School Nutrition Professionals' Employee Safety Experiences During the Onset of the COVID-19 Pandemic.

OBJECTIVE: To explore the real-time personal/employee safety experiences and perspectives of school nutrition professionals ranging from frontline staff to state leadership across the US as they responded to the initial weeks of the coronavirus pandemic. METHODS: A cross-sectional survey was administered electronically March 31-April 20, 2020, to school nutrition staff, managers, directors, and state agency personnel. Descriptive statistics were calculated, and a thematic analysis of an open-ended item was conducted. RESULTS: School nutrition professionals (n = 504) from 47 states responded. Most (86.6%) reported that ensuring employee safety was somewhat or much more difficult during the pandemic, and they were unaware of an emergency plan. Themes from open-ended responses regarding employee safety concerns included, exposure and transmission risk, processes, and personal concerns. CONCLUSIONS AND IMPLICATIONS: Attention to the safety and concerns of school nutrition employees is vital for continuation of these programs during this pandemic and for future emergency situations.

"I was able to eat what I am supposed to eat"-- patient reflections on a medically-tailored meal intervention: a qualitative analysis.

BACKGROUND: Medically-tailored meal programs that provide home-delivered medically-appropriate food are an emerging intervention when type 2 diabetes co-occurs with food insecurity (limited or uncertain access to nutritious food owing to cost). We sought to understand the experiences of medically-tailored meal program participants. METHODS: We conducted semi-structured interviews with participants in a randomized trial of medically-tailored meals (NCT02426138) until reaching content saturation. Participants were adults (age > 20 years) with type 2 diabetes in eastern Massachusetts, and the interviews were conducted from April to July 2017. Interviews were transcribed verbatim and coded by two independent reviewers. We determined emergent themes using content analysis. RESULTS: Twenty individuals were interviewed. Their mean age was 58 (SD: 13) years, 60.0% were women, 20.0% were non-Hispanic black, and 15.0% were Hispanic. Key themes were 1) satisfaction and experience with medically-tailored meals 2) food preferences and cultural appropriateness, 3) diabetes management and awareness, and 4) suggestions for improvement and co-interventions. Within these themes, participants were generally satisfied with medically-tailored meals and emphasized the importance of receiving culturally appropriate food. Participants reported several positive effects of medically-tailored meals, including improved quality of life and ability to manage diabetes, and stress reduction. Participants suggested combining medically-tailored meals with diabetes self-management education or lifestyle interventions. CONCLUSIONS: Individuals with diabetes and food insecurity expressed satisfaction with the medically-tailored meal program, and reported that participation reduced stress and the burden of diabetes management. Suggestions to help ensure the success of medically-tailored meal programs included a strong emphasis on culturally acceptability and accommodating taste preferences for provided foods, and combining medically-tailored meals with diabetes education or lifestyle intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT02426138.

Effect of oral supplements on the nutritional status of nasopharyngeal carcinoma patients undergoing concurrent chemotherapy: A randomized controlled Phase II trial.

OBJECTIVES: The objectives of this study were to prospectively compare individualized dietary counseling with or without oral nutritional supplements (ONSs) in nasopharyngeal carcinoma (NPC) patients undergoing concurrent chemoradiotherapy (CCRT) in a Phase II, randomized trial. MATERIALS AND METHODS: Between June 2014 and August 2016, Stage II-IVb NPC patients were randomly enrolled. The primary endpoint was change in body weight between during CCRT, and the secondary endpoints were change in body mass index (BMI) and fat-free mass index (FFMI). RESULTS: Fifty-two patients were randomized; 19 patients in the control group and 23 in the ONS group were eligible for analysis. Weight, BMI, and body composition parameters significantly decreased from baseline to week 6. FFMI was significantly better in patients with ONS intake >2/3 planed than the control group (P = 0.028). Weight and BMI maintenance was slightly better in patients with total intake >2/3 planed (P = 0.170 and P= 0.229, respectively). The mean Patient-Generated Subjective Global Assessment score was also better in the ONS group at the end of CCRT (P = 0.053). CONCLUSIONS: ONSs with individualized dietary counseling may be beneficial in patients with enough intake, and further prospective studies with large groups of patients are warranted.

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults.

