Implementation Of Nutrition Guidelines Research Articles

Adherence to Dietary Recommendations in Organized Living Beneficiaries with Severe Mental Disorders and Their Caregivers.

People with severe mental disorders often require special care. Other than institutionalized care, some organizations provide housing options and special care in the form of organized living. Few studies provide a detailed description of nutrient intake in this type of care. The aim of this prospective study was to assess nutritional status and adherence to dietary recommendations in both people with mental disorders (beneficiaries) and their caregivers. Across three levels of care, 46 beneficiaries and 19 caregivers participated in the study. The mean intakes of energy (kcal/day) and macro- and micronutrients (g/day) were estimated from a 3-day dietary record and compared with dietary reference values (DRVs) set by the European Food Safety Authority (EFSA). The majority of participants did not meet energy intake recommendations (kcal/day). The contribution of total fat to energy intake (% E) was higher than recommended in both beneficiaries and caregivers with 42.1 ± 4.4% and 38.5 ± 6.5%, respectively. A total of 45.2% of beneficiaries and 61.1% of caregivers had their carbohydrate intake within the recommended range. Fiber intake was well below the recommendations (25 g/day) in all groups. Across all levels of care, lower micronutrient intake for pantothenic acid, biotin, folate, potassium, magnesium, copper, selenium, and iodine was observed. Based on the current results, the development and implementation of nutritional guidelines may be targeted to specific populations and nutrient intakes.

The evaluation of a FEDS communication tool to improve mealtime outcomes in an older intellectual disability residential centre

Aim: Eating involves a range of functions including motor, sensory, and cognitive skills. Feeding, eating, drinkning (FEDS) and swallowing disorders can occur with the breakdown of any of the aforementioned functions. Difficulty swallowing, or dysphagia, can result in both physical and nutritional issues that can put a person at risk of aspiration, choking, malnutrition and death. While there are no figures on the prevalence of dysphagia in an older intellectual disability residential population, studies have shown that 28.6 – 68% of people with dementia have a FEDS disorder. Other studies have shown that 36% people with an intellectual disability in a hospital based setting can have a FEDS disorder. It is also acknowledged that the FEDS disorders within this population can largely go unrecognised. Malnutrition in a residential setting in Ireland has been identified as 25% - 32% of residents in a care home. Method: 5 key areas were audited staff practices versus therapist guidelines as follows: 1) food and fluid consistencies; 2) supervision and support; 3) environment 4) Documentation of FEDS and 5) nutritional guidelines. A training programme was developed to address deficits in these areas, rolled out to all staff involved in providing care and support to resident at mealtime. Staff were also surveyed in relation to their training needs pertaining to providing support at mealtime. Each service user was risk assessed using the INDI/IASLT guidelines on management of FEDs difficulties in the residential care setting. Each service user was proved with a mealtime placemat, colour coded to indicate their level of risk in relation to FEDs at mealtimes and with all their FEDS guidelines. The practices on the unit were re-audited 3 months and 1 year post intervention Results: The results show an improvement in the implementation of FEDs guidelines, in particular the improvement of implementation of nutrition guidelines, which improved from 31% to 87.5% 3 months post implementation of the communication tool. A year post implementation show the change was sustained. There was also a significant improvement in the implementation of consistency recommendations from 80% to 97.5%. This change was also sustained 1 year post intervention. In addition to the improvement of FEDS guidelines with the placemat communication tool, the nutritional status of residents at risk of malnutrition also improved. The average weight gain in residents (n=7) at risk of malnutirion was 3.4kg over the period of a year. Conclusion: Effective communication tools in the form of a placemat to carers can help improve communication of FEDS guidelines and improve nutritional status of people at risk of malnutrition.

Adopting and implementing nutrition guidelines in recreational facilities: Public and private sector roles. A multiple case study

BackgroundRecreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them.MethodsWe used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools.ResultsThe keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers’ nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY.ConclusionsANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor. Where ANGCY uptake does occur, changes to the food environment may be relatively minor. Stronger government measures may be needed to require recreational facilities to improve their food environments and to limit availability of unhealthy foods.

Improving children's nutrition environments: A survey of adoption and implementation of nutrition guidelines in recreational facilities

BackgroundAlthough the mandate of recreational facilities is to enhance well-being, many offer foods inconsistent with recommendations for healthy eating. Little is known regarding recreational facility food environments and how they might be improved, as few studies exist. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are intended to ensure access to healthy food choices in schools, childcare and recreational facilities. This study investigated awareness, adoption and implementation of the ANGCY among recreational facilities in Alberta, Canada, one year following their release.MethodsA cross-sectional telephone survey was conducted from June - December, 2009 (n = 151) with managers of publicly funded recreational facilities that served food. The questionnaire included 10 closed and 7 open ended questions to assess the organizational priority for healthy eating, awareness, adoption and implementation of the ANGCY. Chi-squared tests examined quantitative variables, while qualitative data were analysed using directed content analysis. Greenhalgh's model of diffusion of complex innovations within health service organizations constituted the theoretical framework for the study.ResultsOne half of respondents had heard of the ANGCY, however their knowledge of them was limited. Although 51% of facilities had made changes to improve the nutritional quality of foods offered in the past year, only a small fraction (11%) of these changes were motivated by the ANGCY. At the time of the survey, 14% of facilities had adopted the ANGCY and 6% had implemented them. Barriers to adoption and implementation were primarily related to perceived negative attributes of the ANGCY, the inner (organizational) context, and negative feedback received during the implementation process. Managers strongly perceived that implementing nutrition guidelines would limit their profit-making ability.ConclusionsIf fully adopted and implemented, the ANGCY have the potential to make a significant and sustained contribution to improving the recreational facility food environment, however one year following their release, awareness, adoption and implementation of the ANGCY remained low. A mandated policy approach could offer an efficacious, cost-effective means of improving the food environment within recreational facilities.

Implementing quantified guidelines for school meals

The findings of earlier documented studies of the nutritional content of school meals point towards the need for nutritional guidelines. If such guidelines are to be met, attempts need to be made to change the types of food consumed by schoolchildren. This paper reports on efforts to assess the nature of foods commonly consumed in a group of London schools, to determine whether a high proportion of fat in the meals is having a ‘diluting effect’ on the nutrient content, and to determine the foods which are the main contributors of important nutrients. The implications of the findings of the reported study are relevant to those involved in the implementation of nutritional guidelines in school meals, notably for nutrition educators and caterers.