Jodi Krall

Diet quality is related to eating competence in cross-sectional sample of low-income females surveyed in Pennsylvania.

Women participants of two federally administered nutrition education programs (n=149, 56% white, 64% food secure, 86% 18-50 years of age,) completed telephone interviews that included three 24-hour dietary recalls and the Satter Eating Competence Inventory. Eating competence is delineated by an Inventory score≥32. Competent eaters had significantly greater intakes of fiber, vitamin A, vitamin E, vitamin C, most B-vitamins, magnesium, iron, zinc, potassium and a higher Healthy Eating Index. Two dietary patterns defined as Prudent and Western were observed. The Prudent pattern was correlated with eating competence and characterized by more healthful foods such as fruits, vegetables and low-fat dairy products. The Western pattern, characterized by foods higher in fat, salt, and sugar, was not related to eating competence. Findings suggest that dietary guidance using an eating competence approach for low-income women is compatible with goals to improve dietary quality and eating patterns.

Validation of a measure of the Satter eating competence model with low-income females

BackgroundThe purpose of this study was to evaluate the construct validity of a version of the ecSatter Inventory (ecSI), a measure of eating competence (EC), as adapted for use in a low-income (LI) population.MethodsFemales (n = 507), aged 18 to 45 years, living in households with a history of participating in the Supplemental Nutrition Assistance Program completed a web-based survey that included the ecSI for LI (ecSI/LI) and valid measures of cognitive and affective eating behavior, food preference and practice, and food preparation.ResultsMost correlations and differences between eating competent and non-eating competent categories and among EC tertiles were compatible with hypothesized relationships. ecSI/LI scores were positively related with self-reported physical activity, food acceptance, fruit and vegetable intake, and food planning/resource management. ecSI/LI scores were negatively associated with body mass index, dissatisfaction with body weight, tendency to overeat in response to external or emotional stimuli, and indices of psychosocial attributes related to disordered eating.ConclusionsThe ecSI/LI is a valid measure of EC for low-income females and provides a tool for researchers and educators to assess intervention outcomes and further explore the EC construct.

Eating Competence of Elderly Spanish Adults Is Associated with a Healthy Diet and a Favorable Cardiovascular Disease Risk Profile

Eating competence (EC), a bio-psychosocial model for intrapersonal approaches to eating and food-related behaviors, is associated with less weight dissatisfaction, lower BMI, and increased HDL-cholesterol in small U.S. studies, but its relationship to nutrient quality and overall cardiovascular risk have not been examined. Prevención con Dieta Mediterránea (PREDIMED) is a 5-y controlled clinical trial evaluating Mediterranean diet efficacy on the primary prevention of cardiovascular diseases (CVD) in Spain. In a cross-sectional study, 638 PREDIMED participants (62% women, mean age 67 y) well phenotyped for cardiovascular risk factors were assessed for food intake and EC using validated questionnaires. Overall, 45.6% were eating-competent. EC was associated with being male and energy intake (P < 0.01). After gender and energy adjustment, participants with EC compared with those without showed higher fruit intake and greater adherence to the Mediterranean diet (P < 0.05) and tended to consume more fish (P = 0.076) and fewer dairy products (P = 0.054). EC participants tended to have a lower BMI (P = 0.057) and had a lower fasting blood glucose concentration and serum LDL-:HDL-cholesterol ratio (P < 0.05) and a higher HDL-cholesterol concentration (P = 0.025) after gender adjustment. EC participants had lower odds ratios (OR) of having a blood glucose concentration >5.6 mmol/L (0.71; 95% CI 0.51-0.98) and HDL-cholesterol <1.0 mmol/L (0.70; 95% CI 0.68-1.00). The OR of actively smoking, being obese, or having a serum LDL-cholesterol concentration > or =3.4 mmol/L were <1.0, but the 95% CI included the 1.0 (P > 0.1). Our findings support further examination of EC as a strategy for enhancing diet quality and CVD prevention.

