J. Pope

Recommendations of Dietitians for Overcoming Barriers to Dietary Adherence in Individuals With Diabetes

PURPOSE The purposes of this research were to (1) identify factors that contribute to the barriers to dietary adherence in individuals with diabetes identified in a 1998 study and (2) obtain recommendations from registered dietitians for strategies to overcome these barriers. METHODS A 10-item, open-ended telephone questionnaire was used to obtain information. The sample included 75 registered dietitians who participated in a previous survey to identify barriers and agreed to a follow-up telephone interview. RESULTS Of the 75 participants, 28% reported spending 5 hours or less per week counseling individuals with diabetes, 64% spent between 6 and 30 hours, and 8% spent more than 31 hours per week. Almost half of the participants (47%) were certified diabetes educators. Factors identified as the greatest contributors to the barriers being evaluated included lack of time, lack of symptoms, lack of education (including follow-up), poor self-esteem/lack of empowerment, and misinformation from family/peers/others with diabetes. The primary recommendations for overcoming each of these barriers included individualizing meal plans and planning ahead, teaching about complications, and setting obtainable goals. CONCLUSIONS The registered dietitians who were surveyed emphasized the importance of individualizing dietary counseling.

Factors that Influence Breastfeeding Decisions among Special Supplemental Nutrition Program for Women, Infants, and Children Participants from Central Louisiana

Although human milk provides optimal nutrition for infants, fewer than one third of US infants are breastfed exclusively for 6 months or more. The objectives of this study were to determine the factors that have the greatest impact on the decisions to breastfeed, and to determine the effect of formula provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the initiation and duration of breastfeeding among WIC participants in a rural parish in central Louisiana. A cross-sectional study was done between September 2007 and March 2008 among 130 WIC participants. Approximately half (51%) of the participants reported breastfeeding their youngest child for a mean of 15.7+/-14.9 weeks, with more white mothers breastfeeding than did African-American mothers or other races (P<0.01). Significantly more people reported that incentives provided to encourage breastfeeding did not affect their decision to breastfeed than those who said incentives affected their decision to breastfeed (P<0.029). Finally, study participants who were breastfed as a child were significantly more likely to breastfeed their children than those who were not breastfed as a child (P<0.022). The majority (96%) of the participants in this study indicated that WIC is providing effective and clear education about the benefits of breastfeeding, and that this advice influenced their decision to breastfeed their children. These findings underscore the importance of emphasizing the health benefits of breastfeeding to increase initiation and duration rates among WIC participants.

Primary Follow-up Care in a Multidisciplinary Setting Enhances Catch-up Growth of Very-low-birth-weight Infants

OBJECTIVE To determine the impact of multidisciplinary primary care follow-up, which included the services of a registered dietitian, on growth outcomes of very-low-birth-weight (VLBW) infants. DESIGN Data were obtained retrospectively from medical records. Forty-two infants receiving follow-up care on an as needed basis from the general pediatric clinic were compared with 33 infants receiving multidisciplinary follow-up care that included routine nutrition intervention from the comprehensive care clinic. Comparisons were made in weight, length, and head circumference measurements; growth rates; and catch-up growth (defined as > or = 5th percentile on growth charts of the National Center for Health Statistics attained by 12 months growth-corrected age). SUBJECTS VLBW infants (< or = 1,500 g at birth) were selected from both follow-up groups. STATISTICAL ANALYSIS Chi 2 Analysis compared the proportions of infants in each group who achieved catch-up growth. Unpaired t tests compared group means in weight, length, and head circumference measurements and growth rates. RESULTS The two groups differed significantly in the number of infants exhibiting catch-up growth for length and head circumference. At 8 months growth-corrected age, 7 (28%) of the general pediatric clinic infants were at the 5th percentile or greater for length compared with 21 (64%) of the comprehensive care clinic infants (P < .01); 15 (60%) of the general pediatric clinic group and 30 (91%) of the comprehensive care clinic group were at the 5th percentile or greater for head circumference (P < .05). At 12 months growth-corrected age, 12 (57%) of the general pediatric clinic infants and 26 (87%) of the comprehensive care clinic infants were at the 5th percentile or greater for length (P < .05); 11 (52%) of the general pediatric clinic infants and 27 (90%) of the comprehensive care clinic infants were at the 5th percentile or greater for head circumference (P < .05). APPLICATIONS Multidisciplinary primary care follow-up that includes the services of a registered dietitian for nutrition intervention can enhance the catch-up growth of VLBW infants through 12 months growth-corrected age.

