Local Dietitians Research Articles

Validity and Reproducibility of a Semiquantitative Food Frequency Questionnaire and Food Picture Book in Nigeria

BackgroundIncreasing noncommunicable diseases in Nigeria are partly related to dietary factors. However, the lack of validated nutrition assessment tools hinders the conduct of nutritional epidemiology research in this population. ObjectivesTo develop a Food Frequency Questionnaire (FFQ) and Food Picture Book (FPB) for Nigerian adults, and to assess its reproducibility and validity compared with 24-h dietary recalls (24DRs) during different seasons in the year. MethodsWe compiled 202 foods for the FFQ through focus groups and consultations with local dietitians. We created an FPB with standardized food portion images to enhance the accuracy of reports of dietary intakes. We administered the FFQs to 205 purposively selected adults in Ibadan, Nigeria at ∼6 monthly intervals between November 2018 and October 2020. We evaluated the FFQ’s reproducibility and validity compared with 24DR across the dry and rainy seasons by examining the consumption of common food and mixed dishes. We computed the Spearman’s correlation coefficients (SCC), intraclass correlation coefficients (ICC), and Wilcoxon signed-rank tests, and generated Bland and Altman plots. ResultsOverall, we studied 110 women (53.7%) and 95 men (46.3%) with a mean age of 45.0 ± 13.4 y (mean ± SD). The reproducibility tests showed a mean ± SD SCC of 0.39 ± 0.14 and mean ± SD ICC of 0.32 ± 0.12. Higher mean ± SD SCC values were noted for cereal products (0.43 ± 0.09), starchy roots and tubers (0.45 ± 0.17), and soups (0.44 ± 0.20). Conversely, lower mean ± SD SCC values were observed for milk products (0.29 ± 0.02), solid fats (0.29 ± 0.26), and fish (0.22 ± 0.19). Regarding validity tests, the overall mean ± SD SCC was 0.27 ± 0.16 and mean ± SD ICC was 0.26 ± 0.16. We observed seasonal variations in intakes of fruits, cassava flour-based products, and nuts, although most foods did not show significant differences in intakes between seasons. ConclusionsOur FFQ and FPB demonstrated moderate correlations and seasonal variations in intakes of certain foods, emphasizing the need to account for seasonality in dietary intakes in nutritional studies in Nigeria and similar countries.

WE3.4 Nutrition in the Surgical Patient: Evaluation of the Current Knowledge and Practice in a Tertiary Centre

Abstract Aims Methods We performed a multi-cycle assessment using the PDSA format. To establish current knowledge a quiz was designed in consultation with local dietitians. The following domains were evaluated against NICE guidelines: A pass mark of 80% was established to aid data collection. Cohort 1 consisted of 47 foundation year 1 doctors undertaking surgical rotations. With the analysis of results from the first cohort a teaching session was designed. Following delivery of the teaching session, the cohort re-attempted the quiz. Results Cohort 1 Conclusions

Flint Families Cook: A Virtual Cooking and Nutrition Program for Families

Amid parental concerns regarding poor nutrition and lack of cooking skills among youth in Flint, Michigan,1 a team of local dietitians, chefs, and researchers created Flint Kids Cook (FKC). The program was grounded in Social Cognitive Theory,2 focusing on improving youth knowledge, skills, and self-efficacy for cooking fresh, healthy foods. A trained chef and registered dietitian co-facilitated interactive lessons designed to increase knowledge and develop skills to prepare healthy meals and snacks at home.

Utilization of Dietitians in the Management of Irritable Bowel Syndrome by Members of the American College of Gastroenterology.

The aim of this study was to identify benefits and barriers to using a gastroenterology (GI) dietitian for irritable bowel syndrome (IBS) care. A 25-question survey was electronically distributed to the members of the American College of Gastroenterology. Information pertaining to demographics, barriers, and values to using a GI dietitian for IBS patient care was collected. Two hundred seventy-nine survey responses were collected. Although 56% of the GI providers feel they are trained to provide nutrition education, almost half (46%) sometimes, rarely, or never provided information to aid menu planning, label reading, or grocery shopping, and 77% spent ≤10 minutes for nutrition counseling. Of those with access to a local dietitian, 91% strongly agreed or agreed that having access to a GI dietitian would help them manage their IBS patient care more effectively, but 42% lack access to a local GI dietitian. Our survey identified gaps in nutrition-based interventions for IBS care.

P4.07: Does our current dietetic input meet the long term needs of our post transplant patient population?

