Need For Nutritional Intervention Research Articles

Estado nutricional dos adolescentes e sua relação com variáveis sociodemográficas: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009

The aim of this study was to describe the nutritional status of adolescents in the 9th year of public and private schools of the Brazilian capitals and its association with socio-demographic variables. By means of a self-completed questionnaire, information related to sex, race, age, public/private school, macro-region of the country, maternal education and family possessions were recorded. Measures of weight and height were measured according to standardized procedures. Height for age and body mass index for age was evaluated according to the World Health Organization reference. Anthropometric measurements of 58,971 adolescents were obtained, of which 2.9% were stunted and 2.9% underweight. There was 23.0% of overweight and 7.3% of obesity, which were higher in the South and Southeast regions. Deficits in height and weight, overweight and obesity were more prevalent in boys. The deficits were higher at public schools while overweight and obesity at private ones. Adolescents whose mothers were less educated or from poorer families had greater deficits in height and the reverse occurred with overweight and obesity. The findings about the deficits, overweight and obesity highlight the need for nutritional interventions designed to reach this stage of life.

Position of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities

It is the position of the American Dietetic Association that the quality of life and nutritional status of older adults residing in health care communities can be enhanced by individualization to less-restrictive diets. The American Dietetic Association advocates for registered dietitians to assess and evaluate the need for nutrition interventions tailored to each person's medical condition, needs, desires, and rights. Dietetic technicians, registered, assist registered dietitians in the assessment and implementation of individualized nutrition care. Health care practitioners must assess risks vs benefits of therapeutic diets, especially for older adults. Food is an essential component of quality of life; an unpalatable or unacceptable diet can lead to poor food and fluid intake, resulting in undernutrition and related negative health effects. Including older individuals in decisions about food can increase the desire to eat and improve quality of life. The Practice Paper of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities provides guidance to practitioners on implementation of individualized diets and nutrition care.

The Nutritional Status of School-Aged Children: Why Should We Care?

The nutritional status of school-aged children impacts their health, cognition, and subsequently their educational achievement. The school is an opportune setting to provide health and nutrition services to disadvantaged children. Yet, school-aged children are not commonly included in health and nutrition surveys. An up-to-date overview of their nutritional status across the world is not available. To provide a summary of the recent data on the nutritional status of school-aged children in developing countries and countries in transition and identify issues of public health concern. A review of literature published from 2002 to 2009 on the nutritional status of children aged 6 to 12 years from Latin America, Africa, Asia, and the Eastern Mediterranean region was performed. Eligible studies determined the prevalence of micronutrient deficiencies or child under- and overnutrition using biochemical markers and internationally accepted growth references. A total of 369 studies from 76 different countries were included. The available data indicate that the nutritional status of school-aged children in the reviewed regions is considerably inadequate. Underweight and thinness were most prominent in populations from South-East Asia and Africa, whereas in Latin America the prevalence of underweight or thinness was generally below 10%. More than half of the studies on anemia reported moderate (> 20%) or severe (> 40%) prevalence of anemia. Prevalences of 20% to 30% were commonly reported for deficiencies of iron, iodine, zinc, and vitamin A. The prevalence of overweight was highest in Latin American countries (20% to 35%). In Africa, Asia, and the Eastern Mediterranean, the prevalence of overweight was generally below 15%. The available data indicate that malnutrition is a public health issue in school-aged children in developing countries and countries in transition. However, the available data, especially data on micronutrient status, are limited. These findings emphasize the need for nutrition interventions in school-aged children and more high-quality research to assess nutritional status in this age group.

