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- Engler-Stringer, Rachel PhD2
- Garcia, Alicia C PhD RD CFE2
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- Ryan-Harshman, Milly PhD RD2
- Aldoori, Walid MB BCh MPA ScD1
- Anderson, Kristin PhD1
- Austin, Zubin PhD1
- Ayliffe, Brenna MScAHN RD1
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- Berenbaum, Shawna PhD PDt1
- Berkow, Susan E PhD CNS1
- Cameron, Jill MSc1
- Castle, David PhD1
- Chan, Kathleen BSc1
- Charbonneau, Kimberly D MScFN C1
- Chaudhary, Neera MHSc RD1
- Chouinard, Laura E BASc RD1
- Cockell, Kevin A PhD1
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- Dalton, Janice E BSc HEc MHS RD1
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- Il est reconnu que les personnes âgées vivant en hébergement constituent une population à risque de souffrir de déshydratation. Un apport insuffisant en eau contribue au maintien d'un état d'hydratation sous-optimal, affectant la qualité de vie et l’état de santé. Selon les résultats des études recensées, entre 32 et 96 % des résidents des centres d'hébergement avaient des apports insuffisants en eau, et plus de 50 % consommaient moins de 1,5 l de boissons et d'eau par jour. Les facteurs de risque contribuant à limiter l'apport en eau des résidents se divisent en deux catégories, selon qu'ils touchent l'individu ou l'environnement social et institutionnel. L'apport en eau des résidents est associé aux repas et à l'administration des médicaments. La diminution de la perception de la soif, le refus volontaire de boire, la dysphagie et la dépendance fonctionnelle sont les facteurs individuels identifiés contribuant le plus à la diminution des apports hydriques. Le manque de soutien familial et de ressources humaines est également un facteur important puisqu'il réduit l'assistance offerte. Les diététistes jouent un rôle capital dans le maintien d'un bon état d'hydratation des résidents en identifiant les facteurs de risque pouvant compromettre les apports hydriques et en assurant l'implantation de mesures correctives appropriées.
- We examined the research literature to determine the skills and attributes that dietetic interns desire in clinical preceptors. A search of three databases produced little information specific to dietetics. Literature on preceptors in other health disciplines identified preceptor attributes that students in clinical placements value. We were able to cluster the data from these studies into four themes: knowledge and experience, personal characteristics, teaching skills and attitudes, and interpersonal relationships. This review suggests a need for further development of dietitian preceptor training, as well as for further research specific to dietetic interns’ needs.
- Over the past century, a major shift in North American food practices has been taking place. However, the literature on this topic is lacking in several areas. Some available research on food and cooking practices in the current context is presented, with a focus on how these are affecting health and how they might be contributing to health inequalities within the population. First, cooking and cooking skills are examined, along with the ambiguities related to terms associated with cooking in the research literature. Food choice, cooking, and health are described, particularly in relation to economic factors that may lead to health inequalities within the population. The importance of developing an understanding of factors within the wider food system as part of food choice and cooking skills is presented, and gaps in the research literature are examined and areas for future research are presented. Cooking practices are not well studied but are important to an understanding of human nutritional health as it relates to cultural, environmental, and economic factors.
