Associations between Dietary Fiber, the Fecal Microbiota and Estrogen Metabolism in Postmenopausal Women with Breast Cancer.

Breast cancer is a hormonally-driven cancer, and various dietary factors are associated with estrogen metabolism, including dietary fiber. Several studies report associations between dietary fiber and breast cancer; however, research on whether fiber influences circulating estrogens through the gut microbiota is rare. The objective of this cross-sectional study among 29 newly-diagnosed (stage 0-II), post-menopausal breast cancer patients is to examine associations between dietary fiber and the gut microbiota that are linked with ß-glucuronidase activity, and purportedly increase circulating estrogens. Spearman's and partial correlations controlling for body mass index and age were performed using dietary recall data, Illumina MiSeq generated microbiota relative abundance, and HPLC-mass spectrometry-derived estradiol and estrone levels.Major findings are: (1) total dietary fiber is inversely associated with Clostridium hathewayi (r= -0.419; p = 0.024); (2) soluble fiber is inversely associated with Clostridium (r=-0.11; p = 0.02); (3) insoluble fiber is positively associated with Bacteroides uniformis sp. (r = 0.382; p = 0.041); and (4) serum estradiol and estrone levels are not correlated with species/genera or dietary fiber, though there is a trend toward an inverse association between soluble fiber and estradiol levels (r= -0.30; p = 0.12). More studies are needed to understand the complex interaction between dietary fiber, intestinal microbiota, and hormonal levels in older females.

Longitudinal Analysis of Nut-Inclusive Diets and Body Mass Index Among Overweight and Obese African American Women Living in Rural Alabama and Mississippi, 2011-2013.

INTRODUCTION: Nuts, when eaten alongside other nutritionally rich foods, may decrease obesity and related chronic disease risks, which are high among African American women in the rural South. We monitored changes in nut intake, other obesity-related foods (fruits, vegetables, red or processed meats, added sugars), and body mass index (BMI) over a 2-year weight loss intervention among 383 overweight and obese African American women in rural Alabama and Mississippi. METHODS: Two dietary recalls were administered at 4 points over 24 months. Mann-Whitney tests compared differences in median food group intake between nut consumers and non-nut consumers, and t tests identified BMI differences between groups. Mixed linear models tested the relationship between nut intake and intake of the select food groups, and between nut intake and BMI over time. RESULTS: Overall nut consumers ate more fruits and vegetables and less red meat than non-nut consumers. Nut consumers had lower BMI values than non-nut consumers. Weight loss by the end of the intervention was significant for nut consumers but not for non-nut consumers, even after accounting for kilocalorie consumption and physical activity engagement. CONCLUSION: Nut consumption is associated with consumption of other nutritionally rich foods and lower BMI among African American women in rural Alabama and Mississippi. Future interventions should target increasing daily nut intake, decreasing added sugar intake, and identifying strategies to encourage positive dietary changes to continue after an intervention.

ACE inhibitors and potassium foods--nurses' knowledge.

PURPOSE: According to Joint Commission standards, patients should be educated about drug-nutrient interactions. Because nurses are well-suited to educating patients, this paper aims to assess their knowledge of ACE inhibitor drugs, nutrient interactions and high- and low-potassium foods. DESIGN/METHODOLOGY/APPROACH: Licensed nurses from a teaching hospital in the US south eastern Atlantic region completed a self-administered questionnaire (n = 83). Means, standard deviations and 95 percent confidence intervals were calculated for continuous data and frequency and percentage distribution for discrete data. Student's t-test was used to evaluate responses by ACE inhibitor patient load and nursing education. FINDINGS: Mean nurse knowledge of ACE inhibitors and potassium was 62 +/- 16 percent and identifying high- and low-potassium foods was 32 +/- 23 percent. Most identified five from 12 high-potassium foods and did not know the designation of six, one from 14 low-potassium foods and did not know the designation of 11. Knowledge scores and identifying high- and low-potassium foods were similar regardless of ACE inhibitor patient load and nursing education. PRACTICAL IMPLICATIONS: ACE inhibitors are the fourth most commonly used drug class in the USA. Nurses are well positioned to recognize potential drug-nutrient interactions owing to changing or adding a drug, dose delivery method, dietary change or a patient's physical or clinical status that may indicate nutrient deficiency. The findings suggest that the nurses surveyed were proficient in identifying ACE inhibitors pharmacology, but that most were unable to identify foods that increase drug-nutrient interaction risk, and thus this is an area in which additional training might be beneficial. ORIGINALITY/VALUE: Case menus were used to portray real-life scenarios in which healthcare practitioners can provide patient education about ACE inhibitor drug and dietary potassium interactions.

