Nutrition Decisions Research Articles

Decisions Regarding Newborn Feeding by Latina Mothers

This study examined the factors that influence Latina mothers' decisions to initiate breastfeeding, formula feeding, or both, and when a given neonatal feeding method is decided, in order to assess the optimum time for healthcare providers to discuss nutrition decisions. A Spanish-speaking health care provider orally administered a 24-question survey to self-identified Latina mothers in the Newborn Nursery at North Carolina Children's Hospital after delivery. A total of 152 Latina mothers, aged 17 to 43 years, were interviewed from September 2014 to September 2015. Three decisive factors resulted from multivariate analysis regarding a participant's decision to exclusively breastfeed: age (27.3 years or younger); deciding about feeding method before pregnancy; and believing that exclusively breastfeeding is best for an infant's growth and development. Overall, 95% of Latina mothers made their decision regarding their infant's nutrition before delivery. Newborn nurseries have trended toward the allocation of substantial resources to the mission of enhancing the likelihood of breastfeeding initiation and success in the newborn period. Perhaps a reallocation of some of these resources for educational interventions earlier in pregnancy should be considered.

Wound Care: What the Medical Director Needs to Know

Wound Care: What the Medical Director Needs to Know

A capillary feeder (CAFE) assay to measure food consumption and diet choice of individual honey bees

Methods for quantifying food consumption are a vital resource for the evaluation of nutritional decisions made by animals. The Capillary Feeder (CAFE) assay has been widely applied to study individual food consumption in the fruit fly, Drosophila. The current methodology is limited in its ability to precisely quantify the feeding behavior of larger insects such as honey bees over long durations. We present the detailed design for a modified CAFE assay suitable for the honey bee (Apis mellifera), a typical data-set that can be collected from this assay, and discuss the possible experimental uses of the modified assay.

Decision Aid for Nutrition Support in Pediatric Oncology: A Pilot Study.

Despite the importance of nutrition support in preventing malnutrition in pediatric oncology, the decision to initiate and choose which nutrition support method is most appropriate can be difficult for parents and healthcare professionals. Decision aids are decision-focused patient information materials. They can improve knowledge, reduce decisional conflict, improve patients' risk perception, and increase patient participation in the decision-making process. They have never been evaluated for pediatric oncology nutrition decisions. We aimed to develop and pilot test a decision aid to assist parents making these decisions in collaboration with their healthcare team. The decision aid was developed in accordance with the International Patient Decision Aid Standards guidelines and evaluated in a single-center pilot study. The parents and healthcare professionals of pediatric oncology patients were eligible. Participants read the decision aid and completed a questionnaire assessing acceptability, usability, and improvement in understanding. Thirty-one parents and 15 healthcare professionals participated. Parents found the decision aid balanced, relevant, and satisfactory overall. Some parents reported the decision aid was too long (26%). Healthcare professionals positively rated the development process, usefulness to parents, and content and format of the decision aid. Forty-three percent reported that using the decision aid would save them time. There were no significant associations between health literacy, decisional satisfaction, decisional regret, acceptability, and improvement in understanding. The decision aid appears acceptable and usable for our target population. Decision aid feedback provided critical data to make modifications before evaluating the decision aid in a randomized controlled trial.

Most consumed processed foods by patients on hemodialysis: Alert for phosphate-containing additives and the phosphate-to-protein ratio

Hyperphosphatemia is common in patients with chronic kidney disease (CKD) stages IV and V because of decreased phosphorus excretion. Phosphatemia is closely related to dietary intake. Thus, a better understanding of sources of dietary phosphate consumption, absorption and restriction, particularly inorganic phosphate found in food additives, is key to prevent consequences of this complication. Our aims were to investigate the most commonly consumed processed foods by patients with CKD on hemodialysis, to analyze phosphate and protein content of these foods using chemical analysis and to compare these processed foods with fresh foods. We performed a cross-sectional descriptive analytical study using food frequency questionnaires to rank the most consumed industrialized foods and beverages. Total phosphate content was determined by metavanadate colorimetry, and nitrogen content was determined by the Kjeldahl method. Protein amounts were estimated from nitrogen content. The phosphate-to-protein ratio (mg/g) was then calculated. Processed meat protein and phosphate content were compared with the nutritional composition of fresh foods using the Brazilian Food Composition Table. Phosphate measurement results were compared with data from the Food Composition Table- Support for Nutritional Decisions. An α level of 5% was considered significant. Food frequency questionnaires were performed on 100 patients (mean age, 59±14 years; 57% male). Phosphate additives were mentioned on 70% of the product labels analyzed. Proteins with phosphate-containing additives provided approximately twice as much phosphate per gram of protein compared with that of fresh foods (p<0.0001). Protein and phosphate content of processed foods are higher than those of fresh foods, as well as phosphate-to-protein ratio. A better understanding of phosphate content in foods, particularly processed foods, may contribute to better control of phosphatemia in patients with CKD.

