A Systematic Review of Literature on Culturally Adapted Obesity Prevention Interventions for African American Youth.

Obesity and overweight prevalence in African American (AA) youth continues to be one of the highest of all major ethnic groups, which has led researchers to pursue culturally based approaches as a means to improve obesity prevention interventions. The purpose of this systematic review was to evaluate culturally adapted obesity prevention interventions targeting AA youth. A search of electronic databases, limited to multicomponent culturally adapted obesity prevention controlled trials from 2003 to 2013, was conducted for key terms. Eleven studies met inclusion criteria. We used the PEN-3 model to evaluate the strengths and weaknesses of interventions as well as to identify cultural adaptation strategies. The PEN-3 model highlighted the value of designing joint parent-youth interventions, building a relationship between AA mentors and youth, and emphasizing healthful activities that the youth preferred. The PEN-3 model shows promise as an overarching framework to develop culturally adapted obesity interventions.

Registered dietitian prescriptive practices in hospitals.

The objective of this cross-sectional study was to describe the level of prescriptive authority and explore barriers to obtaining prescriptive authority of registered dietitians in acute health care facilities. A sample of 1,500 clinical nutrition managers was electronically surveyed; data from 351 respondents (23% response rate) were analyzed using descriptive statistics and chi(2) tests. Many (54%) respondents reported no prescriptive authority, 36% reported dependent prescriptive authority, and 10% reported independent prescriptive authority. Most (95%) respondents with no prescriptive authority and (89%) with dependent prescriptive authority valued independent prescriptive authority. The two most commonly listed barriers to independent prescriptive authority were opposition (52% no prescriptive authority, 48% dependent prescriptive authority) and liability (40% no prescriptive authority, 48% dependent prescriptive authority). Forty-five percent of respondents with independent prescriptive authority reported the route to independent prescriptive authority was via clinical privileges. Based on the responses of this sample, the authors conclude the majority of respondents do not have, but value, independent prescriptive authority. The issue of liability as a barrier to independent prescriptive authority might need further study to determine reasons why liability is perceived as a barrier to independent prescriptive authority.

Cultural perceptions of health and diabetes among Native American men.

Diabetes continues to affect minority populations disproportionately, especially Native Americans. Identifying culturally-specific definitions of health and diabetes is critically important for relevant and effective diabetes prevention programs. Qualitative interviews were conducted with 20 Native American men from two tribal clinics. Verbatim transcripts were analyzed by means of grounded theory, to identify culturally-specific definitions of health and diabetes. The men defined health in terms of physical capabilities and presence of disease. Conversely, the men viewed diabetes as an inexorable downward course that slowly manifests itself through various complications and ultimately results in death. Men feared for their own diagnoses as well as the diagnosis of family or community members whom they considered to be at-risk. Additional information about the perceptions of health and diabetes in racial and ethnic minority populations will significantly contribute to the development of effective diabetes prevention programs.

Recruitment and Baseline Characteristics of Participants in the Lifestyle Improvement Through Food and Exercise (LIFE) Study.

African Americans experience poorer diabetes outcomes than non-Hispanic Whites. Few clinical trials of diabetes self-management interventions specifically target African Americans, perhaps due to well-documented barriers to recruitment in this population. This paper describes strategies used to successfully recruit 211 low-income African Americans from community clinics of a large, urban public hospital system to a randomized clinical trial of an 18-month diabetes self-management intervention. Diabetes-related physiological, psychosocial, and behavioral characteristics of the sample are reported. The sample was 77% female, mean age = 55, mean A1C = 8.5%, 39% low health literacy, 28.4% moderate/severe depression, and 48.3% low adherence. Participants ate a high-fat diet with low vegetable consumption. Relative to males, females had higher BMI, depression, and stress, and better glycemic control, less physical activity, and less alcohol consumption. Males consumed more daily calories, but females consumed a greater proportion of carbohydrates. Gender-specific diabetes self-management strategies may be warranted in this population.

Most commonly consumed foods and food perceptions in Native American women.

OBJECTIVE: To identify commonly consumed foods and the relationship of health perception on food intakes. METHODS: One hundred seventy-five Native American women completed a 1-d or 4-d food records. Perceptions of health value were obtained by the food sort method. Frequency analyses identified commonly consumed foods. Relations between intakes and perception of health value were evaluated by Spearman's correlations. RESULTS: Coffee and tea, soda (diet and regular), white bread, and table fats were the most commonly consumed foods in both samples. Health value had little impact on consumption. CONCLUSIONS: Understanding the foods consumption and the role of perception on intakes allows for targeted nutrition education programming.

