Nutrient comparisons of margarine/margarine-like products, butter blend products and butter in the US marketplace in 2020 post-FDA ban on partially hydrogenated oils.

OBJECTIVE: To evaluate the fatty acid profiles and relevant vitamin and mineral compositions of margarine/margarine-like products and butter blend products available in the US marketplace and to compare with butter. DESIGN: Analysis of the food and nutrient composition information available for margarine/margarine-like products, butter blend products and butter in the 2021 version of the University of Minnesota Nutrition Coordinating Center (NCC) Food and Nutrient Database. SETTING: The US retail food marketplace in 2020. PARTICIPANTS: A selection of eighty-three margarine/margarine-like or butter blend products available in the USA in 2020 and regular and whipped butter (both salted and unsalted). RESULTS: All products contained no or negligible amounts of trans fat. Mean daily values (DV) for SFA per 1 tablespoon ranged from 11 % for margarine/margarine-like tub and squeeze products to 18 % for margarine/margarine-like stick products and butter blend products. In contrast, one tablespoon butter provides 36 % of the DV for SFA. Results from ANOVA comparing the percent of total fat from SFA, PUFA and MUFA by product type indicated significant differences for SFA (P < 0·01) and PUFA (P < 0·01), but not MUFA (P = 0·07). CONCLUSIONS: Leading brands of margarine/margarine-like and butter blend products examined in this study were found to be in greater alignment with current dietary recommendations for fatty acids and cholesterol than butter. Margarine/margarine-like tub and squeeze products were found to be optimal over margarine/margarine-like stick products and butter blend products. Future research should include an examination of private label products.

Nutrient Composition of a Selection of Plant-Based Ground Beef Alternative Products Available in the United States.

BACKGROUND: Sales of plant-based foods intended as direct replacements for animal products have been growing in the United States. Little is known about the nutritional quality of these products. OBJECTIVE: Our aim was to evaluate the nutritional quality of a selection of plant-based ground beef alternative products available in the US marketplace and compare it with the nutrient content of ground beef. DESIGN: We conducted an analysis of the food and nutrient composition information available for plant-based ground beef alternative products in the 2020 version of the University of Minnesota Nutrition Coordinating Center Food and Nutrient Database. PARTICIPANT/SETTING: We analyzed a selection of 37 plant-based ground beef alternative products available in the United States in 2019. MAIN OUTCOMES MEASURES: Food product content of energy, macronutrients, fatty acids, vitamins, minerals and selected additional food components was measured. STATISTICAL ANALYSIS: The percent Daily Value (DV) per 3-ounce cooked portion of each product was determined for nutrients with a DV. The median, interquartile range (IQR), minimum, and maximum nutrient values were calculated for all products by classification as vegan and nonvegan. RESULTS: The median saturated fat content of the plant-based ground beef alternatives products as a %DV was 4% (IQR 2%). Vitamin and minerals for which median %DV values for plant-based ground beef alternative products were 10% or higher included folate (10%, IQR 10%), niacin (21%, IQR 7%), iron (10%, IQR 5%), phosphorous (10%, IQR 4%), sodium (18%, IQR 7%), manganese (20%, IQR 20%), and copper (24%, IQR 10%). The median dietary fiber content of the plant-based ground beef alternative products was 15% of the DV (IQR 6%). Most of the products contained less protein, zinc, and vitamin B12 than ground beef. CONCLUSIONS: The major brands of plant-based ground beef alternative products examined in this study have nutritional strengths as well as some shortcomings. Additional research to examine a broader set of plant-based meat alternative products, such as those designed as substitutes for chicken and pork, is warranted.

The Effect of Education on Chlorhexidine Use in the NICU.

BACKGROUND: Neonates are at greater risk for central line-associated bloodstream infection (CLABSI) because of prolonged vascular access for nutrition and medications. Skin antisepsis using chlorhexidine gluconate (CHG), particularly the formulation with alcohol (CHG/alcohol), during central line insertion and maintenance activities is a key clinical care process associated with CLABSI reduction. One area of ongoing confusion for many clinicians is whether to adhere to the manufacturer's recommendations that CHG remain on the skin following the procedure to promote persistent microbicidal effects or to foster product removal in hopes of preventing skin-related complications. PURPOSE: Determine the effect of a targeted education program on the knowledge and attitudes of nurses who place peripherally inserted central catheters in the NICU regarding the use and removal of CHG antiseptic. METHODS: A quasi-experimental presurvey/postsurvey quality improvement project (QI project) recruited participants from the electronic mailing list of a national neonatal nursing organization. RESULTS: There was a statistically significant deficiency in knowledge or misinformation related to the use of CHG/alcohol on the presurvey assessment. Eight questions reflecting knowledge consistent with most recent evidence were answered correctly only 11.4-25.7 percent of the time, all of which were considered statistically significant. Following completion of the education program, a nearly 100 percent correct response rate on all but three postsurvey questions resulted. CONCLUSIONS: This quality improvement project demonstrated success in the ability to change knowledge surrounding the removal of CHG/alcohol from the skin of babies in the NICU following completion of a targeted education program and the effectiveness of targeted web-based educational programs.