Juggling the five dimensions of food access: Perceptions of rural low income residents

Using focus groups (n = 6) from six West Virginia counties we assessed how low income, rural women (n = 30) enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program perceived the food environment and the ability to access healthy food.For WIC clients who are at risk for nutrition problems and live at or below 185% of poverty, challenges with food access threaten the positive aspects and impacts of the WIC program.We undertook a qualitative analysis by coding the focus group data on rural food access, into three themes. Our analysis demonstrated how the three major themes interact with five dimensions of food access and underscores the issues with food access that decrease the effectiveness of the food packages and nutrition education that low income WIC participants receive. To increase food access we recommend creating a formal structure where vendors and low income clients may discuss concerns; encouraging greater investment in rural communities through state issued incentives to build full service grocery stores or informal transportation networks; and additional research on the status of low income clients as social change agents capable of addressing issues that act as barriers to their shopping experiences. However, even with the data and prior literature, the pathways by which these environmental factors shape nutrition remain unclear-entangled - much like the issues that low income, rural residents must juggle when they make grocery shopping and nutrition decisions.

Energy Expenditure Overestimation Bias in Elliptical Trainer Machine

Elliptical trainers are a common mode of aerobic exercise in recreationally active populations. Those with a weight loss goal might rely upon the energy expenditure (EE) estimation that many elliptical brands provide to keep track of calories (kcals) burned and make nutritional decisions. For this reason, it is important to evaluate the accuracy of the algorithms used by elliptical trainers to estimate EE. PURPOSE:To compare EE estimates by a common brand of elliptical trainer to that measured using open circuit spirometry, at different combinations of resistance and pedal speed. METHODS:Twenty subjects (10 male, 10 female; 34 ± 12 yr; 175.3 ± 10.7 cm; 77.1 ± 14.1 kg) consented to participate. Each completed three 15-min bouts of elliptical exercise on the same elliptical trainer, with at least 24 hr between exercise bouts. Pedal rates were held constant throughout each bout at 50, 60, or 70 RPM, and resistance was increased incrementally every 5 min from level 5 to 10 to 15. The different cadences were completed in a randomized order between participants. Expired gases were collected continuously throughout the 15 min. Heart rate, distance (mi), and EE from the elliptical readout were recorded every 1 min. RPE was collected twice per resistance level. A two-tailed paired samples t-test was used to compare elliptical EE to measured EE. A linear regression model was used to evaluate the ability of the elliptical EE to predict measured EE. Significance for all statistical measures was held at an alpha level of 0.05. RESULTS:The difference between EE estimates from the elliptical and measured VO2 was significant (p<0.0001), with the elliptical machine overestimating EE during a 15 minute session by an average of 10.21 kcals. Measured EE in kcals as derived from open circuit spirometry was significantly predicted by elliptical EE according to the equation: Measured EE = 0.95*(Elliptical EE) - 3.161 CONCLUSIONS:The elliptical trainer used demonstrated a bias to overestimate EE. This should be taken into account by health/fitness professionals using these estimations to program for clients. There may be some variation in the EE correction regression depending on elliptical model, and proper machine calibration should be ensured.

