Developing a nutrition screening tool for children with cystic fibrosis ages 0 to 2 years: Children with cystic fibrosis nutrition screening tool.

BACKGROUND: For children with cystic fibrosis (CF), achieving and maintaining optimal growth by the age of 2 years is critical for future health outcomes. A standardized nutrition screening is needed to identify growth problems, enable timely interventions, and improve nutritional outcomes for children (0 to 2 years) with CF. The purpose of this study was to develop a nutrition screening tool for children (0 to 2 years) with CF to identify nutrition risk at every clinical encounter. METHODS: A retrospective cross-sectional study was used to develop a nutrition screening tool to determine if nutrition interventions needed to change (at-risk) or continue (not at-risk). Retrospective data for pertinent nutrition factors were collected for 99 children attending an accredited CF clinic. The nutrition factors were compared to a dietitian assessment. A stepwise discriminant analysis determined weight-for-age (WFA) and weight-for-length (WFL) z-scores were significant. Then anthropometric data and corresponding dietitian assessment results were collected for children with CF attending two other accredited CF clinics (n = 29, n = 30). Discriminant analysis was used to determine sensitivity and specificity of the nutrition factors and to create a nutrition screening tool equation. RESULTS: The nutrition screening model that included WFA z-score, LFA z-score, WFL z-score, and weight change velocity adequacy determined nutrition risk the best. The sensitivity was 89.7 %, specificity 83.2 %, NPV 93.3 %, and PPV 75.4 % for this model. CONCLUSION: The nutrition screening tool equation developed in this study standardizes the process to identify children (0 to 2 years) with CF at nutrition risk. Further validation is needed.

Current Dietetic Internship Admission Criteria and Selection Processes: Results From an Electronic Survey of Directors.

BACKGROUND: Members of the dietetics profession have been discussing and confronting the lack of diversity within the profession. The Academy of Nutrition and Dietetics is committed to diversity and inclusion efforts. OBJECTIVE: Our aim was to determine current admission criteria and practices used by Dietetic Internships (DIs) across the United States. DESIGN: This was a cross-sectional study using electronic survey with open and close-ended items conducted in the fall of 2020. PARTICIPANTS: The electronic survey was distributed to 261 DI directors. Statistical analysis performed Descriptive statistics were calculated for each variable using SPSS software. Six topically related open-ended items were analyzed through a qualitative thematic approach. RESULTS: DI directors (n = 89) were primarily female (n = 76) and White (n = 77). Most admissions process and criteria decisions were made by committees. Directors (n = 79) reported using a predefined rubric/scoring system for candidate evaluation. Many (n = 60) indicated not using Graduate Record Examination scores. All reported considering Didactic Program in Dietetics' grade point average; personal statement quality; professional interests and goals; and type and quantity of previous dietetics-related work and volunteer experience. The admission factors rated (on a 7-point scale) most important were quality of interview (mean = 6.03), Didactic Program in Dietetics' grade point average (mean = 5.67), type of work and volunteer experience (mean = 5.62), quality of personal statement (mean = 5.5), recommender comments (mean = 5.41), and quantity of work and volunteer experience (mean = 5.40). Most (n = 80) indicated that they were satisfied with their selection processes. CONCLUSIONS: Educators should continue refining admissions processes as professional gatekeepers, consider reducing application fees, diversifying and training selection committees, re-evaluating admission criteria, and assessing how criteria weights.

Content Analysis of Websites of Didactic Programs in Dietetics for Evidence of Diversity, Equity, and Inclusion.

OBJECTIVE: To examine websites of didactic programs in dietetics (DPD) for diversity, equity, and inclusion (DEI)-related language and to assess perceived gender and ethnic/racial representation in images. METHODS: We conducted a content analysis on the first 6 website images and 3-elements of DPD (n = 212) websites (mission statement, goals and objectives, and the immediate landing page). Descriptive statistics and a website DEI score were calculated. RESULTS: Equity and inclusion-related terms appeared on < 5% of websites. Diversity and culture-related terms appeared on about one-third of websites. On average, researchers perceived 28.45% of people in website images as non-White, and 20.11% as non-female. Most websites received low DEI scores. CONCLUSIONS AND IMPLICATIONS: The DPD websites had a limited representation of DEI-related terms and image representation of individuals perceived to be non-female and non-White. Leaders of DPDs may consider displaying and describing the program's commitment to DEI on the website for potential students.

Patient-centered care: Dietitians' perspectives and experiences.

