Dietitian-supported dietary intervention leads to favorable dietary changes in patients with type 2 diabetes: A randomized controlled trial.

AIMS/INTRODUCTION: It remains to be fully elucidated whether nutrition education by dietitians can lead to specific positive changes in the food choices of patients with diabetes. MATERIALS AND METHODS: A total of 96 patients with type 2 diabetes and diabetic kidney disease were randomly assigned to the intensive intervention group that received nutritional education at every outpatient visit and the control group that received nutritional education once a year. The total energy intake, energy-providing nutrients and 18 food groups were analyzed at baseline, and 1 and 2 years after the intervention in 87 patients. Furthermore, the relationship between the changes in hemoglobin A1c, body composition and changes in the total energy or energy-producing nutrient intake was analyzed in 48 patients who did not use or change hypoglycemic agents during the study period. RESULTS: The total energy intake, carbohydrates, cereals, confections, nuts and seeds, and seasonings significantly decreased, and fish and shellfish intake significantly increased during the study period in the intensive intervention group, whereas these changes were not observed in the control group. The decrease in the total energy intake and carbohydrates after 2 years was significantly greater in the intensive intervention group than in the control group. The change in the total energy and carbohydrate intake showed a significant positive correlation with that in muscle mass. The multivariate analysis showed that the decrease in total energy intake was independently associated with that in muscle mass. CONCLUSION: Dietitian-supported intensive dietary intervention helps improve the diet of patients with type 2 diabetes.

The Status of Enteral Nutrition Formula Use by Dietitians in Hospitals Within Busan and Gyeongnam Area.

This study was conducted to analyze the status of medical food selection process in hospitals within Busan and Gyeongnam area. The survey was distributed to 396 hospitals (general, tertiary and long-term care hospitals) and finally 68 surveys were used for analysis. The questionnaire consisted of 9 general items and 10 items related to enteral nutrition (EN). From the survey we found out that general hospitals and tertiary hospitals normally hire clinical dietitian, while long-term care hospitals hire dietitians with no further qualifications (χ2 = 27.918, p < 0.001). A significant relationship was found between hospital size and the priority for choosing medical foods for patients (χ2 = 11.852, p < 0.05). In general and tertiary hospitals, medical foods were provided exactly according to the doctor's prescription, whereas in long-term care hospitals, only half followed the doctor's direction and half of them provided the products that has been conventionally used. There was also a significant relationship between hospital size and the method for determination of nutrition requirements (χ2 = 20.496, p < 0.001). Finally, the priority of considerations when developing a 'medical food guidelines' was shown in the following order; 1) the type of medical food that can be selected according to the disease state, 2) the nutrient content and comparison table for commercial products, and 3) how to manage complications that may occur when supplying medical food for patients. Developing an EN practice guideline for making a sensible selection of medical foods will provide a valuable information for better patient care.

High Turnover in Clinical Dietetics: A Descriptive Analysis.

Purpose: To identify key attributes of Canadian clinical registered dietitian (RD) jobs associated with high rates of turnover.Methods: Managers of clinical RDs in Canada were eligible to complete a survey on the topic of turnover in clinical RD positions. Specifically, key details were sought regarding positions with the highest and lowest turnover in each manager's portfolio.Results: High turnover (HT) positions turned over an average of 4.0 times in a 5-year period in contrast to 0.3 times in low turnover (LT) positions. Resignation was the top reason for turnover in both HT and LT positions. HT and LT positions were of analogous full-time equivalent, had comparable caseloads, and served clients/patients with similar diagnoses including diabetes and neurological conditions.Conclusions: There is significant variation in the frequency of turnover across positions in clinical dietetics in Canada. What differentiates HT positions from LT positions remains unclear. More research is required to guide managers seeking to balance turnover and preclude uneven nutrition care quality across units and programs.

COVID-19 and changes in Korean consumers' dietary attitudes and behaviors.