Health Professional Perspectives about the Future of Clinical Education: An ASAHP Clinical Education Committee Report.

In 2018, the Clinical Education Task Force (CETF) of ASAHP presented five recommendations to address clinical education needs. In 2019, the ASAHP Interprofessional Education Task Force (IPTF) established a regional summit for academic and industry constituents to improve health professional education and training. This article describes the steps taken to render a one-day St. Louis regional summit to receive stakeholder feedback on the nationally published recommendations for clinical education. The electronic survey was distributed to potential summit attendees about the CETF recommendations. Data categories captured included demographic details and questions about priorities, use, and engagement with the recommendations, and one open-ended question for each of the recommendations invited respondents to provide feedback. There were 349 respondents: 34% clinical preceptors/coordinators/directors, 31% academic program faculty, and 18% administrators. Common themes included the establishment of common goals between academic programs and healthcare organizations for partnership building, better recognition of the value of interprofessional collaborative practice, and technology as vital to the evolution of the healthcare system. Future directions should include regional summit meetings to address the implementation of the CETF recommendations relative to regional and localized challenges. Consensus-building efforts should address the diversity in responses relative to interprofessional collaborative efforts and clinical education research.

Cost-analysis of nutrition support in patients with severe acute pancreatitis.

PURPOSE: The purpose of this research was to assess the preferred route of nutrition support (enteral versus parenteral) for treatment of severe acute pancreatitis in the acute care setting. Further, in cases when enteral nutrition is the preferred route, is nasal-bridling a lower-morbidity and cost-effective method? DESIGN/METHODOLOGY/APPROACH: A retrospective review of pre-existing data from an 870-bed hospital system. Medical records were reviewed via an online database system (n = 25 patients) with severe acute pancreatitis. Length of stay and cost were analyzed. FINDINGS: More patients received TPN versus the nasal-jejunal (post-pyloric) tube feeds group. No significant relationship was found between total cost and number of co-morbidities or between either of the two treatment groups. However, a medium to large effect size was shown which could indicate a significant relationship in a larger sample size. ORIGINALITY/VALUE: The findings of this research add to the literature already available and will be of interest to those who specialize in this area.

Assimilation, Acculturation, and Allostatic Load in U.S.- and Foreign-Born Hispanics.

The present study assessed how the adaptation to American culture by United States (U.S.)-born and foreign-born Hispanics living in the U.S. may influence stress-related physiological aspects that may impair health. Data on 8,360 Hispanics living in the U.S. categorized as U.S.-born (n = 3347) and foreign-born (n = 5013) from NHANES 1999-2010 (ages 18-85) were used. Stress-related physiological impact was measured by the allostatic load index (ALoad). Adaptation to American culture was evaluated through three acculturation-related measures. The average age was 39.39 years in a sample where 51% were males. ALoad was classified as no load (15.41%), low load (55.33%), and high load (29.24%). The U.S.-born Hispanics showed higher ALoad compared to foreign-born Hispanics (p < 0.001). Among foreign-born Hispanics, length of residence (LOR) and age of arrival in the U.S. (AOA) were associated with higher ALoad scores (p < 0.05), and in U.S.-born Hispanics, age and sex were positively associated and education was negatively associated with ALoad scores (p < 0.05). Adaptation to American culture in foreign-born Hispanics living in the U.S. appears to influence levels of ALoad in this population.

Diet Quality in Early Care and Education Centers: A Comparison of Menu, Served, and Consumed Lunch Measures.

OBJECTIVE: Assess if diet quality (DQ) differs among 3 lunch measures commonly used to assess DQ in early care and education (ECE) centers, which include what is listed on the menu, served, and consumed. DESIGN: This quantitative observational study measured DQ of food and beverage items listed on the menu, what children were served, and what they consumed during one lunch meal. SETTING: Alabama ECE centers. PARTICIPANTS: ECE centers (n = 28) with attendance of ≥10 children ages 3 to 5 years and provided lunch daily. MAIN OUTCOME MEASURE(S): DQ measured through Healthy Eating Index-2015 (HEI) scores, which were calculated for the menu, served, and consumed lunch measures. ANALYSIS: Menu, served, and consumed HEI scores compared using either Kruskal-Wallis or ANOVA. Dunn Bonferroni or Duncan post hoc tests identified which group differed. RESULTS: Total HEI scores were significantly higher among menus, compared with served and consumed (P = .001). Served and consumed total HEI scores were not different. CONCLUSIONS AND IMPLICATIONS: Menu DQ differed from both the served and consumed lunch measures. These findings support the need for nutrition education on the importance of menu adherence in ECE centers.