Changes in Resting Energy Expenditure Following Orthotopic Liver Transplantation.

BACKGROUND: There is no consensus whether resting energy expenditure (REE) following orthotopic liver transplantation (OLT) is altered. METHODS: The objectives of this investigation were to describe changes in measured REE (mREE) using indirect calorimetry in 25 OLT patients on days 5, 10, and 15 after baseline (within 72 hours following OLT) and compare mREE changes with those calculated with 2 predicted equations for energy expenditure (pREE): the Harris-Benedict and Schofield equations. RESULTS: Patients were 57 ± 5.4 years of age, 44% were male, 36% were black, and 72% had liver disease of viral etiology. Measured REE (at baseline and days 5, 10, and 15, per kcal/d: 1832 ± 952, 1565 ± 383, 1538 ± 345, 1578 ± 418) and kcal per kilogram of body weight (22.7 ± 12.8, 18.4 ± 4, 18.7 ± 3.8, 21 ± 6.5) did not change over time. In contrast, changes in pREE based on either the Harris-Benedict (P < .001) or Schofield (P = .006) equation using measured weights at each corresponding time point and lowest body weight during the study to estimate dry weight were significant. CONCLUSIONS: Wide ranges in both mREE and mREE expressed per kilogram of body weight at each study time point were observed in contrast to pREE, which declined by day 15. The observed differences in mREE over time suggest indirect calorimetry is indicated if available following OLT. Additional research is warranted to determine the most appropriate predictive equation with suitable stress factors to use when indirect calorimetry is not available.

Impact of core and secondary foods on nutritional composition of diets in Native-American women.

OBJECTIVE: To identify the core and secondary foods among Native-American women in Oklahoma and to determine their impact on nutrient and Food Guide Pyramid serving intakes. DESIGN: This descriptive study explored food intakes from 4-day weighed food records. Nutrient intakes were estimated using reference data used in national survey data. SUBJECTS/SETTING: Seventy-one Native-American women receiving services from three tribal health clinics in northeast Oklahoma. Statistical analyses performed A food-use frequency score was computed using frequencies of individuals consuming foods across each of 4 days of records. Leading contributors of nutrients and Food Guide Pyramid servings were identified from core and secondary foods. RESULTS: Thirty foods comprised the list of core foods, led by soda, coffee, and white bread. A majority of total energy, fat, saturated fat, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, carbohydrate, calcium, vitamin C, folate, discretionary fat, and added sugar were derived cumulatively from the core and secondary foods. Forty percent of fruit Food Guide Pyramid servings were accounted for by two core foods, bananas, and orange juice. More than half of meat and vegetable Food Guide Pyramid servings were derived from core and secondary foods. CONCLUSIONS: Food patterning data are helpful in the development of effective nutrition education programs. We identified less nutrient-dense core foods that are contributing to discretionary fat and added sugar intakes. Targeted nutrition education programs for Native Americans should promote the nutrient-dense core and secondary foods, such as whole-wheat bread and fruit, while providing more healthful food alternatives to less nutrient-dense foods.

A diabetes prevention assessment tool for American Indians.

INTRODUCTION: American Indians have a disproportionately higher risk of developing type 2 diabetes. Few data are available about the perceptions of diabetes among American Indians, and no culturally appropriate tools are available for assessment of perceptions related to health and diabetes. METHODS: A diabetes prevention assessment tool was developed to measure perceptions of health and diabetes among American Indians. Predominant themes from qualitative interviews were used to develop the items for the tool. Data were collected at two autumn powwows, or intertribal dances, in Oklahoma. Reliability testing was performed using 185 surveys from American Indian adults not living on reservations. Principal axis factor analysis was performed to identify possible relationships among the items. RESULTS: Five themes, or factors, were found to categorize the perceptions of health: 1) lifestyles, 2) barriers to healthy lifestyles, 3) personal responsibility, 4) self-care behaviors, and 5) culturally defined well-being. Two factors classified the perceptions of diabetes: 1) a cognitive factor, related to personal experience, and 2) an affective factor, related to emotions. CONCLUSION: Our diabetes assessment tool identified factors that should be considered when developing health promotion and diabetes prevention programs for American Indians. A valid assessment tool for the American Indian population could provide valuable, formative data that would increase understanding of the culturally related obstacles to health promotion and diabetes prevention.