- Noelle Martin BSc (HEc) Honors FN, MScFN (candidate),
- Alicia C. Garcia PhD, RD, CFE, and
- Beverly Leipert RN, PhD
Photovoice is an innovative qualitative method of participatory action research based on health promotion principles; however, it has not been used to its full potential in health care, particularly in nutrition and dietetics. Photovoice is also based upon the theoretical literature on education for critical consciousness, feminist theory, and community-based approaches to documentary photography. Participants take photographs representing their views on a specific topic and discuss them in a group process of critical reflection. Originally designed for research with rural women, Photovoice has been used with a variety of population groups throughout the lifespan, such as adolescents, nurses and nursing students, professional groups, Aboriginal women, the elderly, immigrant and low-income groups, and patients with a variety of diseases. The use of Photovoice as a research method is not restricted by health conditions, financial situation, employment status, or literacy level. It is used in community settings, professional practice, or institutional learning environments to explore participants’ views and opinions. We review studies in which Photovoice has been used, as well as the impacts, advantages, limitations, and ethics of its use. Gaps in knowledge and its potential use in nutrition and dietetic research are identified.- Milly Ryan-Harshman PhD, RD,
- Ellen Vogel PhD, RD, FDC,
- Holly Jones-Taggart PhD,
- Julia Green-Johnson PhD,
- David Castle PhD,
- Zubin Austin PhD, and
- Kristin Anderson PhD
Nutrigenomics is concerned with the role of nutrients in gene expression, and nutrigenetics is the study of how genetic variants or polymorphisms (mutations) can affect responses to nutrients; nutritional genomics is the umbrella term. Nutritional genomics can be expected to revolutionize the way dietitians and other health professionals identify people with chronic diseases and treat those diseases. Understanding the science of nutritional genomics is important to dietitians and other health professionals because major scientific advancements such as this usually have a significant impact on ethics, policy, and practice. Blood lipid profiles are one area in which nutritional genomics has quickly advanced knowledge. New knowledge is available on blood lipid profiles and associated conditions, such as obesity and type 2 diabetes. New technology has also had an impact on policy and practice issues, and ethics is an important issue to consider.- Telediabetes is a form of telemedicine used to provide education and clinical care to persons living with diabetes. Web-based delivery modes using cellular telephones and/or computers are of particular interest as they are becoming increasingly available. A review of current research on the practice of web-based telediabetes to adults with type 2 diabetes was conducted to determine the potential impact of this delivery mode on professional dietetics practice. Nine articles meeting the inclusion criteria were identified, critiqued, and summarized. Studies varied greatly in breadth and scope; consequently, few general conclusions could be drawn about telediabetes programs. Telediabetes programs were discussed in the context of soundness, effectiveness, cost-effectiveness, and practical characteristics. Trends indicated a promising future for telediabetes. Dietitians should view telemedicine as a viable tool for service delivery and increase their knowledge, competency, advocacy, and research efforts in this area.
- Recent concerns about adolescent nutrition and unhealthy weights have prompted an examination of the myriad influences on dietary intake during adolescence. Included here are a summary of the literature on family influence on dietary intake, specifically during adolescence and within the family context, a summary of family meal patterns, and a systematic review of the known influences of family meals on dietary intake. Because of the complexity of families in today’s society, models were developed to depict the broad context of familial influences on adolescent nutritional behaviours and attitudes and to describe what is known and not known about family meal influences on adolescent dietary intake and quality. A systematic review of the literature revealed seven articles specifically related to adolescents, family meals, and dietary intake, which were analyzed for strength of evidence and plausibility. In spite of data collection methods relying on self-report, results suggested that family meals were associated with improved dietary intakes. Families in today’s societies are complex. Nevertheless, parents have the potential to influence positively, through family meals, what food is provided, where it is provided (e.g., home, restaurant), and within what type of atmosphere it is provided.
- A systematic review was conducted of community-based nutrition and physical activity strategies for chronic disease prevention targeting low-income populations. A computer search of the relevant published literature from 1996 to 2004 was done using Medline, EMBASE, ERIC, CINAHL, PubMed, and HealthSTAR databases. The primary objective was to develop an inventory of intervention strategies. The interventions ranged in approach from traditional group sessions taught by allied health professionals, peer-led workshops, one-on-one counselling print material, and home-based telephone and mail interventions to multimedia strategies and experiential activities such as food demonstrations and group exercise. The results suggest that nutrition and physical activity interventions aimed at low-income audiences tend to be delivered in an interactive visual format, to be culturally appropriate, to be administered in accessible primary care settings, and to provide incentives.
