC), and whether engagement differed by gender and between elementary and secondary school students. A cross-sectional survey of grade 6–8 public school students (n = 937) from 20 elementary and 6 secondary schools assessed student-reported participation in a range of food and nutrition activities. Statistical analyses included descriptive statistics and multilevel logistic regression to examine associations between participation with gender and school type. Overall, <50% of students reported engaging in most of the food and nutrition activities examined in the 2011–2012 school year, including: food preparation (36%), choosing/tasting healthy foods (27%), learning about Canada’s Food Guide (CFG) (45%), learning about foods grown in BC (35%), gardening (21%), composting (32%), and recycling (51%). Females were more likely to report recycling and learning about CFG and BC-grown foods (P < 0.05). Secondary students were more likely to report activities focused on working with or learning about food/nutrition (P < 0.05). Despite local and provincial efforts to engage students in food and nutrition experiences, participation in most activities remains relatively low, with few students exposed to multiple activities. Continued advocacy is needed from the dietetics community to improve student engagement in food and nutrition activities.
  • Nutrient and Food Group Intakes of Manitoba Children and Youth: A Population-Based Analysis by Pulse and Soy Consumption Status
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 4 • pp. 189 - 194
    Poor eating habits among children are associated with negative health outcomes. The objective of this study was to use pulse/soy consumption as an indicator to evaluate the eating profile of young Manitobans. Data from the Canadian Community Health Survey Cycle 2.2 were used for analysis and restricted to Manitoba residents aged 2 to 18 years (n = 1840). Consumers were identified as individuals who reported eating at least 1 pulse/soy product during their recall. On any given day, 8.2% of Manitobans reported consumption of pulses/soy. Intakes of fibre, protein, magnesium, and zinc were higher in consumers only when expressed relative to total caloric intake. Consumers also reported increased intakes of meat and alternatives. Total intakes of vitamin D, fibre, and fruit and vegetable consumption were low among all groups. Sodium intakes in both groups were high when compared with levels recommended by health professionals. These results indicate that there are many dietary issues affecting Manitoba children, suggesting the need for more research targeting dietary habits of children and youth, the quality of the food supply, and effective strategies in nutrition education.
  • Energy Intake and Food Habits between Weight Maintainers and Regainers, Five Years after Roux-en-Y Gastric Bypass
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 4 • pp. 195 - 198
    We explored differences in dietary behaviours, energy, and macronutrient intake among individuals who had regained or maintained weight loss 5 or more years after Roux-en-Y gastric bypass (RYGB). This study assessed 27 adults who underwent RYGB an average of 12.1 ± 3.7 years before this study was conducted. Dietary assessment was performed using 3-day food records. Daily energy intake (kcal), protein (g), carbohydrate (g), fat (g), and alcohol intake (g) were computed using the ESHA’s Food Processor®. Participants were classified by percent weight loss, maintainers (≥38 %), and regainers (≤30 %). Daily carbohydrate consumption was greater in regainers (222 ± 84.3 g) compared with maintainers (162 ± 67.5 g), (P < 0.05). Thirty-seven percent of participants were not consuming the recommended amount of protein and 26% reported never taking vitamin supplements after surgery. Alcohol consumption was higher among regainers (18.5 ± 30.9 g) compared with maintainers (2.6 ± 6.5 g), (P < 0.05). Finally, 74% of the participants reported no contact with a Registered Dietitian, whereas 78 % were in contact with a health care professional once a year post-surgery. Differences were seen in carbohydrate intake and alcohol consumption between weight maintainers and regainers. These data suggest dietitians need to play a more active role in the long-term care of this medically complex population.
  • The Effects of Glucose Therapy Agents—Apple Juice, Orange Juice, and Cola—on Enteral Tube Flow and Patency
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 2 • pp. 93 - 97
    To develop evidence-based hypoglycemia treatment protocols in patients receiving total enteral nutrition, this study determined the effect on enteral tube flow of glucose therapy agents: apple juice, orange juice, and cola, and it also examined the effects of tube type and feed type with these glucose therapy agents. For this study, 12 gastrostomy tubes (6 polyethylene and 6 silicone) were set at 50 mL/h. Each feeding set was filled with Isosource HN with fibre or Novasource Renal. Each tube was irrigated with 1 glucose therapy agent, providing approximately 20 g of carbohydrate every 4 h. Flow-rate measurements were collected at 2 h intervals. The results showed that the glucose therapy agent choice affected flow rates: apple juice and cola had higher average flow rates than orange juice (P = 0.01). A significant difference was found between tube type and enteral formula: polyethylene tubes had higher average flow rates than silicone tubes (P < 0.0001), and Isosource HN with fibre had higher flow rates than Novasource Renal (P = 0.01). We concluded that apple juice and cola have less tube clogging potential than orange juice, and thus may be considered as primary treatment options for hypoglycemia in enterally fed patients. Polyethylene tubes and Isosource HN with fibre were less likely to clog than silicone tubes and Novasource Renal.
  • Content Validity for a Child Care Self-assessment Tool: Creating Healthy Eating Environments Scale (CHEERS)
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 2 • pp. 89 - 92
    The purpose of this project was to develop and content validate both a formative and summative self-assessment scale designed to measure the nutrition and physical activity environment in community-based child care programs. The study followed a mixed-method modified Ebel procedure. An expert group with qualifications in nutrition, physical activity, and child care were recruited for content validation. The survey was subjected to expert review through digital communication followed by a face-to-face validation meeting. To establish consensus for content validity beyond the standard error of proportion (P < 0.05) the content validity index (CVI) required was ≥0.78. Of the initial 64 items, 44 scored an acceptable CVI for inclusion. The remaining items were discussed, missing concepts identified, and a final CVI employed to determine inclusion. The final tool included 62 items with 5 subscales: food served, healthy eating program planning, healthy eating environment, physical activity environment, and healthy body image environment. Content validation is an integral step in scale development that is often overlooked or poorly carried out. Initial content validity of this scale has been established and will be of value to researchers and practitioners interested in conducting healthy eating interventions in child care.
  • Defining Research Priorities for Nutrition and Mental Health: Insights from Dietetics Practice
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 1 • pp. 35 - 42
    In 2014, a national initiative aimed at defining a research agenda for nutrition and mental health among diverse stakeholders was completed and included insights from more than 300 registered dietitians. This study explores the data from dietitians based on their years of practice, mental health experiences, and community of practice in relationship to identified mental health and nutrition research priorities. Analysis of numerical data (n = 299) and content analysis of open-ended responses (n = 269) revealed that respondents desired research for specific mental health conditions (MHCs), emotional eating, food addiction, populations with special needs, and people encountering major life transitions (e.g., recovery from abuse, refugees). Findings from the quantitative and textual data suggested that dietitians want research aimed at addressing the concerns of those in the community, fostering consumer nutrition knowledge and skill acquisition, and developing services that will impact quality of life. Subgroup analysis indicated that dietitians: (i) in early years of practice want information about specific MHCs; (ii) living in smaller towns and rural areas want data about the cost benefits of dietetics practice in mental health; and (iii) who also had additional stakeholder roles (e.g., service provider) selected priorities that address gaps in mental health services. This study highlights opportunities to tailor nutrition and mental health research that advance dietetics practice.
