Dietetic Research Research Articles

Abstracts from Dietetic Research Event – June 4-5, 2009

Once again, the Dietitians of Canada (DC) national conference in Charlottetown provided an opportunity to showcase current research in dietetics and nutrition through the Canadian Dietetic Foundation for Dietetic Research (CFDR) Research Event. We had a large number of abstracts submitted this year, and included 24 oral presentations and 47 posters in the program. I was abstract editor 15 years ago when the DC conference was held in Charlottetown, and I was delighted to see the increased level of interest since then. It is critical for dietitians to be involved in research because it forms the framework and foundation for dietetics. We need to be the generators of the knowledge base for our profession, whether we are students, interns, collaborators, or principal investigators, and whether that knowledge is generated through measuring the impact of our practice, conducting basic research, or exploring the experiences and attitudes of those in our own profession. One of the most exciting things about research in nutrition and dietetics is the diversity of methods and approaches used. In fact, the abstracts included in the DC Conference 2009 are as diverse as our profession. Research presented will enhance our understanding of advances in nutrition education, national guidance, underlying mechanisms of chronic disease, and food service management, to name just a few areas. Settings also vary from public health to long-term care to university laboratories. Dietitians shared their “better practices” in such areas as nutrition screening and assessment, enhancing teaching and learning in undergraduate dietetic education and graduate studies, and health literacy and school nutrition. The “buzz” that these presentations and posters are sure to create will keep our profession vibrant and growing. On behalf of the membership of Dietitians of Canada, I would like to thank Dr. Candice Rideout and Kimberley Hernandez who, along with myself, constituted the small but hard-working Abstracts Review Committee. They not only gave up their time, they provided their expertise in judging a large number of abstracts. I would also like to thank the Canadian Foundation for Dietetic Research for its ongoing support of practice-based research in Canada. I am particularly grateful to Diana Sheh and Isla Horvath for shepherding us through the review process and the scheduling of presentations. Please join me in celebrating Canadian dietetic research represented in these abstracts of the poster sessions and oral abstract presentations from this year's CFDR Research Event.

Research and dietetic practice: An inevitable linkage

Research and dietetic practice: An inevitable linkage

Canadian Dietitians’ Understanding of the Client-Centered Approach to Nutrition Counseling

Many dietetic researchers have recommended the use of a client-centered approach to counseling, but little has been written about what that means from the perspective of the practicing dietitian. The purpose of this study was to explore dietitians’ understanding of the client-centered approach to nutrition counseling. In-depth qualitative interviews were conducted with 25 Canadian dietitians from a variety of practice areas. Interview transcripts were analyzed using a form of inductive, thematic analysis. Results suggest that although participants believe that practicing in a client-centered manner is important, they were struggling in their attempt to balance their practice values and beliefs with the realities of their work environments. Meeting clients’ needs and wants was seen as critical to the client-centered approach, but there was some indecision around who determines these needs and what the difference is between needs and wants. Recognizing the expertise that clients can bring to the counseling relationship was also an issue for participants. Additional research to explore the way that dietitians learn how to counsel can lead to a better understanding of how to develop effective therapeutic relationships with our clients within the confines of current workplace environments.

Nutritional advice and treatment by dietitians to patients with amyotrophic lateral sclerosis/motor neurone disease: a survey of current practice in England, Wales, Northern Ireland and Canada