Does Women\u2019s Empowerment in Agriculture Matter for Children\u2019s Health Status? Insights from Northern Ghana

Given that women in rural communities in developing countries are responsible for the nutrition and health-related decisions affecting children in their care, their empowerment may influence the health status of their children. The association between women’s empowerment, measured by using a recently developed Women’s Empowerment in Agriculture Index, and children’s health status is examined for a sample of households in Northern Ghana applying a Multiple Indicators Multiple Causes (MIMIC) model. The MIMIC approach is used to link multiple indicator variables with multiple independent variables through a “single underlying” latent variable. Height-for-age and weight-for-height z-scores are used as indicators of the underlying children’s health status and women’s empowerment in agriculture and control variables are used as the multiple independent variables. Our results show that neither the composite empowerment score used to capture women’s empowerment in agriculture nor its decomposed components are statistically significant in their association with the latent children’s health status. However, the associations between children’s health status and control variables such as mother’s education, child’s age, household’s hunger scale and residence locale are statistically significant. Results also confirm the existence of the ‘single underlying’ common latent variable. Of the two health status indicators, height-for-age scores and weight-for- height scores, the former exhibited a relatively stronger association with the latent health status. While promoting women’s empowerment to enhance their ability to make strategic life choices, it is important to carefully consider how the achievement of these objectives will impact the women’s well-being and the well-being of the children in their care.

Decisions Regarding Newborn Feeding By Latina Mothers

This study examined the factors that influence Latina mothers' decisions to initiate breastfeeding, formula feeding, or both, and when a given neonatal feeding method is decided, in order to assess the optimum time for healthcare providers to discuss nutrition decisions. A Spanish-speaking health care provider orally administered a 24-question survey to self-identified Latina mothers in the Newborn Nursery at North Carolina Children's Hospital after delivery. A total of 152 Latina mothers, aged 17 to 43 years, were interviewed from September 2014 to September 2015. Three decisive factors resulted from multivariate analysis regarding a participant's decision to exclusively breastfeed: age (27.3 years or younger); deciding about feeding method before pregnancy; and believing that exclusively breastfeeding is best for an infant's growth and development. Overall, 95% of Latina mothers made their decision regarding their infant's nutrition before delivery. Newborn nurseries have trended toward the allocation of substantial resources to the mission of enhancing the likelihood of breastfeeding initiation and success in the newborn period. Perhaps a reallocation of some of these resources for educational interventions earlier in pregnancy should be considered.

Nutrition support practices in South African ICUs: Results from a nationwide pilot survey

Background. Nutrition support of the critically ill can positively affect clinical outcomes. International audit data of nutrition practices in intensive care units (ICUs) suggest that inconsistent application of recommended nutrition support practices (NSPs) occurs. There are no data on NSPs in South African (SA) ICUs. Objective. To perform a national pilot survey of NSPs in private SA adult ICUs. Methods. A descriptive, observational, cross-sectional survey was performed among prescribers of nutrition support in private ICU facilities. Participants were targeted through non-randomised convenience sampling and invited to complete a 51-item electronic questionnaire covering ICU demographics, profile of nutrition prescribers, and nutrition assessment support, delivery and monitoring practices. Results. Responses were received from 125 practitioners in 60% of representative private hospitals with ICU facilities, mainly general/mixed ICUs. Forty-six percent of respondents reported structured nutrition support teams and 61% reported that practices were governed by formal nutrition support protocols. Enteral nutrition was reported to be based upon published guidelines by 72% of dietitians, while parenteral nutrition decisions were reportedly based mainly on clinical judgement (43%). For both enteral and parenteral feeding practices, compliance with guidelines was inconsistent. There was a disjuncture between various NSPs as reported by dietitians and by nurses. Nurses generally appeared unaware of published nutrition guidelines. Conclusion. Various disparities in reported nutrition practices were revealed, suggesting that the organisation and operations of teams and the implementation of protocols informed by published nutrition guidelines may not be well established in private SA ICUs.

