Dietary Nonadherence Research Articles

Perceived barriers to recommended dietary adherence in patients with type 2 diabetes in Iran

ObjectiveTo identify barriers to recommended dietary adherence in patients with type 2 diabetes. DesignObservational cross-sectional study. SampleOne hundred-forty six overweight/obese volunteers with type 2 diabetes, who had previously received dietary advice for at least one year, were recruited from two diabetes clinics in Tabriz, north-west of Iran. MeasurementsA 24-item questionnaire was designed to assess dietary barriers. The validity and reliability of the questionnaire were assessed by Content Validity Index, Content Validity Ratio and Cronbach's alpha, respectively. An exploratory factor analysis with principal component analysis extraction and varimax rotation was utilized in order to extract the underlying factors of dietary nonadherence. ResultsFactor analysis yielded seven barrier factors including: situational barriers/difficulty resisting temptation [percent variance=11.64%], stress-related eating disorder/cost [percent variance=9.11%], difficulty with meal and snack plans [percent variance=8.76%], confusion [percent variance=8.45%], work-related issues [percent variance=7.72%], small portion size [percent variance=6.87%] and lack of palatability/family support [percent variance=6.78%]. These factors explained about 59.4% of the total variance. ConclusionsOverall, patients with type 2 diabetes perceived some barriers to recommended dietary adherence. In dietary counseling, considering and addressing these barriers will likely be effective in increasing the dietary adherence for patients with type 2 diabetes in Iran.

12. Creation of a low-salt food bank

Heart failure (HF) causes more elderly hospitalizations than any other disease resulting in over 1 million hospital admissions and up to 6.5 million hospital days annually according to the American Heart Association. It has been proposed that over two-thirds of hospitalizations are preventable with 24% attributed to dietary nonadherence. Local food banks (FB) traditionally do not offer low-salt (LS) products. Patients in our outpatient clinic often verbalize frustration not only with adhering to a LS diet but also in finding available LS products.

13. Creative salt solutions

The Heart Failure Clinic (HFC) opened its doors in Fall of 2002. Today, there are 5.3 million people and 660,000 new cases anually. HF is the only cardiac condition increasing in prevalence with a projected 10 million patients in the US by 2037. Over 2/3 of HF hospitalizations are preventable with 24% atributed to dietary nonadherence. There continues to be a pervasive knowledge deficit concerning sodium content of food. Currently the average sodium intake is 3,400 mg per day with up to 6,000 mgs daily.

Predictors of dietary and fluid non‐adherence in Jordanian patients with end‐stage renal disease receiving haemodialysis: a cross‐sectional study

The purpose of this study is to provide insight into the relationship between dietary and fluid non-adherence, depressive symptoms, quality of life, perceived barriers and benefits of exercise, and perceived social support among Jordanian patients with end-stage renal disease receiving haemodialysis using Pender's health promotion model. Non-adherence to dietary and fluid restrictions is a leading cause of treatment failure and poor outcomes in end-stage renal disease. Yet, factors that interfere with the patients' ability to follow their dietary restrictions are unknown. A descriptive, correlational, cross-sectional design was used. Jordanian patients (n = 190) with end-stage renal disease receiving haemodialysis from three main Jordanian cities were included. The dialysis diet and fluid nonadherence questionnaire, Beck Depression Inventory-II, Quality Of Life Index, Dialysis Patient-Perceived Exercise Benefits and Barriers Scale, and the Multidimensional Perceived Social Support were employed to measure the key variables. Patients were more likely men with mean age of 48·2 ± 14·9. Only 27% of the patients showed full commitment to diet guidelines and 23% to fluid guidelines during the last 14 days. Depression (M = 18·8 ± 11·4) had significant negative association with quality of life (importance and satisfaction) (r = -0·60, r = -0·32, p = 0·001, respectively). Multiple hierarchal regressions revealed a predictive model of only two variables: age (B = -0·22, p = 0·05) and residual renal function (B = -0·23, p = 0·012) for dietary non-adherence. Non-adherence to diet and fluid guidelines association with individual characteristics, health perception and psychosocial variables should be investigated in a longitudinal design. Relationship of non-adherence with culture-related factors should deeply be assessed among Jordanian patients with end-stage renal disease receiving haemodialysis. Identification of the factors that may worsen dietary and fluid non-adherence may lead to improved therapeutic interventions within the mainstream of medical practice for Jordanian patients with end-stage renal disease receiving haemodialysis.