Assessment of nutritional status in children and adolescents with post-infectious bronchiolitis obliterans

To assess the nutritional status of children and adolescents with bronchiolitis obliterans and to analyze associations with clinical and nutritional factors. The study included 57 patients. Nutritional status was assessed using z scores for weight/age, stature/age, weight/stature in children, and stature/age and body mass index percentiles in adolescents. Body composition was assessed via tricipital skin folds, subscapular skin folds, and the sum of both plus the muscular circumference of the arm; pulmonary function was also investigated in subjects over 8 years old. The high percentages of malnutrition and risk for malnutrition are noteworthy: 21.7 and 17.5%, respectively. Among children, weight/age and stature/age detected higher percentages of malnutrition (21.6 and 16.2%), while weight/stature underestimated this diagnosis. Among adolescents, body mass index detected a high percentage of malnutrition (25%) and of risk for malnutrition (20%). Body composition analysis detected 51% of patients with low muscle reserves, and the majority of patients had normal fat reserves. Compromised pulmonary function was associated with poor performance at exercise (r = 0.434; p = 0.024). Malnutrition and/or nutritional risk and low muscle reserves were significantly associated with the 6-minute walk test (p = 0.032; p = 0.030). There was no association between spirometry and the nutritional variables (p > 0.05). These results emphasize the need for nutritional intervention, and suggest that, in addition to using weight and height indices for nutritional assessment, it is necessary to combine these with an analysis of body composition, so that a larger number of patients with malnutrition and/or at an increased risk for developing malnutrition may be identified and correctly managed.

Dietary Intake and Eating Behaviors of Young Adults Differ According to Student Status and Residence

Text: Few U.S. young adults consume diets consistent with current recommendations for health and little data are available to guide interventions for this diverse population. This study aimed to describe dietary intakes and eating behaviors of young adults according to postsecondary student status and residence. The sample consisted of 428 two-year college students, 587 four-year college students, and 649 nonstudents enrolled in a population-based study (Project EAT-II). Participants (44% male, mean age 20.5 years) completed surveys and food frequency questionnaires by mail in 2003-2004. Linear regression models adjusted for demographics were used to examine group differences. Differences according to student status were found for intakes of dark-green/orange vegetables, whole grains, soft drinks, saturated fat, and breakfast frequency. In general, male and female four-year students reported a more healthful dietary pattern compared to two-year students and non-students. Within categories of student status, differences were also found according to residence. Among twoyear students and non-students, males who lived with their parents generally reported more healthful patterns (e.g., less fast food, more frequent breakfast meals) in comparison to those who rented their residence. Among four-year students, females who lived on campus generally reported more healthful patterns (e.g., higher intakes of fruit and calcium) in comparison to those who rented their residence or lived with their parents. The results suggest a great need for nutrition interventions for young adults who are two-year college students and non-students. Interventions will need to be designed to support the unique needs and challenges of those living in different residential situations.

Home-based practices of complementary foods improvement are associated with better height-for-age Z score in 12-23 months-old children from a rural district of Burkina Faso.