  • Practice-based Research Program Promotes Dietitians' Participation in Research
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 1 • pp. 43 - 46
    Barriers to dietitians' participation in research include lack of time, self-perceived competence, confidence, administrative support, and funding. Providence Health Care, a multi-site health care organization in Vancouver, British Columbia implemented the Practice-based Research Challenge (RC), a 1-year research program, to support interdisciplinary teams of nurses and allied health professionals to conduct practice-relevant research projects. Funding, mentoring, and research education were provided to research teams. From 2011 to 2015, 37% of all dietitians in the organization were involved in the RC in 4 cohorts of the 1-year program. An online survey was conducted to understand these dietitians' interest and experience in the RC. The survey results indicated that the major reasons for participating in the program were to increase knowledge, improve patient care, and to work on a project of interest. Respondents thought they gained knowledge, enhanced professional development, and improved patient care. A majority stated they would likely conduct future research. The RC enabled and supported dietitians' participation in research; infrastructure supports for research and enabling a culture of research participation are key contributors to promoting dietitians involvement in research.
  • Parental Health Beliefs, Socio-demographics, and Healthcare Recommendations Influence Micronutrient Supplementation in Youth with Celiac Disease
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 1 • pp. 47 - 53
    To identify parental influences affecting micronutrient supplementation in children and adolescents (2–18 years of age) with Celiac Disease (CD), a multi-method (survey, focus groups) study was conducted. A 35-item questionnaire consisting of open- and closed-ended questions was launched nationally via Canadian Celiac Association internet sites. Five focus groups were conducted using a semi-structured interview guide. The survey and semi-structured interview guide content was vetted for face and content validity. Thematic analyses were conducted on the focus group content and open-ended survey questions, and χ2 and Fischer’s exact analysis were performed on closed-ended survey data. Survey respondents were predominantly mothers (97%) of female children (80 F, 49 M) between the ages of 9–12 (31%) with CD, residing in western provinces (55%) with a combined family income ≥$100 000/year (63%). Seventy-seven percent of parental respondent’s children or adolescents consumed micronutrient supplements, for 1–5 years (52%), 7 days a week (65%), as both multi-vitamin and single vitamin preparations (40%). Parental influences on child micronutrient use included health beliefs and knowledge, parental supplement use, supplement characteristics, age of child (above or below 13 years), household routines, and provincial residential status (P < 0.05). Parents relied on health professional recommendation (69%; MD, RD) and the internet (21%) as sources of information regarding child micronutrient supplementation. Parental health beliefs and knowledge, socio-demographic factors, and practitioner recommendation influence micronutrient supplement use in children and adolescents with CD.
  • Impact of an Optional Experiential Learning Opportunity on Student Engagement and Performance in Undergraduate Nutrition Courses
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 2 • pp. 84 - 88
    We examined the impact of an optional experiential learning activity (ELA) on student engagement and performance in 2 undergraduate nutrition courses. The ELA involved completion of a 3-day food record, research lab tour, body composition assessment, and reflective take-home assignment. Of the 808 students in the 2 courses (1 first-year and 1 second-year course), 172 (21%) participated. Engagement was assessed by the Classroom Survey of Student Engagement (CLASSE), and performance was assessed by percentile rank on midterm and final exams. Students’ perceived learning was assessed using a satisfaction survey. Paired-samples t tests examined change in CLASSE scores and percentile rank from baseline to follow-up. Frequencies and thematic analysis were used to examine responses to Likert scale and open-ended questions on the satisfaction survey, respectively. There was an 11%–22% increase (P < 0.05) in the 3 dimensions of student engagement and a greater increase in percentile rank between the midterm and final exams among participants (7.63 ± 21.9) versus nonparticipants (−1.80 ± 22.4, P < 0.001). The majority of participants indicated the ELA enhanced their interest and learning in both their personal health and the course. Findings suggest ELAs related to personal health may improve interest, engagement, and performance among undergraduate students.
  • An Innovative, Strengths-Based, Peer Mentoring Approach to Professional Development for Registered Dietitians
    Canadian Journal of Dietetic Practice and Research • Vol. 76 • No. 4 • pp. 185 - 189
    The Professional Development Network (PDN) program was implemented to enhance mentoring and learning opportunities for dietitians at a multisite health care organization. Program development, implementation, and evaluation were carried out by a Professional Practice Council composed of dietitians in the organization. An exploratory evaluation was conducted after the first year of PDN implementation. Evaluation data were collected from an online survey containing open- and closed-ended questions and PDN documents submitted by dietitians. Data were analyzed with descriptive statistics and thematic analysis. Survey results indicate the PDN provided a mechanism for dietitians to learn from each other, apply learning to their career development, reflect on their strengths, and connect with others in the department. Analysis of PDN documents showed that dietitians pursued learning related to clinical practice, technology, private practice, and research. Mentoring interactions were also described by participants within PDN documents. Findings from this study demonstrate how multiple frameworks from academic literature can be integrated to create a professional development program in a dietetics practice environment. Evaluation results from this study may provide useful insights for others interested in implementing professional development programming.
  • Hospital Patients Are Not Eating Their Full Meal: Results of the Canadian 2010–2011 nutritionDay Survey
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 1 • pp. 25 - 29
    nutritionDay is a 1-day cross-sectional survey identifying how nutrition care is provided. This paper provides results of the first 2 Canadian nutritionDay surveys. In November 2010 and 2011, data from standardized questionnaires were collected from 193 units in Canadian hospitals consisting of unit demographics and patient information including weight history, health status, nutrition assessment, nutrition therapy, food intake and 30-day outcomes. Results indicated that overall, 46% of the 1905 patients reported weight loss in the previous 3 months, and in half of these it was greater than 5 kg. Only 50% of the units had nutrition teams and nutrition therapy was provided to less than 14% of patients. More than 50% of patients ate less than normal in the previous week and 57% ate less than half of their meal on nutritionDay. Within the next 30 days the majority of patients went home, 10% remained in hospital, and 6% were readmitted. In this study, nutritionDay provided relevant information on nutrition assessment, weight history, food intake, nutrition therapy, length of stay, and outcomes in participating Canadian institutions. Data from 2010 and 2011 can help to both reflect on current practices and define continuous improvements through benchmarking with the overall goal of mitigating suboptimal nutrition intake during hospitalization.
  • Use of an Experiential Learning Assignment to Prepare Future Health Professionals to Utilize Social Media for Nutrition Communications
    Canadian Journal of Dietetic Practice and Research • Vol. 77 • No. 1 • pp. 30 - 34
    Social media has become a popular platform for reputable health organizations to disseminate health information to the public. However, future health professionals may receive little training in social media communication. To train future dietetic professionals, we incorporated a social media assignment into a Communications course curriculum to facilitate effective use of social media for the profession. For the assignment, students were instructed to make 2 posts on Facebook. The posts were due 3 weeks apart so that students received feedback on their first post before making their second post. To demonstrate the type of social media communication commonly used by reputable health organizations, the first post raised awareness or provided nutrition education. The second post used Facebook’s “comment” feature, to respond to another student’s first post, demonstrating the use of social media for community engagement. Both posts included a hyperlink that the user could click to get more information. Students were evaluated on the hook, main points, professionalism, credibility, and effectiveness of inviting the reader to the hyperlinked website and its ease of navigation. Dietetics educators should be encouraged to incorporate social media education into their curriculums for the benefit of future dietitians and their clients.
