Nutrition Decisions Research Articles

P101 Comparison of Food Sources of Energy Among Adults that Skip Versus Consume Breakfast

<h3>Background</h3> Breakfast consumption is associated with lower rates of chronic disease and higher intakes of vitamins and minerals, including calcium, folic acid, and zinc. Skipping breakfast may further pose a threat to diet quality, which may result in less desirable food choices later in the day. Previously, breakfast consumption in children was examined, yet less is known regarding adults. <h3>Objective</h3> To examine the proportional contribution of food sources to energy intake for adults who skipped vs ate breakfast. <h3>Study Design, Setting, Participants</h3> This cross-sectional study used data from 31,514 adults, aged 18 years+, from the 2005-2016 National Health and Nutrition Examination Survey. Participants were categorized according to whether they skipped (n = 4,993) or ate (n = 26,521) breakfast on the recorded day of intake. <h3>Measurable Outcome/Analysis</h3> Dietary intakes were assessed by a 24-hour dietary recall and meal occasions were self-designated by participants. Food sources were categorized into What We Eat in America Food Categories. Sums of energy were aggregated and used to determine the proportions of energy from each food source for the total day as well as during breakfast and snacks. <h3>Results</h3> Adults who skipped breakfast consumed greater proportions of total energy from mixed dishes, sweetened-beverages, alcoholic beverages, and sandwiches, and less energy from breads, plant-proteins, milk, fruit, and eggs than those who ate breakfast. Breakfast energy mainly came from breads, eggs, and milk. Snack energy came from sweetened-beverages, alcoholic beverages, sweets, and savory snack-foods for those who skipped breakfast. For adults who ate breakfast, it came from sweets, alcoholic beverages, and savory foods; however, they also consumed more plant-proteins and fruit than those who skipped breakfast. <h3>Conclusions</h3> Making 1 poor nutritional decision, such as skipping breakfast, likely leads to other poor nutritional decisions throughout the day. Educational efforts should address breakfast's role in promoting nutritional adequacy and improving overall diet quality.

Science, advocacy, and quackery in nutritional books: an analysis of conflicting advice and purported claims of nutritional best-sellers

Nutritional decisions may be important for health, and yet identifying trustworthy sources of advice can be difficult to achieve. Many people turn to books for nutritional advice, making the contents of these books and the expertise of their authors relevant to public health. Here, the top 100 best-selling books were identified and assessed for both the claims they make in their summaries and the credentials of the authors. Weight loss was a common theme in the summaries of nutritional best-selling books. In addition to weight loss, 31 of the books promised to cure or prevent a host of diseases, including diabetes, heart disease, cancer, and dementia; however, the nutritional advice given to achieve these outcomes varied widely in terms of which types of foods should be consumed or avoided and this information was often contradictory between books. Recommendations regarding the consumption of carbohydrates, dairy, proteins, and fat in particular differed greatly between books. To determine the qualifications of each author in making nutritional claims, the highest earned degree and listed occupations of each author was researched and analyzed. Out of 83 unique authors, 33 had an M.D. or Ph.D degree. Twenty-eight of the authors were physicians, three were dietitians, and other authors held a wide range of jobs, including personal trainers, bloggers, and actors. Of 20 authors who had or claimed university affiliations, seven had a current university appointment that could be verified online in university directories. This study illuminates the range of the incongruous information being dispersed to the public and emphasizes the need for future efforts to improve the dissemination of sound nutritional advice.