A national survey of neonatal peripherally inserted central catheter (PICC) practices.

PURPOSE: The purpose of this study was to assess and describe the practices involved in the insertion and maintenance of peripherally inserted central catheters (PICCs) in neonates in level III neonatal intensive care units (NICUs) in the United States and to compare the findings with current recommendations and evidence. SUBJECTS: The study included responses from 187 nurses, nurse practitioners, and neonatologists who place PICCs in NICUs representing 43 states. METHODS: A 90-question, multiple-choice survey of a variety of PICC practices was sent to NICU directors and nursing staff responsible for PICC insertion. The explorative survey was sent by electronic and standard mail services. A descriptive analysis of the responses was performed. MAIN OUTCOME MEASURES: Main outcome measures included the response rate to the survey and the summarized responses of multiple categories of PICC practices. PRINCIPAL RESULTS: Of the 460 level III NICUs contacted, 187 returned surveys meeting criteria for analysis, yielding a 42% response rate. Responses showed wide variation of PICC practices in multiple aspects of PICC insertion and maintenance. The greatest level of conformity was seen with the following practices: use of 2 nurses to perform a dressing change, trimming the PICC, using a kit or cart containing insertion supplies, use of maximal sterile barrier precautions during insertion, catheter tip residing in the superior vena cava for upper body insertions, and not heparin locking, infusing blood products, performing catheter repair, or inserting using Modified Seldinger Technique. Some identified practices, such as infusion tubing change and catheter entry techniques, were contrary to current evidence and demonstrated a lack of correct information, and some represented safety concerns for the neonates having PICCs. CONCLUSION: This extensive national survey of NICU PICC practices showed wide variation in multiple aspects of PICC insertion and maintenance. A gap between the evidence and current practice was evident in many facets of training, insertion techniques, and maintenance processes. The data suggest a need for an increase in awareness of clinicians of current practice guidelines and standards and the need for further research to develop an evidence basis for many aspects of PICC care where lacking.

Nosocomial infection reduction in VLBW infants with a statewide quality-improvement model.

OBJECTIVE: To evaluate the effectiveness of the California Perinatal Quality Care Collaborative quality-improvement model using a toolkit supplemented by workshops and Web casts in decreasing nosocomial infections in very low birth weight infants. DESIGN: This was a retrospective cohort study of continuous California Perinatal Quality Care Collaborative members' data during the years 2002-2006. The primary dependent variable was nosocomial infection, defined as a late bacterial or coagulase-negative staphylococcal infection diagnosed after the age of 3 days by positive blood/cerebro-spinal fluid culture(s) and clinical criteria. The primary independent variable of interest was voluntary attendance at the toolkit's introductory event, a direct indicator that at least 1 member of an NICU team had been personally exposed to the toolkit's features rather than being only notified of its availability. The intervention's effects were assessed using a multivariable logistic regression model that risk adjusted for selected demographic and clinical factors. RESULTS: During the study period, 7733 eligible very low birth weight infants were born in 27 quality-improvement participant hospitals and 4512 very low birth weight infants were born in 27 non-quality-improvement participant hospitals. For the entire cohort, the rate of nosocomial infection decreased from 16.9% in 2002 to 14.5% in 2006. For infants admitted to NICUs participating in at least 1 quality-improvement event, there was an associated decreased risk of nosocomial infection (odds ratio: 0.81 [95% confidence interval: 0.68-0.96]) compared with those admitted to nonparticipating hospitals. CONCLUSIONS: The structured intervention approach to quality improvement in the NICU setting, using a toolkit along with attendance at a workshop and/or Web cast, is an effective means by which to improve care outcomes.

Development and evaluation of a method for calculating the Healthy Eating Index-2005 using the Nutrition Data System for Research.