Patterns of continuing professional education in registered dietitians and dietetic technicians, registered.

This study compared the continuing professional education (CPE) activities of registered dietitians (RDs) with those of dietetic technicians, registered (DTRs). A descriptive research study was used with data from the baseline survey evaluating the Commission on Dietetic Registration's (CDR) Professional Development Portfolio. The survey was sent to 3,530 randomly selected RDs and DTRs; 1,429 surveys were returned (40.5% response rate), with 41% of RDs contacted responding and 32% of DTRs responding. Guidance used when selecting CPE activities and type of CPE activity selected were measured. DTRs sought more guidance than RDs when selecting CPE activities (P=.001). A significantly higher percentage of RDs than DTRs selected lectures, workshops, journal clubs, satellite courses, exhibits, professional leadership, professional reading, and poster sessions as CPE activities (P<.05). These findings will aid CPE providers in knowing which CPE activities are typically selected by both dietetics credential groups. DTRs may need guidance in selecting CPE activities.

Social and cultural barriers to diabetes prevention in Oklahoma American Indian women.

INTRODUCTION: The prevalence of diabetes is disproportionately higher among minority populations, especially American Indians. Prevention or delay of diabetes in this population would improve quality of life and reduce health care costs. Identifying cultural definitions of health and diabetes is critically important to developing effective diabetes prevention programs. METHODS: In-home qualitative interviews were conducted with 79 American Indian women from 3 tribal clinics in northeast Oklahoma to identify a cultural definition of health and diabetes. Grounded theory was used to analyze verbatim transcripts. RESULTS: The women interviewed defined health in terms of physical functionality and absence of disease, with family members and friends serving as treatment promoters. Conversely, the women considered their overall health to be a personal issue addressed individually without burdening others. The women presented a fatalistic view of diabetes, regarding the disease as an inevitable event that destroys health and ultimately results in death. CONCLUSION: Further understanding of the perceptions of health in at-risk populations will aid in developing diabetes prevention programs.

Emic perspectives of body weight in overweight and obese white women with limited income.

OBJECTIVE: The purpose of this study was to develop an understanding of body weight from emic perspectives of limited-income overweight and obese white women. DESIGN: In-depth individual interviews, including the use of contour drawings and body dissatisfaction parameters. SETTING: All methods were conducted in the homes of the research participants. PARTICIPANTS: A purposeful sample of limited-income white women (N=25), ages 19 to 44 years. PHENOMENA OF INTEREST: Personal perceptions of attractiveness, health, body weight, and body dissatisfaction. ANALYSIS: Transcripts were analyzed using content analysis. Triangulation of data was achieved by comparing data elicited by different methods in different sections of the interview. RESULTS: Disordered eating habits were common and considered consequences of social, economic, and familial pressures. Food was often used as a means of coping with life pressures. Social and economic barriers were identified as impeding the adoption of more healthful lifestyles. Weight loss was a low priority owing to financial, emotional, familial, and health care constraints. CONCLUSIONS AND IMPLICATIONS: Multidisciplinary programs addressing financial, emotional, and nutritional concerns may be the most effective for weight management among white limited-income women. Additional research is necessary to verify the results of this study with larger samples.

Personal attributes and job competencies needed by EFNEP paraprofessionals as perceived by EFNEP professionals.

OBJECTIVE: To determine the personal attributes and job competencies that are necessary for the job success of Expanded Food and Nutrition Education Program (EFNEP) paraprofessionals as perceived by EFNEP professionals. DESIGN: A qualitative descriptive design and a 3-round modified Delphi methodology was used. PARTICIPANTS: A convenience sample of 14 state and 20 county EFNEP professionals participated in all 3 Delphi rounds. The response rates for state and county professionals for all 3 Delphi rounds were 70% and 91%, respectively. VARIABLES MEASURED: Personal attributes and job competencies were generated and the level of importance was determined. ANALYSIS: An independent t test was employed to determine differences between importance scores by professional position. RESULTS: Thirty-seven personal attributes, 18 job competencies prior to hire, and 43 job competencies after training were generated and the majority were very important to important. County EFNEP professionals tended to score personal attributes and job competencies as more important than state EFNEP professionals. IMPLICATIONS: These personal attributes and job competencies prior to hire can guide hiring decisions and initial training content. The job competencies after training can shape content for inservice training.

Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners.

It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners (NNS) when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference. A preference for sweet taste is innate and sweeteners can increase the pleasure of eating. Nutritive sweeteners contain carbohydrate and provide energy. They occur naturally in foods or may be added in food processing or by consumers before consumption. Higher intake of added sugars is associated with higher energy intake and lower diet quality, which can increase the risk for obesity, prediabetes, type 2 diabetes, and cardiovascular disease. On average, adults in the United States consume 14.6% of energy from added sugars. Polyols (also referred to as sugar alcohols) add sweetness with less energy and may reduce risk for dental caries. Foods containing polyols and/or no added sugars can, within food labeling guidelines, be labeled as sugar-free. NNS are those that sweeten with minimal or no carbohydrate or energy. They are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The Food and Drug Administration approval process includes determination of probable intake, cumulative effect from all uses, and toxicology studies in animals. Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. All NNS approved for use in the United States are determined to be safe.

The use of prealbumin and C-reactive protein for monitoring nutrition support in adult patients receiving enteral nutrition in an urban medical center.

BACKGROUND: Serum prealbumin (PAB) is commonly used to assess protein status and is often used to monitor the response to nutrition support. However, during inflammation, the liver synthesizes acute-phase proteins such as C-reactive protein (CRP) at the expense of PAB. OBJECTIVE: The purpose of this retrospective study was to determine whether changes in PAB reflect the delivery of adequate nutrients or changes in inflammatory status in hospitalized adults (≥18 years) receiving enteral nutrition (n = 154). METHODS: Protein and energy intake were compared to changes in PAB, assessed at baseline and twice weekly. C-reactive protein was assessed when PAB was <18 mg/dL to determine the presence and severity of inflammation. RESULTS: In a sample of mostly critically ill patients, there was no significant difference in change in PAB for those receiving ≥60% of calorie needs (2.74 ± 9.50 mg/dL) compared to <60% of calorie needs (2.48 ± 9.36 mg/dL; P = .86). Changes in PAB correlated only with changes in CRP (r = -0.544, P < .001). In a subgroup analysis of 62 patients with repeated measures of PAB and CRP, PAB increased significantly only in the bottom 2 tertiles for calorie delivery and the lowest tertile for protein delivery. CONCLUSIONS: These results indicate that PAB may not be a sensitive marker for evaluating the adequacy of nutrition support in critically ill patients with inflammation. Only change in CRP was able to significantly predict changes in PAB, suggesting that an improvement in inflammation, rather than nutrient intake, was responsible for the increases in PAB levels.

State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change.

Behavior change theories and models, validated within the field of dietetics, offer systematic explanations for nutrition-related behavior change. They are integral to the nutrition care process, guiding nutrition assessment, intervention, and outcome evaluation. The American Dietetic Association Evidence Analysis Library Nutrition Counseling Workgroup conducted a systematic review of peer-reviewed literature related to behavior change theories and strategies used in nutrition counseling. Two hundred fourteen articles were reviewed between July 2007 and March 2008, and 87 studies met the inclusion criteria. The workgroup systematically evaluated these articles and formulated conclusion statements and grades based upon the available evidence. Strong evidence exists to support the use of a combination of behavioral theory and cognitive behavioral theory, the foundation for cognitive behavioral therapy (CBT), in facilitating modification of targeted dietary habits, weight, and cardiovascular and diabetes risk factors. Evidence is particularly strong in patients with type 2 diabetes receiving intensive, intermediate-duration (6 to 12 months) CBT, and long-term (>12 months duration) CBT targeting prevention or delay in onset of type 2 diabetes and hypertension. Few studies have assessed the application of the transtheoretical model on nutrition-related behavior change. Little research was available documenting the effectiveness of nutrition counseling utilizing social cognitive theory. Motivational interviewing was shown to be a highly effective counseling strategy, particularly when combined with CBT. Strong evidence substantiates the effectiveness of self-monitoring and meal replacements and/or structured meal plans. Compelling evidence exists to demonstrate that financial reward strategies are not effective. Goal setting, problem solving, and social support are effective strategies, but additional research is needed in more diverse populations. Routine documentation and evaluation of the effectiveness of behavior change theories and models applied to nutrition care interventions are recommended.