Repositioning nutrition is central to development. Childcare practices, which include feeding practices, appear in the conceptual framework of malnutrition. The objective of this study was to analyze the nutritional status of young children in relation to feeding practices. This cross-sectional, community-based study was conducted in the rural district of Kongoussi (Burkina Faso). Three hundred ninety nine children (95% of expected 420 children: 30 clusters of 14 children), 6-23 months of age, were recruited by “probability proportionate-tosize” cluster sampling. Items related to the early and current breastfeeding patterns and the mode of complementary feeding were recorded by interview of the mothers. Fortified cereals were defined as home-based improved flours by mixing “soumbala,” fishmeal, toasted groundnut, or several of these local foods with cereal. Soumbala is a fermented product from the African bean tree used both as a condiment and as a meat substitute in soups, because it is rich in protein and micronutrients. The height-for-age Z-score (HAZ) and weight-for-height Z-score (WHZ) were computed using height and weight measurements. Adjusted mean HAZ and WHZ were derived from multiple linear regression models and compared using analysis of variance (ANOVA) and post hoc t-test with Bonferroni correction. The prevalence of wasting was 26.3% (95% CI: 21.5% - 30.5%). The mean WHZ (± standard deviation) was –1.39 (± 1.14). The WHZ was associated with the children's age and the mother's nutritional status. The prevalence of stunting was 35.8% (95% CI: 29.4% - 41.1%). The mean HAZ was –1.68 (± 1.15). After adjustment for children, mothers and household characteristics, and for current and past breastfeeding patterns, the HAZ remained associated with the mode of complementary feeding among children 12-23 months of age (p=0.018), but not among children 6-11 months of age (p=0.136). Among children 12-23 months of age, the adjusted mean HAZ (standard error) was –1.33 (0.63), -1.61 (0.30), and –2.11 (0.32) for children using fortified cereals, unfortified cereals, or no complementary feeding, respectively (p=0.018). These results underline the high frequency of malnutrition in the rural district of Kongoussi, and the great need for nutritional intervention. The prevention of growth impairment in this area could be based on home fortification of complementary foods using locally available foods; this is more sustainable. Thorough research is needed to specify and standardize the procedures of utilisation of the available foods in the prevention of growth impairment. Keywords: Fortification, Cereals, Stunting, Children, BurkinaAJFAND Vol. 8 (2) 2008 pp. 204-218

Nutritional status of advanced lung cancer patients and its effect on survival

9567 Background: Weight loss and malnutrition are common in patients with non-small cell lung cancer (NSCLC) and have a negative impact on survival. Early detection and intervention may impact positively on quality of life. The Patient Generated Subjective Global Assessment (PG-SGA) is a validated tool for screening nutritional status and triaging cancer patients with a potential score of 36 (Ottery, 2000). Methods: We measured the need for nutritional intervention in 118 newly diagnosed advanced NSCLC outpatients (stages 3B/4) using the PG-SGA score prior to any treatment. Patients were triaged into 4 Nutritional Triage (NT) groups based on Ottery’s recommendations: scores of 0–1 (NT I) required no intervention, 2–3 (NT II) required education, 4–8 (NT III) required intervention by a dietitian and 9 or greater (NT IV) were in critical need of nutritional intervention. We investigated the association between NT groups and weight loss, survival, inflammatory markers (CRP), LDH and albumin. Results: 118 recently diagnosed outpatients (M 63, F 55) aged 64 ± 11.3 years were studied. Patients were triaged into NT I - 21 (18percnt;) pts, NT II - 13 (11percnt;) pts, NT III - 34 (29percnt;) pts and NT IV - 50 (42percnt;) pts. Median PG-SGA score was 7. 76percnt; of pts had 0–5percnt; weight loss in the past month, 10percnt; had a weight loss of 5–10percnt; and 14percnt; had a weight loss >10percnt;. Low albumin, high LDH and high CRP were significantly associated with a higher PG-SGA score (p=0.016, 0.029 and 0.022 respectively). The NT group was significantly associated with survival. Overall median survival was 7.0 months. The median (95percnt; CI) survival of patients in NT groups I, II, III and IV was 12 (CI: 9–16), 10 (CI: 7–13), 8 (CI: 6–10), 4 (CI: 2–6) months respectively, p<0.0001.The amount of weight loss was also significantly associated with survival. Those with <5percnt; weight loss had a survival of 8 (CI: 5–10) mo vs. 5 (CI: 2–9) mo in those with weight loss ≥5percnt;. Conclusions: The need for nutritional intervention in advanced lung cancer patients is very high. There was a significant association between the PG-SGA NT groups and survival. Weight loss alone may not identify patients in need of nutritional intervention. However the weight loss was still discriminatory with respect to survival. The PG-SGA is a simple screening tool for triaging the nutritional needs of patients with advanced lung cancer. No significant financial relationships to disclose.

Assessing dietary patterns in Barbados highlights the need for nutritional intervention to reduce risk of chronic disease.