OBJECTIVE: To develop and evaluate a method for calculating the Healthy Eating Index-2005 (HEI-2005) with the widely used Nutrition Data System for Research (NDSR) based on the method developed for use with the US Department of Agriculture's (USDA) Food and Nutrient Dietary Data System (FNDDS) and MyPyramid Equivalents Database (MPED). DESIGN: Cross-sectional. SETTING: Non-institutionalized, community-dwelling adults aged 70 years and above. SUBJECTS: Two hundred and seventy-one adults participating in the Geisinger Rural Aging Study (GRAS) and 620 age- and race-matched adults from the National Health and Nutrition Examination Survey 2001-2002 (NHANES) were included in the analysis. The HEI-2005 scores were generated using NDSR in GRAS and compared to scores generated using FNDDS and MPED in NHANES. RESULTS: Similar total HEI-2005 scores (mean 62·0 (se 0·75) in GRAS v. 57·4 (se 0·55) in NHANES) were estimated, and the individual components most strongly correlated with total score in both samples were compared. Cronbach's coefficient α values of HEI-2005 were 0·52 in GRAS and 0·43 in NHANES. CONCLUSIONS: Since NDSR is commonly used for educational purposes, in clinical settings and in nutrition research, it is important to develop methodology for assessing diet quality through the use of HEI-2005 with this dietary analysis software application and its accompanying food and nutrient database. Results from the present study show that HEI-2005 scores can be generated with NDSR using the method described in the present study and the detailed USDA Center for Nutrition Policy and Promotion technical report as guidance.

Evaluation of the comprehensiveness and reliability of the chromium composition of foods in the literature ().

In the early 1960s, trivalent chromium Cr(3+) became recognized as an essential trace element due to its potential metabolic and cardiovascular benefits. No comprehensive chromium database currently exists; thus a thorough review of the literature was conducted to examine the availability and reliability of chromium data for foods. A number of key issues were identified that challenge the feasibility of adding chromium to a food and nutrient database. Foremost, dietary chromium data reported in the literature prior to 1980 cannot be relied on because of problematic analytical issues before that time. Next, paucity of data emerged as an issue that could impede database completeness. Finally, large variation in reported chromium content of foods may render disputable representative chromium values. This variation has been speculated to originate from differences in growing and particularly processing foods. Furthermore, contamination of chromium from laboratory equipment and/or materials is possible and also believed to contribute to the variation observed in reported values. As a result, database developers must carefully consider the availability and reliability of information on the chromium composition of foods when deciding whether to incorporate chromium into or exclude it from a nutrient database.

Infiltration and extravasation: update on prevention and management.

Infiltration and extravasation are risks of intravenous administration therapy involving unintended leakage of solution into the surrounding tissue. Consequences range from local irritation to amputation. While immediate action using appropriate measures (ie, dilution, extraction, antidotes, and supportive treatments) can decrease the need for surgical intervention, many injuries may be prevented by following established policy and procedures. However, timely surgical intervention, when necessary, can prevent more serious adverse outcomes. Clinicians should be prepared to act promptly when an event occurs. Thorough incident documentation helps determine whether infusion care meets the standard of practice and is a keystone to medicolegal defense.

External jugular cannulation in infants and children.

Placement of a peripherally inserted central catheter (PICC) is commonplace in infants and children for the infusion of medications, hydration, and nutritional solutions. Vein depletion caused by repeated and prolonged need for vascular access devices has forced practitioners to consider alternate veins for providing care. The external jugular vein has a positive history of use for insertion of the PICC and is becoming increasing popular for this purpose. Pertinent anatomy, patient selection criteria, preparation, and catheter insertion and maintenance processes related to the catheter placed and residing in the external jugular vein are discussed.

Technological advances for PICC placement and management.

Placement of a peripherally inserted central catheter (PICC) is often complicated by the infant's small size and previous use of the peripheral veins, making the traditional means of insertion inadequate. New techniques and technologies, previously reserved for pediatric and adult patients, are now available for use in neonates and can enhance the practice of neonatal PICC teams. The modified Seldinger technique allows insertion of the PICC via smaller peripheral veins while decreasing venous trauma and enhancing the rate of successful placement. A second useful technique, the catheter exchange procedure, allows insertion of a new catheter within the same vein when complications such as occlusion, breakage, or inappropriate position occur and require removal of the currently dwelling PICC. Clinicians caring for neonates and infants must continually update their knowledge and skill by incorporating new techniques into their practice.

Validity and reliability of a behavior-based food coding system for measuring fruit, 100% fruit juice, vegetable, and sweetened beverage consumption: results from the Girls Health Enrichment Multisite Studies.

