Nutrition Visits Research Articles

Impact of Medically Tailored Meals on Clinical Outcomes Among Low-Income Adults with Type 2 Diabetes: A Pilot Randomized Trial.

Adults with type 2 diabetes (T2DM) and adverse social determinants of health experience barriers to healthful eating, and achieve poorer glycemic control and clinical outcomes. To examine the impact of medically tailored meals (MTM) with medical nutrition therapy (MNT) on clinical outcomes among adults with DM. Pilot randomized controlled trial. English-speaking adults with DM and hemoglobin A1c (A1c) levels > 8% insured by Maryland Medicaid plans. The treatment group received home delivery of 12 medically tailored, frozen meals and a fresh produce bag weekly for 3months, and individual calls with a registered dietitian monthly for 6months in addition to usual care. The control group received usual care. Outcomes were change from baseline to 6months in A1c (primary), body mass index (BMI), blood pressure, food insecurity, and diabetes-related quality of life, knowledge, and self-efficacy (secondary). We randomized 74 adults; 77% completed data collection. The mean age was 48years, 40% were male, 77% were Black, and the mean A1c was 10.3%. Eighty-six percent of meals were delivered, and on average 4.8 nutrition visits were completed. At 6months, both groups had similar improvements in A1c (- 0.7 vs. - 0.6%); the control group reported more favorable changes in diabetes medications. Changes in systolic blood pressure and BMI at 6months did not differ between groups. Diabetes-related quality of life, knowledge, and self-efficacy improved modestly, but not differently by group. Food insecurity decreased significantly from baseline to 3months in the intervention (53 to 17%) compared to control (48 to 44%; p < 0.05), which lessened but remained significant at 6months. Recruitment and retention of an at-risk group of adults with DM was feasible. Intervention uptake was good but did not improve clinical outcomes. More comprehensive and clinically integrated interventions are likely needed to achieve significant clinical benefits. NCT04034511.

Predictors of enrollment in a virtual diabetes prevention program among women veterans: a retrospective analysis

BackgroundThe Diabetes Prevention Program (DPP) is a nationally disseminated lifestyle intervention shown to prevent type 2 diabetes (diabetes). However, enrollment in the program remains variable. We sought to identify patient characteristics associated with enrollment in a virtual DPP program among women Veterans to inform ongoing diabetes prevention efforts.MethodsWe conducted a retrospective analysis of 2021–2024 Department of Veterans Affairs (VA) data collected through the VA Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 Program, an effectiveness-implementation trial to expand access to preventative health services for women Veterans. We included women meeting DPP eligibility criteria (BMI ≥ 25 kg/m2 [or ≥ 23 if Asian] with ≥ 1 risk factor for diabetes [e.g., prediabetes]) who received care at six VA sites implementing virtual DPP. We used logistic regression to examine the association between DPP enrollment and prior use of VA preventive services for weight management or diabetes prevention including the VA MOVE! clinic, Whole Health visits, nutrition visits, weight loss medications, and/or metformin. We adjusted for sociodemographic factors, comorbidities, number of DPP recruitment contacts, and site.ResultsA total of 1473 women Veterans received DPP outreach. On average, their age was 53 years (range 20–96), BMI 34 kg/m2, HbA1c 5.9%, 0.7% were Asian, 44% Black, 2% Hispanic, and 44% White. In our adjusted models, prior use of VA preventative services was not significantly associated with DPP enrollment. Younger women (OR:0.97, p = 0.002) and those who received more recruitment contacts (OR:2.63, p < 0.001), were significantly more likely to enroll in DPP. Women with housing instability were significantly less likely to enroll (OR:0.44, p = 0.029).ConclusionsWe found no difference in women Veterans’ enrollment in DPP based on prior use of VA weight management and prevention services. Frequency of outreach by VA sites may increase engagement in lifestyle interventions. Virtual DPP may support engagement in preventive lifestyle interventions for diverse groups of women Veterans, as a first program or as a complement to other VA services.Trial registrationClinicalTrials.gov, NCT05050266. Registered on 20 September 2021.

Experiences With Outpatient Nutrition Services Among Caregivers of Youth With Type 1 Diabetes.