Acute beetroot juice supplementation improves exercise tolerance and cycling efficiency in adults with obesity.

BACKGROUND: Exercise training improves health outcomes in individuals with obesity (IO); however, it remains challenging for IO to adhere to exercise. Thus, it is critical to identify novel strategies that improve exercise tolerance (ET) and adherence in IO. Beetroot juice (BRJ), high in inorganic dietary nitrate, consistently improves exercise performance in athletes, individuals with cardiopulmonary diseases, and nonobese lean individuals. These improvements may be explained by reduced oxygen uptake (VO2 ) during exercise, enhanced blood flow, and greater mitochondrial efficiency. To date, we are aware of no studies that have compared the effects of BRJ, sodium nitrate (NaNO3), and nitrate-depleted BRJ (PLA) for improving ET and cardiometabolic health in IO. PURPOSE: Determine if BRJ improves ET, exercise efficiency (EE), and cardiometabolic health in IO and identify possible mechanisms of action. METHODS: Vascular hemodynamic, submaximal- and maximal-exercise VO2 , and time to exhaustion (TTE) were assessed in 16 participants 2.5 hr following consumption of: 1) BRJ, 2) NaNO3 , 3) PLA, or 4) CON. RESULTS: A significant treatment effect was observed for submaximal exercise VO2 (p = .003), and TTE (p < .001). Post hoc analyses revealed lower VO2 during submaximal exercise in BRJ compared to PLA (p = .009) NaNO3 (p = .042) and CON (0.009), equating to an average improvement of ~ 7% with BRJ. TTE was greater for BRJ compared to other treatment arms, PLA (p = .008), NaNO3 (p = .038), and CON (p=<0.001), equating to ~ 15% improvement with BRJ. No significant changes were observed for other outcomes. CONCLUSIONS: Consumption of BRJ improved EE during submaximal exercise by 7%, and TTE by 15% compared to other conditions. These results suggest that BRJ may improve EE and exercise tolerance in IO.

Reasons for Late-Night Eating and Willingness to Change:A Qualitative Study in Pregnant Black Women.

OBJECTIVE: Late-night eating during pregnancy is associated with greater risk for gestational diabetes. The purposes of this study were to describe reasons why women engage in late-night eating and to understand perceptions about changing this behavior. DESIGN: Focus groups using a semi-structured interview script. SETTING: Urban university-affiliated obstetric clinic. PARTICIPANTS: Low-income black women (n = 18) with overweight/obesity at entry to prenatal care. PHENOMENON OF INTEREST: Late-night eating. ANALYSIS: Exhaustive approach coding responses to specific questions. RESULTS: Individual and interpersonal contributors to late-night eating included hunger, altered sleep patterns, fetal movement, and the influence of others. Food choices were largely driven by taste and convenience. Some women reported that they could alter nightly eating patterns, whereas others would consider changing only if late-night eating were associated with a severe illness or disability for the child. CONCLUSIONS AND IMPLICATIONS: There was considerable heterogeneity among the participants of this study regarding reasons for late-night eating during pregnancy and attitudes toward changing this behavior. Although the themes identified from this study cannot be generalized, they may be useful to inform future studies. Future research might develop strategies to overcome individual and social factors that contribute to late-night eating during pregnancy.

Dietary Patterns Among Overweight and Obese African-American Women Living in the Rural South.

INTRODUCTION: Obesity and chronic diseases disproportionately affect African-American women in the rural South (US) and may be influenced by adherence to a typical Southern-style diet. There is a need to examine dietary patterns of this population and to determine if consumption of nutritionally rich foods like nuts is associated with consumption of other nutritious foods. The objectives of this study were to identify (1) dietary patterns of overweight/obese African-American women in the rural South; (2) the role that nuts play in the diet; (3) and adherence to federal food group recommendations across dietary patterns. METHODS: Secondary data analysis of two baseline 24-h dietary recalls was performed on 383 overweight/obese African-American women enrolled in a weight loss intervention in Alabama and Mississippi between 2011 and 2013. Cluster analysis identified dietary patterns. t tests and chi-square tests tested demographic and dietary differences across clusters. The proportion of women in each cluster who met federal recommendations for fruit, vegetable, nuts, added sugar, and sodium intake was calculated. RESULTS: Two dietary patterns were found. Nut intake frequency was higher in cluster 2 (P < .001), which was characterized by a higher intake frequency of fruits and vegetables, but high mean daily intake of added sugar (12.26 ± 7.67 tsp) and sodium (2800 ± 881 mg). Ninety-two percent of participants in this cluster consumed red/processed meats daily. CONCLUSION: Even among women in this population who consume a more plant-based dietary pattern containing nuts, there is still a need to decrease intake of added sugar, sodium, and red meat.