BACKGROUND/OBJECTIVES: The coronavirus disease 2019 (COVID-19) outbreak has dramatically changed nearly every aspect of our lives. Although Dietary lifestyle includes attitudes and behaviors to meet their most basic needs, but few studies have examined the pattern of changes in dietary lifestyle driven by COVID-19. This study explores changes in dietary attitudes and behaviors among Korean consumers after COVID-19. SUBJECTS/METHODS: An online survey was conducted with 549 Korean adults aged 20 and older to identify general demographics and changes in dietary attitudes and behaviors. Data were collected from Oct 12 to Oct 18, 2020. Frequency, percentage, and mean values were calculated and a K-means cluster analysis was performed to categorize consumers based on the 5S of dietary attitudes (i.e., savor-oriented, safety-oriented, sustainability-oriented, saving-oriented, and socializing-oriented). RESULTS: Findings indicate consumers considered safety, health, and freshness to be most important when choosing groceries and prepared meal such as home meal replacement and delivery food. Among the types of services, a large proportion of consumers increased their delivery and take-out services. Regarding retail channels, the increase in the use of online retailers was remarkable compared to offline retailers. Finally, consumers were classified into four segments based on changes in dietary attitudes: "most influenced," "seeking safety and sustainability," "abstaining from savor and socializing," and "least influenced." Each type of consumer exhibited statistically significant differences by sex, age, household composition, presence of disease, and perceived risk of COVID-19. CONCLUSIONS: This exploratory study provides initial insights for future research by identifying various aspects of dietary attitudes and behaviors among Korean consumers after COVID-19.

Beyond the clinical walls: registered dietitian nutritionists providing medical nutrition therapy in the home setting.

BACKGROUD/OBJECTIVES: Registered dietitian nutritionists (RDN) are providers of medical nutrition therapy (MNT) to address health and chronic disease. Traditionally, RDNs have provided care in healthcare facilities including hospitals and private care facilities. The purpose of this study was to determine how RDN individualized MNT in the home impacted nutrition, physical activity, and food security. SUBJECTS/METHODS: This is a secondary data analysis. The mean age of the participants (n = 1,007) was 51.6 years old with a mean body mass index (BMI) of 34.1 kg/m2. Individualized MNT visits were delivered by an RDN in the home setting from January to December 2019. Participants were referred by healthcare professionals or self-referred. Participants had MNT benefits covered by their health insurance plan (43.3% Medicaid; 39.8% private insurance; 7.9% Medicare, 9% other). Health outcomes related to nutrition care were measured. Outcomes included self-reported consumption of nutrition factors and physical activity. Our secondary outcome focused on food security. The changes in weight, BMI, physical activity, and nutrition factors were analyzed by a linear regression model or linear mixed model, adjusting for age, sex, baseline value, and number of appointments. Food security was summarized in a 2 by 2 contingency table. RESULTS: Baseline values had significantly negative impacts for all changes and number of appointments was significant in the changes for weight and BMI. Increases in physical activity were significant for both female and male participants, 10.4 and 12.6 minutes per day, respectively, while the changes in weight and BMI were not. Regarding dietary factors, the consumption total servings per day of vegetables (0.13) and water (3.35) significantly increased, while the consumption of total servings of whole grain (-0.27), fruit (-0.32), dairy (-0.80) and fish (-0.81) significantly decreased. About 24% (of overall population) and 45% (of Medicaid population) reported improvements in food security. CONCLUSIONS: This study found that home visits were a useful setting for MNT delivered by RDNs. There is a strong need for individualized counseling to meet the participants' needs and personal goals.

Evaluación antropométrica en gestantes atendidas en el Policlínico Turcios Lima, Pinar del Río / Anthropometric assessment in pregnant women at N0-1 Basic Working Team from Turcios Lima University Polyclinic, 2020