  • Moving Forward with School Nutrition Policies: A Case Study of Policy Adherence in Nova Scotia
    Canadian Journal of Dietetic Practice and Research • Vol. 76 • No. 4 • pp. 172 - 177
    Many Canadian school jurisdictions have developed nutrition policies to promote health and improve the nutritional status of children, but research is needed to clarify adherence, guide practice-related decisions, and move policy action forward. The purpose of this research was to evaluate policy adherence with a review of online lunch menus of elementary schools in Nova Scotia (NS) while also providing transferable evidence for other jurisdictions. School menus in NS were scanned and a list of commonly offered items were categorized, according to minimum, moderate, or maximum nutrition categories in the NS policy. The results of the menu review showed variability in policy adherence that depended on food preparation practices by schools. Although further research is needed to clarify preparation practices, the previously reported challenges of healthy food preparations (e.g., cost, social norms) suggest that many schools in NS are likely not able to use these healthy preparations, signifying potential noncompliance to the policy. Leadership and partnerships are needed among researchers, policy makers, and nutrition practitioners to address the complexity of issues related to food marketing and social norms that influence school food environments to inspire a culture where healthy and nutritious food is available and accessible to children.
  • Examining the Cultural Competence of Third- and Fourth-Year Nutrition Students: A Pilot Study
    Canadian Journal of Dietetic Practice and Research • Vol. 76 • No. 4 • pp. 178 - 184
    The purpose of this study was to provide preliminary Canadian research assessing nutrition students’ cultural competence and to identify areas for future education initiatives in dietetic education that could ultimately improve dietitians’ cultural competence. A mixed-methods study was conducted using a 24-item questionnaire that was administered to students enrolled in third- and fourth-year undergraduate nutrition classes (n = 133). In total, 115 questionnaires were analyzed for quantitative data, and 109 were analyzed for qualitative data. The students scored an overall medium–high level of cultural competence. Out of the 5 areas examined (skills, attitudes, awareness, desires, knowledge), students’ multicultural knowledge scores were the lowest. It was found that a lower number of barriers to learning about other cultures were significantly associated with a higher overall cultural competence score, and taking a course in cultural foods significantly increased the students’ knowledge and overall cultural competence (P ≤ 0.05). The qualitative data found that students felt the cultural competence curriculum had gaps and identified several ideas for improvement. In conclusion, this research data provides novel insights into the cultural competence of Canadian dietetic students and additionally supports future research and curriculum development to enhance cultural competence.
  • Developing and Pilot Testing the Readiness and Motivation Interview for Families in Pediatric Weight Management
    Canadian Journal of Dietetic Practice and Research • Vol. 76 • No. 4 • pp. 190 - 193
    Clinical acumen is often used to assess families’ motivation prior to initiating pediatric obesity management due to a lack of available tools. The purpose of this pilot study was to (i) develop and (ii) pilot test the “Readiness and Motivation Interview for Families” (RMI-Family) in pediatric weight management. We conducted 5 focus groups with parents (n = 15), youth with obesity (n = 11), and health care providers (n = 8) to explore perceptions of barriers to making healthy behaviour changes, which led to the creation of the RMI-Family as a semi-structured interview. Five domains (treat foods, overeating, emotional eating, total physical activity, and screen time) emerged from the focus groups to inform the development of the RMI-Family, which was then pilot tested with a sample of youth with obesity and their parents (n = 11 dyads). Interviewers administered the RMI-Family to youth (age 12.8 ± 1.7 years; body mass index [BMI] z-score: 2.71 ± 0.43) and parents (age 47.1 ± 3.7 years; BMI: 33.5 ± 10.1 kg/m2). The RMI-Family was feasible to administer, easily understood by families, and may be a useful tool for assessing families’ motivation. Research is underway to determine the psychometric properties and utility of the RMI-Family in predicting clinical outcomes in pediatric weight management.
  • Construct Validation of Three Nutrition Questions Using Health and Diet Ratings in Older Canadian Males Living in the Community
    Canadian Journal of Dietetic Practice and Research • Vol. 76 • No. 4 • pp. 194 - 199
    Brief nutrition screening tools are desired for research and practice. Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-II, 14 items) and the abbreviated version SCREEN-II-AB (8 items) are valid and reliable nutrition screening tools for older adults. This exploratory study used a retrospective cross-sectional design to determine the construct validity of a subset of 3 items (weight loss, appetite, and swallowing difficulty) currently on the SCREEN-II and SCREEN-II-AB tools. Secondary data on community-dwelling senior males (n = 522, mean ± SD age = 86.7 ± 3.0 years) in the Manitoba Follow-up Study (MFUS) study were available for analysis. Participants completed the mailed MFUS Nutrition Survey that included SCREEN-II items and questions pertaining to self-rated health, diet healthiness, and rating of the importance of nutrition towards successful aging as the constructs for comparison. Self-perceived health status (F = 14.7, P < 0.001), diet healthiness (ρ = 0.17, P = 0.002) and the rating of nutrition's importance to aging (ρ = 0.10, P = 0.03) were correlated with the 3-item score. Inferences were consistent with associations between these construct variables and the full SCREEN-II. Three items from SCREEN-II and SCREEN-II-AB demonstrate initial construct validity with self-perceived health status and diet healthiness ratings by older males; further exploration for criterion and predictive validity in more diverse samples is needed.
  • Food Literacy: Definition and Framework for Action
    Canadian Journal of Dietetic Practice and Research • Vol. 76 • No. 3 • pp. 140 - 145
    The term food literacy is emergent, and as a result the literature reflects a great variety of definitions. Simultaneously, new research and food literacy programming is being developed without an agreed upon definition of what food literacy is and how food skills, food security, and health literacy may fit with the definition. We undertook a scoping review and conceptual analysis to identify how the term is understood and to determine shared components of definitions. We found that although most definitions included a nutrition and food skills component, there was great variation in how the ability to access, process, and enjoy food was affected by our complex food system. We propose a definition of food literacy that includes the positive relationship built through social, cultural, and environmental experiences with food enabling people to make decisions that support health. We offer a framework that situates food literacy at the intersection between community food security and food skills, and we assert that behaviours and skills cannot be separated from their environmental or social context. The proposed definition and framework are intended to be guiding templates for academics and practitioners to position their work in education and advocacy, bringing together separate spheres for collective action.