Brain volume and white matter in youth with type 2 diabetes compared to obese and normal weight, non-diabetic peers: A pilot study☆

Type 2 Diabetes Mellitus (T2DM) and obesity are linked to specific patterns of subcortical brain atrophy and decreased microstructural integrity of white matter. Fifteen adolescents (12–21‐years‐old, 80% Caucasian, 15% African American, mean BMI = 32)–five with T2DM confirmed by oral glucose tolerance test, five matched obese adolescent controls without diabetes (OBCN), and five matched (race, sex) normal‐weight controls (NWCN)–underwent Magnetic Resonance Imaging (MRI) for the collection of gray matter volume and white matter integrity. Analyses of Variance (ANOVAs) of the neuroimaging data revealed significant differences in caudate nucleus volume [F(2,12) = 7.79, p < 0.05] such that the normal‐weight group had significantly greater volume than the obese and T2DM groups (NWCN>OBCN, p = 0.020; OBCN > T2DM, p = 0.042; and NWCN > T2DM; p = 0.003) after controlling for participant Body Mass Index (BMI). Similarly, there was a main effect for the volume of the thalamus [F(2,12) = 4.39, p < 0.05] with greater volume for both the NWC and the OBC groups in comparison to the T2DM group (NWC > T2DM, p = 0.020; OBC > T2DM; p = 0.040). Finally, an examination of white matter integrity among the three groups illustrated a pattern of white matter integrity reduction between normal‐weight participants and both obese controls and T2DM participants, with T2DM demonstrating the greatest deficit in functional anisotropy (FA) volume, but these results were not significant after further controlling for BMI. Results from the current pilot study illuminate a host of brain morphology differences between youth with T2DM, obese youth, and normal‐weight controls; future research with a larger sample size is critical.

A Shared Decision-Making Approach to Telemedicine: Engaging Rural Patients in Glycemic Management

Telemedicine can connect specialist health care providers with patients in remote and underserved areas. It is especially relevant in diabetes care, where a proliferation of treatment options has added further complexity to the care of an already complex, highly prevalent disease. Recent developments in health reform encourage delivery systems to use team-based models and engage patients in shared decision-making (SDM), where patients and providers together make health care decisions that are tailored to the specific characteristics and values of the patient. The goal of this project was to design, integrate, and evaluate a team-based, SDM approach delivered to patients with diabetes in a rural community, building upon the previously established telemedicine for reach, education, access, and treatment (TREAT) model. Patients in this feasibility study demonstrated improvement in hemoglobin A1c values, and reported better understanding of diabetes. Providers reported the SDM aids increased cohesion among team members (including patients) and facilitated patient education and behavioral goal setting. This project demonstrated that SDM could be integrated into the workflow of a telemedicine team visit with good provider and patient satisfaction.

The Nurse Education and Transition (NEAT) model: educating the hospitalized patient with diabetes

BackgroundThe number of patients with a diabetes mellitus (DM)-related diagnosis is increasing, yet the number of hospital-based diabetes educators is being reduced. Interest in determining effective ways for staff nurses to deliver diabetes education (DE) is mounting. The purpose of this multi-phase feasibility study was to develop and evaluate the Nurse Education and Transition (NEAT) inpatient DM education model.MethodsExploratory focus groups were conducted with staff nurses from inpatient units at academic tertiary and community hospitals to gain insight into barriers, content, delivery and support mechanisms related to providing DE to hospitalized patients. Findings informed the development of the NEAT model, which included a delivery protocol and toolkit with brief educational videos on key diabetes topics uploaded onto iPads, patient assessments and “teach back” tools, a discharge survival skills summary sheet, and guidelines for electronic medical record documentation and scheduling outpatient DE visits. Trained staff nurses used NEAT to deliver DE to hospitalized patients with DM and then participated in follow-up focus groups to assess their experiences, with particular attention to the usefulness of NEAT in meeting the needs of nurses related to the delivery of diabetes survival skill education. Information generated was analyzed to identify emerging key themes.ResultsExploratory focus groups revealed that staff nurses view teaching patients with DM as part of their job, but report barriers. Nurses agreed that inpatient DE should be designed to assure safety after discharge and advised that it be patient-centered, targeted, assessment-based and user friendly. Nurses who participated in the delivery of NEAT found that the process and tools met the majority of the basic DE needs of their patients while relieving their workload. In particular, they reported that video and iPad technology provided a convenient and standardized method for facilitating teaching at the bedside, but requested that an interactive feedback mechanism be added to encourage patient self-knowledge assessment.ConclusionsThis study presents challenges staff nurses face in providing DE to hospitalized patients and identifies opportunities and strategies for improving content and delivery to ensure safe transition of patients with DM from hospital to outpatient setting.

