Healthcare Resource Utilization and Costs in Celiac Disease: A US Claims Analysis.

INTRODUCTION: Celiac disease (CeD) is a lifelong immune-mediated enteropathy in which dietary gluten triggers an inflammatory reaction in the small intestine. This retrospective cohort study examines healthcare resource utilization (HRU) and costs between patients with CeD and matched controls. METHODS: Patients with CeD (cases) with an endoscopic biopsy and ≥2 medical encounters with a CeD diagnosis between January 1, 2010, and October 1, 2015, were identified in the MarketScan databases. The date of the first claim with a CeD diagnosis on or after the endoscopic biopsy was the index date. Cases were matched 1:1 to patients without CeD (controls) on demographic characteristics and Deyo-Charlson Comorbidity Index score. Clinical characteristics, all-cause, and CeD-related HRU and costs (adjusted to 2017 US dollars) were compared between cases and controls during the 12 months before (baseline) and 24 months after (follow-up) the index date. RESULTS: A total of 11,008 cases (mean age 40.6 years, 71.3% women) were matched to 11,008 controls. During the follow-up, a higher proportion of cases had all-cause and CeD-related HRU including inpatient admissions, emergency department visits, gastroenterologist visits, dietician visits, endoscopic biopsies, and gastroenterology imaging (all P ≤ 0.002). Incremental all-cause and CeD-related costs were in the first ($7,921 and $2,894) and second ($3,777 and $935) year of follow-up, driven by outpatient services costs. DISCUSSION: In this US national claims database analysis, there was evidence of an increase in both all-cause and CeD-related HRU and related costs in patients with CeD compared with matched patients without CeD, suggesting a significant economic burden associated with CeD.

The State of Nutrigenomic Education in Poland.

BACKGROUND: In Poland, 45 higher education institutions offer degrees in dietetics. However, only 20 of these offer nutrigenomics or nutrigenetics courses. OBJECTIVES: The purpose of this study was to assess the current state of nutri-genomic education in Poland and to evaluate the level of nutrigenomic knowledge held by dieticians. METHODS: A cross-sectional survey was performed to examine the self-reported attitudes of 193 dietetics students and dietetics professionals who graduated from 33 Polish higher-level institutions. RESULTS: The great majority of respondents were familiar with nutrigenomics and had a positive attitude to it, and this attitude was independent of whether they participated in nutrigenomics courses. Sixty-six percent of the respondents had received training in nutrigenomics, but nutrigenomic education did not meet the expectations of 57% of dieticians. Dieticians possess low levels of self-reported knowledge of nutrigenomics, and only about 15% of respondents know how to effectively communicate information on genetic risk to patients and understand the effect of nutrients on molecular mechanisms. Despite this lack of knowledge, 59% of respondents had a positive attitude to nutri-genomics, and 63% of them had a great interest in broadening their knowledge. Subjects who had participated in nutrigenomics courses exhibited a better understanding of several areas of nutrigenomics. They were especially interested in practical aspects of nutrigenomics, such as the essence of personalized diets and the practical application of nutrigenomics. CONCLUSIONS: In conclusion, Polish dieticians have a positive attitude to nutrigenomics but do not perceive themselves as well educated in this field, which is partly due to systemic problems. The study shows the need for improvements in nutrigenomic education in Poland.

Is dietitian use associated with celiac disease outcomes?

A gluten-free diet (GFD) is the treatment for celiac disease (CD), but due to its complexity, dietitian referral is uniformly recommended. We surveyed patients with CD to determine if dietitian use is associated with quality of life, symptom severity, or GFD adherence. The survey utilized three validated CD-specific instruments: the CD quality of life (CD-QOL), CD symptom index (CSI) and CD adherence test (CDAT). Four hundred and thirteen patients with biopsy-proven CD were eligible for inclusion. The majority (77%) were female and mean BMI was 24.1. Over three-quarters of patients (326, 79%) had seen a dietitian, however, 161 (39%) had seen a dietitian only once. Age, sex, and education level were not associated with dietitian use; nor was BMI (24.6 vs. 24.0, p = 0.45). On multivariate analysis, adjusting for age gender, education, duration of disease, and body mass index, dietitian use was not associated with CD-QOL, CSI, or CDAT scores. Our survey did not show an association between dietitian use and symptom severity, adherence, or quality of life. Delay in diagnosis was associated with poorer outcomes. This is a preliminary study with several limitations, and further prospective analysis is needed to evaluate the benefits and cost-effectiveness of dietitian-referral in the care of celiac disease patients.