The dietary habits of the Caribbean have been changing to include more fast foods and a less nutrient dense diet. The aims of this study are to examine dietary patterns in Barbados and highlight foods for a nutritional intervention. Four-day food diaries collected from control participants in the population-based, case-control Barbados National Cancer Study (BNCS). Forty-nine adult participants (91% response) completed the diaries providing 191 days of dietary data. Total energy intake was almost identical to data collected 5-years earlier in the Barbados Food Consumption and Anthropometric Survey 2000, but the percent energy derived from fat was from 2.1% to 5.2% higher. Sugar intake exceeded the Caribbean recommendation almost four-fold, while intakes of calcium, iron (women only), zinc and dietary fibre were below recommendations. Fish and chicken dishes were the two largest sources of energy and fat. Sweetened drinks and juices provided over 40% of total sugar intake. These data provide existing dietary patterns and strongly justify a nutritional intervention program to reduce dietary risk factors for chronic disease. The intervention could focus on the specific foods highlighted, both regarding frequency and amount of consumption. Effectiveness can be evaluated pre- and post-intervention using our Food Frequency Questionnaire developed for BNCS.

Poverty and Food Intake in Rural America: Diet Quality Is Lower in Food Insecure Adults in the Mississippi Delta

Objective To determine if measures of diet quality differ between food insecure and food secure adults in a rural high-risk population. Design Random digit dialing telephone survey of a cross-section of the population designed to collect data on food intake, household demographics, and food security status. Setting A representative sample of adults who live in 36 counties in the Lower Mississippi Delta region of Arkansas, Louisiana, and Mississippi. Subjects One thousand six hundred seven adults, both white and African American. Main outcome measures Food security status and diet quality, as defined by adherence to the Healthy Eating Index and Dietary Reference Intakes by determinations from self-reported food intake (1 day intake). Statistical analyses Regression analysis, t tests, Wald statistic, and beta tests were employed. Results Food secure adults scored higher on Healthy Eating Index than food insecure adults ( P=0.0001), but the regression model showed no differences when multiple factors were included. Food secure individuals consistently achieved higher percentages of the Dietary Reference Intakes (specifically Estimated Average Requirements and Adequate Intakes) than food insecure individuals, with the greatest differences seen for vitamin A ( P<0.0001), copper ( P=0.0009), and zinc ( P=0.0022) and very little difference for vitamins C ( P=0.68) and E ( P=0.32). Both populations consumed diets extremely low in fiber. Conclusions Food insecurity is associated with lower quality diets in this population. It is acknowledged that serious limitations are associated with the use of one 24-hour recall and for comparison between food intake and assessment of food security. These findings still suggest a pressing need for nutrition interventions to improve dietary intake in these at-risk impoverished individuals.

Nutritional determinants of plasma total homocysteine distribution in the Canary Islands

We sought to define plasma homocysteine reference values in healthy individuals in the Canary Islands and to determine its relations to folate and vitamin B12 intakes and concentrations. Cross-sectional study. Population-based representative sample of 557 participants, aged 18-65 years, from the Canary Islands Nutrition Survey (ENCA). All participants completed two 24-h dietary recalls and a general questionnaire collecting socio-demographic and health-related lifestyle information. Plasma homocysteine and serum vitamin B12 levels were measured by immunoassay, whereas folate levels through an automated ionic capturing method. Median plasma homocysteine was 11.9 micromol/l, higher in men (13.1 micromol/l) than in women (10.9 micromol/l) (P<0.001) and positively associated with age in both sexes (P<0.001). The prevalence of hyperhomocysteinaemia (> or = 15 micromol/l), 21.4%, was also greater in men (32.2%) than in women (13.4%). There were significant negative correlations between plasma homocysteine and serum (r=-0.32, P<0.001) and erythrocyte (r=-0.26, P<0.001) folate, as well as serum vitamin B12 (r=-0.28, P<0.001) concentrations. When divided in quartiles of vitamin intakes or concentrations, men with the lowest vitamin B12 and folate serum values had significantly higher plasma homocysteine concentrations than those in the other three quartiles. In women, hyperhomocysteinaemia was higher in the lowest quartiles of folate intake and serum and erythrocyte folate concentrations. These data provide further evidence that hyperhomocysteinaemia is a sensitive marker of inadequate folate and vitamin B12 status, allowing for the identification of those with greatest need for nutritional interventions.