Effects of Family-Centered Media Literacy Training on Family Nutrition Outcomes

Parents frustrated about food marketing influences need media management skills to challenge marketing messages and interpret factual content. We tested a media literacy-based, family-centered intervention to reduce effects of appealing, but unrealistic, food marketing. We hypothesized that participation would facilitate family discussion that improves the home dietary environment and increases youth consumption of fruits and vegetables. Parent-child (age 9-14) dyads (N = 189) participated in a matched-group, pretest/posttest field experiment testing a 6-week media literacy-based curriculum. Hypothesis testing employed multiple analysis of covariance and Bayesian multigroup structural equation modeling (MGSEM). Improved nutrition outcomes for parents included talk with youth about food nutrition labels (d = 0.343) and ratio of healthy to unhealthy food in home (d = 0.232); youth improved talk with parent about food nutrition labels (d = 0.211), vegetables eaten yesterday (d = 0.264), and fruit eaten yesterday (d = 1.386). Bayesian MGSEM revealed that in the intervention group, 12 of 17 tested paths were significant (p < .05), compared with only 4 in the control group, with average effect size magnitudes of 0.236 and 0.113, respectively. Media literacy education can empower parents and improve youths' critical thinking to reduce negative effects of food marketing on families and improve use of media to obtain nutrition information that aids dietary choices. This approach reduces the risk for reactance from youth who like media and resist limiting media use, while helping families use media together to make better nutrition decisions.

Development and Validating of a Quest for Predicting Nutrition Literacy Promoting Behavior Based on the Theory of Planned Behavior in Southern Iran, 2017

Background: The evidence suggests nutrition style as a key determinant of health. On the other hand, nutrition literacy is a key determinant of nutrition decisions and behaviors. This study aimed to develop and validate an inventory in order to predict nutrition literacy promoting behavior based on the theory of planned behavior (TPB) in the youth. Methods: In this cross-sectional study, 203 students (100 females and 103 males) were selected using the randomized cluster method from dormitories in Shiraz University of Medical Sciences. They were supposed to complete Nutrition Literacy Promoting Behavior based on TPB (TPB-NLPB) questionnaire. The tool was developed using relevant scientific literature and its validity was confirmed by the experts’ panel (n = 6). The instrument includes four subscales: attitude toward behavior, subjective norm, perceived behavioral control, and behavioral intention. The reliability and validity of the instrument were assessed by exploratory and confirmatory factor analysis and Cronbach’s alpha coefficient. Results: The coefficients of Cronbach’s alpha (α = 0.87), Guttmann method (λ1 = 0.84 to λ6 = 0.91), and convergent validity (0.74) were estimated (P &lt; 0.01). The exploratory factor analysis demonstrated five factors, which clarified 64.91% of the scale’s variance. Second-order confirmatory factor analysis pointed out that the factor was well matched up onto the principal factor. Consequently, the five-factor model was appropriate for the data using fit index techniques for adjusting the scale. Conclusions: The results confirmed the well-adjusted reliability and psychometric properties of the TPB-NLPB and its usefulness for the relevant studies.

Factors influencing food service provision decisions in centre-based early childhood education and care services: Cooks' perspective.

Considerable public effort has been directed at centre-based childcare as an early childhood education and care (ECEC) setting to promote healthy food-related behaviours in young children. However, in the real-world setting, best practice, evidence-based guidelines are not always well-translated into usual, day-to-day routines. This study aims to understand what factors influence the centre-based childcare cooks' food and nutrition decisions for children aged 2-5years. Semi-structured qualitative interviews were conducted with cooks in centre-based childcare using purposeful maximum variation sampling and data analysed thematically. Fourteen cooks were interviewed from 14 services across South Australia. Central to providing a healthy food environment was expert-led knowledge and training gained through the workplace over several years and the embodiment of the service's healthy food and nutrition policy, evidenced through menu planning to maintain a focus on healthy eating. Threatening these positive, routine practices and decisions were pressures to modify menus in response to increasing food allergies and changing cultural and family preferences, in the absence of ongoing relevant training and expertise at the system-level. Children in ECEC benefit from cooks' commitment to providing nutritious foods; however, the requirements to extend their role to respond to increasing demands without relevant system-level support and training puts the children at risk of not being exposed to health-promoting menus and possible errors in providing dietary modifications. ECEC cooks urgently need access to system-level support and training. SO WHAT?: Understanding and addressing the barriers experienced by cooks and the complexity of factors that inform their food-related decision-making will sustain the implementation of effective, healthy eating guidelines and nutrition practices in ECEC.