  • Examining the Promotion of Healthy Eating among Exercise Specialists: A Cross-sectional Study
    Canadian Journal of Dietetic Practice and Research • Vol. 76 • No. 2 • pp. 76 - 80
    The aim of this cross-sectional study was to survey exercise specialists about nutrition counselling practices, their own dietary practices, and to identify potential relationships. An electronic survey was used to examine characteristics and strategies used for assessing and promoting healthy eating to clients. Exercise specialists (n = 94) were recruited through a public registry and through targeted advertising on 2 professional websites in Alberta, Canada. Eighty-five percent of respondents promoted healthy eating to clients. Confidence in assessing and promoting healthy eating was moderate to low. Those with more than 6 years of professional experience reported higher confidence compared with those with less than 1 year of experience in assessing healthy eating (P < 0.05) and promoting healthy eating (P < 0.01). Confidence was higher among those with more professional experience but who did not meet Canada's Food Guide recommendations (P < 0.05). Professional experience, personal dietary practices, and confidence are important characteristics when considering the assessment and promotion of healthy eating by exercise specialists. Promoting collaborative relationships between registered dietitians and exercise specialists would likely benefit exercise specialists when they are assessing and promoting healthy eating among their clients.
  • Canned Navy Bean Consumption Reduces Metabolic Risk Factors Associated with Obesity
    Canadian Journal of Dietetic Practice and Research • Vol. 76 • No. 1 • pp. 33 - 37
    The high prevalence of obesity and its metabolic co-morbidities require dietitians to promote lifestyle modifications that can be effectively implemented into practice and are feasible for customers to adhere to. The objective of this study was to determine the effect of commercially available ready-to-eat canned navy beans added to the habitual diet on risk factors associated with obesity. Fourteen overweight and obese adults consumed 5 cups of canned navy beans per week for 4 weeks. The study results demonstrated that bean consumption results in reduced waist circumference in females by 2.5 cm and males by 2.1 cm (P < 0.001). The effect of beans on pulse rate, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL) were sex dependent (P < 0.05). In males, pulse rate, TC, and LDL were decreased by 6.5%, 11.5%, and 18%, respectively. In females, pulse rate increased by 9.6%, and TC and LDL were relatively unchanged. There was a trend for a decreased glucose AUC (P = 0.06) in response to a glucose load. This study demonstrates that consuming 5 cups per week of ready-to-eat canned navy beans for 4 weeks reduces metabolic risk factors associated with obesity and therefore can be used as a tool in dietetic practice.
  • An Evaluation of a Pilot Protected Mealtime Program in a Canadian Hospital
    Canadian Journal of Dietetic Practice and Research • Vol. 76 • No. 2 • pp. 81 - 85
    The study evaluated the impact of a pilot “protected mealtime” program on meal experience and care of hospitalized acute care patients. A 4-month pilot protected mealtime program was implemented on a 35-bed acute, older adult ward. A pre- and post-observational audit was implemented to examine interruptions during lunch, food intake, hand hygiene, and positioning practices on the ward. A staff questionnaire was administered to gain the opinions of health care team members about the protected mealtime program. The observational audit showed a significant decrease in the number of total interruptions (Z = −2.496, P = 0.013, r = −0.42). Hand hygiene practices improved and no effect was found on mealtime patient positioning at mealtimes. Staff questionnaire responses indicated positive changes to the patients’ mealtime experiences. The protected mealtime program appeared to improve patient mealtime experiences and patient care. Enabling patients to eat their meals uninterrupted will assist in ensuring that patients in hospital are adequately nourished.
  • Micronutrients on the Menu: Enhancing the Quality of Food in Long-term Care for Regular, Nontherapeutic Menus
    Canadian Journal of Dietetic Practice and Research • Vol. 76 • No. 2 • pp. 86 - 92
    Micronutrient (vitamin and mineral) deficiencies may exacerbate prevalent health conditions occurring in long-term care (LTC) residents, and current food provision may potentiate this problem. A micronutrient-focused, food-first approach to menu planning may address this gap by emphasizing nutrient-dense foods. The objectives were to determine if: (i) selected LTC menus met micronutrient and Canada's Food Guide (CFG) recommendations, and (ii) recommendations can be met through food alone with strategic menu planning. Regular, nontherapeutic menus (week 1, all meals) from diverse LTC homes (n = 5) across Canada were analyzed for micronutrient content using Food Processor and CFG servings. Site dietitians confirmed menu analyses. Five super-menus were created and analyzed for comparison. The nutrient content of the menus varied significantly across homes. Micronutrients of greatest concern were (mean ± SD) vitamin D (8.90 ± 5.29 µg/d) and vitamin E (5.13 ± 1.74 mg/d). Folate, magnesium, and potassium were also below recommendations. Super-menus of equal food volume met recommendations for all micronutrients except vitamin D (56%), vitamin E (84%), and potassium (85%). Meeting most micronutrient recommendations is possible with creative and deliberate menu planning. Knowledge translation of best practices is needed.
  • The Good Food Box Pilot Project as a Contribution to Addressing Food Accessibility in the Elderly
    Canadian Journal of Dietetic Practice and Research • Vol. 75 • No. 4 • pp. 191 - 194
    The Good Food Box (GFB) is a program that offers fresh produce to community members. The implementation of a GFB pilot project targeting the elderly in Côte Saint-Luc (CSL) is described. Feasibility is evaluated in terms of partnerships necessary to realize the project and suitability of the GFB among seniors. Outcomes, lessons learned, and future directions are also discussed. GFBs were delivered biweekly for 10 weeks to 14 participants over the age of 65 years. Baseline and final surveys were administered to assess user satisfaction and effects of the project. Overall, participants were satisfied, finding the location convenient and the produce to be of excellent quality. Respondents also indicated an increased quantity of fresh fruits and vegetables in their home and an enhanced connection with the community. Many participants commented on excessive quantity and difficulty preparing certain products, demonstrating that the GFB may not be practical for all seniors. Smaller quantities and volunteer assistance could improve the program. Following the successful pilot project, the GFB was expanded to all members of the CSL community. Using the GFB as a major source of fresh produce will positively impact the health and quality of life for those who reside within the community.
  • Assessment of Nutritional Adequacy of Packaged Gluten-free Food Products
    Canadian Journal of Dietetic Practice and Research • Vol. 75 • No. 4 • pp. 186 - 190
    Purpose: There is concern about the nutritional quality of processed gluten-free (GF) products. The aim was to investigate the nutrient composition and cost of processed GF products compared with similar regular products.Methods: Product size, price, caloric value, and macro- and micronutrient composition were compared between foods labeled “Gluten-free” and comparable regular products in 5 grocery stores in 3 Canadian cities. Data were calculated per 100 g of product.Results: A total of 131 products were studied (71 GF, 60 regular). Overall, calories were comparable between GF and regular foods. However, fat content of GF breads was higher (mean 7.7 vs. 3.6 g, P = 0.003), whereas protein was lower (mean 5.0 vs. 8.0 g, P = 0.001). Mean carbohydrate content of GF pasta was higher (78 vs. 74 g, P = 0.001), whereas protein (7.5 vs. 13.3 g, P < 0.001), fibre (3.3 vs. 5.8 g, P = 0.048), iron (9% vs. 25%DV, P < 0.001), and folate content (5% vs. 95%DV, P < 0.001) were lower. Mean price of GF products was $1.99 versus $1.23 for regular products (P < 0.001).Conclusions: Some commonly consumed packaged GF foods are higher in fat and carbohydrates and lower in protein, iron, and folate compared with regular products. GF products are more expensive. Dietitians should counsel patients on the GF diet regarding its nutritional and financial impact.