Attitudes and acceptability of soy‐based yogurt by college students

Purpose – This study aims to address consumer attitudes toward and acceptance of commercial soymilk and dairy yogurts containing varying levels of fat.Design/methodology approach – A convenience sample was used, consisting of 185 students from a university in northern Louisiana. Four yogurts (soymilk yogurt, full fat dairy yogurt, low fat dairy yogurt, and non‐fat dairy yogurt) were evaluated. A 9‐point hedonic scale was used to evaluate each yogurt for overall acceptance. Questionnaires were used to ascertain consumer knowledge of the benefits of soy, attitudes toward soymilk yogurt and demographic characteristics of subjects.Findings – Acceptance scores for soymilk yogurt were significantly lower than scores for traditional dairy yogurts ( p<0.0001). Consumer attitudes regarding the health benefits of soy correlated with overall acceptance of soymilk yogurt (r=0.29; p<0.0001). Results indicate that college students are unaware of the health benefits of soy, and presently prefer traditional dairy yogurt ...

Are patients with diabetes receiving the same message from dietitians and nurses

PURPOSE The purpose of this study was to determine if registered dietitian (RD) and registered nurse (RN) certified diabetes educators (CDEs) provide similar recommendations regarding carbohydrates and dietary supplements to individuals with diabetes. METHODS A survey was mailed to CDEs in the southern United States. Participants were asked to indicate their recommendations for use of carbohydrates, fiber, artificial sweeteners, and 12 selected dietary and herbal supplements when counseling individuals with diabetes. RESULTS The survey sample consisted of 366 CDEs: 207 were RNs and 159 were RDs. No statistically significant differences were found between RNs and RDs in typical carbohydrate recommendations for treatment of diabetes. However, RDs were more likely than RNs to make recommendations for fiber intake or use of the glycemic index. A significant difference also was found in the treatment of hypoglycemia: RNs were more likely than RDs to recommend consuming a carbohydrate source with protein to treat hypoglycemia. CONCLUSIONS Although some differences existed, RD and RN CDEs are making similar overall recommendations in the treatment of individuals with diabetes.

Nutrition support at the end of life: Opinions of Louisiana dietitians

The purpose of this study was to determine the opinions of registered dietitians in Louisiana concerning nutrition support at the end of life. A questionnaire was mailed to the 777 active members of the Louisiana Dietetic Association. Questions addressed 3 issues: removal of nutrition support, the role of patients and family in decision making, and the role of the dietitian in decisions to use nutrition support for the terminally ill. A mean composite score was determined for each category. Kruskal-Wallis 1-way ANOVA was conducted on the composite scores to determine differences in responses by age, years of practice, and area of current practice. At least 60% of the respondents agreed with foregoing, withholding, or withdrawing nutrition support at the end of life. Most of the dietitians agreed that the patient or family is more qualified than the health care professional to make decisions about nutrition support at the end of life. More than 95% of the dietitians agreed that the dietitian should be involved in the decision-making process. However, only 50% of the dietitians felt fully qualified to provide the information needed to help a patient or family make the decision about nutrition support at the end of life. Differences of opinions about the removal of nutrition support were found by age, number of years of practice, and current area of practice. Results from this study may encourage dietitians to explore their own attitudes and seek continuing education on ethical dilemmas to enable them to make better decisions, provide better care, and become better patient advocates.

Nutrition-Related Quality of Life After Laparoscopic Gastric Bypass

Postoperation gastric bypass patients completed a 47-item nutrition-related quality of life (NQOL) survey. No correlation was found between percentage weight loss and scores for NQOL. However, significant differences in NQOL were found when participants were divided into 4 groups on the basis of time since surgery. Significantly lower NQOL scores were found in the group 19–36 months since surgery versus those who had more recently had surgery. To promote increased quality of life after laparoscopic gastric bypass, nutrition counseling should address the need for permanent changes in dietary intake and participation in a lifelong exercise program for long-term success with maintenance of weight loss. Patients should also be encouraged to seek the help of an eating disorder specialist if an eating disorder is present.