OBJECTIVE: To (1) explore RDNs' descriptions of patient-centered care (PCC), (2) measure Registered Dietitian Nutritionists' (RDNs) preferences for PCC and (3) identify factors that affect RDNs' PCC preferences. METHODS: A survey instrument including two open-ended items exploring RDN descriptions of and experiences with PCC, the Patient-Practitioner Orientation Scale (PPOS), and various factors that could influence PCC (e.g., work intensification, work engagement, and work/demographic characteristics) was expert reviewed, pilot tested, and distributed electronically to 4697 RDNs. A regression analysis was conducted, and two open-ended items were qualitatively analyzed. RESULTS: Three themes emerged when RDNs described PCC (n = 375): dietitian/patient relationship (95.7%), organizational influence (64.4%), and interprofessional teams (26.3%). RDNs (n = 318) scored 4.60/6 on the PPOS. Higher levels of work engagement were predictive of higher PPOS scores, and heavier workloads were predictive of lower PPOS scores (p < 0.05). Primary work position also influenced PPOS scores (p<0.05). CONCLUSION: RDNs have varying personal definitions of and experiences with PCC, however there are common themes. RDNs generally prefer PCC and score moderately high on the PPOS. PRACTICE IMPLICATIONS: To strengthen preferences for PCC, managers should create manageable workloads and prioritize work engagement. Continued emphasis on interprofessional collaboration with and organizational promotion of RDNs could improve PCC.

Changes in handgrip strength in children with cystic fibrosis compared to children without cystic fibrosis.

BACKGROUND & AIMS: Cystic Fibrosis (CF) may impact nutritional status. Handgrip strength (HGS) may be used for nutrition assessment. The objective of the study was to evaluate changes in HGS over time in children with CF compared to children without CF. A secondary purpose was to analyze the relationship of clinical characteristics of CF with HGS. METHODS: A prospective, longitudinal study was conducted. The non-CF group (n = 76) was recruited from a school and the CF group (n = 75) from an accredited CF center. Height, weight, mid-upper arm circumference, triceps skinfold, and HGS were measured at baseline and approximately three and six months in both groups. Data for pulmonary function, nutrition risk, enteral supplementation, CF transmembrane conductance regulator modulator, steroids, antibiotics, vitamin levels, CF related diabetes (CFRD), and recent hospitalization were collected for the CF group. A mixed model determined the difference in the change in HGS between the CF group and the non-CF group. For all analyses, p=<0.05 was significant. RESULTS: The rate of change in HGS z-score in the CF-group (0.18 ± 0.05) versus the non-CF group (0.06 ± 0.06) was not significant (p = 0.15). Initial mean dominant HGS z-score was significantly lower (p = 0.02) in those with vitamin D deficiency (-1.35 ± 0.09) versus those without (-1.02 ± 0.11). HGS z-score significantly (p = 0.02) decreased over time in children with CFRD (-0.19 ± 0.22) versus children without CFRD (0.32 ± 0.14), p = 0.02. CONCLUSION: Serial measurements of HGS may help detect changes in muscle function related to CFRD and vitamin D deficiency. Further investigation is warranted to elucidate HGS's role in nutrition assessment of children with CF.

Current Practices Using Pediatric Malnutrition Indicators: A Survey of Dietitians Working in Pediatrics.

BACKGROUND: In 2014, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition recommended indicators to identify malnutrition in children aged 1 month to 18 years. The purpose of this study was to evaluate current practices and the effectiveness of the consensus statement-recommended pediatric malnutrition indicators. METHODS: A cross-sectional electronic survey link was posted in the Pediatric Nutrition Practice Group (subscribers = 3160) and Clinical Nutrition Management Practice Group's Pediatric Subunit (subscribers = 177) community discussion boards. Additionally, flyers with the survey link were distributed to registered dietitian nutritionists (RDNs) currently working in pediatrics at the 2018 Food & Nutrition Conference & Expo. Frequencies described participant characteristics, awareness of indicators, and use of indicators. Researchers used the Fisher exact test to determine associations between categorical variables. RESULTS: Two hundred eighty-one surveys were included in data analysis. A majority of RDNs (88.6%) reported they knew the indicators existed and considered themselves knowledgeable about the indicators. Weight loss was the most frequently used indicator, with 224 RDNs (80%) reporting use as often or always. Mid-upper arm circumference (MUAC) was the least used indicator with only 68 RDNs (25%) using it often or always. Most RDNs (71.5%) reported that their facility used International Classification of Disease, Tenth Revision codes to document malnutrition. CONCLUSION: RDNs working with pediatric populations consistently use the recommended malnutrition indicators; however, further education is needed on the appropriate use of MUAC and length/height per age as malnutrition indicators.

Evaluating Changes in Handgrip Strength in Children With Cystic Fibrosis: A Pilot Study.