Many children with type 1 diabetes do not meet nutritional guidelines. Little is known about how caregivers perceive the necessity of registered dietitian (RD) visits or how satisfied they are with nutrition care. This study aimed to evaluate nutrition experiences and perceptions of care among caregivers of children with type 1 diabetes at an academic medical center. We analyzed 159 survey responses. Using multivariable logistic regression, we assessed factors associated with the perception of need for annual nutrition visits, satisfaction with RD care, and encouragement from a nurse or doctor to meet with an RD. Covariates included age (<13 vs. ≥13 years), type 1 diabetes duration (≤3 vs. >3 years), sex, race/ethnicity, and insulin pump and continuous glucose monitoring use. More than half of caregivers (56%) considered annual visits necessary. Shorter type 1 diabetes duration (odds ratio [OR] 1.92, 95% CI 1.02-3.63) was associated with this finding. Less than half (46.5%) reported satisfaction with nutrition care; higher satisfaction was also correlated with shorter type 1 diabetes duration (OR 2.20, 95% CI 1.17-4.15). Although 42% reported meeting with an RD in the past year, less than two-thirds (62%) reported receiving a medical provider recommendation for nutrition care. Leading reasons for not meeting with an RD were "I am knowledgeable in nutrition and do not need to see an [RD]" (41%) and "I had a past visit with an [RD] that was not helpful" (40%). Our findings suggest that satisfaction with and perceived need for nutrition care may wane with longer type 1 diabetes duration. Improved strategies for therapeutic alliance between caregivers and RDs and engagement of families at later stages of type 1 diabetes are needed.

Abstract 14777: Effectiveness of Virtual vs Face-to-Face Medical Nutrition Therapy in Patients With Hyperlipidemia

Introduction: Medical nutrition therapy provided by registered dietician nutritionists (RDNs) is an effective therapy for treating lipid disorders. There has been a shift in practice for patients to receive nutrition counseling virtually rather than in-person. Hypothesis: We evaluated whether virtual nutrition visits are as effective as face-to-face (F2F) visits at reducing lipid levels. Methods: We performed an observational study of patients seen by a RDN as part of the University of Michigan Preventive Cardiology lipid management program from 3/31/2019 - 9/31/22. Lipid markers, including total cholesterol (TC), high-density lipoprotein (HDL), and triglycerides (TG) were collected prior to meeting with an RDN and a median of 33 days later. Low-density lipoprotein (LDL) was calculated using the Sampson equation (patients with TG &gt;800 mg/dL were excluded). We used a paired T-test to evaluate the mean difference in lipid marker pre-post visit. Linear regression was used to compare the impact of virtual and F2F nutrition visits. Results: 192 patients were included (41 virtual visits and 151 F2F visits). After a single virtual or F2F visit with an RDN, TC, LDL, and non-HDL decreased (all p-values &lt;0.05, Figure). HDL decreased for F2F visits only. Change in TG was not significant for either group. There were no significant differences between virtual and F2F for changes in mean pre-post visit for any lipid markers (TC p=0.37, LDL p=0.54, non-HDL p=0.29, HDL p=0.72, TG p=0.67). Conclusions: Both virtual and face-to-face RDN visits lead to overall improvement in lipid profiles at post-visit follow-up. Telehealth is an effective way for patients to receive nutrition counseling and may help to overcome barriers in access to treatment for hyperlipidemia.

0110 The Influence of Changing School Start Times on Frequency and Timing of Nurse’s Visits for Sleep and Nutrition

Abstract Introduction Healthy school start times are important for ensuring students obtain sufficient sleep, which may impact other health outcomes. Previous studies have not examined the impact of changing school start times on nurses’ visits related to sleep and nutrition in students in grades K-12 after district-wide changes to delay start times in middle and high school and advance start times in elementary school. Methods Electronic medical record data (reason for student visit and time of visit) were retrieved from nursing offices for elementary (n=44), middle (n=14), and high (n=6) schools. For this study, we included sleep and nutrition visits within the first two hours of the school day in April/May for the year prior (pre-change) and two years after (post-change, follow-up) implementing new school start times. Within each school level (i.e., elementary, middle, high), descriptive statistics examined the number of visits by health category. Results In elementary school, nurse visits increased in the first two hours when school start times were moved from 9:00am to 8:00 am for both sleep (pre-change n=45; post-change n=78; follow-up n=58) and nutrition (pre-change n=30; post-change n=63; follow-up n=48). For middle school, nurse visits slightly decreased in the first two hours of school when start times were moved from 8:00am to 8:50am for both sleep (pre-change n=14; post-change n=11; follow-up n=11) and nutrition (pre-change n=47; post-change n=42; follow-up n=6). High school nurse visits also slightly decreased in the first two hours of school when start times moved from 7:10am to 8:20am for both sleep (pre-change n=16; post-change n=7; follow-up n=7) and nutrition (pre-change n=5; post-change n=5; follow-up n=2). Conclusion While not unexpected, elementary school nurse visits for sleep and nutrition increased when start times were moved earlier. However, at follow-up, visit frequency notably decreased, suggesting that it may take time for families to adjust to the new start times. For both middle and high school students, nurse visits for sleep and nutrition slightly decreased with later start times. More research is needed to determine optimal start times for elementary school students, as healthy start times are essential for adolescent health and well-being. Support (if any) RWJF Evidence for Action (#75277)