Correlates of fruit and vegetable intake among Norwegian schoolchildren: parental and self-reports

To identify correlates of 6th and 7th graders' (age 10-12 years) fruit and vegetable intake, to investigate parent-child correlations of fruit and vegetable intake, and to compare parents' and children's reports of children's accessibility, skills and preferences with respect to fruit and vegetables. The results presented are based on the baseline survey of the 'Fruits and Vegetables Make the Marks Project', where 38 schools participated. Fruit and vegetable intake was measured by food frequency questions. Theoretical factors, based on Social Cognitive Theory, potentially correlated to intake were measured, including behavioural skills, accessibility, modelling, intention, preferences, self-efficacy and awareness of 5-a-day recommendations. In total, 1950 (participation rate 85%) 6th and 7th graders and 1647 of their parents participated. Overall, 34% of the variance in the pupils' reported fruit and vegetable intake was explained by the measured factors. The strongest correlates to fruit and vegetable intake were preferences and accessibility. The correlation between the children's and their parents' fruit and vegetable intake was 0.23. The parents perceived their children's accessibility to be better than what was reported by the children (P<0.01), while the children reported their skills to be better than what was perceived by their parents (P<0.01). The results from this study clearly point to a need for nutrition interventions aimed at parents. An important next step will be to investigate whether the identified correlates predict future fruit and vegetable intake, and whether they mediate any changes in intake in an intervention study.

Examining gender, racial, and age differences in weight concern among third, fifth, eighth, and eleventh graders

Weight management and concern, body weight beliefs, and perceptions of friend's and family's weight concerns were examined in this study by race, grade, and gender. A stratified random sample was used to select schools within nine districts in South Carolina and an anonymous self-report paper–pencil questionnaire was completed by the students. The final sample included 3151 African American (42.3%) and White (57.7%) children (51.7% female) in the third ( n=599), fifth ( n=686), eighth ( n=1168), and eleventh ( n=698) grades. White girls were more likely to report being overweight ( P=.0042), having higher personal weight concerns ( P<.0001), and perceiving higher friend ( P<.0001) and family weight concerns ( P<.0001) than the African American girls. Using multiple regression, 29.8% of the variance in the children's personal weight concern scores was explained by perceptions of family's weight concerns ( R 2=.1659), gender ( R 2=.0762), perceptions of friend's weight concerns ( R 2=.0392), grade ( R 2=.0094), a Race×Gender interaction ( R 2=.0042), and race ( R 2=.003). Most of the children, particularly the white girls, have personal weight concerns and dieting practices which place them at risk for possible health problems. These results support the need for nutrition interventions and education in early childhood. Programs to prevent obesity and eating disorders should be tailored for differences by gender, grade, and race.

Intégration de lˈévaluation nutritionnelle à lˈexamen médicallors de lˈadmission à lˈhôpital

Protein-calorie malnutrition (PCM) negatively affects the healing process, morbidity and mortality as well as medical costs. The nutritional assessment at hospital admission is essential in order to determine the need for nutritional intervention and for optimizing it. Based on clinical evolution, the nutritional evaluation assesses the adequacy of energy intake to metabolic requirements, energy reserves and bodily functions. A global evaluation of nutritional status aims at defining whether the patient is well-nourished, moderately or severely malnourished and whether the causes of PCM will disappear, improve or worsen. A global nutritional evaluation should also define the healing potential in order to decide if the nutritional intervention should be immediate or delayed, maximal or partial. The diagnosis and quantification of PCM is based on several parameters determined by clinical, biochemical and functional tests. This review summarizes the clinically relevant methodologies and proposes a protocol for the nutritional evaluation of patients at hospital admission.