Introduction: As a super-regional centre with patients from all over the UK frequent face to face contact is not feasible, therefore telephone or email dietetic consultations are necessary. Current dietetic review practice is to personally see patients at their annual review and outpatient appointments to provide assessment of nutritional parameters, intake and matching this to need. Telephone consultations are more ad hoc but are amenable to be standardised so to provide a robust dietetic follow up. We therefore report on current practise and recommendations for future standards of care. Aim: To review our current practise of dietetic input and provide recommendations for future standards of care. Methods: Dietetic notes of all patients who have a small bowel containing graft throughout 2018 who are cared for at Birmingham Children’s Hospital, were retrospectively reviewed to identify all patient contact during the study year. We then looked at the intensity of nutritional support and dietetic needs. Of note, some patients will also have local dietetic intervention. Results: 32 patients were under review throughout 2018. Table 1 shows the dietetic input required and table 2 the median number of reviews each group received. As expected the patients requiring the most intense dietetic intervention have received the most input. It is vital however to consider individual patient need as some patients on less intense intervention required more frequent review demonstrated in the range of patient contacts. 6 patients also had local dietetic input. Conclusion: Dietetic input into small bowel graft patients in imperative. Rationalisation of resources means that those at high risk or high supplemental needs should be prioritised and a standard of care developed. We propose the following standard:- Develop care pathway for each group highlighting frequency of follow up and method to escalate concerns to consultant. Written information for families regarding review process to ensure early reporting of concerns. Referral to local Dietitian where appropriate. Telephone proforma to ensure consistency.

Health Professionals’ Perceptions of a Pediatric Nutrition Support Program Led by a Clinical Dietitian at a Low-resource Hospital Setting in Malawi (P12-028-19)

ObjectivesThe first four dietitians graduated in Malawi in 2017, providing a new opportunity to build capacity to introduce nutrition support in an acute care setting. We designed and implemented a pediatric nutrition support program at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi including the hiring of a local dietitian in August 2018. Upon introducing this program, we aimed to qualitatively assess perceptions around the nutrition support program from the perspective of health professionals at QECH. MethodsQualitative interviews using a narrative research approach were undertaken to understand perceptions about the nutrition support program. Participants were selected through a purposive sampling approach across the eight wards within the nutrition support program at QECH. Interviews were held with nurses (n = 5) and clinicians and surgeons (n = 11) at QECH in November and December 2018. These interviews were audio-recorded before being transcribed and themes were then coded inductively using NVivo 11 software. ResultsAll participants of the qualitative interviews emphasized the importance and impact of the nutrition support program in enhancing care of hospitalized children and therefore improving child outcomes such as tolerability of clinical interventions, decreased duration of stay, and reduced risk of hospital readmission. Other themes that arose were the receptiveness of guardians of children who received nutrition support, the importance of engaging other health professionals in nutrition support, and the need for prioritization of nutrition support by the Ministry of Health to sustain and scale up this type of program in Malawi. ConclusionsQualitative interviews with nurses, clinicians, and surgeons highlighted the value of nutrition support to improve quality of care in low-resource hospital settings. Integration of dietitians into the healthcare system in low- and middle-income countries like Malawi will require further advocacy around the potential for nutrition support to improve outcomes in vulnerable children. Funding SourcesThe introduction of the nutrition support program was funded by the Centre for Global Child Health Catalyst Grant from the Hospital for Sick Children.

The introduction of a paediatric nutrition support program led by a clinical dietitian at a low-resource hospital setting in Malawi

ABSTRACTIn low- and middle-income countries, nutrition support strategies are often suboptimal or non-existent in hospital settings. This is further compounded by high rates of malnutrition in these countries. The first four dietitians graduated in Malawi in 2017 providing a new opportunity to build capacity to introduce nutrition support in an acute care setting. A paediatric nutrition support program was implemented at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi including the hiring of a local dietitian. This capacity building paper explains the development and introduction of the nutrition support program including a description of perceptions of health professionals at QECH working alongside the dietitian. In the first four months of the program at QECH, the dietitian provided nutrition support to 183 different patients across paediatric wards. Nutritional interventions predominantly included infant formula and breastmilk fortification, provision of therapeutic feeds orally or via nasogastric tubes, increased dietary protein intake for children identified to be at high risk, and nutritional counselling to caregivers. More complex nutritional interventions were also given such as the insertion of gastrostomy tubes to deliver nutrition directly to the stomach. Following the introduction of the program, qualitative interviews were done with health professionals at QECH including nurses (n = 5) and physicians (n = 11). All participants emphasized the importance and impact of the nutrition support program in enhancing the care of hospitalized children, therefore improving outcomes such as tolerability of clinical interventions, decreased duration of stay, and reduced risk of hospital readmission. In conclusion, there is a need for nutrition support provided by a dietitian for different paediatric patients which was corroborated by positive feedback from health professionals at QECH. Integration of dietitians into the healthcare system by respective Ministries of Health will require advocacy around the potential for nutrition support to strengthen the quality of care of vulnerable children.A Chichewa abstract for this paper is available in a supplementary file.