  • A Nutrition Screening Form for Female Infertility Patients
    Canadian Journal of Dietetic Practice and Research • Vol. 75 • No. 4 • pp. 195 - 201
    A Nutrition Screening Form (NSF) was designed to identify lifestyle risk factors that negatively impact fertility and to provide a descriptive profile of 300 female infertility patients in a private urban infertility clinic. The NSF was mailed to all new patients prior to the initial physician's visit and self-reported data were assessed using specific criteria to determine if a nutrition referral was warranted. This observational study revealed that 43% of the women had a body mass index (BMI) <20 or ≥25 kg/m2, known risks for infertility. Almost half reported a history of “dieting” and unrealistic weight goals potentially limiting energy and essential nutrients. A high number reported eating disorders, vegetarianism, low fat or low cholesterol diets, and dietary supplement use. Fourteen percent appeared not to supplement with folic acid, 13% rated exercise as “extremely” or “very active”, and 28% reported a “high” perceived level of stress. This preliminary research demonstrated that a NSF can be a useful tool to identify nutrition-related lifestyle factors that may negatively impact fertility and identified weight, BMI, diet, exercise, and stress as modifiable risk factors deserving future research. NSF information can help increase awareness among health professionals and patients about the important link between nutrition, fertility, and successful reproductive outcomes.
  • Enhanced Dietetics Education Through Collaboration: A Study to Identify Opportunities
    Canadian Journal of Dietetic Practice and Research • Vol. 75 • No. 2 • pp. 101 - 104
    With the aim of enhancing dietetics education in Nova Scotia, key stakeholders were engaged in identifying current practice issues along with opportunities for collaboration to address them. A survey containing five open-ended questions was distributed by email to a purposive sample of 24 participants affiliated with three universities with dietetics programs. Participants fell into five categories: internship coordinators, dietetics educators, recent internship graduates, current interns, and prospective interns. The response rate was 58%. Data were thematically analyzed through a process of constant comparison. Primary themes emerged, which reflected survey participants’ concerns about three current practice issues: province-wide standards, internship placement availability, and the overall educational experience. Additional comments suggested that overall dietetic educational experiences could be improved if relevant clinical experiences were offered and preceptor workloads were accommodated. The creation of province-wide standards for assessing interns’ level of competency was perceived to offer multiple benefits, including decreased preceptor workloads. Participants believed that collaborative actions might increase internship placements and improve the overall dietetic internship experience for interns and preceptors.
  • A Sustainable Dietetics Bridging Program: Development and Implementation in Atlantic Canada
    Canadian Journal of Dietetic Practice and Research • Vol. 75 • No. 2 • pp. 95 - 100
    A provincial focus on immigration and improved foreign credential recognition has led to an investigation of best practices and subsequent recommendations for the development and implementation of a sustainable university-based bridging program for internationally educated dietitians in Atlantic Canada. Data were collected from various sources and used to inform program decisions and direction. An advisory framework was established through a core group representing dietetics education and regulation and internationalization. Subsequently, a key stakeholder group was formed. As a result of this collaboration and research, a dietetics bridging framework was developed and a program pilot tested. Lessons learned may inform similar endeavours and highlight the importance of collaborative leadership and collaboration among multiple stakeholders, and of creatively addressing program sustainability issues while keeping learners (internationally educated dietitians) at the centre.
  • Experiences of People of Acadian Descent Receiving Hemodialysis in Southwest Nova Scotia
    Canadian Journal of Dietetic Practice and Research • Vol. 75 • No. 2 • pp. 342 - 345
    We conducted a group interview with five hemodialysis patients of Acadian descent. Our purpose was to learn about their intakes of Acadian foods so we could tailor our advice for other Acadian patients receiving hemodialysis. This approach builds on evidence that addressing cultural aspects of food choice and aligning dietary recommendations with usual intakes create optimal conditions for diet adherence while preserving personal habits and heritage. In this study, “the Acadian diet” held multiple meanings for different participants, participants varied in their intakes of traditional Acadian foods, intakes of traditional Acadian foods were decreasing in younger generations, and the desire to preserve kidney function had priority over eating much-loved traditional foods. These findings support the practices of individualized nutritional and dialysis care and discourage generalized nutrition messages based on assumptions of homogeneity of all people within a cultural group.
  • Promoting Nutritional Well-being in Seniors: Feasibility Study of a Nutrition Information Series
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 4 • pp. 175 - 180
    Better Living Health and Community Services developed a 12-week community-based nutrition information series (NIS) for people aged 55 or older. The purpose of this feasibility study was to describe briefly the process of developing and implementing the 12-week NIS and to identify the practicality and plausibility of the program in terms of its process and content attributes, using Thorncliffe Park community as the test site. A pre- and post-test design was used to identify changes in participants’ perception of their nutritional and overall well-being. Twenty-four participants who completed at least four sessions participated in the post-evaluation follow-up. Only participants’ perception of their eating habits demonstrated a significant, positive improvement (t24=2.1, P<0.05). The results suggest that the NIS has the potential to promote the health and well-being of community-living seniors. The development and implementation of the NIS provided considerations for program practicality. However, additional work is needed to examine the plausibility of the program in meeting its stated objective to promote awareness of nutrition as an important concept for healthy aging. Community-practising dietitians are instrumental in providing credible nutrition information to facilitate healthy eating in older Canadians.
  • A Study of Challenges and Opportunities: For Long-term Care Dietitians in British Columbia
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 3 • pp. 131 - 137
    While demand for long-term care (LTC) in Canada is expected to grow in the coming years, little is known about the current LTC dietetic workforce or its members’ practice-related concerns. A web-based survey was developed and distributed to and subsequently completed by 75 LTC dietitians in British Columbia. The survey was intended to characterize dietitians’ demographic characteristics, educational and employment experiences, salaries and benefits, future employment plans, and concerns about current practice. Regression models were used to examine the associations between demographic, educational, and employment characteristics and self-reported hourly wages. The majority of respondents were employed at more than one facility (57%) and did not belong to a union (71%). The mean hourly wage for LTC dietetics positions was $37.50 ± $5.85, and was significantly higher for positions that did not provide additional employee benefits (p<0.05). Hourly wages were not significantly higher for dietitians with more years of experience or graduate-level education. Concerns were raised about potential implications of revised residential care regulations for workload, and only 36% of respondents reported being committed to working in the area of LTC dietetics in the future. This study highlights practice-related challenges and future opportunities to build the LTC dietetic workforce, and can inform planning for training, recruitment, and retention.