RESUMEN Introducción: el riesgo de complicaciones durante el embarazo o el parto, como consecuencia de una ganancia de peso inadecuada, ha generado un creciente interés en la medicina. Objetivo: describir las principales medidas antropométricas, en gestantes del Grupo de Trabajo 1, del Policlínico Universitario Turcios Lima, en el período de enero a junio de 2020. Métodos: se realizó un estudio observacional, descriptivo y transversal. El universo de estudio estuvo representado por 443 gestantes y la muestra por las 87 que cumplieron con los criterios de inclusión y exclusión. Para la obtención de la información fueron utilizadas las historias obstétricas y las Historias de Salud Familiar. Se utilizaron métodos de estadística descriptiva, frecuencia absoluta, frecuencia relativa y el método porcentual, además de la media y desviación estándar. Resultados: existió un predominio de las gestantes normopeso al inicio del embarazo, entre 20 y 29 años. Según la distribución de las gestantes de acuerdo a la ganancia de peso durante el segundo y tercer trimestre, existió una superioridad de las que tienen una ganancia de peso ideal. De acuerdo a las medidas antropométricas en el primer control las pacientes se encontraron en las medidas establecidas, la mayoría de ellas, en cuanto a la media como tendencia central, con una dispersión de la desviación estándar, cerca de los datos primarios para el perímetro braquial y la circunferencia del brazo. Conclusiones: la medición de las diferentes medidas antropométricas en la gestante permite integrar un diagnóstico integral y estratificar riesgos y complicaciones.

ABSTRACT Introduction: the risk of complications during pregnancy or delivery, as a consequence of an inadequate weight gain has generated an increasing interest in medicine. Objective: to describe the main anthropometric measures in pregnant women at N0-1 Basic Working Team from Turcios Lima University Polyclinic during January-June 2020. Methods: an observational, descriptive and cross-sectional study was carried out. The target group comprised 443 pregnant women and the sample included 87, who were intentionally taken from those who met the inclusion and exclusion criteria. To collect the information the obstetric and family-clinical histories were revised. Descriptive statistics was applied, along with absolute and relative frequencies, the percentage methods as well as the mean and standard deviation. Results: normal weight at the beginning of pregnancy and ages between 20 and 29 predominated. According to the distribution of pregnant women related to weight-gain during the second and third trimester, there was a higher rate of those having an ideal weight-gain. In relation to the anthropometric measurements at the first control, it can be emphasized, these were among the established ranges, the majority of them, regarding to the mean, as central trend, with a dispersion of the standard deviation, close to the primary data for the brachial perimeter and the circumference of the arm. Conclusions: different anthropometric measurements in pregnant women allow establishing a comprehensive diagnosis and to stratify risks and complications.

Aprimoramento e validação de conteúdo de instrumentos para avaliar a qualidade de dietas hospitalares / Improvement and validation of the content of instruments to evaluate quality of hospital diets

Introdução: A avaliação da qualidade das refeições hospitalares pode contribuir para a melhor aceitação pelo paciente. Objetivo: Aprimorar e validar o conteúdo de instrumentos para avaliar a qualidade das dietas hospitalares. Método: Estudo realizado em unidade hospitalar do Rio de Janeiro para aprimoramento de formulário próprio para fiscalização do fornecimento de refeições. Para atender a todas as dimensões da qualidade, o formulário foi desdobrado em dois instrumentos, para avaliação da qualidade sensorial (AQS) e da qualidade higiênico-sanitária (AQH), e seu conteúdo foi submetido à validação através de painel de especialistas e da técnica Delphi adaptada. Após aprovado, foi aplicado em 12 cardápios das grandes refeições para avaliação das conformidades. O estudo foi aprovado pelo Comitê de Ética da instituição. Resultados: Tanto para AQS como para AQH, os itens relacionados a "apresentação/design", "clareza semântica", "facilidade de entendimento" e "facilidade de preenchimento" obtiveram concordância na primeira rodada. Uma segunda rodada foi necessária para readequação da "capacidade de avaliação" nos dois instrumentos. Após obtenção de no mínimo 91,7% de concordância para AQS e o mínimo de 90,1% para AQH, os instrumentos foram considerados validados. A média do índice de restos foi de 22%; as grandes refeições obtiveram percentuais maiores (32,4%) que as pequenas refeições (10,6%-21,5%). Para os cardápios das grandes refeições que apresentaram "não conformidade" para peso, textura, aparência, sabor e temperatura, foram solicitadas medidas de correção. Conclusão: As inconformidades observadas nas grandes refeições podem explicar o maior índice de restos, comparado às pequenas refeições. Espera-se que a aplicação rotineira dos instrumentos contribua para a melhor avaliação dietética dos pacientes hospitalizados e minimize o risco de desnutrição. Após adaptações, outras unidades de alimentação e nutrição podem fazer uso desses instrumentos para avaliar as dimensões da qualidade das refeições fornecidas. (AU)