Comparison between the nutritional status of eutrophic and overweight adolescents living in Brazil

The present study aimed to compare the nutritional status of normal and overweight adolescents. Sixty-four girls (36 normal-weight and 28 overweight) aged between 12 and 18 years were evaluated. Weight, height, body mass index and abdominal circumference were determined. Values of glucose, red blood cells, cholesterol and cholesterol fractions were analyzed. The diet history method and a food frequency questionnaire were used in order to obtain the quantitative and qualitative profiles of each participant’s diet. The amount of total cholesterol, LDL-cholesterol, triglycerides and glucose were increased in the group of overweight adolescents as compared with the normal group, although no statistically significant differences could be found. The diet history showed that there was no difference between the groups regarding ingestion of energy and nutrients. Both groups presented high protein diets and calcium and folic acid ingestion below recommended values. The food frequency questionnaire showed an increased ingestion of fatty foods by the overweight adolescents when compared with the normal group. Thus there is a need for nutritional intervention in these adolescents in order to prevent chronic diseases.

The Effects of a Nutrition Intervention on Body Weight and Body Composition of HIV-Infected Individuals at Risk of Wasting Syndrome

Wasting syndrome is an opportunistic disease associated with HIV infection, and is characterized by a loss of lean body mass. The purpose of this study was to employ a non-experimental nutrition intervention in order to stop or reverse the wasting process. Thirteen free-living individuals were examined in a community setting, and all subjects were screened to be at risk for wasting syndrome based on parameters of nutritional and economic risk. The intervention consisted of individualized nutrition counseling and access to a food pantry with groceries and nutritional supplements. Body composition was measured with bioelectncal impedance analysis (BIA). Measurements at baseline indicated that many (54% to 62%) of the subjects were malnourished based on standards for percent of ideal body weight (%IBW), body mass index (BMI), percent of ideal body cell mass (%1BCM), and phase angle. Results showed that most (64% to 85%) of the subjects increased in total weight, %IBW, BMI, %IBCM, phase angle, and body fat mass. The mean difference for all thirteen subjects was an increase of 5.5 pounds of total weight, 3.8% of %IBW, 0.28 degrees of phase angle; and 0.84kg/m2 of BMI (p<.05). Subjects improved mean body cell mass by 2.3% of %IBCM and had a 2.9 pound increase in body fat mass which approached significance. The number of days spent in the study varied for each subject; however, being in the study for a longer time was not significantly correlated with a greater increase in the variables measured. Subjects malnourished at baseline displayed a pattern of greater increase compared to those in average standard categories of nutritional status. These findings illustrate the positive outcomes of nutrition therapy on body weight and body composition and support the need for nutrition intervention for free-living individuals infected with HIV who are at risk for wasting syndrome.

Nutrition and obesity in the chronic mentally ill.

The aim of this study was to determine the need for nutrition intervention in a group of people living in mental health residential houses in the Northern Sydney Area. A nutrition assessment was conducted by the researcher using a face-to-face interview with mental health residents and a survey on medical background completed by case managers. The prevalence of overweight and obesity was significantly greater than that reported for the general population. Respondents also had a significantly higher prevalence of abdominal obesity than the general population. No respondent met the minimum core food group requirements as outlined in the 12345+ Food and Nutrition Plan. The needs assessment has shown that nutrition promotion is required in this group. The task ahead is to motivate the group to change their food and nutrition behaviours, where many barriers to a healthy lifestyle exist.

Malnutrition in hospitalized pediatric patients. Current prevalence.