- John L. Sievenpiper BASc, MSc,
- Alexandra L. Jenkins BSc, RD, CDE,
- Dana L. Whitham BSc, RD, CDE, and
- Vladimir Vuksan PhD
Insulin resistance is a prevalent condition, in which insulin loses its normal physiological action. Since people were first classified as insulin resistant over 60 years ago, one of the main discoveries has been that insulin resistance clusters with other risk factors such as obesity, elevated triglycerides, and low high-density lipoprotein cholesterol, increasing cardiovascular disease risk. Although insulin resistance appears to manifest first in the periphery and then in the liver, other sites, such as the brain and the pancreatic β-cell, may play pathogenic roles. Factors contributing to insulin resistance at these sites include perturbations in free fatty acids, glucose, and hormone-signalling, some of which may be linked to various genetic polymorphisms. Appropriate nutritional treatment for insulin resistance is controversial. Two main approaches are drawn from diabetes recommendations: i) a high-carbohydrate, low-fat, highfibre diet emphasizing low glycemic-index foods and ii) sharing calories between monounsaturated fat and complex carbohydrate at the expense of saturated fat. Recent interest in insulin resistance has prompted the development of new guidelines. Promising data have also emerged, showing that a high-carbohydrate, high-fibre, low-fat diet plus exercise programs maintained through intensive counselling can decrease diabetes risk by over 40%. Additional research is required to confirm the sustainability of this approach and sort out the determinants of insulin resistance so that more effective nutritional interventions will result.- This paper summarizes existing evidence on the impact of food information programs. Published and unpublished literature produced within the past decade was searched and reviewed. Relevant data were tabulated and key findings summarized. Food information programs are becoming increasingly popular as tools to help consumers select a healthy diet. The key feature of a food information program is a package logo on foods meeting nutrition criteria set by the program's administering body. The logo acts as a health message. Several countries, including Canada, have adopted food information programs. Critics believe that these programs oversimplify the concept of healthy eating, that consumers misinterpret the logo's meaning, that licensing fees prohibit small companies from participating, and that the programs are limited to purchase behaviour and do not necessarily have an impact on dietary intake. Consumers report support for the programs and are able to interpret a logo's meaning accurately. In addition, evidence shows the programs have had a positive impact on the nutrient composition of foods. Research is still needed, however, to establish the impact of such programs on food purchases and dietary intake, and the overall and long-term effectiveness of the programs as a nutrition intervention.
- Ilene Hyman PhD, BSc (PT),
- Sepali Guruge BScN, MSc, PhD Student,
- Mary-Jo Makarchuk MHSc, MSc, RD,
- Jill Cameron MSc, and
- Vaska Micevski MScN, RN
Little attention has been given to the dietary patterns of new immigrant women in Canada. Research suggests that before migration, many immigrants, especially those from non-Western countries, consume a healthy diet, but this changes on migration. This paper presents information from a recently completed literature review conducted for the Women's Health Council of the Ontario Ministry of Health and Long-Term Care. The paper includes a review of the major determinants of food choice and health promotion strategies appropriate to new immigrant women. Our findings suggest that nutrition intervention for new immigrant women must consider the social context of these women's lives, address cultural, linguistic, economic and informational barriers and consider how these change over time. Recommendations are also made on how to best promote healthy eating in this group.- Energy requirements of children and adolescents with cerebral palsy appear to be disease-specific and different from the current recommendations for healthy children, varying depending upon functional capacity, degree of mobility, severity of disease, and level of altered metabolism. Feeding problems are prevalent in many of these children, and can result in inadequate energy intake. Wasting of voluntary muscles, a common symptom of cerebral palsy, contributes to reduced resting energy needs; nevertheless, the location of the central nervous system lesion may also influence energy requirements. To guarantee individualized, accurate, and optimal energy recommendations for this population, resting energy expenditure should preferentially be measured by indirect calorimetry. Equations and formulae to predict healthy people's resting energy expenditure are available, but tend to overestimate these children's energy needs. Future studies should address the role of the central nervous system in regulating energy metabolism in this population. When adequately nourished, children and adolescents with cerebral palsy appear more tranquil and require decreased feeding time, which gives caregivers time to develop the child's functional independence and character. Understanding energy requirements of this population will provide caregivers and health professionals with guidelines for providing optimal nutritional status.