Clinical Inertia as a Clinical Safeguard

INERTIA IS THE RESISTANCE OF A PHYSICAL OBJECT TO A change in its state of motion or rest. Phillips et al have described clinical inertia as “failure of health care providers to initiate or intensify therapy when indicated.” Although clinical inertia may apply to all medical fields, given the lag time between advances in clinical understanding and incorporation into clinical guidelines, as well as the other time needed for the translation of clinical guidelines into clinical practice, Phillips et al intended to limit the discussion of inertia to disorders in which abnormal values may be the only manifestation of the disease, such as diabetes, hypertension, and dyslipidemia. Main causes of clinical inertia include overestimation of care provided, use of “soft” reasons to avoid intensification of therapy (incorrect perception of clinical improvement, dietary nonadherence, and concerns about translation of clinical trials results to individual patients), and lack of understanding about achieving therapeutic goals. While physicians may cite patient refusal or nonadherence as the reason for clinical inertia, it seems likely that in many instances, physician inertia is the reason for the problem. Why physicians—who may have knowledge of and may be familiar with standard-of-care guidelines—seem to be subject to clinical inertia is still an open question. However, there may be an alternative interpretation for the phenomenon: clinical inertia may be a clinical safeguard for the drugintensive style of medicine fueled by the current medical literature.

Mesalamine for Refractory Celiac Disease

Mesalamine for Refractory Celiac Disease

Depressive Symptoms and Dietary Nonadherence in Patients with End-Stage Renal Disease Receiving Hemodialysis: A Review of Quantitative Evidence

Patients with end-stage renal disease (ESRD) who receive hemodialysis have high rates of psychosocial distress and nonadherence to diet prescription. The purpose of this study was to examine the quantitative research evidence about the effect of depressive symptoms on dietary adherence. A systematic search of the literature using MEDLINE, CINAHL, PubMed, and PsycINFO databases was performed for quantitative research studies. Forty-four studies met inclusion criteria and were included in this review. Nearly all studies supported an association between depressive symptoms and dietary adherence in patients with ESRD. Depressive symptoms were associated with dietary nonadherence in patients with ESRD.

Characteristics and in-hospital outcomes for nonadherent patients with heart failure: Findings from Get With The Guidelines-Heart Failure (GWTG-HF)

Medication and dietary nonadherence are precipitating factors for heart failure (HF) hospitalization; however, the characteristics, outcomes, and quality of care of patients with nonadherence are unknown. Recognizing features of nonadherent patients may provide a means to reduce rehospitalization for this population. GWTG-HF registry data were collected from 236 hospitals and 54,322 patients from January 1, 2005 to December 30, 2007. Demographics, clinical characteristics, in-hospital outcomes, and quality of care were stratified by precipitating factor for HF admission. Multivariate logistic regression analysis was used to determine the association of nonadherence with length of stay (LOS) and in-hospital mortality. Clinicians documented dietary and/or medication nonadherence as the reason for admission in 5576 (10.3%) of HF hospitalizations. Nonadherent patients were younger and more likely to be male, minority, uninsured, and have nonischemic HF. These patients had lower ejection fractions (34.9% vs 39.6%, P < .0001), more frequent previous HF hospitalizations, higher brain natriuretic peptide levels (1813 vs 1371 pg/mL, P < .0001), and presented with greater signs of congestion. Despite this, nonadherent patients had shorter LOS (odds ratio 0.94, 95% CI 0.92-0.97) and lower in-hospital mortality (odds ratio 0.65, 95% CI 0.51-0.83) in multivariate analysis. Although nonadherent patients received high rates of Joint Commission core measures, rates of other evidence-based treatments were less optimal. Nonadherence is a common precipitant for HF admission. Despite a higher risk profile, nonadherent patients had lower in-hospital mortality and LOS, suggesting that it may be easier to stabilize nonadherent patients by reinstituting sodium and/or fluid restriction and resuming medical therapy.

Imaging of Inflamed and Vulnerable Plaque in Coronary Arteries with 18F-FDG PET/CT in Patients with Suppression of Myocardial Uptake Using a Low-Carbohydrate, High-Fat Preparation

PET/CT imaging with (18)F-FDG has been used to detect inflammation in carotid and aortic plaque; its use in detecting coronary plaque has been limited by avid (18)F-FDG uptake by the myocardium. We investigated whether (18)F-FDG PET/CT could be used to image inflammation in coronary arteries as a potential noninvasive method to detect vulnerable plaque. We retrospectively studied 32 patients treated for malignancy who underwent (18)F-FDG PET/CT and concomitant cardiac catheterization. As part of the recently described protocol, all patients were instructed to eat a low-carbohydrate, high-fat meal the night before and drink a vegetable oil drink the morning of the study. We reviewed the patients' baseline characteristics and their (18)F-FDG PET/CT scans for adequacy of myocardial uptake suppression and correlated the presence of angiographically apparent plaque with (18)F-FDG uptake in the major coronary arteries. Two independent observers assessed the angiographic images and (18)F-FDG PET scans. A total of 95% of patients had 2 or more coronary disease risk factors, and 25% had unstable symptoms; 30% of index catheterizations resulted in intervention. In 20 of 32 patients (63%), myocardial suppression was good (12) or adequate (8). Inadequate suppression was due to self-reported dietary nonadherence. Patients with good, adequate, and poor suppression had maximal myocardial standardized uptake values of 2.8 +/- 0.7, 5.0 +/- 1.3, and 17.0 +/- 9.7, respectively. We identified (18)F-FDG uptake in 15 patients in 1 or more coronary segments. A trend to significance in correlation between presence of angiographic disease and signal in the vessel was observed (P = 0.07; 80 vessels examined). A total of 7 patients with significant coronary artery disease had aortic (18)F-FDG uptake. In this retrospective study, we demonstrated the potential use of (18)F-FDG PET in imaging of inflammation in coronary arteries. The potential of (18)F-FDG PET is also being investigated in a prospective study.