Development of Evaluation Tools to Assess the Effectiveness of a Guided Grocery Store Tour Nutrition Education Program: A Pilot Study

Evaluate the effectiveness of a guided grocery store tour to improve Nutrition Knowledge (NK) and Food Selection Behaviors (FSB) among low-income adults in Pitt County, North Carolina. The study was conducted in collaboration with the Pitt County Health Department and used the national curriculum, Cooking Matters At The Store (CMATS). Local dietitians led each tour and focused on label reading, comparing unit prices, whole grains, and purchasing fruits/vegetables (fresh, frozen, canned). Each tour ended with a “$10 Challenge” in which participants use knowledge learned to make a healthy meal with a budget. Participants made additional baskets if they did not meet the challenge on the first try. NK was evaluated with a 16-item pre/post survey. FSB were evaluated during the $10 Challenge by photographing each meal created by participants. Descriptives and Wilcoxin-signed rank tests were used to analyze data. A total of 28 participants from 10 tours were included in the final sample. Participants were primarily female (98.6%) and were Black. NK significantly improved (82.81% (pre), 89.06% (post); p-.03). Approximately 69% of participants met the $10 challenge on the first round. No significant differences were observed in calories or macronutrients between the first, and second or third challenge baskets created. Overall, evaluation of the CMATS program demonstrated improvement in NK and FSB. Due to high pre-scores, the NK survey questions need revision. Future research will evaluate the program in a larger sample of low-income adults.

More-2-Eat: evaluation protocol of a multi-site implementation of the Integrated Nutrition Pathway for Acute Care

BackgroundNutrition care in hospitals is often haphazard, and malnourished patients are not always readily identified and do not receive the care they require. The Integrated Nutrition Pathway for Acute Care (INPAC) is an algorithm designed to improve the prevention, detection and treatment of malnutrition in medical and surgical patients. More-2-Eat is an evaluation of the implementation of INPAC care activities (e.g. screening) in five diverse medical units from different hospitals in Canada. The primary purpose is to understand how tailored implementation affects INPAC uptake and factors that impact this implementation. The principal outcome is a toolkit that can provide guidance to others.MethodsThis participatory action research uses a before-after time series design to address several research questions focused on implementation and uptake of INPAC (e.g., Does the implementation of INPAC improve the detection of malnutrition? Do nutrition care related knowledge, attitudes and practices scores of unit staff change with the implementation of INPAC?). A six-month developmental phase where baseline data were collected is followed by a twelve-month implementation phase and a three-month sustainability phase. Qualitative and quantitative data are collected concurrently, and to address key research questions, these data are merged. Quantitative data are collected on-site by trained local dietitians and include chart audits of nutrition care practices and a more detailed assessment of recruited patients on quality of life, disability, frailty, food intake and barriers to food intake. Thirty-day post discharge follow up for these patients occurs by researchers via a telephone interview at three time points within baseline and implementation phases, to ascertain the same and other outcomes (e.g. readmission to hospital). Qualitative data include focus groups and key informant interviews completed by researchers, monthly teleconferences among the sites and site-completed forms that track implementation activities. Resource utilization of dietitian time for various care activities (e.g. assessment) and staff time to assist patients at mealtimes is also collected.DiscussionMore-2-Eat provides an example of how implementation can be tailored when a care algorithm is embedded into routine practice. The project also highlights important learning points with respect to data collection and techniques to support implementation.Trial registrationRetrospectively registered ClinTrials.gov Identifier: NCT02800304 June 7, 2016.

Diving deeper: ways to improve the early identification of young clients with disordered eating in rural areas

Connections with a local mental health service for young people, headspace, led to collaboration between local health service dietitian's and headspace staff. This partnership enables early detection and treatment of young people with disordered eating in Tamworth NSW. A project identified the need to enhance staff awareness of nutrition and disordered eating, improved management of young people with disordered eating and streamlined referral processes to local dietitians. Specific education was conducted for headspace, Tamworth staff about food, mood and body image in young people. Staff then attended formal training in identifying and assessing eating disorders. Staff identified the development of a dietetic service for disordered eating, as a priority for headspace, Tamworth. Standard intake forms were adapted with more detailed questions about intake and attitudes to food and body image. Referral processes to dietitians were improved and referral numbers increased markedly. The demand for eating disorder specific dietetic services led to funding for an on-site dietitian one day per week. Dietitian led monthly clinical case review, staff inservices and young person cooking skills classes have all commenced since the service began. Improved screening and referral processes have identified the need to ‘dive deeper’ into nutrition for this target group.