Given the increasing number and diversity of older adults and the transformation of health care services in the United States, it is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that all older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs. Programs must include food assistance and meal programs, nutritional screening and assessment, nutrition education, medical nutrition therapy, monitoring, evaluation, and documentation of evidence-based outcomes. Coordination with long-term care services and support systems is necessary to allow older adults to remain in their homes; improve or maintain their health and manage chronic disease; better navigate transitions of care; and reduce avoidable hospital, acute, or long-term care facility admissions. Funding of these programs requires evidence of their effectiveness, especially regarding health, functionality, and health care-related outcomes of interest to individuals, caregivers, payers, and policy makers. Targeting of food and nutrition programs involves addressing unmet needs for services, particularly among those at high risk for poor nutrition. Registered dietitian nutritionists and nutrition and dietetics technicians, registered must increase programmatic efforts to measure outcomes to evaluate community-based food and nutrition services.

Medically Tailored Meal Delivery for Diabetes Patients with Food Insecurity: a Randomized Cross-over Trial.

BACKGROUND: Food insecurity, defined as inconsistent food access owing to cost, leads to poor health. OBJECTIVE: To test whether a medically tailored meal delivery program improved dietary quality in individuals with type 2 diabetes and food insecurity. DESIGN: Randomized cross-over clinical trial. PARTICIPANTS: Forty-four adults with diabetes, hemoglobin A1c > 8.0%, and food insecurity (defined as at least one positive item on the two-item "Hunger Vital Sign"). INTERVENTION: In the Community Servings: Food as Medicine for Diabetes cross-over clinical trial (NCT02426138), conducted from June 2015 to July 2017, we randomly assigned the order of "on-meals" (home delivery of 10 meals/week for 12 weeks delivered by Community Servings, a non-profit organization) and "off-meals" (12 weeks usual care and a Choose MyPlate healthy eating brochure) periods. MAIN MEASURES: The primary outcome was Healthy Eating Index 2010 score (HEI), assessed by three 24-h food recalls in both periods. Higher HEI score (range 0-100; clinically significant difference 5) represents better dietary quality. Secondary outcomes included food insecurity and self-reported hypoglycemia. KEY RESULTS: Mean "on-meal" HEI score was 71.3 (SD 7.5) while mean "off-meal" HEI score was 39.9 (SD 7.8) (difference 31.4 points, p < 0.0001). Participants experienced improvements in almost all sub-categories of HEI score, with increased consumption of vegetables, fruits, and whole grains and decreased solid fats, alcohol, and added sugar consumption. Participants also reported lower food insecurity (42% "on-meal" vs. 62% "off-meal," p = 0.047), less hypoglycemia (47% "on-meal" vs. 64% "off-meal," p = 0.03), and fewer days where mental health interfered with quality of life (5.65 vs. 9.59 days out of 30, p = 0.03). CONCLUSIONS: For food-insecure individuals with diabetes, medically tailored meals improved dietary quality and food insecurity and reduced hypoglycemia. Longer-term studies should evaluate effects on diabetes control (e.g., hemoglobin A1c) and patient-reported outcomes (e.g., well-being).

Dietetics Practice in the Unique, Culturally Diverse Pacific Island Region.

The Pacific Island region is geographically the most isolated region in the world representing a diverse population of indigenous peoples, migrated groups and new-comers. Rates of chronic disease are predominately high in populations identified as Pacific Islander. The practice of dietetics, defined as nutrition education for the prevention of disease and medical nutrition therapy for the treatment of chronic diseases, proves challenging with the unique cultural diversity in the region. There is a need to describe dietetics practice, populations served, and needs for resources identified by nutrition-related topic and cultural relevance for Registered Dietitian Nutritionists in the Pacific Island region. An online survey was distributed to all members of the Hawai'i Affiliate of the Academy of Nutrition and Dietetics in 2013-2014. The online survey yielded 104 usable responses. Most participants were female and lived and worked in the Hawaiian Island region. One-third of practicing Registered Dietitian Nutritionists saw >100 patients or clients per month. Most prevalent populations served were identified as Asian and Pacific Islanders. Culturally relevant resources of the highest need were relevant to Asian and Pacific Islander cultures, specifically addressing weight control and diabetes. Dietetics practice in the Pacific Island region is unique given the prevalence of Asians and Pacific Islanders served by Registered Dietitian Nutritionists. Findings will inform the development of new, culturally appropriate online nutrition resources, to enhance dietetics practice in the region. Making these resources available online will be useful for Registered Dietitian Nutritionists and other health care practitioners working in the Pacific Island region.

