Cuirong Ren

The Medicine Wheel Nutrition Intervention: A Diabetes Education Study with the Cheyenne River Sioux Tribe

OBJECTIVE The Northern Plains Indians of the Cheyenne River Sioux Tribe have experienced significant lifestyle and dietary changes over the past seven generations that have resulted in increased rates of diabetes and obesity. The objective of this study was to determine if Northern Plains Indians with type 2 diabetes mellitus who are randomized to receive culturally adapted educational lessons based on the Medicine Wheel Model for Nutrition in addition to their usual dietary education will have better control of their type 2 diabetes than a nonintervention, usual care group who received only the usual dietary education from their personal providers. DESIGN A 6-month, randomized, controlled trial was conducted January 2005 through December 2005, with participants randomized to the education intervention or usual care control group. The education group received six nutrition lessons based on the Medicine Wheel Model for Nutrition. The usual care group received the usual dietary education from their personal providers. PARTICIPANTS One hundred fourteen Northern Plains Indians from Cheyenne River Sioux Tribe aged 18 to 65 years, with type 2 diabetes. METHODS Weight, body mass index (BMI), hemoglobin A1c, fasting serum glucose and lipid parameters, circulating insulin, and blood pressure were measured at the beginning and completion. Diet histories, physical activity, and dietary satiety surveys were measured at baseline and monthly through completion. Differences were determined using Student t tests, chi(2) tests, and analysis of variance. RESULTS The education group had a significant weight loss (1.4+/-0.4 kg, P<or=0.05) and decrease in BMI (1.0+/-0.1, P<or=0.05) from baseline to completion. The usual care group had no change in weight (0.5+/-0.5 kg) or BMI (0.5+/-0.2). There were no between group differences due to intervention in energy, carbohydrate, protein, and fat intake and physical activity. CONCLUSIONS The culturally based nutrition intervention promoted small but positive changes in weight. Greater frequency and longer duration of educational support may be needed to influence blood glucose and lipid parameters.

Implementation of a Multidisciplinary Team That Includes a Registered Dietitian in a Neonatal Intensive Care Unit Improved Nutrition Outcomes

This study determined whether nutrition outcomes of neonates who were receiving neonatal intensive care were improved with the implementation of a fully functioning multidisciplinary team that included a registered dietitian. A medical record review was conducted of neonates with birth weights of 1500 g or less who were cared for in Sanford Childrens Hospital neonatal intensive care unit from January 1 to December 31, 2001 (prior to functioning multidisciplinary team establishment) and January 1 to December 31, 2004 (subsequent to establishment of a multidisciplinary team). Data from charts in the 2 time periods were examined for differences in nutrition outcomes. Outcome variables included length of stay, birth weight, discharge weight, weight gained for specified time periods, weight at full feeds, weight gain per day, length, head circumference, and number of days to start enteral feeding. Analysis of covariance, controlling for the effect of birth weight, was used to determine differences and was considered significant at P < .05. The mean length of stay (65 days, 95% confidence interval [CI]: 48-68 vs 72 days, 95% CI: 53-73) was not different for the 2 periods. The mean weight at the beginning of enteral feeding was significantly less in the period prior to the establishment of the multidisciplinary team (1099 g, 95% CI: 955-1165 vs 1164 g, 95% CI: 1067-1211, respectively). Weight at discharge, total weight gained, total daily weight gained, daily weight gain from birth to the initiation of enteral feeds, daily weight gain from birth to full feeds, and head circumference growth were significantly greater for neonates in the postgroup than in the pre-multidisciplinary team group. Implementation of a multidisciplinary team that included a registered dietitian improved the nutrition outcomes of low birth weight infants in a neonatal intensive care unit.

Traditional open-bay versus single-family room neonatal intensive care unit: a comparison of selected nutrition outcomes

In contrast to the traditional open-bay–type design of the neonatal intensive care unit (tNICU), infants in developmentally appropriate NICU (dNICU) are housed in individual rooms with greater control of light and noise. Previous reports have documented positive influence of the dNICU in cardiorespiratory status, physiologic stability, and weight gain of the infants. The objective of this study was to explore selected nutrition outcomes of infants in the dNICU versus tNICU.

Fun Fruit and Veggie Event enhances acceptance of fruits and vegetables in school-aged children.

This study assessed the effectiveness of a “Fun Fruit and Veggie Event” on the acceptance of fruits and vegetables, using mean differences between pre- and postsurveys, in school-aged children from 15 schools in South Dakota: kindergarten to 4th grade (K-4, n = 787) and 5th to 12th grades (5–12, n = 310). The event had a positive impact on fruit and vegetable acceptance, knowledge, action steps to incorporate fruits and vegetables into the diet, and consumption. The K-4 students increased acceptance for 3 of the 6 vegetables and showed no change in fruit acceptance. The 5–12 students increased acceptance for 17 of the 31 vegetables and 13 of the 22 fruits, had significant improvement in basic knowledge of fruits and vegetables (P < .001), willingness to incorporate more fruits and vegetables into the diet in 3 of 12 scenarios, and increased consumption of 100% fruit juice (P < .001) and fruits (P < .0001). Teacher surveys indicated that students had a greater awareness of fruits and vegetables. School-based interventions that include fruits and vegetables in a fun and exciting manner enhance knowledge and self-reported acceptance of fruits and vegetables in children.

Practitioner Perception of Nutrition Education in the Medical Curriculum for Diagnosis of Failure to Thrive in Infants and Children

A questionnaire to determine medical practitioner perception of nutrition education for diagnosis of failure to thrive (FTT) was sent to 2 medical practitioner listservs. Participants were members of the professional listserv and practicing medical practitioners. A total of 312 practitioners from 41 states responded to the online survey. Twelve percent were extremely satisfied with their training for diagnosing FTT with an increased comfort level based on years of practice. Practitioners consider experience to be the leading type of training for making diagnoses. Sixty-seven percent of participants reported registered dietitian consultation with FTT diagnoses.