BACKGROUND: Body mass index (BMI) is used to determine nutrition status in children with cystic fibrosis (CF); however, lean body mass (LBM) is more strongly associated with pulmonary function. Handgrip strength (HGS) measures muscle function and is reflective of LBM. The aims of this study were to assess relationships among HGS, nutrition status, and pulmonary function; changes in HGS posthospitalization; and any relationship between HGS and nutrient intake. METHODS: Twenty-three children with CF aged 6-18 years participated. BMI z scores, nutrition risk scores, and pulmonary function were assessed about 5 months before, days 5-7 of hospitalization, and about 6 weeks posthospitalization. HGS z scores and arm anthropometrics were measured during and after hospitalization. Nutrient intakes were assessed during hospitalization. RESULTS: Mean HGS z score at hospitalization was -1.95 ± 0.92 and posthospitalization was -1.59 ± 1.06 (P = .007). Mean BMI z score prehospitalization was -0.17 ± 0.63, at hospitalization was -0.09 ± 0.64, and posthospitalization was 0.06 ± 0.54 (P = .065). Mean forced expiratory volume in 1 second (FEV1 ) prehospitalization was 93.52 ± 17.35, at hospitalization was 85.65 ± 21.57, and posthospitalization was 95.63 ± 18.18 (P = .001). No significant relationship was found between HGS z scores and BMI z scores (P = .892) or HGS z scores and FEV1 (P = .340). CONCLUSIONS: HGS z scores and FEV1 significantly increased at follow-up. HGS z scores were lower than the standard even though mean BMI z scores classified participants as normal nutrition status.

Handgrip Strength and Malnutrition (Undernutrition) in Hospitalized Versus Nonhospitalized Children Aged 6-14 Years.

BACKGROUND: Diagnosing undernutrition in hospitalized pediatric populations is crucial to provide timely nutrition interventions. Handgrip strength (HGS), a measurement of muscle function, is a reliable indicator of undernutrition. However, limited research exists on HGS in hospitalized pediatric patients. The primary aim of this study was to determine if HGS differed between hospitalized children within 48 hours of admission and nonhospitalized children. A secondary purpose was to describe the association of HGS with height, weight, body mass index (BMI), mid upper arm circumference (MUAC), activity level, disease severity, nutrition risk, and nutrition intervention. METHODS: One hundred nine hospitalized and 110 nonhospitalized patients aged 6-14 years participated in this cross-sectional nonequivalent control group design study. Weight, height, MUAC, and HGS were measured within 48 hours of hospital admission for the hospitalized group or immediately following a well-child visit for the control group. RESULTS: Based on analysis of covariance, the HGS was estimated to be 12.4 ± 0.37 kgF (mean ± SE) for hospitalized subjects and 13.1 ± 0.37 for nonhospitalized subjects ( P = .2053). HGS was associated with age ( P < .0001), height ( P < .0001), dominant hand ( P < .0001), and MUAC z scores ( P = .0462). CONCLUSION: HGS was not significantly different between hospitalized and nonhospitalized participants, although anthropometric measurements were similar between groups. A strong relationship was demonstrated between HGS and BMI and MUAC z scores. Further research is needed that examines serial HGS measurements, feasibility in hospitalized patients, and the association of HGS measurements and nutrition risk.

Using the Hospital Nutrition Environment Scan to Evaluate Health Initiative in Hospital Cafeterias.

BACKGROUND: Health-promoting environments advance health and prevent chronic disease. Hospitals have been charged to promote health and wellness to patients, communities, and 5.3 million adults employed in United States health care environments. METHODS: In this cross-sectional observational study, the Hospital Nutrition Environment Scan (HNES) was used to measure the nutrition environment of hospital cafeterias and evaluate the influence of the LiVe Well Plate health initiative. Twenty-one hospitals in the Intermountain West region were surveyed between October 2013 and May 2014. Six hospitals participated in the LiVe Well Plate health initiative and were compared with 15 hospitals not participating. The LiVe Well Plate health initiative identified and promoted a healthy meal defined as <600 kcal, <700 mg sodium, and <30% fat. Signage with nutrition information and health initiative branding were also posted at point of purchase. Hospital cafeterias were scored on four subcategories: facilitators and barriers, grab-and-go items, menu offerings, and selection options at point of purchase. RESULTS: Overall, hospitals scored 35.3±13.7 (range=7 to 63) points of 86 total possible points. Cafeterias in health initiative hospitals had significantly higher mean nutrition composite scores compared with non-health initiative hospitals (49.2 vs 29.7; P<0.001). CONCLUSIONS: Promoting healthy entrées with nutrition information and branding has a positive influence on the nutrition environment of hospital cafeterias. Additional research is needed to quantify and strategize ways to improve nutrition environments within hospital cafeterias and assess the influence on healthy lifestyle behaviors.