Demystifying Nutritional Support in Cancer (FR451)

•Describe the pathophysiology and stages of the cancer-related anorexia-cachexia syndrome.•Describe methods to assess cancer-related anorexia-cachexia at the bedside.•Describe the interventions according to stages of cancer-related anorexia-cachexia. Central to managing nutrition in the cancer patient is recognizing and managing the anorexia-cachexia syndrome. Research characterizes the anorexia-cachexia syndrome as a metabolic syndrome associated with advanced cancer producing loss of muscle with or without the loss of fat mass. Its development is a turning point in the disease trajectory of a cancer patient, with continued weight loss associated with a shorter survival time, and it is responsible for death in up to 20% of cancer patients. Anorexia-cachexia is a significant cause of morbidity that manifests as weight loss, asthenia (loss of energy and strength), anemia, and alterations in immune function. Research now recognizes anorexia-cachexia as a continuum consisting of three stages, defined as precachexia, cachexia, and refractory cachexia. Not all patients traverse the entire spectrum. Interventions potentially modifying the effect of anorexia-cachexia differ according to stages. Patients are often inappropriately recommended extreme types of nutritional support according to the stage of cancer and extent of the metabolic syndrome. Patients also experience messages that force them to adhere to therapies that are no longer appropriate for the stage of anorexia-cachexia. From presenters with diverse backgrounds in oncology, nursing, cachexia research, and community palliative care, and through didactics, case presentations, and audience participation, the session will accomplish four major goals for the attendees: (1) enhance knowledge of the basic pathophysiology of the anorexia-cachexia syndrome, (2) improve clinical assessment of anorexia-cachexia with a focus on clinical bedside assessment and technological advances, (3) characterize interventions according to stage of anorexia-cachexia, and (4) develop attendees’ skills at communicating with patients and families about cancer and nutrition. When this session is completed, palliative care specialists will walk away better equipped to participate in complex nutritional decision making for cancer patients.

The impact of traffic light color-coding on food health perceptions and choice.

Government regulators and consumer packaged goods companies around the world struggle with methods to help consumers make better nutritional decisions. In this research we find that, depending on the consumer, a traffic light color-coding (TLC) approach to product labeling can have a substantial impact on perceptions of foods' health quality and food choice. Across 3 lab experiments and a field experiment, we find that TLC labels provide nondieters with an information processing cue that directly influences evaluations in a manner that is consistent with the "stop" and "go" logic behind the traffic light labels. In contrast, we find that dieters do not simply adopt the red, yellow, and green cues into their health quality evaluations. Instead, regardless of the color, the TLC approach increases the depth at which dieters process label information. Dieters tend to focus on the costs of consumption and, as a result, lower their health quality evaluations. In a field study, measuring actual behavior in a grocery store, health quality evaluations predicted consumption and consistent with the color coding of the labels nondieters consumed the most when they were presented with a predominantly green label.

Influence of stage of lactation on quantitative and qualitative milk production parameters in goats

Goat lactation is synonymous to an agricultural production function with three distinct production regions namely: early, mid and late lactation. It is characterised by an increase in milk yield in early lactation to a possible peak in the mid lactation and then a decline in milk yield as it reaches the end of lactation. However, the other milk constituencies (protein, fat, lactose, etc ) do not follow the same trend as total milk yield through the 3 lactation stages. Therefore, it is suffice to suggest that the understanding of the physiological changes in these stages of lactation is crucial in maximizing milk production in goats. The present discussion explores the importance of different stages of lactation in milk production in influencing yield and milk composition. Milk yield and its composition are influenced by various factors, among these stage of lactation is very significant. The proportion of protein, lactose, fat and total solids declined slightly with advance in lactation and a steady fall in milk yield. This is on the basis that milk yield is a function of the number of mammary secretory cells and their metabolic activity change during the course of lactation. The significant stage of lactation effect in most studies may have practical implications in determining optimal feeding management to maximize total lactation yield and milk composition. Therefore, the knowledge of physiological activities during different stages of lactation is critical to dairy animal nutrition and management decision support systems for optimization of goat dairy flock production processes.