Fuentes de información sobre el consumo alimentario en España y Europa / Sources of information on food consumption in Spain and Europe

La estimación del consumo de alimentos y la ingesta de nutrientes es un tema de creciente interés. Actualmente, tanto en Europa como en España, existen numerosas fuentes de información sobre el consumo de alimentos que nos ofrecen la información a distintos niveles nacional, familiar o individual, todas ellas son de gran utilidad, pero incluyen algunas limitaciones. Los datos obtenidos permiten, entre otras cosas, conocer los hábitos alimentarios, explorar la calidad de la alimentación, estudiar la ingesta de energía y nutrientes y/o evaluar la exposición a riesgos alimentarios. Entre las fuentes existentes en España se pueden resaltar dos encuestas de especial relevancia: la encuesta de presupuestos familiares del Instituto Nacional de Estadística (INE) y el panel de consumo de alimentos del Ministerio de Agricultura, Alimentación y Medio Ambiente (MAGRAMA). Ambas proporcionan desde hace bastantes años información relativa al consumo de alimentos en los hogares. Tanto a nivel europeo como español sería necesario, para mejorar la utilidad de los datos, estandarizar el tipo de encuestas utilizadas para poder realizar comparaciones (AU)

Estimation of food consumption and nutrient intake is a topic of growing interest. Currently, both in Europe and in Spain, there are numerous sources of information on food consumption, that we provide information on different levels: national, household and individual, all of them are useful, but including some limitations. The data obtained allow, among other things, meet dietary habits, explore the food quality, study the energy and nutrient intake and / or assessing exposure to food risks. Among the existing sources in Spain can highlight two surveys especially useful: the Household Budget Survey of the National Statistics Institute (INE) and Food Consumption Panel Ministry of Agriculture, Food and Environment (MAGRAMA). Both provide for many years food consumption in households. Both European and Spanish would be necessary to improve the usefulness of the data, standardize the type of survey used and could be comparable between them (AU)

Increasing supplemental nutrition assistance program/electronic benefits transfer sales at farmers' markets with vendor-operated wireless point-of-sale terminals.

BACKGROUND: Supplemental Nutrition Assistance Program (SNAP) (formerly Food Stamp Program) participants can use their benefits at many farmers' markets. However, most markets have only one market-operated wireless point-of-sale (POS) card swipe terminal for electronic benefits transfer (EBT) transactions. It is not known whether providing each farmer/vendor with individual wireless POS terminals and subsidizing EBT fees will increase SNAP/EBT purchases at farmers' markets. OBJECTIVE: To evaluate the effects of multiple vendor-operated wireless POS terminals (vs a single market-operated terminal) on use of SNAP benefits at an urban farmers' market. DESIGN: Time-series analyses of SNAP/EBT sales. SETTING: The Clark Park farmers' market in West Philadelphia, PA, which accounts for one quarter of all SNAP/EBT sales at farmers' markets in Pennsylvania. INTERVENTION: Vendors were provided with individual wireless POS terminals for 9 months (June 2008-February 2009.) The pilot program covered all equipment and wireless service costs and transaction fees associated with SNAP/EBT, credit, and debit sales. MAIN OUTCOME MEASURE: Monthly SNAP/EBT sales at the Clark Park farmers' market. STATISTICAL ANALYSES: SNAP/EBT sales data were collected for 48 months (January 2007-December 2010). Time-series regression analysis was used to estimate the effect of the intervention period (June 2008-February 2009) on SNAP/EBT sales, controlling for seasonal effects and total SNAP benefits issued in Philadelphia. RESULTS: The intervention was associated with a 38% increase in monthly SNAP/EBT sales. Effects were greatest during the busy fall market seasons. SNAP/EBT sales did not remain significantly higher after the intervention period. CONCLUSIONS: Providing individual wireless POS terminals to farmers' market vendors leads to increased sales. However, market vendors indicated that subsidies for equipment costs and fees would be needed to break even. Currently, SNAP provides some support for these services for supermarket and other SNAP retailers with landline access, but not for farmers' markets.

Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome.