The Progression of Prediabetes to Type 2 Diabetes in Children and Adolescents in the United States: Current Challenges and Solutions

Prediabetes, the precursor of type 2 diabetes (T2D), is on the rise among children and adolescents in the United States. The natural history of prediabetes is poorly characterized in children compared to adults. The available data indicate a phenotype of an accelerated β-cell failure in youth with prediabetes. Data from randomized controlled trials showed no benefit on β-cell preservation or A1c in youth with prediabetes from therapeutic agents such as metformin and insulin. As a result, the American Diabetes Association recommends only lifestyle intervention, but not therapeutic agents, for the management of prediabetes in children and adolescents. These recommendations for lifestyle modification in youth, largely derived from data in adults, lack the precision necessary for efficacy in youth. However, a recent 4-year real-world study on youth reported that adherence to nutrition visits was associated with a 4-fold reduction in the likelihood of progressing from prediabetes to T2D. The finding that this reversal is associated with reduced insulin resistance (IR) and not with decreased body weight is novel and provides the foundation for trialing investigational products that may protect β-cells and reduce IR and/or body weight. This study provides the much-needed foundation for further exploration of the impact of lifestyle modification in conjunction with other approaches for the reversal of prediabetes in youth. The systematization of the protocol for medical nutrition therapy for the reversal of prediabetes in youth will ensure optimal and consistent results from adherent patients. This communication provides updates on the pathobiology of prediabetes in youth and a clear direction for efficacious studies in the field.

Effectiveness of an electronic clinical decision support system in improving the management of childhood illness in primary care in rural Nigeria: an observational study

ObjectivesTo evaluate the impact of ALgorithm for the MANAgement of CHildhood illness (‘ALMANACH’), a digital clinical decision support system (CDSS) based on the Integrated Management of Childhood Illness, on health...

Prediabetes: Adherence to Nutrition Visits Decreases HbA1c in Children and Adolescents.

BackgroundPrediabetes, the precursor of type 2 diabetes (T2D), is on the rise in the US, but the determinants of its progression are poorly characterized in youth.ObjectiveTo determine the impact of nutrition visits, as a surrogate marker of lifestyle modification, on the trajectory of prediabetes over a 4-year period.HypothesisAdherence to nutrition visits could reduce BMI and lower HbA1c.MethodsA 4-year retrospective study of 108 youth with prediabetes who were recommended to receive medical nutrition therapy every 3 months following their diagnosis. Subjects were divided into 2 groups: the non-adherent group who had ≤1 nutrition visit/year, and the adherent group with ≥2 nutrition visits/year.ResultsThere were 46 male subjects, mean age 12.4 ± 3.6y; and 62 female subjects, mean age, 13.3 ± 3.0y, p=0.2. The adherent group (n=44, 41.5%) had higher BMI z-scores, but similar values for HbA1c, metformin use, and racial/ethnic composition compared to the non-adherent group. Overall, 18(17.0%) subjects progressed to T2D in 4y and consisted of 14(22.6%) of the 62 non-adherent subjects and 4(9.1%) of the 44 adherent subjects. The non-adherent subjects progressed to T2D at a mean duration of 25.8 ± 12.6 months while the adherent subjects progressed at a mean duration of 34.9 ± 11.8 months. The hazard ratio of progression from prediabetes to T2D for the non-adherent versus adherent group was 3.88 (95%CI 1.26-11.98, p=0.02). The results remained significant after adjusting for age, sex, race/ethnicity, BMI, and metformin use.ConclusionAdherence to nutrition visits was associated with a 4-fold reduction in the likelihood to progress from prediabetes to T2D in US youth.

