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Riddle E, Munoz N, Clark K, Collins N, Coltman A, Nasrallah L, Nishioka S, Scollard T, Simon JR, Moloney L. Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: An Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet 2024; 124:896-916.e24. [PMID: 38583584 DOI: 10.1016/j.jand.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.
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Affiliation(s)
- Emily Riddle
- State University of New York at Oneonta, Oneonta, New York
| | - Nancy Munoz
- Veterans Affairs Southern Nevada Healthcare System, Las Vegas, Nevada
| | | | | | - Anne Coltman
- Commission on Dietetic Registration, Chicago, Illinois
| | - Lamia Nasrallah
- Outpatient Nutrition Services, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | | | - Judy R Simon
- Nutrition and Health Promotion Consultant, Easton, Maryland
| | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, Illinois.
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Katsaridis S, Grammatikopoulou MG, Gkiouras K, Tzimos C, Papageorgiou ST, Markaki AG, Exiara T, Goulis DG, Papamitsou T. Low Reported Adherence to the 2019 American Diabetes Association Nutrition Recommendations among Patients with Type 2 Diabetes Mellitus, Indicating the Need for Improved Nutrition Education and Diet Care. Nutrients 2020; 12:nu12113516. [PMID: 33203138 PMCID: PMC7696891 DOI: 10.3390/nu12113516] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022] Open
Abstract
Patient adherence to guidelines is important for improved outcomes and prognosis. Nevertheless, many patients with type 2 diabetes mellitus (T2DM) do not comply with the recommendations regarding medication, physical activity, diet or self-care. The present cross-sectional study aimed to assess the level of adherence to the dietary recommendations issued by the American Diabetes Association (ADA) among patients with T2DM in Komotini, Greece. A total of 162 adults with T2DM (64.7 ± 10.6 years old), of which 41.4% were men, were recruited from the Sismanoglio Hospital and participated in the study. The level of adherence to individual recommendations issued by the ADA was assessed using yes/no questions. The overall adherence rate to the guidelines was low (41.2%). According to the multivariable analysis, age and medication therapy were identified as contributors to the compliance rate. No differences were noted in the total compliance rate between patients of different religious denominations (Muslims/Christians). Patients on oral antidiabetic agents (OAA) were more adherent compared with those on insulin therapy. A mere 3.7% of the participants had received nutrition education by a registered dietitian, 9.9% were following an individualized diet plan to improve glycemia, and 3.1% had set specific energy goals to reduce body weight. These findings are indicative of the need for the delivery of improved nutrition education.
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Affiliation(s)
- Savvas Katsaridis
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Sindos, GR-57400 Thessaloniki, Greece; (S.K.); (M.G.G.)
| | - Maria G. Grammatikopoulou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Sindos, GR-57400 Thessaloniki, Greece; (S.K.); (M.G.G.)
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, GR-56429 Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Laboratory of Clinical Pharmacology, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece;
| | - Christos Tzimos
- Northern Greece Statistics Directorate, Hellenic Statistical Authority, 218 Delfon Str, GR-54646 Thessaloniki, Greece;
| | - Stefanos T. Papageorgiou
- Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece;
| | - Anastasia G. Markaki
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hellenic Mediterranean University, PO Box 8556, Trypitos, GR-72300 Sitia, Greece;
| | - Triada Exiara
- Department of Internal Medicine, Sismanoglio General Hospital, 45 Sismanogliou Str, GR-69133 Komotini, Greece;
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Papageorgiou General Hospital, GR-56429 Thessaloniki, Greece
- Correspondence: (D.G.G.); (T.P.)
| | - Theodora Papamitsou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece
- Correspondence: (D.G.G.); (T.P.)
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Fukuda Y, Kohara M, Hatakeyama A, Ochi M, Nakai M. Influence of Geriatric Patients' Food Preferences on the Selection of Discharge Destination. J Clin Med Res 2020; 12:705-710. [PMID: 33224372 PMCID: PMC7665873 DOI: 10.14740/jocmr4337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/29/2020] [Indexed: 01/09/2023] Open
Abstract
Background The nonprotein calorie/nitrogen (NPC/N) ratio of food remains poorly investigated. Thus, this study examined the nutritional factors that influence the choice of discharge destination for geriatric patients. Methods We retrospectively investigated the patient characteristics, clinical laboratory test results, and hospital food consumption of 65 geriatric patients (80.0 ± 8.2 years; 31 males, 34 females), who were receiving oral nutritional support at a small mixed-care hospital and further explored their discharge destinations. The NPC/N ratios were calculated according to the menus for the meals provided during the first 4 weeks after admission. For logistic regression analysis, the objective variables were discharge destinations (i.e., nursing care facilities including home or medical institutions) whereas the predictor variables were age, sex, nursing care level, hospitalization duration, serum albumin level (Alb), estimated glomerular filtration rate (eGFR), and NPC/N ratio. Results Compared with age and nursing care level, sex (partial regression coefficient (B) = -5.140, P = 0.002), hospitalization duration (B = 0.077, P = 0.004), Alb (B = 3.223, P = 0.013), eGFR (B = -0.071, P = 0.019), and NPC/N ratio (B = -0.224, P = 0.001) are significantly correlated with the selection of discharge destination. Conclusions For geriatric patients who went to medical institutions, the need for prolonged hospitalization, male sex, hospitalization duration, stable serum Alb, low eGFR, low NPC/N ratio (i.e., high protein proportion), and the quantity of hospital food consumed were the possible factors that influence their discharge destination.