Introduction: The assessment of the quality of hospital diets can contribute to better acceptance of the patients. Objective: The study aimed to improve and validate the content of instruments for assessing the quality of hospital diets. Methods: Study developed at a hospital in Rio de Janeiro to improve the form used for inspection of the supply of meals. To include all dimensions of quality, the form was divided into two instruments, for evaluation of sensory quality (ESQ) and hygienic and sanitary quality (EHQ), and its content was submitted to validation through a panel of experts using the Delphi technique adapted. Once approved, the instruments were applied to 12 menus of the two large meals to assess conformities. The study was approved by the institution's Ethics and Research Committee. Results: For both ESQ and EHQ, the items related to "presentation/design", "semantic clarity", "easy to understand" and "easy to fill in" obtained agreement in the first round. A second round was necessary to readjust the "capacity to assess hygienic and sanitary quality" in both instruments. After obtaining 91.7% of agreement for ESQ and 90.1% for EHQ, the instruments were considered validated. The mean rest index was 22%; large meals obtained higher percentages of waste (32.4%) than small meals (10.6% -21.5%). For the menus of the large meals that presented "non-conformities" for weight, texture, appearance, flavor and temperature, corrective measures were requested. Conclusion: The non-conformities observed in large meals may explain the high leftover index, compared to small meals. It is expected that the routine application of the instruments may contribute to a better dietary assessment of hospitalized patients and reduce the risk of malnutrition. After adaptations, other food and nutrition units can use these instruments to assess the dimensions of the quality of the provided meals. (AU)

Health practitioner practices and their influence on nutritional intake of hospitalised patients.

OBJECTIVES: In the hospital setting, poor dietary intake interacts with disease and represents a major and modifiable cause of malnutrition. Understanding barriers to adequate dietary intake is an important strategy to guide the development of interventions to improve nutrition intake. The aim of this study reported in this paper was to explore patient, family and health care professionals' perceptions of barriers to and enablers of adequate nutrition care and dietary intake of medical inpatients. METHODS: An exploratory qualitative study design incorporating group and individual interviews of patients (n = 14), their family members (n = 4), and health care professionals (n = 18) was undertaken. Participants were recruited pragmatically, using a mix of convenience and purposive sampling. A theoretically informed, semi-structured interview schedule was based on observations of practice and the Theoretical Domains Framework. Interviews were audio-recorded, transcribed verbatim and analysed inductively using a general inductive approach. RESULTS: Three key themes emerged from analysing participant interviews. Siloed approaches to nutrition care reflected the diverse range of health care professionals responsible for nutrition care but who often worked in isolation from their colleagues. Competing work priorities for nurses reflected the challenge in prioritise nutrition care which was often constrained because of other care needs or work-related pressures. Helping patients to eat highlighted that nurses were often the only health care professional who would provide assistance to patients at mealtimes and lack of available staff could negatively influence patients' nutrition intakes. CONCLUSIONS: We have identified many complex and interrelated barriers which preclude adequate dietary intake in acute medical patients. These predominantly reflect issues inherent in the hospital culture and environment. Multi-faceted and sustainable interventions that support a facilitating nutrition culture and multidisciplinary collaboration, inclusive of patients and families, are needed to address these underlying barriers.

The impact of electronic meal ordering systems on hospital and patient outcomes: A systematic review.