Clinical Care Among Individuals with Prediabetes in Primary Care: a Retrospective Cohort Study.

BackgroundThe incidence of diabetes in the general US population (6.7 per 1000 adults in 2018) has not changed significantly since 2000, suggesting that individuals with prediabetes are not connecting to evidence-based interventions.ObjectiveWe sought to describe the clinical care of individuals with prediabetes, determine patient factors associated with this care, and evaluate risk for diabetes development.DesignRetrospective cohort study using linked claims and electronic health record data.ParticipantsWe created a cohort of adults with prediabetes based on laboratory measures. We excluded patients with a prior history of diabetes, pregnancy in prior 6 months, or recent steroid use.Main MeasuresWe measured ordering and completion of clinical services targeting prediabetes management and diabetes incidence within 12 months following cohort entry. We tested the strength of the association between individuals’ characteristics and outcomes of interest using bivariate and multiple logistic regression.ResultsOur cohort included 3888 patients with a laboratory diagnosis of prediabetes (incident or prevalent prediabetes). Within 12 months, 63.4% had repeat glycemic testing, yet only 10.4% had coded diagnoses of prediabetes, 1.0% were referred for nutrition services, and 5.4% were prescribed metformin. Most patients completed labs and nutrition visits when referred and filled metformin when prescribed. Individuals with a higher glycemic level or BMI were more likely to receive prediabetes clinical care. Six percent of individuals developed diabetes within 12 months of cohort entry and had higher glycemic levels and BMI ≥ 30 kg/m2. In the adjusted model, Black individuals had 1.4 times higher odds of developing diabetes than White individuals.ConclusionsRates of prediabetes clinical care activities are low and have not improved. Strategies are urgently needed to improve prediabetes care delivery thereby preventing or delaying incident diabetes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07412-9.

Pilot trial of remote monitoring to prevent malnutrition after hepatopancreatobiliary surgery

BackgroundPatients undergoing hepatopancreatobiliary (HPB) surgery, such patients with pancreatic, periampullary, and liver cancer, are at high risk for malnutrition. Malnutrition increases surgical complications and reduces overall survival. Despite its severity, there are limited interventions addressing malnutrition after HPB surgery. The aim of this pilot trial was to examine feasibility, acceptability, usability, and preliminary efficacy of a remote nutrition monitoring intervention after HPB surgery.MethodsParticipants received tailored nutritional counseling before and after surgery at 2 and 4 weeks after hospital discharge. Participants also recorded nutritional intake daily for 30 days, and these data were reviewed remotely by registered dietitians before nutritional counseling visits. Descriptive statistics were used to describe study outcomes.ResultsAll 26 patients approached to participate consented to the trial before HPB surgery. Seven were excluded after consent for failing to meet eligibility criteria (e.g., did not receive surgery). Nineteen participants (52.6% female, median age = 65 years) remained eligible for remote monitoring post-surgery. Nineteen used the mobile app food diary, 79% of participants recorded food intake for greater than 80% of study days, 95% met with the dietitian for all visits, and 89% were highly satisfied with the intervention. Among participants with complete data, the average percent caloric goal obtained was 82.4% (IQR: 21.7).ConclusionsThis intervention was feasible and acceptable to patients undergoing HPB surgery. Preliminary efficacy data showed most participants were able to meet calorie intake goals. Future studies should examine intervention efficacy in a larger, randomized controlled trial.Trial registrationClinicaltrials.gov. Registered 16 September 2019, https://clinicaltrials.gov/ct2/show/NCT04091165.

Study protocol on the safety and feasibility of a normocaloric ketogenic diet in people with amyotrophic lateral sclerosis