Multicentre, Cluster‐Randomized Clinical Trial of Algorithms for Critical‐Care Enteral and Parenteral Therapy (ACCEPT).

Background: The provision of nutrition support for patients in intensive care units (ICUs) varies widely both within and between institutions. We tested the hypothesis that evidence‐based algorithms to improve nutrition support in the ICU would improve patient outcomes. Methods: A cluster‐randomized controlled trial was performed in the ICUs of 11 community and 3 teaching hospitals between October 1997 and September 1998. Hospital ICUs were stratified by hospital type and randomized to the intervention or control arm. Patients at least 16 years of age with an expected ICU stay of at least 48 hours were enrolled in the study (n = 499). Evidence‐based recommendations were introduced in the 7 intervention hospitals by means of in‐service education sessions, reminders (local dietitian, posters) and academic detailing that stressed early institution of nutrition support, preferably enteral. Results: Two hospitals crossed over and were excluded from the primary analysis. Compared with the patients in the control hospitals (n = 214), the patients in the intervention hospitals (n = 248) received significantly more days of enteral nutrition (6.7 vs 5.4 per 10 patient‐days; p = .042), had a significantly shorter mean stay in hospital (25 vs 35 days; p = .003) and showed a trend toward reduced mortality (27% vs 37%; p = .058). The mean stay in the ICU did not differ between the control and intervention groups (10.9 vs 11.8 days; p = .7). Interpretation: Implementation of evidence‐based recommendations improved the provision of nutrition support and was associated with improved clinical outcomes.

Helping Teens Navigate a Safe Passage From Childhood to Adulthood

Helping Teens Navigate a Safe Passage From Childhood to Adulthood

An Exploratory Study of Physician Referrals to Dietitians Before and After Distribution of Materials Promoting Nutrition Care Services

This study was conducted to examine physician referral practices to licensed registered dietitians (LRD) for nutrition care services (NCS) before and after distribution of promotional materials and to determine whether demographic characteristics such as age, gender, years in practice and location of practice, were associated with physicians’ referral practices. The survey population consisted of all (624) internal medicine physicians and family practice physicians registered with the North Dakota Board of Medical Examiners in North Dakota. A pre-survey was mailed to physicians which queried their present referral practices, reasons for non-referrals, awareness of reimbursement for NCS in North Dakota (ND), and NCS they were most likely to incorporate into their practice. The physicians were personally contacted, by local dietitians, to hand-collect the survey. A return rate of 17.6% was achieved. A brochure and four fact sheets were mailed, intermittently, to the physicians. The materials contained information about: benefits of NCS for patients with diabetes and high cholesterol, reimbursement of NCS in ND, and general background information about the dietetic profession. A post-survey was mailed to the physicians. A return rate of 30.8% was achieved. Of the physicians responding yes, they had received the materials, 30% indicated their referrals had increased since receiving the brochure and fact sheets. The findings from this study exemplify the positive impact that marketing can have on physician referrals to dietitians, and can help justify the need for development and implementation of marketing strategies. Dietitians must take an active role in marketing on an individual, state, and national level, in order to stay ahead of the competition and remain foremost in the minds of physicians for NCS.

American Dietitians Residing in Europe:: A Professional Profile

A twenty question survey addressing the areas of education, employment, and individual information was sent to the 121 members of the American European Dietetic Association (AEDA) residing in Europe. The purpose was to assess the proportion who were working and to examine their areas of practice and duties. Obstacles to employment were also investigated. A total of 58 responses was obtained. Most respondents were R.D.s, and 60% had at least a Master's level education. 72% indicated they planned to return at some point to practice in the United States. Half of the respondents were employed part- or full-time. Of those not employed, the most often cited reason (55%) was attributed to lack of job opportunities, followed by family limitations. In many cases, those who were not formally employed undertook dietetics or nutrition related volunteer work. Regarding the employed group, important routes to finding employment were given as Military, professional networking, and professional publication listings. The most predominant area of employment was Foodservice, followed by Clinical Nutrition. The most frequently indicated job responsibility was individual outpatient counseling, although responsibilites were numerous and varied for each individual. The majority spoke predominantly English in the workplace. Salaries varied widely. Several of the respondents (7%) had started their own businesses, some outside the Held of dietetics. Individual information concerning age, spare time activities, length of residence and residency status was also requested. Numerous comments were provided indicating the variations in training, status, and practice requirements of local dietitians between different countries. Comments also esteemed the AEDA for its strong supportive role in helping American R.D.s abroad with networking as well as helping to reduce an often-felt initial sense of professional isolation. The AEDA provides a forum for exchange of ideas and is useful to keeping up with developments in the field, both in the US and international arenas.