BACKGROUND: This paper presents the rationale, reliability, and validity of a behavior-based food coding system for measuring fruit (F), juice (J), vegetable (V), sweetened beverage, and water consumption in children. METHODS: Coding algorithms for FJV, sweetened beverages, and water were developed for use with the Nutrition Data System for Research (NDS-R). Two hundred and ten 8- to 10-year-old African American girls at four field centers completed two 24-h dietary recalls at baseline and at 12 weeks follow-up after a weight gain prevention intervention. Differences in mean baseline consumption of selected food variables and other selected nutrients across the four field centers were analyzed. Intraclass correlation coefficients (ICCs) for reliability across 2 days of food recalls and 12-week test-retest reliability correlations were calculated. For the purposes of this paper, nutrient intake estimates were considered construct validators of food intake, and validity was assessed by correlating the coded food variable servings with nutrient intake. RESULTS: ICCs varied from zero (0.001 for beta carotene equivalents) to moderate (0.44 for sucrose), indicating substantial instability in consumption or reporting. Twelve-week test-retest correlations were slight to moderate (0.09 for lycopene to 0.49 for folate). FJV consumption was negatively related to percent energy from fat (r = -0.28; P = 0.001) and positively related to other nutrients. Sweetened beverage consumption was positively related to energy, sucrose, fructose, and vitamin C consumption. CONCLUSIONS: This behavior-based food coding system demonstrated construct validity among 8- to 10-year-old African American girls and can measure the desired food groups.

Assessment of the infant with a peripheral intravenous device.

Inserting, monitoring, and maintaining peripheral venous access is an integral component of neonatal nursing care. Although complications associated with peripheral vascular devices are typically minor, some infants may experience life-threatening sequelae or serious and prolonged alterations in function. This article provides a review of the relevant anatomy and physiology of the peripheral venous system, techniques for maintaining catheter security, and guidelines for conducting a systematic physical assessment. The most commonly occurring complications, such as infiltration, phlebitis, and occlusion, are described. The etiology of the complications, signs and symptoms, and key evidence-based prevention strategies are outlined.

Assessment of infants with peripherally inserted central catheters: Part 2. Detecting less frequently occurring complications.

Peripherally inserted central catheters (PICCs) are frequently placed in neonates to optimize nutrition and provide stable infusions of critical medications into the central vascular system. PICCs have been associated with a number of device-specific complications that can manifest during insertion, while the line is indwelling, and/or after the removal of the line. The first article of this series in Focus on the Physical, titled "Assessment of Infants With Peripherally Inserted Central Catheters: Part I. Detecting the Most Frequently Occurring Complications," presented assessment strategies to detect common complications such as catheter occlusions and catheter-related bloodstream infections. Part 2 of this series emphasizes the importance of ongoing systematic assessment of PICCs for device-specific complications such as catheter migration, dislodgement, breakage, phlebitis, and thrombosis, as well as the life-threatening complications of pleural and pericardial effusion and tamponade. Each complication is described, along with a review of the etiology, a description of presenting signs and symptoms, and key clinical interventions.

Assessment of infants with peripherally inserted central catheters: Part 1. Detecting the most frequently occurring complications.

Inserting, maintaining, and monitoring vascular access are integral components of neonatal care. Advances in vascular access technology have led to the insertion of peripherally inserted central catheters (PICC) to provide stable venous access for early and aggressive parenteral nutrition. Medications that are irritating or damaging, or those with a high osmolality or a nonphysiologic pH, can also be safely administered into the central venous system. The need for repeated peripheral intravenous attempts, as well as the associated pain and physiologic instability, are virtually eliminated once a PICC line is placed. Complications related to PICCs may occur at any phase of therapy: during insertion, while indwelling, or after discontinuing the line. The risk factors associated with PICCs are distinctly different from peripheral intravenous lines because of their long dwell time, central placement, and potential to migrate. Part 1 of Focus on the Physical offers a review of the relevant anatomy of the vascular system and a discussion of the appropriate sites for catheter tip placement. Guidelines for a systematic physical assessment, along with recommendations for standardized PICC documentation, are provided. A review of the signs and symptoms of more frequently occurring complications, such as catheter occlusion and bloodstream infections, is presented to enhance awareness of PICC-specific complications in the neonate and to expedite early detection and treatment. Part 2 of this series will focus on systematic assessment for less common complications such as catheter migration, dislodgement, breakage, and thrombosis, as well as the life-threatening complications of pleural and pericardial effusion.