P14 Increasing Critical Nutrition Literacy Through a College-Level, Introductory Nutrition Course

Background Nutrition literacy, derived from health literacy, is the ability to understand basic nutrition information needed to make appropriate nutrition decisions. Critical nutrition literacy (CNL), analogous to critical health literacy, indicates the highest level, defined as the ability to critically analyze and apply nutrition information, using more advanced critical appraisal skills. However, previous research on CNL has solely been cross-sectional. Objective To determine if a college-level, introductory nutrition course with a required laboratory component is associated with an increase in CNL. Study Design, Settings, Participants A non-experimental, pre-post study design of a four-credit, 13-week, academic course intervention in a sample of college students from the University of Rhode Island enrolled in Applied General Nutrition. Measurable Outcome/Analysis Students consenting to participate in research completed a demographic survey and a validated, five-item CNL Scale. CNL items were administered on a five-point anchored Likert scale from strongly disagree to strongly agree, with five indicating high CNL. Repeated measures analysis of variance (ANOVA) was used to assess if students increased their CNL score after completing the course. Results Out of the 118 consenting students, 80 students had complete data for CNL and demographics, and were between the ages of 18 and 24. The average age was 18.7 ± 1.1 (SD) years old; the majority were white (82%), female (79%), freshmen (61%), lived on-campus (70%), and had a meal plan (75%). Participants significantly increased their CNL score from baseline to post intervention from 2.34 ± 0.7 (SD) to 2.63 ± 0.7 (SD) (P Conclusion Results indicated that there was a significant increase in CNL score from baseline to post intervention, although the increase was limited. Future introductory nutrition classes should highlight the ability to critically analyze nutrition information, through determining its credibility and truth, and how to use this information to improve dietary choices. Funding USDA.

Development of Nutritional Fulfillment Funds for Pregnant Women Using Web-Based Sugeno Method Case Study: "NURANI" Maternity Clinic and Maternity Hospital

&#x0D; The high rate of malnutrition in various regions and the increasing prevalence of obesity, especially in big cities, is a double burden of nutritional problems in Indonesia. Meanwhile, the utilization of health facilities by those lower classes people in particular is still low and the health service itself is far from optimal. Besides, the pregnant women are also reluctant to consult their nutrients experienced during pregnancy. From the above problems, an application which can help pregnant women in making nutritional decisions at the time of pregnancy without consulting to consult a doctor / nutritionist was finnally made, that is Sugeno Fuzzy method. This method can provide the right nutritional decisions for pregnant women. The purpose of this study is to assist and facilitate pregnant women in the fulfillment of nutrition during pregnancy. Input used in this study is BMI, age of pregnant woman and age of pregnancy. While the output of the end result of this application system is to provide decisions about the nutrients experienced by pregnant women, they are less nutrition, ideal nutrition and excessive or much nutrition. The results of the experiment gives the calculation; the error rate of 62 % and the accuracy of 38 %.&#x0D;

Does a parenteral nutrition decision support system for total nutrients improve prescription procedure and neonatal growth?

Background and objectives: Parenteral nutrition (PN) is an integral part of the nutritional support of critically ill neonates in the intensive care units (ICU). The evaluation of a decision support system for total nutrients (DSSFTN) is of great importance for clinical practice. This study’s aim was to evaluate the impact caused by implementation of a DSSFTN on PN support and neonatal growth. This pilot work was supported by the hospital PN team (PNT) in order to assess possible benefits stemming from the use of DSSFTN.Materials and methods: DSSFTN development is based on the incorporation of pharmaceutical and therapeutic protocols. Thirty-eight neonates were recruited. Inclusion criteria included: patients should (a) be hospitalized in ICU, (b) receive PN support at least for 15 days, (c) have birth weight 550–1600 g. One exclusion criterion was applied: patients should have no inborn error of metabolism. 15 doctors prescribed PN for two groups of neonates. PN was calculated by doctors for Group 1 (19 neonates) and respectively was calculated by the DSSFTN (and checked by doctors) for Group 2 (19 neonates). A questionnaire was completed later by doctors to evaluate DSSFTN.Results: The implementation of DSSFTN led to appropriate composition and administration of PN. Growth was not significantly different between the study groups. Compliance with guidelines was observed. DSSFTN ameliorated intercommunication among doctors.Conclusions: The implementation of DSSFTN enables health professionals to facilitate the complex task of prescribing. It ensures the consistency of PN prescriptions, as it leads to appropriate dosing in all nutrients. DSSFTN provides real-time PN interventions (clinical conditions and enteral amounts are included additionally) and minimizes exposure to human errors.