- The mass media, including broadcast, electronic, and print media, have become entrenched in Canadians’ daily lives. Spending the majority of their leisure time with mass media puts Canadians at increased health risk. Our review of the research literature shows that television (TV) viewing and content are linked to potential consumer health risks due to developed health attitudes, beliefs, and behaviours. The associated health risks of children and youth are of particular concern. Excessive TV viewing has been associated with obesity development, increased energy consumption, reduced energy expenditure, negative body image development, and reduced concern with the concept of self-care. Media literacy, the ability to view critically and understand mediated messages, is a possible technique to mitigate these adverse effects. The enhanced inclusion of media literacy concepts in health education activities of dietetic practice is advocated. Dietitians could increase their understanding of research findings on the health-related effects of mass media use and the implications of including media literacy in daily practice. Such awareness would further augment available health promotion strategies.
- Selenium is an essential trace element involved in several key metabolic activities via selenoproteins, enzymes that are essential to protect against oxidative damage and to regulate immune function. Selenium also may have other health benefits unrelated to its enzymatic functions. It may provide important health benefits to people whose oxidative stress loads are high, such as those with inflammatory or infectious diseases like rheumatoid arthritis or human immunodeficiency virus/acquired immunodeficiency syndrome, or who are at high risk for cancers, particularly prostate cancer. Some studies have generated compelling evidence that selenium is beneficial, either alone or in conjunction with other micronutrients. Additional data from large clinical trials that provide the highest level of evidence will be key to determining the benefits accrued at various selenium intake levels. When the strength of the evidence becomes sufficient, clinical health professionals will need to use dietary and clinical assessment methods to ensure that people at increased risk for cancer or inflammatory and infectious diseases can be appropriately advised about selenium intake.
- Purpose: Collective kitchens are community-based cooking programs in which small groups of people cook large quantities of food. They have developed over the past 20 years, and hundreds of groups have been formed across the country. However, collective kitchens described in the literature vary considerably in structure, purpose, and format. The purpose of this review is to synthesize research on this topic. Methods: Articles and theses were collected through searches of major databases, and synthesized to improve understanding of current information, and of continuing gaps in the knowledge of collective kitchens in Canada. Results: The limited published research on collective kitchens suggests that social and learning benefits are associated with participation. Some indication exists that participants also find the food cooked to be high quality, culturally acceptable, and acquired in a manner that maintains personal dignity. Whether collective kitchens have an impact on food resources as a whole is unclear, as research has been limited in scale. Conclusions: The role of collective kitchens in community building and empowering participants often is noted, and bears further investigation. Dietitians and nutritionists have a unique opportunity to facilitate the health promotion and food security benefits of collective kitchens.
- Overview: Iron is an essential nutrient, playing a central role in oxygen transport and cellular energy metabolism. The importance of ensuring adequate bioavailable dietary iron stems from the severe consequences associated with iron deficiency (ID) and anemia, including reduced immune function and resistance to infection, developmental delays and irreversible cognitive deficits in young children, impaired physical work performance, and adverse pregnancy outcomes. Specific populations: Poor dietary iron intake and ID exist in Canada, particularly in women of reproductive age. Data from the provincial nutrition surveys suggest that the prevalence of inadequate iron intakes (and low intakes of absorbable iron) among women under 50 years of age is over 10%, which may reflect poor iron status. Teenage girls are at risk for low iron stores because of the adolescent growth spurt and the onset of menstruation; those who are vegetarian are at even greater risk. Conclusions: The Canadian diet has changed so that grain products are now the main source of dietary iron for all age groups. The public must be educated to ensure the consumption of adequate quantities of bioavailable iron and enhancing factors such as vitamin C. Industry, government, and health professionals must work together to promote healthy eating patterns and the selection of appropriate foods.