Meal Provision as a Strategy for Supporting Weight Loss and Improving Metabolic Parameters in Type 2 Diabetes

J.L. is a 65-year-old white woman diagnosed with type 2 diabetes at age 62 years. She has struggled with weight gain during her adult years and has repeatedly attempted to lose weight through various popular diets. Nevertheless, her weight continued to increase, and her glycemic control became increasingly erratic. She reports monitoring her blood glucose infrequently because seeing elevated glucose values causes her to feel “out of control” and depressed. She is generally not physically active and has recently been very inactive because of a leg injury resulting from a fall. At her last physician visit, J.L.'s height was 5′7″, and her weight was 230 lb (BMI 36 kg/m2), her highest adult weight. Her hemoglobin A1c (A1C) was 7.2% on 1,000 mg of meformin twice daily taken with breakfast and with her evening meal, plus 8 mg of rosiglitazone once daily. Her blood pressure was 126/82 mmHg on 150 mg of irbesartan daily, and her lipid panel showed an LDL cholesterol of 107 mg/dl, HDL cholesterol of 42 mg/dl, and triglycerides 156 mg/dl on 20 mg of rosuvastatin daily. J.L.'s physician referred her to a registered dietitian, who determined that J.L. was frustrated and overwhelmed with her attempts to follow multiple dietary recommendations and that meal planning was a considerable stressor for her. This contributed to dietary nonadherence. In addition, J.L.'s leg injury made meal preparation difficult. The dietitian suggested that J.L. try a portion- and nutrient-controlled meal plan that would provide a high degree of structure and support. This option could enable J.L. to experience success with weight loss and help improve her glycemic control and other metabolic parameters. Also, the meals could be used as a …

Effect of warfarin nonadherence on control of the International Normalized Ratio.

The frequency and causes of ab- errant International Normalized Ratios (INRs) in warfarin recipients and the percentage explainable by warfarin nonadherence were studied. The medical records of patients whose warfarin therapy was monitored by a telephone-based anticoagulation service in a Midwestern urban hospital between March 2000 and March 2001 were reviewed for causes of out-of-range INRs, the percentage of out-of-range INRs attributable to warfarin nonadherence, and demographic and clinical variables predictive of nonadherence. Data from 347 patients were studied. The cohort yielded 4305 INRs, of which 1002 (23%) were out of range (lower than 1.8 or higher than 3.4). Thirty-six percent of the out-of-range INRs were due to warfarin or dietary nonadherence, 9% were due to medical systems problems (including drug interactions), 18% were due to a change in clinical status, and 38% were idiopathic. Age younger than 65 years, age greater than 80 years, and living closer to the laboratory were predictive of warfarin nonadherence. Warfarin nonadherence was the most common cause of explainable aberrant INRs in patients taking warfarin. Age younger than 65 years, age greater than 80 years, and living close to the laboratory were predictive of warfarin nonadherence.

Factors contributing to rehospitalization of elderly patients with heart failure.

This article describes factors contributing to rehospitalizations of elderly patients with heart failure. Advanced practice nurses' logs, study questionnaires, and medical record summaries from a recent clinical trial provided rich, descriptive information about a variety of social and behavioral factors surrounding rehospitalization in these medically fragile older people. Medication and dietary nonadherence were factors affecting symptom appearance and rehospitalization. Social and behavioral factors, such as the absence of strong social support or motivation, contributed to nonadherence. These results suggest that social and behavioral factors must be identified and addressed in an individualized manner to prevent recurrent hospitalizations for elderly patients with heart failure.

Patient perspective on factors contributing to nonadherence to diabetes regimen.

This study assessed levels of regimen adherence and reasons for nonadherence to different aspects of diabetes regimen for persons with type I (insulin-dependent, N = 24) and type II (non-insulin-dependent, N = 184) diabetes. Standardized questions revealed few differences between type I and type II participants on either levels of reported adherence or reasons for nonadherence. Subjects reported adhering least well to dietary and physical activity components of the regimen. Open-ended questions revealed that the most common reasons for dietary nonadherence were the situational factors of eating out at restaurants and inappropriate food offers from others. In contrast, negative physical reactions were the most frequently reported reasons for exercise nonadherence. The implications of these findings for diabetes education are discussed.