  • Dietary Patterns of Female University Students: With Nutrition Education
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 3 • pp. 138 - 142
    Dietary patterns were examined in a convenience sample of 36 female University of Alberta students, all of whom had completed at least one nutrition course. Data from a validated food frequency questionnaire were used to determine if students had a dietary pattern similar to that recommended in Eating Well with Canada's Food Guide (EWCFG) or by the Traditional Healthy Mediterranean Diet Pyramid (THMDP), as measured using a Mediterranean Diet Quality Index Score. No student consumed the THMDP minimum number of portions of legumes, seeds, and nuts, of olive oil, or of whole grains. The majority did not meet the minimum EWCFG recommendations for any food group. The results suggest that nutrition education alone may be insufficient to ensure optimal dietary patterns among female university students. The methodology reported in this study is novel in assessing whether dietary patterns resemble the THMDP or the EWCFG.
  • Sarcopenia and Physical Function: In Overweight Patients with Advanced Cancer
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 2 • pp. 69 - 74
    Advanced cancer is associated with numerous metabolic abnormalities that may lead to significant body composition changes, particularly muscle loss or sarcopenia. Sarcopenia in cancer has been associated with poor clinical outcomes, including poor physical function. Accurate tools to assess body composition are expensive and not readily available in clinical settings. Unfortunately, little is known about the efficacy of affordable and portable techniques to assess functional status in patients with cancer. We investigated the prevalence of sarcopenia and its association with different portable and low-cost functional status measurement tools (i.e., handgrip strength testing, a two-minute walking test, and a self-report questionnaire) in overweight/obese patients (body mass index ≥ 25 kg/m2) with advanced cancer. Twenty-eight patients (68% men) aged 64.5 ± 9.5 years with advanced lung or colorectal cancer were included. Sarcopenia was assessed by measuring appendicular skeletal muscle (ASM) adjusted by height (ASM index), using dual energy X-ray absorptiometry. Approximately 36% of patients had sarcopenia. Average handgrip strength was greater in men without sarcopenia than in men with it (p=0.035). In men, ASM index was positively correlated with average (r=0.535, p=0.018) and peak handgrip strength (r=0.457, p=0.049). No differences were observed among female patients. Handgrip strength was associated with sarcopenia in male patients with advanced cancer, and therefore it may be used as a portable and simple nutritional screening tool.
  • Role of the Nutrition Professional: In High-risk Obstetrics Inpatient Teams
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 2 • pp. 75 - 79
    Beyond the management of gestational diabetes and weight control, limited literature exists on nutritional management in high-risk pregnancies. This study is a starting point for understanding the role of the registered dietitian (RD) in high-risk obstetrics (HRO) inpatient teams. Demographic information was gathered on Ontario HRO inpatient units and patient characteristics, and the RD’s role in this setting was explored. Representatives from all six HRO units in Ontario completed a questionnaire. Five of the HRO units had an RD on the team. The RDs stated that their primary role in the unit involved providing nutrition education and support, screening patients for nutritional risk, and writing vitamin and mineral orders. This was the first study in which RDs’ role in HRO inpatient units was examined. Existing literature supports the role of good nutrition in preventing and treating the conditions seen in HRO units; however, RDs’ specific role remains unclear. Future studies are needed to analyze the effect of nutrition on these HRO conditions, and to support the development of best practice guidelines.
  • The Role of Registered Dietitians: In Health Promotion
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 2 • pp. 80 - 83
    We used our experience assisting in the development of and evaluating the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a basis for exploring roles that registered dietitians (RDs) can play within health promotion, and how others perceive the RD role. Data were generated via 12 key informant interviews and observations during a multiple case study of recreation facilities that had and had not adopted the ANGCY. We also drew on dialogue and personal observations during development of the ANGCY. Dietitians working in government, academia, community settings, private practice, and industry played an important role throughout the development and implementation of the ANGCY. Some sectors proactively sought RD expertise, while others with less ability to pay accessed RDs’ services less. Informants generally regarded RDs in a positive light. Findings indicate the profession should incrementally adjust training models to reflect emerging areas of practice, and highlight the need for RDs to proactively seek new avenues in which to apply their skills. These actions will help RDs remain the trusted source of food and nutrition information, not only in health care, but also within health promotion settings.
  • Promoting eHealth Literacy in Older Adults: Key Informant Perspectives
    Canadian Journal of Dietetic Practice and Research • Vol. 74 • No. 1 • pp. 37 - 41
    Health literacy has the potential to improve an individual’s capacity to access, understand, evaluate, and communicate basic health information and services in order to make appropriate health decisions. We developed a research agenda to help older adults become aware of health literacy and its function in promoting their nutritional health and well-being. A key activity is the development, implementation, and evaluation of an eHealth literacy tool, eSEARCH, targeted at older adults to help improve their eHealth literacy skills. Before consultations were held with this subpopulation to assess their eHealth literacy needs and abilities, key informant interviews were conducted with eight experts in the field of health literacy, the older adult population, and/or online communications. Some experts were identified from the relevant literature; others were identified by informants who had already been interviewed. Informants were asked nine questions about the perceived importance of health literacy in Canada, key considerations in developing an eHealth literacy tool, and supporting resources for advancement of the eHealth literacy tool. Informants agreed that health literacy is a key concept and stressed that key considerations for development of the eSEARCH tool are identifying the target population’s needs, focusing on health promotion, and increasing confidence in information-seeking behaviours. Identified challenges are ensuring accessibility, applicability to older adults, and adoption of the tool by dietetic and other health care professionals.
  • A Participatory Food Costing Model: In Nova Scotia
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 4 • pp. 181 - 188
    In recognition of the growing challenge that food insecurity has on population health, a multisectoral partership in Nova Scotia has been working since 2001 to address province-wide accessibility to a nutritious diet. The participatory food costing (PFC) model has been at the forefront of provincial and national efforts to address food insecurity; a local foods component was incorporated in 2004. This model has engaged community partners, including those affected by food insecurity, in all stages of the research, thereby building capacity at multiple levels to influence policy change and food systems redesign. By putting principles of participatory action research into practice, dietitians have contributed their technical, research, and facilitation expertise to support capacity building among the partners. The PFC model has provided people experiencing food insecurity with a mechanism for sharing their voices. By valuing different ways of knowing, the model has faciliated muchneeded dialogue on the broad and interrelated determinants of food security and mobilized knowledge that reflects these perspectives. The development of the model is described, as are lessons learned from a decade of highly productive research and knowledge mobilization that have increased stakeholders’ understanding of and involvement in addressing the many facets of food security in Nova Scotia.