Prevalence and magnitude of body weight and image dissatisfaction among women in dietetics majors / Prevalencia y magnitud de la insatisfacción con el peso e imagen corporal en mujeres estudiantes de Dietética

Some authors have suggested that body weight dissatisfaction may be high in students majoring in dietetics. Therefore, this study was conducted to examine the extent of body weight and image dissatisfaction in a sample of women in dietetics major. Additionally, predictors of magnitude of body weight dissatisfaction were analyzed. Participants were 62 volunteers with normalweight whose mean age was 21.87±1.89 years old (non-random sample). The assessment instruments included anthropometric measurements, a somatomorphic matrix test and an eating disorders inventory (EDI-2). Data were analyzed using SPSS vs. 15.0. A larger proportion of students chose an ideal body weight lower than actual weight (67.7%) and body image with less body fat and more muscle mass than actual values (56.4%). The magnitude of body weight dissatisfaction was associated with muscle mass and body fat dissatisfaction, and with the subscale of EDI-2 “body dissatisfaction”. So, from a public health standpoint, we consider important to continue working in this line of research with the aim of better understanding the extent of body weight dissatisfaction in women dietitians, and how this dissatisfaction could interfere with their professional practice.

Algunos autores han sugerido que los estudiantes de Dietética pueden presentar una elevada insatisfacción con el peso corporal. Por este motivo, se llevó a cabo el presente trabajo con el objetivo de analizar la insatisfacción con el peso y la imagen corporal en una muestra de mujeres estudiantes de Dietética. Además, se analizaron predictores de la magnitud de la insatisfacción con el peso corporal. Las participantes fueron 62 voluntarias con normopeso que tenían una media de edad de 21,87±1,89 años (muestra no aleatoria). La evaluación incluyó medidas antropométricas, el test somatomórfico matrix y el eating disorders inventory (EDI-2). Los resultados se analizaron con el programa estadístico SPSS vs. 15.0. Un elevado porcentaje de estudiantes eligieron un peso ideal menor que su peso actual (67,7%) e imágenes corporales con menos grasa corporal y más masa muscular que la que tienen actualmente (56,4%). La magnitud de la insatisfacción con el peso corporal se asoció con la insatisfacción con la grasa corporal y la masa muscular, y con la subescala “insatisfacción corporal” del EDI-2. Por lo que, desde el punto de vista de salud pública, consideramos de interés seguir trabajando en esta línea de investigación con el objetivo de comprender mejor el grado de insatisfacción con el peso corporal en mujeres dietistas, y cómo esa insatisfacción podría afectar a su práctica profesional.

Dietary management of women with polycystic ovary syndrome in the United Kingdom: the role of dietitians.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common endocrine condition associated with hyperandrogenism, infertility and metabolic dysfunction. Weight management through diet and lifestyle modifications are fundamental to its management; however, presently, there are no official dietary guidelines. The present study aimed to explore the dietary and lifestyle strategies followed by women with PCOS and the contribution of dietitians to its management. METHODS: A questionnaire was completed by 105 UK dietitians focused on the service provided and a patient questionnaire and 7-day food diary were completed by women with PCOS (n = 206 and n = 196, respectively). Food diaries were analysed for energy and macronutrient intake and the questionnaire focused on the dietary advice received. RESULTS: Advice provided by dietitians focused on a reduction in energy intake (78%) and dietary glycaemic index (77%), often in combination. Of the women with PCOS who were following a diet specifically for their PCOS (57%), regimes included a low glycaemic index (34%), weight loss diets (16%) or a combination (26%). Of interest, 73% of overweight women were not following a diet to promote weight loss. Nutritional information predominately came from books, with only 15% of women having seen a dietitian. Eighty-four percent of women with PCOS who had increased physical activity (48%) self-reported an improvement in their symptoms. CONCLUSIONS: Women with PCOS recognise the importance of diet, but few received dietary advice from a registered dietitian. The dietary information women with PCOS received was often from an unregulated source. A consensus statement of evidence-based dietary advice for women with PCOS is needed and would be a useful resource for dietitians.