BACKGROUND: Malnutrition is a serious clinical issue associated with adverse patient and hospital outcomes. Hospitals need to consider interventions that support the provision of optimal nutritional management and care for patients. Electronic meal ordering (EMO) systems provide an alternative to traditional paper-based meal ordering with the capacity to support appropriate orders, monitor nutritional status, and potentially improve clinical outcomes. METHODS: This review aimed to identify the impact of EMO systems on hospital and patient outcomes. We sought quantitative evidence (peer-reviewed and grey literature) from studies evaluating EMO systems in healthcare facilities, published after 1999 and available in the English language. RESULTS: We identified 23 studies evaluating one of three distinct EMO system-supported models: spoken menu, room service, and self-service. While limited, the evidence indicated that EMO systems were associated with: improved patient satisfaction; decreased food waste; increased consumption; and, for spoken menus, more time with patients. There was no substantive evidence of impact on clinical outcomes. CONCLUSIONS: Whether EMO systems meet their potential to support nutritional monitoring and positively impact clinical outcomes remains unanswered within the evidence. Thus, policy makers and hospital management currently have a poor evidence base upon which to make decisions about the value of implementing EMO. Whether these systems can provide support and guidance to patients during meal ordering, improve order appropriateness and accuracy through compliance checking, identify patients in need of dietary education or those at risk of malnutrition are critical areas of focus for future research.

Comparación de instrumentos regulatorios para expendios de productos en nivel educativo medio superior y superior entre México y países latinoamericanos y miembros de la OCDE / Comparison of Regulatory Instruments for Product Sales in Secondary Schools and Universities in Mexico, Latin American Countries, and OECD Members

Antecedentes: ante la creciente incidencia y prevalencia de obesidad, por recomendación de organismos como la OMS y la OCDE, diversos países han emitido instrumentos regulatorios para normar la oferta alimentaria en las instituciones educativas. Objetivo: comparar el instrumento mexicano para el expendio de productos preparados y procesados en escuelas con instrumentos regulatorios en el ámbito internacional, y reflexionar sobre su aplicabilidad práctica. Materiales y métodos: en esta revisión documental se recolectaron instrumentos de 20 países para distintos niveles educativos, y se seleccionaron aquellos aplicables al nivel medio superior y superior. Resultados: se identificaron instrumentos heterogéneos y con distinto nivel de obligatoriedad, que dictaminan criterios nutricionales y otros elementos de la alimentación. En el nivel medio superior, 17 países regulan expendios, mientras que en el superior solo lo hacen tres. Así mismo, se muestran incrementos graduales en operatividad y cumplimiento de dichos instrumentos en los distintos países. Para el caso de México, se identificaron puntos de mejora en la aplicabilidad, monitoreo y evaluación del instrumento regulador. Conclusiones: las políticas influyen en la disponibilidad y accesibilidad de alimentos y bebidas; por lo anterior, su cumplimiento y estrecha vigilancia tendría un impacto positivo en los consumos alimentarios y los patrones dietéticos.

Background: Due to the rising incidence and prevalence of obesity and the issuance of WHO and OECD recommendations, various countries have developed regulatory instruments to standardize food offerings in educational institutions. Objective: Compare the Mexican instrument for sales of prepared and processed food products in secondary schools and universities with other international regulatory instruments, and reflect on its application and practicality. Materials and Methods: For this document revision, instruments from 20 countries were collected for various education levels, of which were selected those that apply to secondary school and universities. Results: Diverse instruments were identified with various levels of regulation, which dictate nutritional criteria and other dietary elements. At the secondary school level, 17 countries regulate sales, while at the university level only 3 countries do so. Likewise, there are gradual increases in operability and requirements among countries. In the case of Mexico, benchmarks for the applicability, monitoring, and evaluation of the regulatory tool(s) were outlined. Conclusion: Policies influence the availability and accessibility of foods and drinks; as such, compliance and close monitoring would have a positive impact on the consumption of food products and dietary patterns.

Impacto do aconselhamento nutricional na evolução antropométrica e dietética dos funcionários de uma unidade básica de saúde / Impact of nutritional counseling on the anthropometric and diet evolution of the staff of a health basic unit