BACKGROUND: Emerging evidence indicates that the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may result in symptoms in some patients with irritable bowel syndrome (IBS). The present study aimed to determine whether a low FODMAP diet is effective for symptom control in patients with IBS and to compare its effects with those of standard dietary advice based on the UK National Institute for Health and Clinical Excellence (NICE) guidelines. METHODS: Consecutive patients with IBS who attended a follow-up dietetic outpatient visit for dietary management of their symptoms were included. Questionnaires were completed for patients who received standard (n = 39) or low FODMAP dietary advice (n = 43). Data were recorded on symptom change and comparisons were made between groups. RESULTS: In total, more patients in the low FODMAP group reported satisfaction with their symptom response (76%) compared to the standard group (54%, P = 0.038). Composite symptom score data showed better overall symptom response in the low FODMAP group (86%) compared to the standard group (49%, P < 0.001). Significantly more patients in the low FODMAP group compared to the standard group reported improvements in bloating (low FODMAP 82% versus standard 49%, P = 0.002), abdominal pain (low FODMAP 85% versus standard 61%, P = 0.023) and flatulence (low FODMAP 87% versus standard 50%, P = 0.001). CONCLUSIONS: A low FODMAP diet appears to be more effective than standard dietary advice for symptom control in IBS.

Adherence of pregnant women to dietary counseling and adequacy of total gestational weight gain / Adhesión de gestantes a los consejos dietéticos y adecuación del aumento de peso en toda la gestación

Introduction: in scientific literature there are not published researches which have used a validated assessment method of adherence to dietary counseling capable of being reproduced.Objective: to evaluate the adherence of pregnant women to dietary counseling during the prenatal periodusing a validated instrument according to the out come of total gestational weight gain. Methods: two hundred and eight adult pregnant women participated in the research. The instrument for adherence classification to dietary counseling was elaborated according to four evaluation criteria: food quantity and quality,meal pattern and adjustment to weekly weight gain. We classified as poor adherence when zero-one criterion wasobserved, good adherence when 2-3 aspects were observed and excellent when the amount was 4 aspects. Results: Pregnant women with good or excellent adherence had a higher adjustment proportion of the total gestational weight gain in comparison to those who presented poor adherence in the second and fourth visits,respectively (p < 0.006; p < 0.007). Women with poor adherence to dietary counseling in the second visit presented about three times more chances of having pooradherence in the fourth visit (OR = 3.11; CI = 1.46-6.36).Conclusion: Adherence of pregnant women to dietary counseling had a positive association with the adjustment of total gestational weight gain (AU)

Introducción: en la literatura científica no se han publicado investigaciones que han utilizado un método validado de avaluación de la adhesión de gestantes a los consejosdietéticos.Objetivo: avaluar la adhesión de gestantes a los consejos dietéticos, durante periodo prenatal, mediante un instrumento válido según los resultados del aumento de peso en toda la gestación. Métodos: participaron de la encuesta 208 gestantes adultas en el período entre 2005 y 2006. El instrumento para la clasificación de la adhesión fue elaborado partiendo de 4 criterios de evaluación: cantidad, calidad alimentar,padrón de comidas, la adecuación de ganancia de peso semanal. Se clasificó como baja adhesión cuando se observó entre 0 y 1 criterios, como buena adhesión, entre2 y 3 criterios, y óptima con 4 criterios.Resultados: las gestantes con buena u óptima adhesión tuvieron una mayor proporción de adaptación del aumento de peso total durante la gestación, comparándose con las que presentaron baja adhesión (p < 0,006;p < 0,007). Las mujeres con baja adhesión en la segunda consulta presentaron 3 veces más probabilidad de tener baja adhesión en la cuarta consulta (OR = 3,11; IC = 1,46-6,36).Conclusiones: la adhesión de las gestantes tuvo asociación positiva con la adaptación precoz al aumento de peso total durante la gestación, demostrando la importancia del cuidado alimentar precoz, fundamento de la advertencia dietética (AU)

Encouraging appropriate, evidence-based use of oral nutritional supplements.