Necessidades de proteínas para a população idosa: revisão / Protein requirements for the elderly population: review

The aging of a human being is a natural biological process rather thana pathologic one, characterized by a series of morpho-physiologicalbiochemical and psychological changes that take place throughout the liveof human beings. The in? uence of the aging process on the nutritionarequirements is the object of many studies that were carried out in order tdetermine the adequate intake of nutrients to meet the requirements of thhealthy elderly population. Elderly people should intake proteins in suf? cienquantity to reduce the loss of muscle mass related to aging. However, thhigh intake of this nutrient might represent some undesirable effects tthe health of elderly people, due to kidney and liver problems. This papereviews some articles on protein requirements for the elderly and dietarstudies in the elderly population related to protein intake, using the PubMedDatabase, in a search period between 1978 and 2003. The keywords usedwere: amino acids, protein recommendation, metabolism, elderly.

El envejecimiento del ser humano es un proceso biológico natural y no patológico caracterizado por una serie de alteraciones morfofisiológicas, bioquímicas y psíquicas que acontecen en el organismo a lo largo de toda la vida. La influencia del proceso de envejecimiento sobre las necesidades nutricionales es objeto de numerosos estudios conducidos para establecer la ingestión adecuada de nutrientes para una población anciana saludable. La ingestión de proteínas en el adulto mayor debe suplir la pérdida muscular relacionada con la edad, sin embargo su consumo en exceso puede provocar problemas renales y alteraciones hepáticas que son indeseables. Este artículo revisa algunos trabajos sobre las necesidades de proteínas para el adulto mayor utilizando la Base de Dados PubMed, en el período de 1978 a 2003. Las palabras clave utilizadas para La búsqueda fueron: aminoácidos, necesidades proteicas, metabolismo, adulto mayor.

O envelhecimento do ser humano é um processo biológico natural, e não patológico caracterizado por uma série de alterações morfofisiológicas, bioquímicas e psicológicas que ocorrem no organismo ao longo da vida. A influência do processo de envelhecimento sobre as necessidades de nutrientes é objeto de numerosos estudos que têm sido conduzidos para estabelecer a ingestão adequada de nutrientes para suprir as necessidades da população idosa saudável. A ingestão de proteínas do idoso deve ser na quantidade suficiente para diminuir a perda muscular relacionada com a idade, entretanto, o consumo elevado deste nutriente também pode apresentar efeitos indesejáveis à saúde dos idosos, devido a problemas renais e alterações hepáticas. Este artigo revisa alguns trabalhos sobre recomendações de proteínas para idosos e estudos dietéticos, em relação à ingestão de proteínas neste grupo etário, utilizando a Base de Dados PubMed, no período de pesquisa compreendido entre 1978 e 2008. Os unitermos utilizados na pesquisa foram: aminoácidos, recomendações de proteína, metabolismo, idoso.

[The actual status of patients receiving home health care from registered dietitians and the way nutrition care management should be].