ObjectivesThis study evaluates the safety and feasibility of a normocaloric ketogenic diet (KD) in people with amyotrophic lateral sclerosis (ALS) for reducing hyperexcitability levels and modulating neuroinflammation. MethodsThis is a prospective, open-label pilot study involving men and women diagnosed with ALS, ages 18 to 75 y. The primary outcome is the safety and reproducibility of the KD in people with ALS. We will monitor secondary clinical outcomes with the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale score, forced vital capacity, the Amyotrophic Lateral Sclerosis Assessment Questionnaire, blood parameters, and gut microbiota analyses. All participants will follow the KD for 8 wk. During the diet, the clinical status of all participants will be monitored every 15 d through neurologic and nutritional visits and biochemical markers. The research ethics committee approved the study. ResultsSafety will be assessed by measuring the number and severity of adverse events, including death, and any changes in blood chemistry, vital signs, and clinical exam results. Tolerability will be assessed to complete the proposed 8 wk of treatment while maintaining adequate nutritional status without inducing malnutrition. ConclusionsAdequate caloric intake is essential in ALS, because insufficient intake induces loss of body mass. We hope that the proposed study will provide a positive result in terms of the safety and feasibility of a KD in people ALS, with the purpose of developing a patient-centered diet program to limit disease progression and possibly improve survival.

936-P: Nutrition Experiences among Caregivers of Youth with Type 1 Diabetes

Many children with type 1 diabetes (T1D) do not meet nutritional guidelines. Little is known about how caregivers perceive the necessity of appointments with a dietitian (RD) or how satisfied they are with their nutrition care. To better understand caregiver nutrition experiences and perceptions, we surveyed 838 families of children &amp;lt;18 years old receiving T1D care at Boston Children’s Hospital (BCH). Of 184 (22%) responses, 159 with complete data were analyzed. Using multivariable logistic regression, we assessed factors associated with caregiver (1) perception of the necessity for annual nutrition visits; (2) satisfaction with nutrition care and (3) encouragement from a nurse or doctor to meet with an RD. Covariates included child’s age, diabetes duration, gender, race and ethnicity, and diabetes technology use. Age and diabetes duration were categorized as &amp;lt;13 and ≥ 13 years old and ≤ 3 and &amp;gt; 3 years, respectively. Among children in the analysis, 55% were ≥ 13 years old and 51% had T1D for ≤ 3 years. Over half (56.6%) of respondents considered it necessary to see a RD every year. Older age (aOR=2.06, 95% CI [1.01, 4.20]) and shorter disease duration (aOR=2.50, 95% CI [1.22, 5.12]) were associated with this perception. Less than half (47.8%) reported satisfaction with their nutrition care, with shorter disease duration associated with a higher likelihood of satisfaction (aOR=2.24, 95% CI [1.13, 4.42]). Only 61.4% of respondents reported encouragement from a nurse or doctor to meet with a RD. No demographic or clinical characteristics were associated with this finding. Our findings suggest that caregiver satisfaction with nutrition care and its perceived need for children with T1D may wane with longer disease duration. However, the perceived need for nutrition services is also higher in parents of teens. Future work should delineate strategies for engaging families in nutrition education that is more tailored to later stages of the T1D journey. In addition, there is a need for teen-focused T1D nutrition care curricula. Disclosure E. N. Gordon: None. B. S. Dykeman: None. K. Greco: None. E. Rhodes: Other Relationship; Self; AstraZeneca. K. Garvey: None.

Nutrition Education Toolbox for Hidradenitis Suppurativa

Diet has been shown to influence disease activity in hidradenitis suppurativa (HS). Modification of dietary intake is the most commonly used lifestyle intervention in HS, and patients frequently report HS improvement after implementing dietary changes. Providing nutrition education may be perceived as not feasible within the time constraints of an outpatient office visit, and many physicians may also not feel equipped to do this. In addition, most insurances have limited coverage for nutrition visits. However, dietary changes may be employed as a low-cost adjunctive treatment option that can be combined with conventional medical treatment to mitigate HS symptoms. Though dietary modification has been increasingly recognized as a commonly used and influential factor in HS management, there is no comprehensive HS nutritional guide. Herein, we provide tools for both physicians and patients to facilitate evidence-based nutrition education in HS through collaboration with dermatologists specializing in HS, a registered dietitian, and a culinary specialist.

Perspectives of Registered Dietitian Nutritionists on Adoption of Telehealth for Nutrition Care during the COVID-19 Pandemic.