  • Referral Criteria for Assessment and Treatment: In an Ambulatory Dysphagia Clinic
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 4 • pp. 189 - 194
    Dysphagia is highly prevalent in patients with chronic neurological disorders and can increase the risk for comorbidities such as aspiration pneumonia and malnutrition. Treatment includes timely access to interdisciplinary health care teams with specialized skills in dysphagia management. A retrospective chart review (n=99 of 125 charts screened) was conducted to evaluate the effectiveness of referral criteria to identify and triage patients with suspected dysphagia to an ambulatory dysphagia clinic. Variables collected included demographic information (age), anthropometric information (body mass index [BMI], each patient’s sex), reason for referral, primary medical diagnosis, symptomatology (e.g., pneumonia, chest congestion), nutrition and swallowing interventions, clinic wait times, missed/cancelled appointments, and referring health care professional. The mean age and mean BMI ± standard deviation of patients reviewed were 68.7 years ± 18.4 years and 25.2 kg/m2 ± 6.7 kg/m2, respectively. Average clinic wait times were 158 days (13 to 368 days) for routine and 52 days (0 to 344 days) for urgent assessments (p<0.001). The most common reason(s) for referral was/were related to dysphagia (n=83), surgery (n=50), and/or gastrointestinal symptomatology (n=28); 80% to 90% of patients received varying diagnostic and treatment services for dysphagia. Development of effective referral criteria is critical to ensure that clients with dysphagia receive timely diagnostic, treatment, and nutrition interventions by interdisciplinary health care teams specializing in dysphagia.
  • Dietary Patterns of Patients: With Advanced Lung or Colorectal Cancer
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 4 • pp. e298 - e303
    The purpose of this study was to identify dietary patterns among patients with advanced cancer. Differences between cancer groups are described, and food groups contributing higher proportions to overall caloric intake are identified. Patients with advanced cancer (n=51) were recruited from a regional cancer centre and completed a three-day dietary record. Food items were categorized according to macronutrient content. After adjustment for body weight, substantial variation in energy intake was observed (range: 13.7 to 55.4 kcal/kg/day). For 49% of patients, protein intake was below recommendations. Overall, patients consumed the largest proportion of their calories from meat (16%), other foods (11%), dessert (9%), fruit (9%), white bread (7%), and milk (7%). Only 5% of patients consumed meal replacement supplements. The results of this descriptive study provide important insights into the dietary habits of patients with advanced cancer. These insights could be translated into the development of effective recommendations for maintaining or improving health and quality of life.
  • Dietitians and Eating Disorders: An International Issue
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 2 • pp. 86 - 90
    The prevalence of eating disorders is higher in university nutrition faculties than in other faculties. We examined beliefs about and approaches to eating disorders in nutrition education faculties around the world. We developed a questionnaire specifically for this project and distributed 664 copies electronically, using contact information obtained in collaboration with Dietitians of Canada and the International Confederation of Dietetic Associations. Using the 101 questionnaires returned from 14 countries, we found that 77% of respondents felt eating disorders are a concern among nutrition students; however, only 15% of programs had policies/procedures to help address these disorders. Forty-eight percent of respondents thought screening for eating disorders would be a good idea; however, 78% of them believed screening would involve ethical issues. In conclusion, eating disorders are a concern in nutrition faculties around the world, and while most feel something should be done, ethical dilemmas contribute to confusion over the best approach. More work is needed in this area.
  • A Team-based Approach to Qualitative Inquiry: The Collaborative Retreat
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 2 • pp. 91 - 97
    A team of researchers undertook a collaborative qualitative study to explore beginning dietitians’ life experiences and the meaning ascribed to those experiences in the context of dietetic practice. Data were collected using Seidman's three-step in-depth phenomenological interviewing method with 12 beginning dietitians who were graduates of the three participating dietetic programs. We outline the collaborative research process and highlight a writing and data analysis technique described as the collaborative retreat, a face-to-face, two-day gathering that facilitated the researchers’ collective decision-making and organization, discussion, and analysis of this complex qualitative data set. Use of a listening guide aided researchers’ understanding and interpretation of participant voices. Researchers concluded that the overall collaborative qualitative research process was positive and self-fulfilling, and that it resulted in multiple benefits for them individually and the research project collectively. Researchers were able to work through methodological and theoretical issues as these arose, with the assistance of technology, writing, listening, and dialogue. Relationship building and relationship maintenance emerged as factors critical to the success of the research process. Collaborative research teams that are committed to listening, writing, and dialogue will find that the collaborative retreat can be a productive site of knowledge generation and mentorship.
  • Regulatory Approval of Plant Sterols in Canada: Implications for Health Care and Clinical Practice
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 1 • pp. 31 - 34
    Health Canada’s recent approval of plant sterols as food ingredients to decrease low-density lipoprotein cholesterol (LDL-C) is believed to be a significant step toward improving Canadians’ cardiovascular health and reducing the economic burden of heart disease. When dyslipidemic patients consume plant sterols at a recommended daily dose of 2 g, they can reduce LDL-C by 10% to 15%, with no deleterious effects on high-density lipoprotein cholesterol. A 10% LDL-C reduction in response to plant sterol consumption is projected to reduce heart disease risk by 25%. Because they are available without a prescription, plant sterols are an option for dietitians who wish to provide cholesterol-lowering guidance beyond traditional dietary advice (i.e., lowering saturated fat intake and restricting dietary cholesterol). In addition, plant sterols can be used in combination with a statin or when statin use is contraindicated, and they have recently emerged as a potentially valuable triglyceride-lowering option. However, the projected improvement in public health and health care savings will be realized only if impediments to daily use are removed. One such impediment is the higher cost of fortified food products, such as yogurt and margarine. If the cost of plant sterol food products is to decline, cost-effective sources must be investigated and a larger range of foods containing plant sterols must be made available.
  • Availability of Nutrition Screening Parameters: In New Brunswick Hospitals and Nursing Homes
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 1 • pp. 35 - 39
    We explored the availability of parameters for a nutrition screening system among elderly people in New Brunswick (NB) health care facilities. Patients aged 65 or older were asked to participate in the study; each participant had been admitted to one of four hospitals or lived in one of six nursing homes. Availability of nutrition screening parameters (weight, height, weight change, serum albumin level, appetite, and food intake record) was assessed by auditing the participants’ medical charts. When data were not available, the feasibility of obtaining them was determined. Additional data related to nutrition screening were also obtained. In total, 421 participants were recruited for the study: 140 (33.2%) who lived in nursing homes and 281 (66.8%) who were in hospitals. Parameters needed to conduct nutrition screening, such as weight upon admission, were available for 83.6% of participants; usual weight was available for 43.0%, height for 86.0%, and serum albumin level for 47.5%. Our findings show that basic parameters for nutrition screening are available, and that implementation of a nutrition screening system is feasible for patients in NB health care facilities.
  • Employers’ Perspectives of Students: In a Master of Public Health (Nutrition) Program
    Canadian Journal of Dietetic Practice and Research • Vol. 73 • No. 1 • pp. e221 - e226
    Efforts to support workforce development led to the launch of a new master of public health program aimed at improving access to graduate studies for practising nutrition professionals. The first cohort of students identified employer support as a key determinant of their success. In order to identify ways of addressing both student and employer needs, we explored the perspectives of students’ employers. Seventeen in-depth, semi-structured, open-ended interviews were conducted with employers. Interviews were audiotaped and transcribed. Transcripts were organized using NVivo software and coded thematically. All employers indicated support for employee education and development in principle, but most faced practical challenges related to limited staffing during education leaves. Organizational policies varied considerably across employer groups. Collective agreements that guided education policy were seen to ensure consistent support for employees, but also to limit creative approaches to education support in some situations. Employers highly valued graduate student projects that were directly related to the workplace; these projects presented opportunities for collaboration among the university, students, and employers. Universities need to work with employers and other stakeholders to identify ways of overcoming barriers to public health nutrition graduate education and workforce development.