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Affiliation(s)
- Yasuko Fukuda
- Department of Food Science and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Ikebiraki-cho, Nishinomiya, Hyogo Prefecture 663-8558, Japan.,Research Institute for Nutrition Sciences, Mukogawa Women's University, Ikebiraki-cho, Nishinomiya, Hyogo Prefecture 663-8558, Japan
| | - Mina Kohara
- Formerly Affiliated With the Department of Nutrition, Nakai Hospital, Nada-ku, Kobe, Hyogo Prefecture 657-0833, Japan
| | - Asami Hatakeyama
- Department of Food Science and Nutrition, School of Human Environmental Sciences, Mukogawa Women's University, Ikebiraki-cho, Nishinomiya, Hyogo Prefecture 663-8558, Japan
| | - Mikako Ochi
- Department of Nutrition, Nakai Hospital, Nada-ku, Kobe, Hyogo Prefecture 657-0833, Japan
| | - Masanobu Nakai
- Department of Nutrition, Nakai Hospital, Nada-ku, Kobe, Hyogo Prefecture 657-0833, Japan
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Siopis G, Wang L, Colagiuri S, Allman‐Farinelli M. Cost effectiveness of dietitian‐led nutrition therapy for people with type 2 diabetes mellitus: a scoping review. J Hum Nutr Diet 2020; 34:81-93. [DOI: 10.1111/jhn.12821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/06/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- G. Siopis
- Charles Perkins Centre School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
| | - L. Wang
- Charles Perkins Centre School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
| | - S. Colagiuri
- Boden Collaboration The University of Sydney Sydney NSW Australia
| | - M. Allman‐Farinelli
- Charles Perkins Centre School of Life and Environmental Sciences The University of Sydney Sydney NSW Australia
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Azeez T, Chimah P, Hassan A, Moradeyo A, Umoren U, Eguzozie E. Dietary recommendation in diabetes care: Carbohydrate counting and caloric content of Nigerian foods. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2020. [DOI: 10.4103/jncd.jncd_64_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kramer H. Diet and Chronic Kidney Disease. Adv Nutr 2019; 10:S367-S379. [PMID: 31728497 PMCID: PMC6855949 DOI: 10.1093/advances/nmz011] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/04/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023] Open
Abstract
Kidney disease affects almost 15% of the US population, and prevalence is anticipated to grow as the population ages and the obesity epidemic continues due to Western dietary practices. The densely caloric Western diet, characterized by high animal protein and low fruit and vegetable content, has fueled the growth of chronic diseases, including chronic kidney disease. The glomerulus or filtering unit of the kidney is very susceptible to barotrauma, and diets high in animal protein impede the glomerulus' ability to protect itself from hemodynamic injury. High animal protein intake combined with low intake of fruits and vegetables also leads to a high net endogenous acid production requiring augmentation of ammonium excretion in order to prevent acidosis. This higher workload of the kidney to maintain a normal serum bicarbonate level may further exacerbate kidney disease progression. This article reviews the potential mechanisms whereby several key characteristics of the typical Western diet may impact kidney disease incidence and progression. Reducing animal protein intake and egg yolk and increasing intake of fruits and vegetables and fiber may prevent or delay end-stage renal disease, but few clinical trials have examined vegetarian diets for management of chronic kidney disease. More research is needed to determine optimal dietary patterns for the prevention of kidney disease and its progression.
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Affiliation(s)
- Holly Kramer
- Department of Public Health Sciences and Medicine
- Division of Nephrology and Hypertension, Loyola University, Chicago, IL
- Address correspondence to HK (e-mail: )
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Chester B, Babu JR, Greene MW, Geetha T. The effects of popular diets on type 2 diabetes management. Diabetes Metab Res Rev 2019; 35:e3188. [PMID: 31121637 DOI: 10.1002/dmrr.3188] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/09/2019] [Accepted: 05/17/2019] [Indexed: 12/23/2022]
Abstract
Type 2 diabetes can be managed with the use of diabetes self-management skills. Diet and exercise are essential segments of the lifestyle changes necessary for diabetes management. However, diet recommendations can be complicated in a world full of different diets. This review aims to evaluate the evidence on the effects of three popular diets geared towards diabetes management: low-carbohydrate and ketogenic diet, vegan diet, and the Mediterranean diet. While all three diets have been shown to assist in improving glycaemic control and weight loss, patient adherence, acceptability, and long-term manageability play essential roles in the efficacy of each diet.
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Affiliation(s)
- Brittannie Chester
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, Alabama
| | - Jeganathan Ramesh Babu
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, Alabama
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, Alabama
- Center for Neuroscience Initiative, Auburn University, Auburn, Alabama
| | - Michael W Greene
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, Alabama
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, Alabama
- Center for Neuroscience Initiative, Auburn University, Auburn, Alabama
| | - Thangiah Geetha
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, Alabama
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, Alabama
- Center for Neuroscience Initiative, Auburn University, Auburn, Alabama
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Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes. J Acad Nutr Diet 2019; 118:343-353. [PMID: 29389511 DOI: 10.1016/j.jand.2017.11.021] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 01/03/2023]
Abstract
It is the position of the Academy of Nutrition and Dietetics that for adults with prediabetes or type 2 diabetes, medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes. It is essential that MNT provided by RDNs be integrated into health care systems and public health programs and be adequately reimbursed. The Academy's evidence-based nutrition practice guidelines for the prevention of diabetes and the management of diabetes document strong evidence supporting the clinical effectiveness of MNT provided by RDNs. Cost-effectiveness has also been documented. The nutrition practice guidelines recommend that as part of evidence-based health care, providers caring for individuals with prediabetes or type 2 diabetes should be referred to an RDN for individualized MNT upon diagnosis and at regular intervals throughout the lifespan as part of their treatment regimen. Standards of care for three levels of diabetes practice have been published by the Diabetes Care and Education Practice Group. RDNs are also qualified to provide additional services beyond MNT in diabetes care and management. Unfortunately, barriers to accessing RDN services exist. Reimbursement for services is essential. Major medical and health organizations have provided support for the essential role of MNT and RDNs for the prevention and treatment of type 2 diabetes.