The management of amyotrophic lateral sclerosis/motor neurone disease (ALS/MND) has shifted from an attitude of nihilism to treatments that prolong survival and offer hope. Nutrition is an integral component of ALS/MND care requiring coordination among acute and community multi-disciplinary teams (MDT). Evidence-based nutrition guidelines exist for this patient group but their use among dietitians is unknown. The aim of this study was to survey the knowledge, practice and guideline use of dietitians working in ALS/MND centres/clinics across England, Wales, Northern Ireland (EWNI) and Canada. Dietetic contact details were obtained from the Motor Neurone Disease Association (MNDA) and the ALS Society of Canada (ALSSC) websites. Telephone interviews were conducted with 23 dietitians using a standardized questionnaire. Multi-disciplinary team membership was high (78%). Only 22% dietitians had >4-years experience in ALS/MND care. Dietitians reported using body weight, percentage weight loss (PWL) and body mass index (BMI) to assess nutritional status. Equations used to estimate energy and protein requirements differed. Most frequent dietary advice was high calorie, texture modification and prescription nutritional supplements. Artificial nutrition and hydration (ANH) was discussed when patients developed dysphagia, energy intake was inadequate, weight loss of 10% or forced vital capacity (FVC) was reduced. A percutaneous endoscopic gastrostomy (PEG) service was available at all clinics/centres. Nutritional assessment techniques and dietary advice should be standardized. Dietetic collaboration at national and international level is recommended to reduce professional isolation. Training and support in ALS/MND nutrition should be made available as part of post-dietetic registration. Further dietetic research is required to stimulate nutritional care.

ADA’s Dietetic Practice-Based Research Network (DPBRN) Members

ADA’s Dietetic Practice-Based Research Network (DPBRN) Members

FROM THE EDITOR

This issue of the Journal represents another landmark development, with the supplementary publication of the abstracts for the 24th National Conference of the Dietitians Association of Australia. The theme of the conference is ‘Food and beyond: exploring frontiers in science and practice’.** Members and subscribers can view the supplement online at http://www.blackwell-synergy.com/loi/ndi. The topics covered in the conference reflect much of the material presented through the Journal, including a plenary session provided by Dr Ruth de Busk, whose Editorial on nutrigenomics in a previous issue of the Journal came to life in her presentation on future dietetics. The Editorial in this issue, provided by Professor Sandra Capra, builds on Professor Capra’s presentation at the conference on the revised nutrient reference values for Australia and New Zealand, with implications for nutrition professionals. Here we are reminded of the challenges faced with defining adequate diets, optimal nutrient intakes and the formulation of food groups. The leading article by McNaughton and the referent research piece by Mann and colleagues both pick up on the impact of decisions that lead to food groups. The logic behind these decisions needs to be made transparent to enable adequate critique of analytical outcomes that use the food group categories. The Mann study draws on dietary methodology, a core element of nutrition and dietetics research. In an analysis funded by Meat and Livestock Australia, the report shows that data from a food frequency questionnaire could produce outcomes showing the impact of red meat consumption on total fat intake to vary from 19.8% to 4.3% depending on how the food classification system was applied. This finding has important implications for practitioners working in both the public health and food industry contexts who need to know how to position their advice on food in a fair, accurate and productive way. Providing effective dietary advice for clinical conditions also requires a strong evidence base. This issue is addressed in the review by Volker and Yunianingtias on the nutritional management of non-alcoholic steatohepatitis, a condition with some association to metabolic syndrome. Although most of the evidence was provided in smaller clinical studies, nutritional therapy was found to be targeted at risk factors. As with metabolic syndrome, diet and exercise intervention appeared to provide benefits, whereas some interesting opportunities with vitamin E and omega-3 fatty acids warranted further exploration. Preventing metabolic syndrome in another population group, recent migrants, would benefit from an understanding of dietary acculturation, the focus of the research by Renzaho and Burns. In a study of 139 Melbourne households, new foods consumed by sub-Saharan migrants were identified as pizza, breakfast cereal and other fast foods, but included new types of vegetables and fruits, and oils (olive and canola). Although concerns about the negative impact of diet acculturation are prudent, there is also room to consider the positives. Breastfeeding mothers are another group that require particular attention from nutritionists, who in turn need to base their advice on a strong evidence base. It is pleasing then to see another systematic review, this time from Giglia and Binns on alcohol and lactation. With a focus on alcohol effects on lactogenesis as well as effects on the infant, the authors conclude that the use of alcohol in this context needs to be prudent, putting limits of only one to two standards drinks after breastfeeding. How parents gain information on diet and nutrition is the focus of the final paper, an insight report from Steinbeck and Owaimrin. Here the focus is on weight management using the Internet. The authors conclude that there appears to be a paucity of accessible information related to childhood weight management. In keeping with the theme of a strong evidence base for practice, the authors also suggest that websites include clinically approved management guidelines and confirm to e-health codes of ethical practice. The June issue of the Journal also includes book reviews on some very interesting new offerings, and an update on articles of interest reported in the nutrition science literature. The continuing education section by Patch, covering consumer behaviour, is something different and relevant to all walks of practice. Combined with the conference supplement, I trust you enjoy the mid-year treat.