  • Implementing Nutrition Diagnosis: At a Multisite Health Care Organization
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 4 • pp. 178 - 180
    The American Dietetic Association Nutrition Care Process (NCP) is designed to improve patient care and interdisciplinary communication through the consistent use of standardized nutrition language. Supported by Dietitians of Canada, the NCP has been gaining prominence across Canada. In spring 2009, registered dietitians at Providence Health Care, an academic, multisite health care organization in Vancouver, British Columbia, began using the NCP with a focus on nutrition diagnosis. The success of nutrition diagnosis at Providence Health Care has depended on support from the Clinical Nutrition Department leadership, commitment from the NCP champions, regularly scheduled lunch-and-learn sessions, revised nutrition assessment forms with a section for nutrition diagnosis statements, and the Pocket Guide for International Dietetics & Nutrition Terminology (IDNT) Reference Manual. Audit results from June through August 2010 showed a 92% nutrition diagnosis completion rate for acute-care and long-term care sites within Providence Health Care. Ongoing audits will be used to evaluate the accuracy and quality of nutrition diagnosis statements. This evaluation will allow Providence Health Care dietitians to move forward with nutrition intervention.
  • Weight Maintenance Through Behaviour Modification: With a Cooking Course or Neurolinguistic Programming
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 4 • pp. 181 - 185
    We compared the effect on weight regain of behaviour modification consisting of either a gourmet cooking course or neurolinguistic programming (NLP) therapy. Fifty-six overweight and obese subjects participated. The first step was a 12-week weight loss program. Participants achieving at least 8% weight loss were randomized to five months of either NLP therapy or a course in gourmet cooking. Follow-up occurred after two and three years. Forty-nine participants lost at least 8% of their initial body weight and were randomized to the next step. The NLP group lost an additional 1.8 kg and the cooking group lost 0.2 kg during the five months of weight maintenance (NS). The dropout rate in the cooking group was 4%, compared with 26% in the NLP group (p=0.04). There was no difference in weight maintenance after two and three years of follow-up. In conclusion, weight loss in overweight and obese participants was maintained equally efficiently with a healthy cooking course or NLP therapy, but the dropout rate was lower during the active cooking treatment.
  • Developing an Interview Guide to Evaluate Practice-based Evidence in Nutrition: Use of the Delphi Technique
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 4 • pp. 186 - 190
    An interview guide was created for qualitative evaluation of the impact of Practice-based Evidence in Nutrition (PEN) on dietetic practice, and its success as a medium for knowledge translation and transfer (KTT). The Delphi technique was used to bring together a diverse group of experts (n=7) with extensive knowledge in KTT and evidence-based practice (EBP); these experts developed the interview guide content. The technique is an effective means of gathering expert input to inform evaluation tool development, particularly in the absence of accepted evaluation guidelines or pre-existing evaluation tools. Although challenges exist with the Delphi technique, it is an adaptable method that can be modified to meet a variety of needs. During this project, the technique was modified to meet specific needs, including participants’ partial anonymity and starting material to reduce the number of required rounds. The resulting interview guide contained open-ended questions focused on respondents’ understanding of EBP and PEN, use of PEN by dietitians in other disciplines, perceptions of the quality/usefulness of PEN, and barriers to and facilitators of PEN use.
  • Evaluation of a Family Education Program: For Overweight Children and Adolescents
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 4 • pp. 191 - 196
    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.
  • Knowledge and Use of Folic Acid: In Women of Reproductive Age
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 4 • pp. 197 - 200
    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.
  • Dietary Intake in: Clients with Chronic Wounds
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 2 • pp. 77 - 82
    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.
  • Menu Planning in Long-Term Care: Toward Resident-centred Menus
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 2 • pp. e126 - e133
    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.
  • Nutritional Status and Eating Habits of Older Manitobans: After Relocating to a Personal Care Home
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 2 • pp. e134 - e139
    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.
  • Développement d'une grille d'analyse: des menus en services de garde à la petite enfance
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 1 • pp. 24 - 30
    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.
  • Access to Dietitians: In Primary Health Care
    Canadian Journal of Dietetic Practice and Research • Vol. 72 • No. 1 • pp. 32 - 36
    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.
  • Determining Knowledge and Behaviour Change: After Nutrition Screening Among Older Adults
    Canadian Journal of Dietetic Practice and Research • Vol. 71 • No. 3 • pp. 128 - 133
    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.
  • Healthful Eating: Beyond Food, a Global Concept
    Canadian Journal of Dietetic Practice and Research • Vol. 71 • No. 2 • pp. e21 - e27
    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.
  • Identification and Treatment of Protein-energy Malnutrition in Renal Disease
    Canadian Journal of Dietetic Practice and Research • Vol. 71 • No. 1 • pp. 27 - 32
    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.
  • Perceived Roles, Benefits, and Supports For Dietetic Internship Preceptors
    Canadian Journal of Dietetic Practice and Research • Vol. 71 • No. 1 • pp. 33 - 38
    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.
  • Risks and Benefits of Fish Consumption For Childbearing Women
    Canadian Journal of Dietetic Practice and Research • Vol. 71 • No. 1 • pp. 41 - 45
    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.
  • Transformation to Room Service Food Delivery In a Pediatric Health Care Facility
    Canadian Journal of Dietetic Practice and Research • Vol. 70 • No. 4 • pp. 200 - 203
    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-specific Food Frequency Questionnaire To Assess College Women’s Eating Habits
    Canadian Journal of Dietetic Practice and Research • Vol. 70 • No. 4 • pp. 204 - 208
    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.
  • Evaluation of a Pilot Arts and Health Module In a Graduate Community Nutrition Program
    Canadian Journal of Dietetic Practice and Research • Vol. 70 • No. 2 • pp. 81 - 86
    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.
  • Nutrition Education Program Design For Youth with Type 2 Diabetes Mellitus
    Canadian Journal of Dietetic Practice and Research • Vol. 69 • No. 4 • pp. 192 - 197
    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.
  • Outcomes of Screening And Nutritional Intervention Among Older Adults in Healthcare Facilities
    Canadian Journal of Dietetic Practice and Research • Vol. 69 • No. 2 • pp. 91 - 96
    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.
  • Moderate Weight Loss: A Self-directed Protocol for Women
    Canadian Journal of Dietetic Practice and Research • Vol. 69 • No. 1 • pp. 23 - 27
    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.
  • Should Long-term Care Residents Be Supplemented with Vitamin D?
    Canadian Journal of Dietetic Practice and Research • Vol. 69 • No. 1 • pp. 28 - 31
    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.
  • Gaining Entry-level Clinical Competence Outside of the Acute Care Setting
    Canadian Journal of Dietetic Practice and Research • Vol. 69 • No. 1 • pp. 32 - 36
    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.
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