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Propelling the Profession with Outcomes and Evidence: Building a Robust Research Agenda at the Academy. J Acad Nutr Diet 2019; 117:S62-S78. [PMID: 28958300 DOI: 10.1016/j.jand.2017.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Kramer H, Jimenez EY, Brommage D, Vassalotti J, Montgomery E, Steiber A, Schofield M. Medical Nutrition Therapy for Patients with Non-Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions. J Acad Nutr Diet 2018; 118:1958-1965. [PMID: 30076072 DOI: 10.1016/j.jand.2018.05.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 01/11/2023]
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11
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Stein K. Fighting for the Profession: The Recent History of Legislative and Public Policy Efforts at the Academy. J Acad Nutr Diet 2017; 117:S19-S36. [DOI: 10.1016/j.jand.2017.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Fighting for the Profession: The Recent History of Legislative and Public Policy Efforts at the Academy. J Acad Nutr Diet 2017; 117:952-969. [DOI: 10.1016/j.jand.2017.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Indexed: 11/22/2022]
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Muscaritoli M, Krznarić Z, Singer P, Barazzoni R, Cederholm T, Golay A, Van Gossum A, Kennedy N, Kreymann G, Laviano A, Pavić T, Puljak L, Sambunjak D, Utrobičić A, Schneider SM. Effectiveness and efficacy of nutritional therapy: A systematic review following Cochrane methodology. Clin Nutr 2016; 36:939-957. [PMID: 27448948 DOI: 10.1016/j.clnu.2016.06.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Disease-related malnutrition has deleterious consequences on patients' outcome and healthcare costs. The demonstration of improved outcome by appropriate nutritional management is on occasion difficult. The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed the Nutrition Education Study Group (ESPEN-NESG) to increase recognition of nutritional knowledge and support in health services. METHODS To obtain the best available evidence on the potential effects of malnutrition on morbidity, mortality and hospital stay; cost of malnutrition; effect of nutritional treatment on outcome parameters and pharmaco-economics of nutritional therapy, a systematic review of the literature was performed following Cochrane methodology, to answer the following key questions: Q1) Is malnutrition an independent predictive factor for readmission within 30 days from hospital discharge? Q2) Does nutritional therapy reduce the risk of readmission within 30 days from hospital discharge? Q3) Is nutritional therapy cost-effective/does it reduce costs in hospitalized patients? and Q4) Is nutritional therapy cost effective/does it reduce costs in outpatients? RESULTS For Q1 six of 15 identified observational studies indicated that malnutrition was predictive of re-admissions, whereas the remainder did not. For Q2 nine randomized controlled trials and two meta-analyses gave non-conclusive results whether re-admissions could be reduced by nutritional therapy. Economic benefit and cost-effectiveness of nutritional therapy was consistently reported in 16 identified studies for hospitalized patients (Q3), whereas the heterogeneous and limited corresponding data on out-patients (Q4) indicated cost-benefits in some selected sub-groups. CONCLUSIONS This result of this review supports the use of nutritional therapy to reduce healthcare costs, most evident from large, homogeneous studies. In general, reports are too heterogeneous and overall of limited quality for conclusions on impact of malnutrition and its treatment on readmissions.
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Clinical Medicine, Sapienza- University of Rome, Viale dell'Università, 37, 00185 Roma, Italy.
| | - Zeljko Krznarić
- Department of Gastroenterology and Centre for Clinical Nutrition, Clinical Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Pierre Singer
- General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - Tommy Cederholm
- Departments of Geriatric Medicine, Uppsala University Hospital and Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Alain Golay
- Service of Therapeutic Education for Chronic Diseases, Geneva University Hospitals, Villa Soleillane, Chemin Venel 7, 1206 Geneva, Switzerland
| | - André Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - Nicholas Kennedy
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Dublin, Ireland
| | - Georg Kreymann
- Baxter Health Care SA Europe, CH 8010 Zurich, Switzerland
| | - Alessandro Laviano
- Department of Clinical Medicine, Sapienza- University of Rome, Viale dell'Università, 37, 00185 Roma, Italy
| | - Tajana Pavić
- Department of Gastroenterology and Hepatology, Clinical Hospital Center "Sisters of Mercy", Zagreb, Croatia
| | - Livia Puljak
- Cochrane Croatia, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Dario Sambunjak
- Department of Nursing, Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, Zagreb, Croatia
| | - Ana Utrobičić
- Cochrane Croatia, University of Split School of Medicine, Soltanska 2, Split, Croatia
| | - Stéphane M Schneider
- Department of Gastroenterology and Clinical Nutrition, University Hospital and University of Nice Sophia-Antipolis, Nice, France
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Stein K. Propelling the Profession with Outcomes and Evidence: Building a Robust Research Agenda at the Academy. J Acad Nutr Diet 2016; 116:1014-30. [PMID: 27085872 DOI: 10.1016/j.jand.2016.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Indexed: 11/26/2022]
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Jacobson TA, Maki KC, Orringer CE, Jones PH, Kris-Etherton P, Sikand G, La Forge R, Daniels SR, Wilson DP, Morris PB, Wild RA, Grundy SM, Daviglus M, Ferdinand KC, Vijayaraghavan K, Deedwania PC, Aberg JA, Liao KP, McKenney JM, Ross JL, Braun LT, Ito MK, Bays HE, Brown WV. National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2. J Clin Lipidol 2015; 9:S1-122.e1. [DOI: 10.1016/j.jacl.2015.09.002] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Erlinger TP, Pollack H, Appel LJ. Nutrition-Related Cardiovascular Risk Factors in Older People: Results from the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc 2015. [DOI: 10.1111/jgs.2000.48.11.1486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Awareness and perception of plant-based diets for the treatment and management of type 2 diabetes in a community education clinic: a pilot study. J Nutr Metab 2015; 2015:236234. [PMID: 25802755 PMCID: PMC4329824 DOI: 10.1155/2015/236234] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/08/2015] [Indexed: 11/18/2022] Open
Abstract
Objective. To assess awareness, barriers, and promoters of plant-based diet use for management of type 2 diabetes (T2D) for the development of an appropriate educational program. Design. Cross-sectional study of patients and healthcare providers. Setting. Regional Diabetes Education Centre in ON, Canada. Participants. n = 98 patients attending the Diabetes Education Centre and n = 25 healthcare providers. Variables Measures. Patient questionnaires addressed demographics, health history, and eating patterns, as well as current knowledge, confidence levels, barriers to, promoters of, and interests in plant-based diets. Staff questionnaires addressed attitudes and current practice with respect to plant-based diets. Analysis. Mean values, frequency counts, and logistic regression (alpha = 0.05). Results. Few respondents (9%) currently followed a plant-based diet, but 66% indicated willingness to follow one for 3 weeks. Family eating preferences and meal planning skills were common barriers to diet change. 72% of healthcare providers reported knowledge of plant-based diets for diabetes management but low levels of practice. Conclusions and Implications. Patient awareness of the benefits of a plant-based diet for the management of diabetes remains suboptimal and may be influenced by perception of diabetes educators and clinicians. Given the reported willingness to try (but low current use of) plant-based diets, educational interventions targeting patient and provider level knowledge are warranted.