Turkish Neonatal Society guideline on enteral feeding of the preterm infant.

Early initiation of enteral feeding with the own mother’s milk and prevention of postnatal growth failure is the target of nutrition in preterm infants. Together with total parenteral nutrition, mouth care and minimal enteral nutrition is started with colostrum in the very early hours of life in small preterm infants. Expressed mother’s milk is given via a gastric tube and gradually increased in accordance with the gestational age/birth weight and the risk factors. For infants born heavier than 1 000 grams, the aim is to reach total enteral feeding at the end of first week, and at the end of the second week for infants weighing less than 1000 grams. Supporting mothers in milk expression and kangaroo mother care, promoting non-nutritive feeding, appropriate fortification of mother’ milk, and initiating and advancing breastfeeding as soon as the infant is ready are all crucial. Donor mother milk, and as a second choice, preterm formula is advised if the mother’s milk is not available. Individualized post-discharge nutrition decisions can be taken in accordance with the actual growth at the time of discharge. The goal is optimal neurodevelopmental achievement together with the prevention of long-term metabolic problems. Late preterm infants, which constitute the majority of preterm infants, also need close nutritional attention and follow-up.

Preliminary Investigation of a Mobile Nutrition Literacy Website for Parents and Young Children.

Parental nutrition literacy (PNL) correlates positively with child diet quality, but interventions for improving PNL are lacking. “Nutricity” is a novel bilingual (English/Spanish) mobile tool designed by the research team to engage parents and young children to interact with nutrition information to make nutrition decisions. The purpose of this study was to inform a future intervention through (1) assessing parental likability of Nutricity, and (2) collecting perceptions of pediatric clinic personnel on the feasibility of introducing Nutricity in pediatric clinics. PNL scores and feedback about Nutricity were collected using mixed methods from 15 English-speaking and 15 Spanish-speaking parents of 1–5 year-old children. Three parents from each language group provided additional feedback via semi-structured interviews. Interviews with 11 pediatric clinic personnel were also conducted to anticipate barriers and formulate strategies for implementing Nutricity as a clinic-based intervention. Nutricity was liked by both language groups and across all PNL levels, with a mean rating of 4.6 on a 5-point scale. Clinic personnel interviews affirmed need for and feasibility of offering Nutricity in clinics.

Mourning and Takotsubo cardiomyopathy: neuroendocrine implications and nutritional management.

This article aims to make reference to some recent mourning aspects considered risk factors for cardiovascular disease, specifically the Takotsubo cardiomyopathy. The objective was to describe the stress from the death of a loved one combining it to the possibility of occurrence of Takotsubo cardiomyopathy through the perception of a traumatic event by the cortex, which triggers the subcortical brain circuit affecting the endocrine response. Given the growing acknowledgement of this cardiomyopathy, it is possible to contextualize the nutritional behaviours and decisions surrounding it, whose benefits must exceed the condition of temporary cardiac dysfunction and extend to food choices that have some influence in the limbic system. It is a descriptive analysis that aims to problematize the theme into reflections based on this experience, considering the foundation with the science of nutrition.

Variation in the Protein Composition of Human Milk during Extended Lactation: A Narrative Review.