Widespread transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a global coronavirus disease 2019 (COVID-19) pandemic that is straining medical resources worldwide. In the United States (US), hospitals and clinics are challenged to accommodate surging patient populations and care needs while preventing further infection spread. Under such conditions, meeting with patients via telehealth technology is a practical way to help maintain meaningful contact while mitigating SARS-CoV-2 transmission. The application of telehealth to nutrition care can, in turn, contribute to better outcomes and lower burdens on healthcare resources. To identify trends in telehealth nutrition care before and during the pandemic, we emailed a 20-question, qualitative, structured survey to approximately 200 registered dietitian nutritionists (RDNs) from hospitals and clinics that have participated in the Malnutrition Quality Improvement Initiative (MQii). RDN respondents reported increased use of telehealth-based care for nutritionally at-risk patients during the pandemic. They suggested that use of such telehealth nutrition programs supported positive patient outcomes, and some of their sites planned to continue the telehealth-based nutrition visits in post-pandemic care. Nutrition care by telehealth technology has the potential to improve care provided by practicing RDNs, such as by reducing no-show rates and increasing retention as well as improving health outcomes for patients. Therefore, we call on healthcare professionals and legislative leaders to implement policy and funding changes that will support improved access to nutrition care via telehealth.

Etiology Intervention Link Predicts Resolution of Nutrition Diagnosis: A Nutrition Care Process Outcomes Study from a Veterans’ Health Care Facility

In this article, we evaluate relationships between Nutrition Care Process (NCP) chain links and improvement or resolution of the nutrition diagnosis. We conducted a retrospective record review for 12 months in a single Veterans Health Administration health care system using the Veterans Health Administration–specific monitoring and evaluation terms, NCP terminology, and its etiology categories to evaluate outcomes. Logistic regression analysis revealed that the strongest predictor for diagnosis improvement was the etiology–intervention link. The odds of improving the nutrition diagnosis were 51.43 times higher when the etiology–intervention link was present. The odds of improving the nutrition diagnosis were 19.74 times higher when the evidence–diagnosis link was present and 9.46 times higher when the intervention–goal link was present. For every added nutrition visit by the registered dietitian nutritionist, the odds of improving the nutrition diagnosis increased by 32.5%. For every increased point on the NCP audit score, the odds of resolving or improving the nutrition diagnosis increased by 37.7%. When applying the NCP, the presence of the etiology–intervention link significantly improves the odds of resolving the nutrition diagnosis in a Veterans Health Administration population. For the first time, we show evidence that the NCP works as designed. Also, we demonstrate that the quality of NCP documentation impacts resolution of the diagnosis, and we describe the methodology for how to evaluate NCP outcomes. Registered dietitian nutritionists are encouraged to critically evaluate links of the NCP chain, assess NCP documentation for quality, and pursue follow-up visits to improve resolution of nutrition problems.

Nutritional Assessment and Malnutrition in Patients With Cirrhosis.

We sought to determine the incidence and outcomes of malnutrition in patients with cirrhosis. We performed a retrospective chart review of 134 patients listed for liver transplant (LT) to assess the presence and degree of malnutrition identified by the Subjective Global Assessment score at the time of initial transplant evaluation, follow-up nutrition visits, and at the time of transplant. Number of admissions/readmissions to the hospital, reason for hospitalization(s), and length of stay were determined. Malnutrition was prevalent at initial nutrition visit (51.9%) and underdiagnosed. By the time of transplant, 61% of the patients were identified as malnourished. Most patients (52%) were awaiting LT for more than 180 days. The change in Subjective Global Assessment score after the initial nutrition assessment was statistically significant (p ≤ .007), with worsening malnutrition severity. Seventy-one patients (53%) required hospitalization while awaiting transplant, with a median hospital stay of 9 days. Nutrition expertise is required for prompt and accurate diagnosis of malnutrition in patients with cirrhosis. Nurses caring for patients with advanced liver disease are in a prime position to provide guidance to optimize patient outcomes.