Objetivo: Avaliar o impacto do aconselhamento nutricionalna evolução antropométrica e dietética dos funcionários deuma Unidade Básica de Saúde (UBS) de Belo Horizonte,Minas Gerais. Métodos: Estudo de intervenção desenvolvidocom funcionários de uma UBS com duração detrês meses. Para avaliação do perfil nutricional, utilizou-seantropometria (Índice de Massa Corporal e Circunferênciade Cintura) e análise do consumo alimentar (Registro Alimentare Questionário de Frequência Alimentar). Houveincentivo a práticas alimentares saudáveis, por meio de seisatividades de educação alimentar e nutricional e três atendimentosnutricionais individualizados. Resultados: Amostrade 22 indivíduos (44% do total de funcionários), 86,4%(n=19) mulheres, 68,2% (n=15) com intuito de reduçãode peso. A intervenção possibilitou melhora no consumodiário de leite/derivados e frutas e queda no consumo defrituras, doces e refrigerantes (p<0,05). Houve reduçãosignificativa no consumo calórico (p=0,015) e de sódio(p<0,0001), e aumento na ingestão diária de água (p=0,004).Apesar disso, não foram constatadas diferenças estatisticamentesignificativas (p>0,05) com relação à antropometriaentre os funcionários que almejavam a redução do peso.Conclusões: O aconselhamento nutricional foi capaz demelhorar o padrão alimentar dos funcionários, sugerindo--se um período maior de intervenção, a fim de se obterresultados mais satisfatórios em relação à antropometria.

Background: Assess the impact of nutritional counseling among the staff of a primary health care (PHC) unit in Belo Horizonte, Minas Gerais. Methods: Intervention study undertaken for 3 months, among the staff of a PHC unit. To assess the nutritional profile, anthropometric (body mass index and waist circumference) and food intake analyses (food record and food frequency questionnaire) were used. Healthy eating practices were encouraged through six nutritional education activities and three individualized nutritional consultations. Results: Of a sample of 22 individuals (44% of the total staff), 86.4% (n=19) were women, of whom 68.2% (n=15) wanted to lose weight. The intervention stimulated improvement of the daily intake of milk/dairy products and fruit, along with a reduction of the consumption of fried foods, sweets and soft drinks (p<0.05). There were significant reductions of caloric (p=0.015) and sodium intakes (p<0.0001), and an increase of daily water intake (p=0.004). Nevertheless, there were no statistically significant differences (p>0.05) with respect to anthropometry among the staff who sought weight reduction. Conclusions: Nutritional counseling improved the staff 's food intake pattern. A longer intervention period would provide more satisfactory anthropometric results.

Prescriçäo e uso de formulados para nutriçäo enteral pelos serviços de nutriçäo hospitalares do município de Campinas (SP) / Prescription and use of formulae for enteral nutrition by the nutrition services of the hospitals in the city of Campinas-São Paulo, Brazil

A nutrição enteral como forma de suporte nutricional é um importante recurso na prática terapêutica, respondendo de forma satisfatória aos casos de limitação à ingestão de alimentos por via oral. Contudo, não existem dados locais sobre a utilização de formulados industrializados ou artesanais pelos Serviços de Nutrição. A fim de avaliar a utilização de cada um dos tipos de formulados, bem como identificar o profissional responsável pela prescrição dos mesmos, procedeu-se a um leventamento nos hospitais de Campinas,SP, por meio de questionários. Os resultados mostram que o emprego da nutrição enteral é prática de rotina nos Serviços, e que não há diferença significativa entre a utilização de formulados industrializadas ou artesanais; mostram também que o médico é o profissional responsável pela prescrição da dieta na maior parte dos Serviços

Tube feeding is a recognized means, for dietary management of a disease, successfully surpassing the limits of patients with impaired feeding. Nevertheless, there is no local data about utilization of industrialized or domestic formulae by the Hospital Nutrition Services. In order to evaluate the utilization of both industrialized and the domestic formulae, as well as the health professional involved with diet prescription, all hospitals located in the city of Campinas, São Paulo, Brazil were interviewed. Results show that enteral nutrition is a routine for most institutions, and there is no significant deference between the use of industrialized or domestic formulae. In Campinas, the physician is responsible for the diet prescription, despite of the presence of a dietitian in the staff

Clinical disorders arising form dietary affluence in countries of the Eastern Mediterranean Region: situation analysis and guidelines for control

This document was one of the earliest publications from the Regional Office which pointed out the increase in non-communicable diseases of chronic metabolic type arising from dietary excess or imbalance, as witnessed in several countries of the Region. The recommendations remain valid to this day and subsequent technical discussions on this subject have to a large extent, pursued similar line of approach