The aim of this review is to evaluate changes in protein parameters in the second year postpartum. There is considerable agreement among authors about the declining trend of human milk protein concentrations, but most research on protein content in breast milk focuses on the first year of life and comes from developed countries. Whereas this is the case for exclusive breastfeeding or for breastfeeding into the first year of life, the opposite applies to weaning or extended breastfeeding. This review is predominantly based on observational epidemiological evidence and on comparative research linking breast milk composition with cutting down on breastfeeding. Studies dating back several decades have shown an increase in the proportion of immunoglobulins, lactoferrin, and serum albumin during weaning. According to the limited data available, it seems likely that the regulation of milk protein composition during involution can be ascribed to alterations in tight junctions. In studies on humans and other mammalian species, offspring suckle more from mothers that produce more dilute milk and the increase in milk protein concentration is positively correlated to a decrease in suckling frequency during weaning. High milk protein contents were first reported in nonindustrial communities where breastfeeding is sustained the longest, but recent papers from urbanized communities have taken credit for rediscovering the increase in protein content of human milk that becomes evident with prolonged breastfeeding. This review presents an overview of the changes in breast milk protein parameters in the second year postpartum to enable milk banks’ practitioners to make informed nutritional decisions on preterm infants.

Food and nutrition literacy (FNLIT) and its predictors in primary schoolchildren in Iran.

This study used a locally designed and validated questionnaire to describe the distribution of food and nutrition literacy (FNLIT) in a cross-sectional sample of 803 students aged 10-12 years from elementary schools in Tehran city, Iran. Logistic regression was used to assess the extent to which various independent covariates were associated with low FNLIT. The data were used to identify significant differences using a range of social and cultural variables relevant to the context of school students in Iran. The results of the study showed that although the total FNLIT level was good, this headline finding masked important differences in the sub-domains. More than half of the children (69%) had high levels of FNLIT in the cognitive domain, but in the skills domain, very few (3%) scored highly. The study also identified some associations between the total FNLIT and its subscales and sociodemographic variables including gender, parent's education and age, birth order. These results highlighted groups within the school population who were at higher risk of having lower FNLIT levels. They also indicate that girls feel more able to exert choice and control over food and nutrition decisions than boys are but may be less able to do so in practice. Overall, these results are a general reminder to schools of the different learning needs of children from different family backgrounds. The article highlights the need for continuous improvement in the health education curriculum of schools in Iran, particularly highlighting the importance of giving greater attention to the development of practical food and nutrition skills alongside more traditional food and nutrition knowledge. Additional studies (with long-term follow-up) are needed to more fully assess and understand the predictors of FNLIT.

Advancing competitive position in healthcare: a hybrid metaheuristic nutrition decision support system

In the highly competitive environment of healthcare industry, managers incorporate patient centered care as a major component in the healthcare mission. Management information systems have gained increasing attention to develop effective plans for patient centered care, and quality improvement in healthcare organizations. Consumers are becoming actively involved in their health, which is great for patient engagement, but to meet this demand, healthcare providers need to make significant changes. Information technology and artificial intelligence can significantly improve workflows for healthcare professionals, and support the development of new services to meet changing consumer demands while maintaining costs. In this study, we aimed to build a decision support system including Genetic algorithm and Simulated Annealing metaheuristic machine learning methods for nutritionists to regulate a hospitals’ nutrition cycle and provide the best possible diet menu solutions while decreasing costs. Our main reason of using hybrid metaheuristic machine learning methods is to obtain a better quality solution on the problem dealt with study. Experimental results showed that; the proposed system is a novel, smart, cost-effective, flexible and machine learning based decision support system for nutritionist and healthcare managers.

Examination of Nutrition Literacy and Quality of Self-monitoring in Behavioral Weight Loss.

Few have examined nutrition literacy (i.e., capacity to process and make informed nutritional decisions) in behavioral weight loss. Nutrition literacy (NL) may impact necessary skills for weight loss, contributing to outcome disparities. The study sets out to identify correlates of NL; evaluate whether NL predicted weight loss, food record completion and quality, and session attendance; and investigate whether the relations of race and education to weight loss were mediated by NL and self-monitoring. This is a secondary analysis of 6-month behavioral weight loss program in which overweight/obese adults (N = 320) completed a baseline measure of NL (i.e., Newest Vital Sign). Participants self-monitored caloric intake via food records. NL was lower for black participants (p < .001) and participants with less education (p = .002). Better NL predicted better 6-month weight loss (b = -.63, p = .04) and food record quality (r = .37, p < .001), but not food record completion or attendance (ps > 0.05). Black participants had lower NL, which was associated with poorer food record quality, which adversely affected weight loss. There was no indirect effect of education on weight loss through NL and food record quality. Overall, results suggest that lower NL is problematic for weight loss. For black participants, NL may indirectly impact weight loss through quality of self-monitoring. This might be one explanation for poorer behavioral weight loss outcomes among black participants. Additional research should investigate whether addressing these skills through enhanced treatment improves outcomes. NCT02363010.