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Factors associated with consulting a dietitian for diabetes management: a cross-sectional study. BMC Health Serv Res 2013; 13:504. [PMID: 24305435 PMCID: PMC3880219 DOI: 10.1186/1472-6963-13-504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 11/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 Diabetes (T2D) has reached epidemic levels in the Middle East region. Despite evidence that it improves health outcomes and saves health costs, dietary counseling for T2D remains grossly under-investigated in this region. The aim of this study was to assess the frequency and determinants of use of dietary counseling services by T2D patients in Lebanon and recommend corrective measures that may guide the planning, organization and delivery of care for chronic diseases in general and diabetes care in particular. METHODS A non-experimental cross-sectional design was utilized to survey outpatients with T2D in two major health centers in Lebanon. Patients diagnosed with T2D were invited to complete a questionnaire consisting of five sections: socio-demographic characteristics, disease attributes, patients' perceptions regarding T2D management, practice of lifestyle modifications, and referral by a physician to a dietitian. The outcome of interest was the use of dietary counseling services by T2D patients at least once since their diagnosis. Descriptive statistics and logistic regression analyses were used to evaluate the frequency and determinants of dietary counseling services utilization. RESULTS A total of 332 T2D patients completed the questionnaire (response rate 94.6%). Although 75% of study participants believed that dietitians can assist them in changing their dietary habits, only 38% had consulted with a dietitian. Among study participants, only 34% were referred to a dietitian by their physician. The main determinants of the use of dietary counseling services were referral by a physician (OR: 112.25; 95% CI = 42.74-294.84), the presence of outpatient social or private health insurance (OR: 5.86; 95% CI = 2.40-14.25) and the belief that a dietitian can assist in changing dietary habits (OR: 3.74; 95% CI = 1.33-10.54). CONCLUSIONS The findings of this study show suboptimal use of dietary counseling services by T2D patients in Lebanon. Key determinants were physicians' referral, financial support for outpatient care, and patients' belief in the usefulness of dietary counseling. Suggested interventions entail enhancing the planning and organization of care through inter-professional collaboration between physicians and dietitians; promoting public financing for high quality outpatient care that includes dietary counseling; and promoting the value of dietary counseling and improving the public image of dietitians.
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Bell CF, Bryant C. Determinants of nutrition appointment attendance among male veterans attending Veterans Health Administration clinics. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2013; 45:739-744. [PMID: 23735718 DOI: 10.1016/j.jneb.2013.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To identify determinants of nutrition appointment attendance among male veterans attending outpatient Veterans Health Administration clinics. METHODS Sequential use of qualitative and quantitative methods. Individual, semi-structured interviews and a mail survey were used to identify factors associated with outpatient nutrition appointment attendance. RESULTS Qualitative analysis of 17 interviews revealed 6 themes reflecting rationales for missed appointments: travel difficulty, forgetting the appointment, competing demands, scheduling difficulty, knowledge not new or useful, and lack of provider support. Analysis of 349 returned surveys indicated past attendance history, health status, and participation in the referral and scheduling process correlated to appointment attendance (P < .05). Regression analysis substantiated the importance of social support (P < .05). CONCLUSIONS AND IMPLICATIONS Veterans Health Administration patients should participate in the referral and scheduling process. Social support, perceived health status, and past attendance history are important considerations for patient and provider to address.
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Affiliation(s)
- Claire F Bell
- Department of Nutrition and Food Service, 120B, James A. Haley VA Hospital, Tampa, FL.
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Deakin T. The diabetes pandemic: is structured education the solution or an unnecessary expense? PRACTICAL DIABETES 2011. [DOI: 10.1002/pdi.1635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Penn DM, Fischer JG, Sun Lee J, Hausman DB, Johnson MA. High BMI and waist circumference are associated with a high prevalence of comorbidities in older Americans Act programs in Georgia senior centers. J Nutr Health Aging 2009; 13:827-32. [PMID: 19812874 DOI: 10.1007/s12603-009-0220-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study characterized the relationship of body mass index (BMI) and high waist circumference (WC) with the prevalence of selected comorbidities among older adults receiving nutrition and wellness services from Georgia's Older Americans Act programs at senior centers. METHODS Participants were a convenience sample (N = 759, mean age = 75 years, 81% female, 63% white, 36% black). Correction factors were applied to measured WC and to measured and self-reported height and weight. RESULTS The prevalence of several comorbidities showed striking relationships with WC and BMI, independent of age, gender, and race. CONCLUSION The health burden of overweight/obesity is very high in these older adults creating an urgent need for evidence-based nutrition, physical activity programs, and therapeutic lifestyle counseling to prevent and manage weight-related comorbidities.
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Affiliation(s)
- D M Penn
- Department of Foods and Nutrition,The University of Georgia, Athens, GA 30602 USA.
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Al Hourani H, Atoum M, Alboqai O, Ismail LC, Al Dhaheri A, Hijjawi N. Effectiveness of dietary intervention for obese women in Jordan. Int J Food Sci Nutr 2009; 60 Suppl 3:76-82. [PMID: 19548164 DOI: 10.1080/09637480903022727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim was to evaluate the outcome of body weight loss consulting in an outpatient nutrition clinic. METHODS Forty-five adult females attended 10 individualized treatment one-to-one sessions. Weight and height were measured and the body mass index was calculated. Triceps, biceps, subscapular and suprailiac skinfold thickness were measured and the fat percentage was calculated. A hypocaloric diet was given to the women; the percentages of carbohydrate, protein and fat in the diet were kept between 50 and 55% for carbohydrates, between 15 and 20% for protein, and < or =30% of fat. RESULTS Average weight loss was 7.4 kg, which was 8.4% of initial. Class III obese subjects achieved the highest weight loss (-9.4 kg). Weight loss was statistically significant after week 1, week 2, week 3, and week 4 (P < 0.001). The body mass index was significantly decreased (P < 0.001). The mean fat percentage was not significantly different. CONCLUSIONS The results indicate the increasing importance of nutrition counselling in Jordan.
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Van Horn L, McCoin M, Kris-Etherton PM, Burke F, Carson JAS, Champagne CM, Karmally W, Sikand G. The evidence for dietary prevention and treatment of cardiovascular disease. ACTA ACUST UNITED AC 2008; 108:287-331. [PMID: 18237578 DOI: 10.1016/j.jada.2007.10.050] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Indexed: 12/31/2022]
Abstract
During the past few decades numerous studies have reported the atherogenic potential of saturated fatty acids, trans-fatty acids, and cholesterol, and beneficial effects of fiber, phytostanols/phytosterols, n-3 fatty acids, a Mediterranean diet, and other plant-based approaches. The purpose of this article is to provide a comprehensive and systematic review of the evidence associated with key dietary factors and risk of cardiovascular disease-an umbrella term encompassing diseases that affect the heart and blood vessels, including coronary heart disease, coronary artery disease, dyslipidemia, and hypertension-in conjunction with the work of the American Dietetic Association Evidence Analysis Library review on diet and lipids, updated with new evidence from the past 2 years. The criteria used and results cited provide scientific rationale for food and nutrition professionals and other health professionals for counseling patients. Details of these searches are available within the American Dietetic Association Evidence Analysis Library online (http://adaevidencelibrary.com). Potential mechanisms and needs for future research are summarized for each relevant nutrient, food, or food component.