Mixed‐methods study identifies key strategies for improving infant and young child feeding practices in a highly stunted rural indigenous population in Guatemala

Guatemala's rural indigenous population suffers from one of the highest rates of chronic child malnutrition (stunting) in the world. Successfully addressing stunting requires defining the barriers to and opportunities for new behaviour-change initiatives. We undertook a mixed-methods assessment of feeding practices and food purchasing behaviours around infants and young children aged 6-36 months in two rural indigenous Guatemalan communities. We found that most caregivers were aware only of acute forms of child malnutrition and that they greatly underestimated the local prevalence of malnutrition. Despite moderate adherence to exclusive breastfeeding and timing of complementary food introduction, diets had poor diversity and inadequate meal frequency. Furthermore, perceptions of food insecurity were high even in the presence of land ownership and agricultural production. Although fortified foods were highly valued, they were considered expensive. At the same time, proportionally equivalent amounts of money were spent on junk foods or other processed foods by most participants. Biological mothers often lacked autonomy for food purchasing and nutritional decisions because of the power exerted by husbands and paternal grandmothers. Our findings suggest several creative and community-based programming initiatives including education about the acute vs. chronic malnutrition distinction, engaging landowners in discussions about domestic food consumption, engaging with caregivers to redirect funds towards fortified foods rather than junk food purchases and directing behaviour-change initiatives towards all household stakeholders.

A Novel Multiobjective Memetic Algorithm Based on IWO-DE and its Application in Nutrition Decision Making Problem

In this paper ,we discuss multiobjective optimization problems solved by Memetic algorithms. We present A novel multiobjective memetic algorithm based on invasive weed optimization and differential evolution (IWO-DE) to solve this class of problems .We present the Nutrition Prescription Model for Meals.the IWO-DE is applied to solve the nutrition decision making problem to map the Pareto-optimum front. The results in the problem show its effectiveness.

PA.23 Understanding practice change in neonatal intensive care using normalisation process theory – a qualitative study

BackgroundIntroducing new practices in complex environments like the Neonatal Intensive Care Unit (NICU) is challenging, but is important in order to improve care. There is a need to better understand...

Clinical Guidelines From the American Society for Parenteral and Enteral Nutrition

The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) is an interdisciplinary society whose vision is to ensure that every patient receives safe, efficacious, and high-quality nutrition care. The society has produced clinical guidelines to assist practitioners in enteral and parenteral nutrition decision making. A.S.P.E.N. clinical guideline development has evolved through the years, and recently has incorporated a rigorous and transparent development process using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) process. This article will examine A.S.P.E.N.'s guideline development process, discuss current population- and disease-specific practice guidelines, and highlight recommendations useful for the clinician involved in nutrition therapy decision making.

Modelling nutrition across organizational levels: From individuals to superorganisms

The Geometric Framework for nutrition has been increasingly used to describe how individual animals regulate their intake of multiple nutrients to maintain target physiological states maximizing growth and reproduction. However, only a few studies have considered the potential influences of the social context in which these nutritional decisions are made. Social insects, for instance, have evolved extreme levels of nutritional interdependence in which food collection, processing, storage and disposal are performed by different individuals with different nutritional needs. These social interactions considerably complicate nutrition and raise the question of how nutrient regulation is achieved at multiple organizational levels, by individuals and groups. Here, we explore the connections between individual- and collective-level nutrition by developing a modelling framework integrating concepts of nutritional geometry into individual-based models. Using this approach, we investigate how simple nutritional interactions between individuals can mediate a range of emergent collective-level phenomena in social arthropods (insects and spiders) and provide examples of novel and empirically testable predictions. We discuss how our approach could be expanded to a wider range of species and social systems.

Nutrition Decisions, Eat Smart, Move More

Nutrition Decisions, Eat Smart, Move More provides students with the skills and information they need to make eating healthy and being active attainable, no matter how busy they are. It goes beyond the facts and provides practical ways students can put their knowledge to work immediately ...-Jones & Bartlett Learning

Fuzzy Co-Evolutionary Genetic Algorithm and its Application in Clinical Nutrition Decision

The fuzzy co-evolution genetic algorithm is applied to clinical nutrition decision-making optimization. By cooperative co-evolutionary algorithm, the decision problem of clinical nutrition is divided into two populations ,which is combined into a complete diet recipe. In this paper, different fuzzy-based definitions of optimality and dominated solution are introduced. The corresponding extension of Co-Evolutionary Genetic Algorithm, so-called Fuzzy Co-Evolution Genetic Algorithm (FCEGA), will be presented as well. To verify the usefulness of such an approach, the approach is tested on analytical test cases in order to show its validity . The solutions, provided by the proposed algorithm for the clinical nutrition diet model,are promising when compared with an existing well-known algorithm.