Nut Intake among Overweight and Obese African-American Women in the Rural South.

OBJECTIVE: Nut consumption decreases risk for obesity and chronic diseases, which are prevalent among African-American women in the rural southeastern United States. The quantity and quality of nut intake in this population is unclear. We examined the amount, source, and quality of nut consumption among overweight and obese African-American women in rural Alabama and Mississippi. METHODS: Two 24-hour dietary recalls were administered to 426 women. Mann-Whitney tests, t-tests, and linear regression models identified differences in added sugar and sodium intake between nut consumers and non-consumers, differences in mean nut, added sugar, and sodium intake between stand-alone and incorporated nut sources, and a relationship between nut intake and added sugar and sodium intake. RESULTS: Forty-two percent of participants consumed nuts, and 16% met federal recommendations for nut intake. Nut consumption was mainly from incorporated sources (65%), which were higher in added sugar (p < .001) and sodium (p < .001), and lower in nut quantity (p < .001) than stand-alone sources. Nut consumers consumed more daily added sugar (p = .004) and sodium (p = .04) than non-consumers. CONCLUSION: Suboptimal quantity and quality of nut intake may impede the health benefits of nut consumption among African-American women in the rural South.

Case-based learning facilitates critical thinking in undergraduate nutrition education: students describe the big picture.

BACKGROUND: The vision of dietetics professions is based on interdependent education, credentialing, and practice. Case-based learning is a method of problem-based learning that is designed to heighten higher-order thinking. Case-based learning can assist students to connect education and specialized practice while developing professional skills for entry-level practice in nutrition and dietetics. OBJECTIVE: This study examined student perspectives of their learning after immersion into case-based learning in nutrition courses. DESIGN: The theoretical frameworks of phenomenology and Bloom's Taxonomy of Educational Objectives triangulated the design of this qualitative study. PARTICIPANTS/SETTING: Data were drawn from 426 written responses and three focus group discussions among 85 students from three upper-level undergraduate nutrition courses. MAIN OUTCOME MEASURES: Coding served to deconstruct the essence of respondent meaning given to case-based learning as a learning method. The analysis of the coding was the constructive stage that led to configuration of themes and theoretical practice pathways about student learning. RESULTS: Four leading themes emerged. Story or Scenario represents the ways that students described case-based learning, changes in student thought processes to accommodate case-based learning are illustrated in Method of Learning, higher cognitive learning that was achieved from case-based learning is represented in Problem Solving, and Future Practice details how students explained perceived professional competency gains from case-based learning. CONCLUSIONS: The skills that students acquired are consistent with those identified as essential to professional practice. In addition, the common concept of Big Picture was iterated throughout the themes and demonstrated that case-based learning prepares students for multifaceted problems that they are likely to encounter in professional practice.

The application of genetics and nutritional genomics in practice: an international survey of knowledge, involvement and confidence among dietitians in the US, Australia and the UK.

As a result of expanding scientific understanding of the interplay between genetics and dietary risk factors, those involved in nutritional management need to understand genetics and nutritional genomics in order to inform management of individuals and groups. The aim of this study was to measure and determine factors affecting dietitians' knowledge, involvement and confidence in genetics and nutritional genomics across the US, Australia and the UK. A cross-sectional study was undertaken using an online questionnaire that measured knowledge and current involvement and confidence in genetics and nutritional genomics. The questionnaire was distributed to dietitians in the US, Australia and the UK using email lists from the relevant professional associations. Data were collected from 1,844 dietitians who had practiced in the previous 6 months. The main outcomes were knowledge of genetics and nutritional genomics and involvement and confidence in undertaking clinical and educational activities related to genetics and nutritional genomics. Mean scores for knowledge, involvement and confidence were calculated. Analysis of variance and χ (2) analysis were used to compare scores and frequencies. Multivariate linear regression was used to determine predictors of high scores. The results demonstrated significant differences in involvement (p < 0.001) and confidence (p < 0.001) but not knowledge scores (p = 0.119) between countries. Overall, dietitians reported low levels of knowledge (mean knowledge score 56.3 %), involvement (mean number of activities undertaken 20.0-22.7 %) and confidence (mean confidence score 25.8-29.7 %). Significant relationships between confidence, involvement and knowledge were observed. Variables relating to education, experience, sector of employment and attitudes were also significantly associated with knowledge, involvement and confidence. Dietitians' knowledge, involvement and confidence relating to genetics and nutritional genomics remain low and further investigation into factors contributing to this is required.