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Affiliation(s)
- Linda Van Horn
- Preventive Medicine, Northwestern University Freinberg School of Medicine, Chicago, IL 60611, USA.
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Finucane FM, Gaffney L, Hatunic M, Burns N, Nolan JJ. Attendance at an Irish diabetes dietetic outpatient clinic. Diabetes Res Clin Pract 2007; 77:335-6. [PMID: 17141352 DOI: 10.1016/j.diabres.2006.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 11/06/2006] [Indexed: 10/23/2022]
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Affiliation(s)
- A James Lee
- University of Massachusetts Lowell, MA, USA.
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Gucciardi E, Demelo M, Lee RN, Grace SL. Assessment of two culturally competent diabetes education methods: individual versus individual plus group education in Canadian Portuguese adults with type 2 diabetes. ETHNICITY & HEALTH 2007; 12:163-87. [PMID: 17364900 DOI: 10.1080/13557850601002148] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To examine the impact of two culturally competent diabetes education methods, individual counselling and individual counselling in conjunction with group education, on nutrition adherence and glycemic control in Portuguese Canadian adults with type 2 diabetes over a three-month period. DESIGN The Diabetes Education Centre is located in the urban multicultural city of Toronto, Ontario, Canada. We used a three-month randomized controlled trial design. Eligible Portuguese-speaking adults with type 2 diabetes were randomly assigned to receive either diabetes education counselling only (control group) or counselling in conjunction with group education (intervention group). Of the 61 patients who completed the study, 36 were in the counselling only and 25 in the counselling with group education intervention. We used a per-protocol analysis to examine the efficacy of the two educational approaches on nutrition adherence and glycemic control; paired t-tests to compare results within groups and analysis of covariance (ACOVA) to compare outcomes between groups adjusting for baseline measures. The Theory of Planned Behaviour was used to describe the behavioural mechanisms that influenced nutrition adherence. RESULTS Attitudes, subjective norms, perceived behaviour control, and intentions towards nutrition adherence, self-reported nutrition adherence and glycemic control significantly improved in both groups, over the three-month study period. Yet, those receiving individual counselling with group education showed greater improvement in all measures with the exception of glycemic control, where no significant difference was found between the two groups at three months. CONCLUSIONS Our study findings provide preliminary evidence that culturally competent group education in conjunction with individual counselling may be more efficacious in shaping eating behaviours than individual counselling alone for Canadian Portuguese adults with type 2 diabetes. However, larger longitudinal studies are needed to determine the most efficacious education method to sustain long-term nutrition adherence and glycemic control.
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Affiliation(s)
- Enza Gucciardi
- School of Nutrition, Ryerson University, Victoria St, Toronto, Ontario, Canada.
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Gans KM, Risica PM, Wylie-Rosett J, Ross EM, Strolla LO, McMurray J, Eaton CB. Development and evaluation of the nutrition component of the Rapid Eating and Activity Assessment for Patients (REAP): a new tool for primary care providers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2006; 38:286-92. [PMID: 16966049 DOI: 10.1016/j.jneb.2005.12.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 12/15/2005] [Indexed: 05/11/2023]
Abstract
OBJECTIVES 1. To describe the development of a dietary assessment tool (Rapid Eating and Activity Assessment for Patients [REAP]) that quickly assesses a patient's diet and physical activity and facilitates brief counselling by a primary care provider, and 2. To describe the evaluation of the REAP in terms of its reliability, validity, and ease of use by primary care providers. DESIGN, SETTING AND PARTICIPANTS The evaluation of REAP included: 1) an implementation feasibility study conducted with 61 medical students and practicing physicians in practice settings at various medical schools; 2) a calibration study with 44 Brown University Medical School students; 3) cognitive assessment testing with 31 consumers in Rhode Island; and 4) a reliability and calibration study of the revised tool with 94 consumers in Rhode Island and Massachusetts. RESULTS The feasibility study revealed moderately high rankings on usefulness, ease, practicality, and helpfulness. The calibration studies demonstrated that REAP has excellent test-retest reliability (r = 0.86, P < .0001), is correlated with the Healthy Eating Index score (r = 0.49, P = .0007), and is significantly associated with intake of most nutrients studied. CONCLUSIONS AND IMPLICATIONS REAP has adequate reliability and validity to be used in primary care practices for nutrition assessment and counselling, and is also user-friendly for providers.
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Affiliation(s)
- Kim M Gans
- Brown University Institute for Community Health Promotion, Providence, RI 02903, USA.
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Gaetke LM, Stuart MA, Truszczynska H. A single nutrition counseling session with a registered dietitian improves short-term clinical outcomes for rural Kentucky patients with chronic diseases. ACTA ACUST UNITED AC 2006; 106:109-12. [PMID: 16390674 DOI: 10.1016/j.jada.2005.09.051] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Indexed: 11/21/2022]
Abstract
Relying on data derived from medical records of past visits to a physician, patients' charts were examined to evaluate the effectiveness of a single nutrition counseling session provided by the same registered dietitian in improving outcome measures for patients with type 2 diabetes mellitus or cardiovascular disease. This was a retrospective study of 175 patients' charts from which laboratory data were extracted before and at 3 months after seeing the dietitian. Records were categorized into two groups based on whether the patient had attended or not attended a single nutrition counseling session. At 3 months, the group that received the nutrition counseling had statistically significant improvements in blood values and body mass index compared with the group that did not receive nutrition counseling. This study further confirms the value of a single nutrition counseling session as an effective approach to treating type 2 diabetes and cardiovascular disease.
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Affiliation(s)
- Lisa M Gaetke
- Department of Nutrition and Food Science, University of Kentucky, 218 Funkhouser Bldg, Lexington, KY 40506-0054, USA.