Ethics Opinion: Conflicts of Interest in Presentations and Publications and Dietetics Research

Ethics Opinion: Conflicts of Interest in Presentations and Publications and Dietetics Research

Using interpretative phenomenological analysis for public health nutrition and dietetic research: a practical guide

The present paper introduces interpretative phenomenological analysis (IPA) as a framework for analysing qualitative research data collected for public health nutrition and dietetic research studies. The theoretical roots of IPA have been set out briefly in order to help researchers decide whether the approach is relevant for them and their particular research questions. IPA can be used to analyse data from one-to-one interviews in order to develop 'thick descriptions' that may help illuminate human experience. IPA can also be used to develop theories and/or models, which could help inform policy. The main body of the paper describes the analytical techniques and procedures used to achieve both outcomes in a practical way, using examples from the author's own research. In the following paper Krueger's methods for analysing focus group data are set out for comparison. It is hoped that these papers will empower researchers with little experience of qualitative research to develop confidence with qualitative data analysis. In addition, it is hoped that the material will stimulate debate amongst more experienced qualitative researchers from a public health or dietetic background.

Mainstreaming international outcomes research in dietetics

Mainstreaming international outcomes research in dietetics

Research: ADA’s commitment

Dietetics is the integration and application of principles derived from the sciences of nutrition, biochemistry, physiology, food management and behavioral and social sciences to achieve and maintain people’s health; therefore, dietetics research is a dynamic collaborative and assimilative endeavor.—From ADA’s Research Philosophy

Communicating and judging the quality of qualitative research: the need for a new language.

Traditionally UK dietitians have tended to take a more quantitative approach to research. Qualitative research which gives an in-depth view of people's experiences and beliefs is also now being used to help answer some important dietetic research questions. A review of the limited number of qualitative research papers in the Journal of Human Nutrition and Dietetics 1990-2002 (nine papers in all), revealed a lack of specific discussion of the quality strategies commonly used in qualitative research. This could indicate a less than robust approach, but might also reflect a different perspective on quality, or simply the difficulties associated with disseminating qualitative research to a profession whose members lack familiarity with the language. The fact that qualitative research seems to be used rarely may also indicate a poor understanding of its role. This paper seeks to clarify the potential role of qualitative research and draws on previously published guidelines for demonstrating quality. It is hoped that this will offer dietitians a framework for carrying out qualitative research and a language for reporting it, as well acting as a stimulus for discussion.