Ability to Categorize Food Predicts Hypothetical Food Choices in Head Start Preschoolers

ObjectiveTo investigate whether preschoolers are able to identify and categorize foods, and whether their ability to classify food as healthy predicts their hypothetical food choice. DesignStructured interviews and body measurements with preschoolers, and teacher reports of classroom performance. SettingSix Head Start centers in a large southeastern region. ParticipantsA total of 235 preschoolers (mean age [SD], 4.73 [0.63] years; 45.4% girls). Intervention(s)Teachers implemented a nutrition education intervention across the 2014–2015 school year in which children were taught to identify and categorize food as sometimes (ie, unhealthy) and anytime (ie, healthy). Main Outcome MeasuresPreschooler responses to a hypothetical snack naming, classifying, and selection scenario. AnalysisHierarchical regression analyses to examine predictors of child hypothetical food selection. ResultsWhile controlling for child characteristics and cognitive functioning, preschoolers who were better at categorizing food as healthy or unhealthy were more likely to say they would choose the healthy food. Low-contrast food pairs in which food had to be classified based on multiple dimensions were outside the cognitive abilities of the preschoolers. Conclusions and ImplicationsNutrition interventions may be more effective in helping children make healthy food choices if developmental limitations in preschoolers' abilities to categorize food is addressed in their curriculum. Classification of food into evaluative categories is challenging for this age group. Categorizing on multiple dimensions is difficult, and dichotomous labeling of food as good or bad is not always accurate in directing children toward making food choices. Future research could evaluate further preschoolers' developmental potential for food categorization and nutrition decision making and consider factors that influence healthy food choices at both snack and mealtime.

Review of Health Impact Assessments Informing Agriculture, Food, and Nutrition Policies, Programs, and Projects in the United States

Policies, programs, and projects related to agriculture, food, and nutrition can significantly affect public health. Health impact assessment (HIA) is one tool that can be used to improve awareness of the health effects of decisions outside the health sector, and increasing the use of HIA for agriculture, food, and nutrition decisions presents an opportunity to improve public health. This study identifies and reviews all HIAs completed in the United States on agriculture, food, and nutri­tion topics. Studies were identified from HIA databases, an Internet search, and expert consulta­tion. Key characteristics were extracted from each study: type of decision assessed, location, level of jurisdic­tion, lead organization, methods of analysis, and recommendations. Twenty-five eligible HIAs that were conducted between 2007 and 2016 address topics such as regulations on land use for agricul­ture; food and beverage taxes; and devel­oping gro­cery stores in food deserts. These HIAs have predominantly supported policy, as opposed to program or project, decisions. Four case studies are presented to illustrate in detail the HIA process and the mechanisms through which HIA findings affected policy decisions. Among other influences, these four HIAs affected the language of legislation and provided guidance for federal regulations. These examples demonstrate several findings: appropriate timing is critical for findings to have an influence; diverse stakeholder involvement gener­ates support for recommendations; and the clear communication of feasible recommendations is highly important. There is substantial scope to increase the use of HIA in the agriculture, food, and nutrition sectors. Challenges include the pau­city of monitoring and evaluation of HIAs’ effects on health outcomes, and the limited funding availa­ble to conduct HIAs. Opportunities include inte­grating HIAs and community food assessments, and more widely sharing HIA findings to inform related decisions in different jurisdictions and to increase support for additional HIAs that address the food system. Note: See the supplemental Excel file (under Article Tools>Supplementary files at left) for more details on the health impact assessments included in this systematic review.