This report clarifies the nutrition status of patients at home. The patients (subjects) received a home health care from registered dietitians. Forty-four percent (44%) of all the subjects are under 3.5 albumins (alb). Regarding a nutrition status, 26 out of 117 patients were regarded as dysphagia by doctor's SGA. Generally, patients who received medical care at acute stage hospital, or rehabilitation hospital, or general hospital, can go back their own home. At acute stage hospital, registered dietician implements a nutrition care management, which accrues nutrition management addition. Nutrition screening at nursing home and hospital show that about 30% of patients are in malnutrition status. Forty-one percent (41.1%) of inpatients, 33% of patients at home and 8.6% of outpatients are assessed at malnutrition. The patients at home need Nutrition Care Management as much as the patients at hospital, because the state of their health has been deteriorated. However, registered dietitians do not fully grasp their living environment well and cannot implement Nutrition Management. This is the actual situation of Nutrition Management for patients receiving domiciliary service.

Sex and seasonal variations of plasma retinol, alpha-tocopherol, and carotenoid concentrations in Japanese dietitians.

AIM: To clarify sex and seasonal variations of plasma antioxidant concentrations among middle-aged Japanese. SUBJECTS AND METHODS: We investigated sex and seasonal variations of plasma antioxidant concentrations, including retinol, alpha-tocopherol, and carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein and lycopene), in 55 middle-aged dietitians (46 women and 9 men) in Aichi Prefecture, Central Japan, who took no supplements from autumn 1996 to summer 1997. Reversed-phase high performance liquid chromatography was used to measure plasma antioxidant concentrations in overnight-fasting blood samples. RESULTS: Plasma levels of alpha-tocopherol, alpha-/beta-carotene, b-cryptoxanthin and lutein were significantly influenced by sex, being significantly higher for women than men in each corresponding season; retinol and lycopene, however, showed no such difference. For women, winter values of alpha-tocopherol, alpha-/beta-carotene, lutein and lycopene were significantly lower than corresponding summer values, and had reached their annual lowest. Retinol failed to show any significant seasonal variation, whereas the winter value of beta-cryptoxanthin had reached its annual highest. For men, beta-cryptoxanthin exhibited significant seasonal changes and was also highest in winter. Winter values of alpha-tocopherol, alpha-/beta-carotene and lycopene were lower compared with other seasons, but not statistically significant, probably due to the small sample size. CONCLUSIONS: The findings indicate that sex and seasonal variations of plasma antioxidant concentrations should be taken into account in nutritional epidemiologic studies.

Adequação da ingestão dietética de atletas adolescentes de 4 modalidades esportivas / Dietary intake adequacy of adolescent athletes of 4 sports

O presente estudo objetivou avaliar a ingestão alimentar quanto à qualidade nutricional de atletas adolescentes do sexo feminino, comparando modalidades esportivas que apresentam características distintas quanto ao gasto energético e ao controle de peso corporal das atletas. Foram estudadas as atletas entre 10 e 14 anos, pertencentes às equipes de natação, vôlei, ginástica olímpica e rítmica do Clube Grêmio Náutico União de Porto Alegre. O cálculo da ingestão de nutrientes foi baseado no registro alimentar de três dias. A ingestão de macro e micronutrientes foi comparada com as recomendações da Organização Mundial de Saúde e com as Dietary References Intake, respectivamente. Foram estudadas 45 atletas (13 nadadoras, 17 jogadoras de vôlei, sete atletas da ginástica olímpica e oito da ginástica rítmica). A natação foi o grupo que apresentou maior média de consumo de energia com diferença de aproximadamente 1000 Kcal/dia das demais modalidades. Com relação ao consumo de carboidrato por quilo de peso corporal, as atletas de natação e GRD apresentaram maior consumo em relação as demais atletas. A média de ingestão de ferro das atletas das quatro modalidades fi cou a cima do recomendado. O vôlei foi a modalidade com maior porcentual de atletas com consumo excessivo de proteína e lipídio, e ingestão insuficiente de carboidrato em relação ao valor energético total. É importante a elaboração de programas de educação alimentar e o acompanhamento nutricional periódico de atletas adolescentes.