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Smith RE, Patrick S, Michael P, Hager M. Medical nutrition therapy: the core of ADA's advocacy efforts (part 1). ACTA ACUST UNITED AC 2005; 105:825-34. [PMID: 15883564 DOI: 10.1016/j.jada.2005.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Smith RE, Patrick S, Michael P, Hager M. Medical Nutrition Therapy: The Core of ADA’s Advocacy Efforts (Part 2). ACTA ACUST UNITED AC 2005; 105:987-96. [PMID: 15942554 DOI: 10.1016/j.jada.2005.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Snetselaar L, Malville-Shipan K, Ahrens L, Smith K, Chenard C, Stumbo P, Gordon J, Thomas A. Raising Medical Students' Awareness of Nutrition and Fitness in Disease Prevention: Nutrition and Fitness Program at the University of Iowa. MEDICAL EDUCATION ONLINE 2004; 9:4358. [PMID: 28253116 DOI: 10.3402/meo.v9i.4358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
At the University of Iowa we devised a learning experience, called the Nutrition and Fitness Program, for third-year medical students. The program was designed to raise awareness of the role of nutrition and exercise in the prevention and treatment of disease. Students spent one afternoon learning about their personal health risk factors, such as body mass index, percent body fat, other anthropometric measures such as waist, hip and mid-arm circumference, blood lipids, bone-mass density, dietary analysis, and fitness assessment. Students spent another afternoon visiting the cardiac rehabilitation center. At the end of each rotation, students gathered for a heart-healthy meal that served as a focus for a discussion with dietitians about important nutrition issues. The literature and our work with medical students support the need and acceptance of a personalized, practical approach to nutrition education. By offering medical students the opportunity to learn about their own nutrition and fitness risk factors, this Nutrition and Fitness Program appears to have played an important role in the students' medical education by narrowing the gap between the "science of nutrition" and the "application of nutrition". Students appreciated learning more about their own health factors and felt that personalizing the information made the learning more valuable and would help in counseling their future patients more effectively.
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Affiliation(s)
- Linda Snetselaar
- a College of Public Health and Department of Internal Medicine College of Medicine University of Iowa
| | - Katherine Malville-Shipan
- a College of Public Health and Department of Internal Medicine College of Medicine University of Iowa
| | - Lois Ahrens
- a College of Public Health and Department of Internal Medicine College of Medicine University of Iowa
| | - Karen Smith
- a College of Public Health and Department of Internal Medicine College of Medicine University of Iowa
| | - Cathy Chenard
- a College of Public Health and Department of Internal Medicine College of Medicine University of Iowa
| | - Phyllis Stumbo
- a College of Public Health and Department of Internal Medicine College of Medicine University of Iowa
| | - Joel Gordon
- a College of Public Health and Department of Internal Medicine College of Medicine University of Iowa
| | - Alexandra Thomas
- a College of Public Health and Department of Internal Medicine College of Medicine University of Iowa
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Jonnalagadda SS. Effectiveness of medical nutrition therapy: Importance of documenting and monitoring nutrition outcomes. ACTA ACUST UNITED AC 2004; 104:1788-92. [PMID: 15565070 DOI: 10.1016/j.jada.2004.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Private Practice Nutrition Referrals and Payment Ratios. TOP CLIN NUTR 2004. [DOI: 10.1097/00008486-200407000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cavallaro V, Dwyer J, Houser RF, Shores K, Cañez I, Hong A, Altman K, Helmick E, Murphy JN. Influence of dietitian presence on outpatient cardiac rehabilitation nutrition services. ACTA ACUST UNITED AC 2004; 104:611-4. [PMID: 15054347 DOI: 10.1016/j.jada.2004.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To describe variations in nutrition services offered in a nationally representative sample of out-patient cardiac rehabilitation programs by presence of a registered dietitian (RD), a survey was conducted of 250 randomly selected centers from 1,111 US outpatient cardiac rehabilitation centers in the 1998/1999 Cardiac Rehabilitation Directory of the American Association of Cardiovascular and Pulmonary Rehabilitation. A total of 190 of the 250 surveys (76%) were returned. Nutrition services offered by programs polled included distribution of nutrition pamphlets, one-on-one nutrition counseling, group nutrition classes, guest lectures on nutrition, and cooking demonstrations. Cardiac rehabilitation programs with an RD offered significantly more nutrition services on average (4.2+/-1.2) than programs without an RD (3.5+/-1.1, P=.01). Programs with RDs were more likely to offer one-on-one nutrition counseling than programs without them (98% and 80% respectively, P<.001), and they were also more likely to offer cooking demonstrations (43% and 17% respectively, P=.02). More, and a greater variety of, nutrition services are offered in cardiac rehabilitation programs that have an RD. Without an RD, exercise physiologists and registered nurses often provide some, but fewer and different, nutrition services.
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Affiliation(s)
- Vanessa Cavallaro
- Massachusetts Department of Public Health, Nutrition and Physical Activity Unit, Massachusetts Partnership for Healthy Weight, Cambridge, 02139, USA.
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Pavlovich WD, Waters H, Weller W, Bass EB. Systematic review of literature on the cost-effectiveness of nutrition services. ACTA ACUST UNITED AC 2004; 104:226-32. [PMID: 14760571 DOI: 10.1016/j.jada.2003.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Employers and health plan directors would like to know whether it is cost-effective to include outpatient nutrition services as a covered benefit. The purpose of this systematic review was to examine the strength of evidence on the cost-effectiveness of outpatient nutrition services from an economic perspective. All randomized controlled trials published between January 1966 and September 2001 that reported on costs and effectiveness of outpatient nutrition services for any indicated condition were identified and reviewed. Paired reviewers abstracted data from and assessed the quality of each eligible randomized controlled trial; 13 studies met the eligibility criteria. Relatively consistent evidence exists to support the cost-effectiveness of nutrition services in the reduction of serum cholesterol levels (eg, 20 dollars to 1,268 dollars per mmol/L decrease in serum low-density lipoprotein level), weight loss (2.40 dollars to 10 dollars per pound lost), and blood glucose (5 dollars per mmol/L decrease), and for target populations with diabetes mellitus and hypercholesterolemia. However, the randomized controlled trials had important limitations and used different cost perspectives. Limited evidence of economic benefit exists to support coverage of outpatient nutrition services for selected indications. More randomized controlled trials of nutrition services should be conducted, taking into consideration all potential candidates for nutrition therapy and all potential costs to patients, providers, and payers.