The psychological construal of health behaviors

IntroductionIn order to optimize the effectiveness of behavior change interventions, we need to understand how the construal level – how we mentally represent or construe events or behaviors – influences health-related choices. ObjectiveTo examine the impact of mental construal on health decisions. Based on the Construal Level Theory, we predicted that people would give more weight to “cognitive considerations” when making a choice after being primed with the high-level perspective, whereas they would give higher weights to “sensory considerations” after being primed with the low-level perspective. MethodIn the first experiment, ninety-nine participants were primed with either high-level or low-level perspective across decision scenarios about vaccination and physical safety. The second experiment investigated nutrition decisions, which asked seventy participants to taste food that either had no label or was labelled “organic”. Organic label should prime high-level construal as it implies outcomes (e.g., product quality and healthiness) that are more distant in time and uncertain, in contrast with sensory dimensions (e.g. taste and appearance), which are immediately present. Participants rated cognitive and sensory considerations as well as action intentions. ResultsThe first study revealed that after the priming with the high-level construal, cognitive considerations became more important than sensory considerations in predicting protective action intentions, whereas after priming with the low-level construal, sensory considerations became more important. The second study revealed that only sensory considerations predicted decisions to consume the non-labelled product and only the cognitive score predicted decisions to consume the organic-labelled product. ConclusionWe demonstrated a moderating effect of construal-level mindset in health-protective decisions. We also discuss the implications for health promotion and policy, such as optimizing the effectiveness of behavior change interventions.

Integrating renal nutrition guidelines into daily family life: a qualitative exploration.

Renal dietary compliance is challenging for individuals with chronic renal disease. Advice may change depending on renal function and medical treatment. Although patients seek support from family members with these changes, no literature exists with respect to how family members experience the offering of this support. The present study aimed to describe and interpret this lived experience of family members. Phenomenological qualitative semi-structured interviews were conducted with 12 adult family members via telephone (transcribed verbatim). Framework analysis and the qualitative software nvivo, version 10 (QSR International Pty Ltd, Melbourne, VIC, Australia) were used. Participants commented on the themes for accuracy of experience representation. Four major themes emerged: (i) intrusion of the renal diet; (ii) dealing with the recommendations of a renal diet; (iii) seeking a new identity; and (iv) transition of family dynamics. Perceived conflicting advice intruded into family life. Children in the family resulted in more complex nutritional decisions. Continuing a diet to avoid perceived family and wider social judgement was not an option. Balance between nurturing the family as a whole and the necessity of attending to the specific needs of one individual with renal disease was challenging. Transition to a new identity included family members being drawn to scientifically guided understandings of nutrition and a medicalisation of daily food requirements, which included low prioritisation of children's nutritional needs. Family members who cooked found the integration of renal nutrition guidelines challenging, with children presenting further challenges. The present study highlights the need to offer practical and psychological support to families who are coping with end-stage renal failure and renal nutritional guidelines.

Sistem Pendukung Keputusan Penentuan Status Gizi Buruk Pada Balita Menggunakan Metode Fuzzy Mamdani

Malnutrition is a condition when a person is declared lack of nutrients, or in other meanhis/her nutrients or nutritional status are below of average standards. As consequent will born unproductive human resources so will impact on all aspects of life. Based on these problems we need a method to determine the nutritional status of babies in order to handle of malnutrition. With the decision support system, it can be easier to monitor the growth and development of babies health and to facilitate decision-making in malnutrition treatment tounder five years old childrens. Fuzzy logic is a problem-solving control system method, which is suitable to implement on a systems and supported by Mamdani method. The data used as input were age, body weight, and body length and conducted a manual search using Mamdani and do Matlab test. If the babies has low age, light of weight, and average body length so the nutritional status is very low. Although the results of the manual calculation and Matlab result is not the same, but still in the same range. As an example,the results obtained using manual search using Mamdani method is 27.7 andthe result of Matlab testis 32.9 both of them have 5.2 difference, but still in the same range with very poor nutritional decisions