This study aims to investigate the nutritional quality of dietary composition of female adolescent athletes, comparing sports modalidities with different caracteristics as for energy expenditure and body weight control severity. This study included swimmers, volleyball players, olympic and artistic gymnasts, between 10 and 14 years old, from Grêmio Náutico União Club, Porto Alegre. Nutrient intake was based on 3-day food records. Macro- and Micro- nutrients intake was compared recommendations of World Health Organization and to Dietary References intake, respectively. We studied 45 athletes (13 swimmers, 17 volleyball players, 7 olympic gymnasts and 8 artistic gymnasts). The swimmers presented higher energy intake, approximately 1000kcal/day higher than the other sports. Swimmers and artistic gymnasts showed hogher carbohydrate intake per kilogram body weight than the other sports. The mean iron intake was higher than de recommendation for all athletes. The volleyball athletes showed higher prevalence of excessive protein and lipid intake and insufi cient carbohydrate intake. A nutrition educational program and periodical nutritional attendance of female adolescent athletes is necessary.

Treatment of child and adolescent obesity: reports from pediatricians, pediatric nurse practitioners, and registered dietitians.

OBJECTIVE: The primary aim of this study was to identify interventions used by pediatric health care providers in treatment of overweight children and adolescents to identify provider educational needs. A secondary aim was to examine the association of certain provider characteristics with recommended evaluation practices. STUDY DESIGN: A random sample of pediatricians, pediatric nurse practitioners, and registered dietitians (RDs) received questionnaires about their diet, activity, and medication recommendations for overweight patients and about referrals to specialists and programs. Results were examined for adherence to published recommendations and for associations with certain respondent characteristics. RESULTS: A total of 940 providers responded (response rate: 19%-33%). The majority recommended "changes in eating patterns" and "limitations of specific foods." Half or more used "low-fat diet" and "modest calorie restriction" in adolescents. Less than 15% used "very low-calorie diet." Fewer RDs recommended more restrictive diets. More than 60% of all groups followed recommended eating interventions for school-aged children and adolescents. More than 80% followed recommended physical activity interventions for all age groups. In each group, about 5% sometimes recommended prescription medication and herbal remedies for adolescents. None recommended surgery. Two thirds of pediatricians and pediatric nurse practitioners often referred to RDs. Approximately 20% referred to child/adolescent weight programs, but for 27% to 42%, these programs or pediatric obesity specialists were not available. No consistent associations between respondent characteristics and adherence to recommended interventions were identified. CONCLUSIONS: The providers generally promoted healthy eating and activity with minimal use of highly restrictive diets or medication to control weight.

Ethical issues in nutritional sciences for the next century: nutrition research and counseling of nutraceutical supplementation and disease

Ethical issues pertaining research and counseling in nutritional sciences will be arising in this new century. This issue will be of great importance especially in the area of nutraceutical supplementation and disease (pharmacological nutrition). Steps to insure bioethical correctness are discussed in this paper.

Early postoperative feeding--results of a North American survey.

Early postoperative feeding (EPOF) practices among North American institutions were investigated using a survey questionnaire to obtain descriptive information regarding the overall utilization and criteria used to identify candidates for EPOF. EPOF was defined as the initiation of enteral nutrition support two to 48 hours postoperatively in major abdominal and thoracic surgical patients. Two hundred and ninety-seven questionnaires were mailed; 170 were completed. Sixty-nine (41%) institutions reported using EPOF. Feeding was initiated less than 12 hours postoperatively in 16% of centres; 84% reported EPOF 13-48 hours postoperatively. The majority (88%) of institutions did not have a specific nutritional guideline for determining which patients should receive EPOF. Objective and subjective nutritional indices, degree of preoperative malnutrition and type of surgery were considered by 23% of respondents when determining the need for EPOF. Percent weight loss, albumin and the anticipated postoperative NPO were considered the most reliable objective indices while decreased dietary intake, cachexic appearance and anorexia were considered the most reliable subjective indices. The results reveal that less than 50% of institutions surveyed use EPOF in major abdominal and thoracic surgical patients and the criteria used to identify candidates for EPOF were found to be variable.