Prevalence and correlates of hyperkalemia in a renal nutrition clinic

Hyperkalemia (HK) is a frequent complication of chronic kidney disease (CKD). Vegetable-based renal diets are considered at risk due to the high potassium (K) content. The aim of this study was to describe the prevalence and correlates of chronic hyperkalemia (HK) in CKD patients on nutritional care, and in particular, the risk of HK in patients on plant-based versus animal-based low-protein diets. We recruited adult patients affected by CKD not on dialysis, afferent to our renal nutrition clinic from November 2014 to May 2019. We evaluated a total of 870 accesses in 219 patients (172m, 47 f, age 67 ± 13years). HK was defined as mild when K serum level was 5.1-5.9mEq/l, moderate when K serum level was 6.0-6.9mEq/l, and severe HK when K serum level was ≥ 7mEq/l. Biochemical, anthropometric data and medications were recorded. The prevalence of HK in all the renal nutrition visits was 26.1%; all but six cases were mild HK, whereas no severe HK was observed. The prevalence of HK was associated with decreased eGFR, up to 36.5% for eGFR < 20ml/min. Medications were similar in hyperkalemic and normokalemic patients, RAASi being present in up to 85% of patients. In a follow-up of 40 ± 14months, no association was found between HK and mortality, whereas HK, at the start of follow-up, showed a trend to increased ESRD risk. Serum potassium levels and prevalence of HK were not different between patients on animal-based low-protein diet and plant-based low-protein diet. In conclusion, chronic HK is quite prevalent in a renal nutrition clinic, especially when eGFR falls down below 60ml/min, thereby reaching the highest prevalence in CKD stage 4. Hyperkalemia is mostly mild, being moderate to severe HK quite infrequent. Hyperkalemia was not associated with higher risk of mortality, whereas a trend, although not statistically significant, was observed for lower ESRD-free survival. Plant-based low-protein diet is not associated with significant higher prevalence of HK with respect to animal-based LPD at the same residual kidney function.

Detection of malnutrition in geriatric trauma patients : Areassessment

Malnutrition in geriatric trauma patients is associated with an increased risk of complications and mortality and is therefore akey risk factor. The assessment of the affected patients plays an important role in improving the outcome of this growing patient group. In 2016 aquestionnaire was sent to 571 departments specialized in traumatology and orthopedics throughout Germany. The following were recorded: level of care, expertise in geriatric trauma, nutrition-based screening procedures and nutritional ward round procedures. The response rate was 57% (n = 325) and closely reflected the treatment reality in Germany with respect to the level of care (superregional, regional or local trauma center and those without special qualifications). In 14% (n = 45) the participants were German Society for Trauma Surgery(DGU)-certified centers for age-related traumatology, while afurther 5% (n = 15) were in the process of certification. The nutritional status was assessed in 56% (n = 181) of the clinics. Most frequently used was the body mass index (74%) followed by the mini nutritional assessment (30%), laboratory parameters (29%) and nutritional risk screening 2002 (19%). Some additional methods were specified. In approximately half of the departments nutritional ward rounds took place in regular wards (50%) and intensive care units (57%). The high response rate of this study seems to show the particular interest for malnutrition in geriatric trauma patients. This is reflected in an increase in the participating clinics compared to past surveys and also the more regularly performed assessment of nutritional status and implementation of nutritional visits. The establishment of suitable and time-effective screening instruments and their implementation are still achallenge.

Reducing the Risk of Developing Diabetes.

Reducing the Risk of Developing Diabetes.

Early Maternal-Efficacy and Competence in First-Time, Low-Income Mothers

ABSTRACTMothers with higher maternal competence in early parenthood are more comfortable performing infant skills and interpreting their infants’ cues. Further, maternal perceptions of self-efficacy are related to her ability to take care of her infant. First-time, low-income mothers’ new role, life stressors, and economic hardships can increase psychological distress resulting in less positive parenting practices. Purpose: This secondary analysis of a mixed methods study compared qualitative interview responses of mothers with the highest and lowest maternal competence scores to determine if interview responses reflected maternal competence, and to validate aspects of Bandura’s Self-Efficacy Theory. During a routine Women, Infant, Children’s (WIC) nutrition visit at 1–6 months after birth, 21 mothers completed 3 measures of self-esteem, sense of mastery, and maternal competence and were interviewed privately using a 9-item semi-structured interview guide that elicited reflections about early mothering experiences. The sample for this study (n = 8) was arrived at by taking mothers with upper (75th, N = 5) and lower (25th, n = 3) percentiles on the Parenting Sense of Competence (PSOC) and directed content analysis to compare their interview responses. In addition, efficacy expectations from Bandura’s Self-Efficacy Theory were validated in this sample by analyzing the interview responses. The findings revealed that mothers with the highest (n = 5) and lowest (n = 3) PSOC scores reported similar concerns with maternal role adaptation. However, mothers who reported lower PSOC scores verbalized more problems in the category “feelings about being a mother.” Health care professionals need to be aware of maternal competence and self-efficacy in new mothers and assist them as they assume the maternal role.