With the considerable cost of disease-related malnutrition to individuals and to society (estimated to be >£13×109 for the UK, 2007 prices), there is a need for effective and evidence-based ways of preventing and treating this condition. The wide range of oral nutritional supplements that may be prescribed for the dietary management of malnutrition and other conditions account for only about 1% (about £99×106, 2007 data) of the prescribing budget in England. Systematic reviews and meta-analyses consistently suggest that ready-made, multi-nutrient liquids which may be prescribed can improve energy and nutritional intake, body weight and have a variety of clinical and functional benefits in a number of patient groups. Meta-analyses have repeatedly shown that oral nutritional supplements produce significant reductions in complications (e.g. infections) and mortality, and a recent meta-analysis shows a reduction in hospital admissions (OR 0·56 (95% CI 0·41, 0·77), six randomised controlled trials). Such benefits suggest that the appropriate use of oral nutritional supplements should form an integral part of the management of malnutrition, particularly as there is currently a lack of evidence for alternative oral nutrition strategies (e.g. food fortification and counselling). As with all therapies, compliance to oral nutritional supplements needs to be maximised and the use monitored. To make sure that those at risk of malnutrition are identified and treated appropriately, there is a need to embed national and local policies into routine clinical practice. In doing so, the economic burden of this costly condition can be curtailed. As recently suggested by the National Institute for Health and Clinical Excellence, substantial cost savings could be made if screening and treatment of malnourished patients was undertaken.

Pressure ulcers and nutritional support: a partnership to improve patient outcomes.

Prevention of pressure ulcers in hospitalized patients represents a challenge with great financial impact for hospitals and serious consequences for patients. A partnership composed of dieticians and nurses was assembled to identify best practices for providing nutritional support and intervention to patients at risk for pressure ulcers. This article describes the process, outcomes, recommendations, and lessons learned by the pressure ulcer/nutrition work group.

Helping older adults meet nutritional challenges.

Prevention of premature chronic diseases is an important component of healthy aging. Nutrition education can help to reduce the risk of premature chronic diseases in some older adults. Home delivered meals and congregate dining services assist vulnerable elderly persons by providing opportunities for nutritional and social support. Screening and assessment tools identify factors affecting nutritional health and can also provide specific directions for planning, implementation, and evaluation of tailored interventions. Dietitians and allied health professionals are well positioned to assist a heterogeneous population of older adults in securing nutritional adequacy.

Targeting of home-delivered meals programs to older adults in the United States.

The Home-Delivered Meals Program (HDM) is an essential component of home-and community-based services available through the National Aging Service Network in the United States. It has the potential to help delay institutionalization and stem rising health care costs for older Americans; little is known, however, about the targeting practices used for HDM. A nationally representative telephone survey of state and local program providers showed that a variety of outreach measures were being employed, but challenges such as inadequate resources, waiting lists, rural delivery, and misconceptions about the program require resolution to ensure optimal service outcomes.

Designing and implementing ethnic congregate nutrition programs for older Americans.

Montgomery County in Maryland is one of the most ethnically diverse regions in the United States. Since the 1970s, traditional American and Kosher meals have been offered at congregate sites in this County, but few seniors of varied ethnicity participated. This article describes creative approaches used in the County Senior Nutrition Program within the Older Americans Act from 1990 to 2007 to develop nutrition sites targeted to seniors in Korean, Vietnamese, and Chinese communities. The services provided are culturally sensitive, and the meals meet both nutritional and food safety standards. With secure funding, programs can be made available to other ethnic groups.

Increasing fruit and vegetable intake among children: comparing long-term effects of a free distribution and a multicomponent program.

The aim of this study was to evaluate and compare the effectiveness of two primary school-based interventions on children's fruit and vegetable (F&V) consumption on the long term (2 years after the start of the interventions). Six primary schools were recruited and randomly assigned to (i) a daily free distribution program for the whole school or (ii) a multicomponent program consisting of a classroom curriculum and parental involvement (without free F&V), and six schools served as controls. Follow-up measurements were conducted at the end of the intervention (Follow-up I) and 1 year later (Follow-up II). Random coefficient analyses for longitudinal data showed that the effects of both interventions did not differ between the two follow-up measurements. The results showed similar effects for the free distribution program and the multicomponent program in increasing children's fruit consumption over time (respectively, 7.2 and 15.2 g day(-1)). The distribution program also increased children's vegetable consumption over time (3.25 g day(-1)), even after repeating the analyses using a pessimistic scenario. Despite the large dropout and its consequences for generalizability of our results, the distribution program is considered as the preferred intervention of the two, and implementation on a larger scale should be investigated.