To document the current prevalence of protein-energy malnutrition compared with that reported from the same institution in 1976. All inpatients of this tertiary-care facility were assessed by anthropometric, laboratory, and clinical nutrition assessment methods in a 1-day cross-sectional survey. The comparison study from 1976 was also a 1-day cross-sectional survey. A tertiary-care facility in Boston, Mass. The entire inpatient population was assessed on a single weekday in September 1992. Prevalence of acute and chronic malnutrition as judged by anthropometric and laboratory data. Data on demographics, admission classification, underlying disease, route of nutrition, and global nutritional status were also assessed. The prevalence of acute protein-energy malnutrition (weight for height) based on the Waterlow criteria was as follows: severe, 1.3%; moderate, 5.8%; mild, 17.4%; and none, 75.5%. The prevalence of chronic protein-energy malnutrition (height for age) was as follows: severe, 5.1%; moderate, 7.7%; mild, 14.5%; and none, 72.8%. Although the prevalence of acute and chronic protein-energy malnutrition was significantly less in 1992 than in 1976 (P = .03 and P < .001, respectively), the numbers are still alarmingly high. Children younger than 2 years and older than 18 years and those with chronic medical conditions had a higher prevalence of protein-energy malnutrition. Twenty-four percent of patients had a serum albumin level less than 30 g/L, 34.8% had a total lymphocyte count less than 1.5 x 10(9)/L, and 24.9% had a hemoglobin concentration less than 105 g/L. One fourth of all patients were obese (> 120% weight for height), with the greatest prevalence in children aged 2 to 18 years. Acute and chronic protein-energy malnutrition remains common in hospitalized pediatric patients in the United States. Important risk factors may be underlying chronic disease, periods of normally rapid growth, and recognized need for nutrition intervention.

Guidelines vs practice in the delivery of diabetes nutrition care

The American Dietetic Association and the American Diabetes Association have published recommendations for the nutrition care of people with diabetes. However, the frequency of this care is rarely documented. As part of a study of diabetes care and education practices, the Michigan Diabetes Research and Training Center collected extensive data from 440 randomly selected adults who receive diabetes care from community physicians. These data provided a basis for comparison between diabetes nutrition care as recommended and as delivered in typical American communities. In this population (mean age = 61 years; 54% women), 89% (393) had non-insulin-dependent diabetes mellitus (NIDDM). Of these, 152 were managed with insulin (NIDDM/I) and 241 were not managed with insulin (NIDDM/NI). Most of the NIDDM/NI group was overweight (71%) and had elevated levels of glycated hemoglobin (62%) and serum cholesterol (53%). Yet they were significantly less likely than those with NIDDM/I to see a dietitian. The most frequently reported reason for not seeing a dietitian was that a physician had not referred them (53%). More than 90% of those with NIDDM/I or NIDDM/NI who were referred to a dietitian saw one. Because this population was from randomly selected communities, physicians, and patients, the results are probably generalizable to other regions of the United States. This study shows that in community practice, insulin use is the primary marker of the need for nutrition intervention, and the lack of physician referred to a dietitian is an important barrier to people receiving recommended diabetes nutrition care.

Hospital-wide screening improves basis for nutrition intervention

The prevalence of malnutrition and need for nutrition intervention were evaluated at the time of admission for 500 consecutive patients at Cleveland Memorial Hospital, a 300-bed acute-care community hospital, in Shelby, NC. The association between the prescribed diet and the need for special nutrition intervention was emphasized. Results indicate that 31% of patients receiving routine diets (regular, soft, full liquid, clear liquid, NPO) and 33% of patients receiving modified diets were malnourished at the time of admission. Chi-square analysis indicated that there was no significant difference (p less than or equal to .05) in the prevalence of malnutrition or the need for special nutrition intervention between the two groups. Yet, many hospital nutrition services are organized to direct their activities primarily to patients receiving modified diets. It is suggested that dietetic practitioners implement a hospital-wide screening process so that patients with special nutrition needs can be identified and appropriate support regimens can be planned.