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Affiliation(s)
- Wendy D Pavlovich
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
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The dietitians challenge: the implementation of nutritional advice for people with diabetes. J Hum Nutr Diet 2003; 16:421-52; quiz 453-6. [DOI: 10.1046/j.1365-277x.2003.00460.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Connor H, Annan F, Bunn E, Frost G, McGough N, Sarwar T, Thomas B. The implementation of nutritional advice for people with diabetes. Diabet Med 2003; 20:786-807. [PMID: 14510859 DOI: 10.1046/j.1464-5491.2003.01104.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
These consensus-based recommendations emphasize the practical implementation of nutritional advice for people with diabetes, and describe the provision of services required to provide the information. Important changes from previous recommendations include greater flexibility in the proportions of energy derived from carbohydrate and monounsaturated fat, further liberalization in the consumption of sucrose, more active promotion of foods with a low glycaemic index, and greater emphasis on the provision of nutritional advice in the context of wider lifestyle changes, particularly physical activity. Monounsaturated fats are now promoted as the main source of dietary fat because of their lower susceptibility to lipid peroxidation and consequent lower atherogenic potential. Consumption of sucrose for patients who are not overweight can be increased up to 10% of daily energy provided that this is eaten in the context of a healthy diet and distributed throughout the day [corrected]. Evidence is presented for the effectiveness of advice provided by trained dieticians. The increasing evidence for the importance of good metabolic control and the growing requirement for measures to prevent Type 2 diabetes in an increasingly obese population will require major expansion of dietetic services if the standards in National Service Frameworks are to be successfully implemented.
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Affiliation(s)
- H Connor
- County Hospital, Hereford HR1 2ER, UK.
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Nerad J, Romeyn M, Silverman E, Allen-Reid J, Dieterich D, Merchant J, A Pelletier V, Tinnerello D, Fenton M. General nutrition management in patients infected with human immunodeficiency virus. Clin Infect Dis 2003; 36:S52-62. [PMID: 12652372 DOI: 10.1086/367559] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Nutritional management is integral to the care of all patients infected with human immunodeficiency virus (HIV). HIV infection results in complicated nutritional issues for patients, and there is growing evidence that nutritional interventions influence health outcomes in HIV-infected patients. We define levels of nutritional care, and we discuss when patients should be referred to providers (i.e., registered dietitians) with nutritional and HIV expertise.
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Affiliation(s)
- Judith Nerad
- Division of Infectious Diseases, John H. Stroger Hospital of Cook County, Chicago, llinois 60612, USA.
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Important Nutrition Education Issues and Recommendations Related to a Review of the Literature on Older Adults. ACTA ACUST UNITED AC 2003. [DOI: 10.1300/j052v22n03_06] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Gans KM, Ross E, Barner CW, Wylie-Rosett J, McMurray J, Eaton C. REAP and WAVE: new tools to rapidly assess/discuss nutrition with patients. J Nutr 2003; 133:556S-62S. [PMID: 12566502 DOI: 10.1093/jn/133.2.556s] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dietary changes can be helpful in preventing or treating a variety of prevalent health problems. Physicians can be helpful in helping patients make positive dietary changes, be physically active and lose weight, but, for a variety of reasons, many physicians do little nutrition counseling. There is a need for brief, user-friendly tools to enable physicians to rapidly and accurately assess patients' diets and exercise habits as well as provide information to aid the physician in delivering effective nutrition counseling. The purpose of this paper is to discuss two new tools, WAVE and REAP, that have been developed by the Nutrition Academic Award to help physicians and other health care providers conduct nutrition assessment and counseling with their patients in a practical and effective manner. The WAVE acronym and tool is designed to encourage provider/patient dialogue about the pros and cons of the patients' current status related to Weight, Activity, Variety and Excess. The Rapid Eating and Activity Assessment for Patients (REAP) is a brief validated questionnaire that is designed to aid providers in performing a brief assessment of diet and physical activity. An accompanying Physician Key aids the provider in discussing the patient's answers and counseling them appropriately. REAP and WAVE can be helpful tools to facilitate nutrition assessment and counseling in the provider office. Depending on patients' health priorities and how much time is available, these tools can be used in a variety of ways to discuss nutrition with patients during a clinical encounter in 1-9 min.
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Affiliation(s)
- Kim M Gans
- Institute for Community Health Promotion, Brown University Medical School, Providence, RI 02903, USA.
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Chima CS, Pollack HA. Position of the American Dietetic Association: nutrition services in managed care. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:1471-8. [PMID: 12396170 DOI: 10.1016/s0002-8223(02)90326-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
It is the position of the American Dietetic Association that medical nutrition therapy is an essential component of disease management and healthcare provided by managed care organizations, and that such care must be provided by qualified nutrition professionals. Compared with traditional fee-for-service reimbursement systems, managed care presents new opportunities for dietetics professionals. Until recently, the lack of billing infrastructure has handicapped nutrition providers who wish to bill for their services and has made it difficult to track the outcomes of nutrition care. With the publication of current procedure terminology codes for medical nutrition therapy (MNT) and the implementation of MNT benefits in Medicare part B for diabetes and nondialysis kidney disease, commercial payers, including managed care organizations (MCOs) are likely to implement or expand their coverage of MNT. A large body of evidence supports the efficacy and cost-effectiveness of MNT coverage within managed care plans. This evidence includes cost analyses of conditions treated by MNT, and clinical trial data confirming the efficacy of MNT in improving patient outcomes. MNT is also an important part of national standards of care for many chronic disease conditions. Based on evidence supporting the role of MNT in improving patient outcomes, the Institute of Medicine (IOM) recommended that MNT services be reimbursed by Medicare when patients are referred by a physician. Provision of appropriate MNT can also help MCOs meet accreditation and quality standards established by entities such as the National Committee for Quality Assurance and the Joint Commission for the Accreditation of Health Care Organizations. Much of the work required to secure a place for MNT in MCOs will be done at the practitioner level, by nutrition professionals themselves. Registered dietitians must market MNT to their customers in managed care by addressing the needs of each player. By emphasizing the importance of MNT and other cost-effective forms of preventive care and disease management, MCOs will be well positioned to improve population health at modest cost.