RELATIVE WEIGHTS AND ACTIVITY LEVELS OF CANADIAN DIETITIANS

PURPOSE When counseling clients, dietitians often recommend healthy weights and active living. This study was conducted to determine to what extent these recommendations are reflected in dietitians' personal lifestyles. METHOD: A questionnaire was sent to a randomly-selected sample of Canadian dietitians (n=695). It sought information on self-reported height and weight (used to calculate Body Mass Index [BMI;kg/m2]), the proportion presently trying to lose weight, the number of times per week ≥30 min of moderate aerobic activity was accumulated, and the proportion who thought they were getting enough exercise. With 2 follow-up mailings, the response rate was 74%. Only 9 respondents were men, so analyses were restricted to women. RESULTS Mean BMI was 23.2±4.0: 70% were in the healthy weight range (BMI 18.5–24.9), 15% were overweight (BMI 25–29.9) and 12% were obese (BMI ≥ 30). Overall, 32% of dietitians were currently trying to lose weight, and this was related to BMI category: 27% of healthy weight, 51% of overweight and 50% of obese dietitians were trying to lose weight. With regard to exercise, 33% accumulated ≥30 min of activity ≥2 times/wk, 40% did so 3–4 times/wk and 27% did so ≥5 times/wk. Exercise frequency was not associated with BMI, which averaged 23.6±3.9, 22.7±3.4 and 23.3±5.0 for the 3 exercise groups, respectively. Altogether, 66% felt they did not get enough exercise, and this was strongly related to exercise frequency: only 2% of those active ≥2 times/wk thought they got enough exercise, compared to 38% and 70% of those active 3–4 and ≥5 times/wk (P<0.001). However, regardless of actual activity level, those who thought they weren't getting enough exercise had higher BMI (23.4±3.6 vs 22.6±4.5, P<0.05). CONCLUSION Most Canadian dietitians report BMI within the healthy range and activity levels consistent with recommendations. Those who are less active appear to be aware of the need to increase their activity. (Supported by a grant from the Canadian Foundation for Dietetic Research)

Editorial

Editorial

Journal of The American Dietetic Association Guidelines for Authors

The Journal of The American Dietetic Association is the official research publication of the American Dietetic Association. Its purpose, expressed in its mission statement, is “To be the premier peer-reviewed journal in the field of nutrition and dietetics and to embody the mission of the American Dietetic Association.” As such, the Journal publishes manuscripts that advance knowledge across the range of research and practice issues in nutrition and dietetics and that support the professional growth of Association members. We invite contributions of original research, review, and application in such areas as nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, foodservice systems, leadership and management, and dietetics education.

Guidelines for Authors

Guidelines for Authors

Research Competencies in the Dietetics Curricula

Investment in dietetics research has the potential to improve general health; increase work performance and learning capacity; extend disease-free life; reduce birth defects, infections, and chronic diseases; and decrease health care costs. Opportunities exist for research in the areas of solid waste management, global environment, health care reform, and foodservice systems management. Research efforts can focus on cost-effectiveness and medical efficacy of dietary services to improve third-party reimbursement. Educators have a stake in creating the future by conducting research, teaching research to dietetic students, and investigating the effectiveness of education. J Am Diet Assoc. 1997;97(suppl 2):S102–S106.

General Clinical Research Center Research Dietitians: Providing Information and Support to the Dietetics Research Community

General Clinical Research Center Research Dietitians: Providing Information and Support to the Dietetics Research Community

Guidelines for Authors

The Journal of The American Dietetic Association is the official research publication of The American Dietetic Association. Its purpose, expressed in its mission statement, is “To be the premier peer-reviewed journal in the field of nutrition and dietetics and to embody the mission of The American Dietetic Association.”As such, the Journal publishes manuscripts that advance knowledge across the range of research and practice issues in nutrition and dietetics and that support the professional growth of Association members. We invite contributions of original research, review, and application in such areas as nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, foodservice systems, leadership and management, and dietetics education.

Guidelines for Authors

The Journal of The American Dietetic Association is the official research publication of The American Dietetic Association. Its purpose, as expressed in its mission statement, is “To be the premier peer-reviewed journal in the field of nutrition and dietetics and to embody the mission of The American Dietetic Association.” As such, the Journal publishes manuscripts that advance knowledge across the range of research and practice issues in nutrition and dietetics and that support the professional growth of Association members. We invite contributions of original research, review, and application in such areas as nutritional science, medical nutrition therapy, public health nutrition, food science and biotechnology, foodservice systems, leadership and management, and dietetics education.

Is it time for computer-assisted decision making to improve the quality of food and nutrition services?

Is it time for computer-assisted decision making to improve the quality of food and nutrition services?