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Neuhouser ML, Miller DL, Kristal AR, Barnett MJ, Cheskin LJ. Diet and exercise habits of patients with diabetes, dyslipidemia, cardiovascular disease or hypertension. J Am Coll Nutr 2002; 21:394-401. [PMID: 12356780 DOI: 10.1080/07315724.2002.10719241] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether free-living individuals diagnosed with diabetes, dyslipidemia, cardiovascular disease or hypertension follow standard dietary recommendations for treatment of these diet-modifiable disorders. METHODS Data are from 1,782 adult men and women who completed an annual clinic visit as part of a large study of diet and health. Usual dietary intake over the previous month was assessed with a self-administered food frequency questionnaire. Trained staff obtained a detailed medical history and information on health and exercise habits, measured height and weight, and collected a fasting blood specimen to measure total serum cholesterol, triglycerides and carotenoids. Multivariate linear regression was used to test associations of diet-modifiable chronic diseases with diet and exercise habits. RESULTS 42% of the study sample reported at least one diet-modifiable disease or risk factor for disease. These individuals had higher total serum cholesterol (p < 0.001) and triglycerides (p < 0.001) compared to those without these conditions. Diabetics consumed a greater percent of energy from fat (p < 0.01), and men with hypertension consumed a greater percent energy from saturated fat (p < 0.05) compared to those without these conditions. There were few other differences in dietary intake between diseased and healthy individuals, and on average, all participants had diets that were not consistent with recommended guidelines for prevention or treatment of these diet-modifiable disorders. Forty-six percent of all participants were overweight or obese, and BMI was significantly higher among participants with at least one diet-modifiable disorder (p < 0.001). Healthy and diseased participants exercised about 17 minutes per day, and compared to non-diabetics, persons with diabetes exercised with 25% less intensity (p < 0.05). CONCLUSION Participants in this sample with diet-modifiable disorders reported that they are motivated to eat less fat, but most are still overweight or obese, consume a diet high in fat and low in fruits and vegetables and engage in very little physical exercise. New strategies are needed to help patients adopt and maintain healthful dietary practices that will reduce their risk.
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Affiliation(s)
- Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
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Wylie-Rosett J, Delahanty L. An integral role of the dietitian: implications of the Diabetes Prevention Program. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:1065-8. [PMID: 12171450 PMCID: PMC2562572 DOI: 10.1016/s0002-8223(02)90241-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Judith Wylie-Rosett
- Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Wylie-Rosett J, Mossavar-Rahmani Y, Gans K. Recent dietary guidelines to prevent and treat cardiovascular disease, diabetes, and obesity. HEART DISEASE (HAGERSTOWN, MD.) 2002; 4:220-30. [PMID: 12147182 DOI: 10.1097/00132580-200207000-00005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nutrition guidelines are emphasizing dietary patterns as primary and secondary prevention trials provide increasing evidence of the importance of lifestyle changes to prevent/control cardiovascular disease (CVD) risk factors such as diabetes and hypertension. Despite the increasing evidence that weight loss and modified dietary patterns are effective, there is considerable debate about the level of carbohydrate that will be most beneficial. Epidemiologic studies indicate that certain ethnic and racial minority groups have increased CVD risk with higher rates of obesity, hypertension, diabetes, and stroke. Immigrant and Native American populations have had a dramatic rise in obesity, diabetes, and ultimately CVD with acculturation, accompanied by a higher fat intake and decreased physical activity. Culturally tailored intervention approaches are being used to reduce risk. The lack of third-party payment still limits the availability of nutrition services. However, medical nutrition therapy is covered by Medicare for diabetes and pending legislation will extend coverage to CVD. Medical education researchers have developed tools such as the WAVE (Weight, Activity, Variety and Excess) pocket guide as a quick method to facilitate addressing referral for medical nutrition therapy that can be readily incorporated into practice settings.
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Affiliation(s)
- Judith Wylie-Rosett
- Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care 2002; 25:608-13. [PMID: 11874956 DOI: 10.2337/diacare.25.3.608] [Citation(s) in RCA: 236] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Joyce Green Pastors
- Virginia Center for Diabetes Professional Education, UVA Health System, Charlottesville, Virginia 22908, USA.
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Schulman JA, Rienzo BA. The Importance of Physicians' Nutrition Literacy in the Management of Diabetes Mellitus. MEDICAL EDUCATION ONLINE 2001; 6:4530. [PMID: 28253748 DOI: 10.3402/meo.v6i.4530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite pharmacological advances in diabetes treatment, medical nutrition therapy (MNT) continues to be an essential component of diabetes management. Nonetheless, physicians have missed opportunities to provide nutrition counseling to their patients. This presents a problem because type 2 diabetes is an epidemic with severe consequences that result from non-adherence to nutrition protocols. The goals of this article are: 1) to explore reasons for the continued paucity of nutrition education in medical training programs, 2) to describe how a power educative approach can be used to improve patient outcomes, and 3) to identify considerations for improving nutrition literacy among physicians. These analyses lead to several recommendations for improving nutrition education for physicians.
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Affiliation(s)
- Jessica A Schulman
- a Department of Health Services Administration
- b Department of Health Science Education University of Florida
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Kyle UG, Morabia A, Slosman DO, Mensi N, Unger P, Pichard C. Contribution of body composition to nutritional assessment at hospital admission in 995 patients: a controlled population study. Br J Nutr 2001; 86:725-31. [PMID: 11749682 DOI: 10.1079/bjn2001470] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Body weight, weight changes and BMI are easily obtainable indicators of nutritional status, but they do not provide information on the amount of fat-free and fat masses. The purpose of the present study was to determine if fat-free mass (FFM) and fat mass were depleted in patients with normal BMI or serum albumin at hospital admission. A group of 995 consecutive patients were evaluated for malnutrition by BMI, serum albumin, and 50 kHz bioelectrical impedance analysis and compared with 995 healthy adults, matched for age and height, and then compared with FFM and fat mass percentiles previously determined in 5225 healthy adults. A BMI of <or=20 kg/m2 was noted in 17.3 % of patients and serum albumin of <or=35 g/l was found in 14.9 % of patients. In contrast, 31 % of all patients were below the tenth percentile for FFM, compared with 10.1 % of controls (chi2, P=0.0001), while 73 % of patients with BMI <or=20 kg/m2 and 31 % of patients with BMI 20-24.9 kg/m2 fell below the tenth percentile for FFM. Furthermore, the FFM was lower in patients than controls and the differences with age in FFM (lower) and fat mass (higher) were greater in patients than in controls. BMI and albumin significantly underestimated the prevalence of malnutrition in patients at hospital admission compared with body composition measurements. Optimal nutritional assessment should therefore include objective measurement of FFM and fat mass.
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Affiliation(s)
- U G Kyle
- Clinical Nutrition and Diet Therapy, Geneva University Hospital, 1211 Geneva, Switzerland
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Bhalotra SM, Mutschler PH. Primary prevention for older adults: no longer a paradox. J Aging Soc Policy 2001; 12:5-22. [PMID: 11303367 DOI: 10.1300/j031v12n02_02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S M Bhalotra
- Heller School, Brandeis University, Waltham, MA 02454, USA.
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Health Maintenance in a Primary Care Clinic for Urban, Indigent Adults. J Wound Ostomy Continence Nurs 2001. [DOI: 10.1097/00152192-200105000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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