Digital Photo Receivers Deliver Herbal Education for Low-income Persons

A significant number of low-income adults, including Hispanics, use herbal products for health care purposes and rely on friends or relatives for product information. Lohse, Stotts, and Priebe surveyed 2,562 low-income caregivers in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics and found 47.7% used an average of 3.3 herbals daily for themselves, their children or both. Despite high herbal usage, educational materials that target low-income adults about the safe use of herbs are directed toward peer counselors rather than caregivers who provide herbal products to preschoolaged children. An evolving health education trend uses new media to join with learners at their stage of readiness, using concepts of health literacy, language, and cognitive processing to stem inequities based on, among others, socioeconomic status. Digital photo receiver (DPR) technology has been successfully applied to nutrition education for low-income audiences. Digital photo receivers offer benefits of portability, content flexibility, and low cost and are designed to provide iterative programming for areas with constantly changing populations, for example, in waiting rooms. This project used DPR technology to deliver an herbal

Impact of a Weight Management Intervention on Eating Competence: Importance of Measurement Interval in Protocol Design:

Purpose: To examine changes in eating competence (EC) in 12-month weight loss intervention. Design: Randomized, parallel-arm with weight loss phase (baseline to month 4) and weight-maintenance phase (months 4-12). Setting: Face-to-face in University classrooms, supervised and self-directed fitness sessions at University fitness center, and home. Participants: Premenopausal, mostly college-educated Pennsylvania women, body mass index >25 (n = 101). Intervention: Twenty-eight, 1-hour classes tailored for extremes of the Dietary Guidelines’ fat recommendations, based on social cognitive theory, problem-based learning delivery over 12 months. Exercise component included supervised and self-directed stretching, aerobics, and strength training. Measures: Anthropometrics, lipid profile, blood pressure, 24-hour dietary recalls, cognitive behavioral measures, Satter Eating Competence Inventory (ecSI). Analysis: General linear model repeated measures analysis of variance for outcome variables. Results: A total of 40% (n = 40) completed the ecSI. Overall, education and supervised exercise session attendance were 77% and 88%, respectively. Similar weight loss for lower and moderate fat groups (6.7 kg and 5.4 kg). The EC was unchanged baseline to month 4 but increased significantly from months 4 to 12, baseline to month 12 for both groups. The EC change baseline to month 12 was inversely associated with weight change from baseline to months 4 and 12. Conclusion: Weight management interventions, likely to introduce concerns with eating attitudes, behaviors, and foods, can reduce EC. Short-term measurement of EC change captures these consequent adjustments without opportunity to regain self-efficacy. Extending the measurement interval better reflects intervention impact on EC.

Exploring Approaches to Facilitate Diabetes Therapy Intensification in Primary Care

Several landmark studies have provided strong support for the position that vigorous treatment of diabetes in the majority of individuals has the potential to reduce the morbidity and mortality of the disease by decreasing its chronic complications (1,2). In response, many advances have been made that include the introduction of highly successful therapies and tools such as more effective medications, blood glucose meters, insulin delivery systems, and needle sizes. Yet, despite this progress, people with diabetes can still have challenges in meeting target goals (3,4) and experience distress related to their treatment plan (5–7). Intensive therapies that have been shown to prevent or slow the progression of complications require people with diabetes to learn and maintain demanding, complex self-care routines. These therapies and routines are often met with fear and reluctance, and adhering to them can be difficult (5,7,8). Furthermore, providers report challenges in introducing advanced therapies for people with diabetes. A survey of physicians’ attitudes found that primary care providers (PCPs) consider diabetes more difficult to treat than other chronic diseases because it requires more monitoring and medication adjustment to achieve treatment goals (9). Physicians also report that there is inadequate support for the increased time and effort required to treat diabetes patients and that neither clinics nor patients can afford what it takes for comprehensive care (9–11). Diabetes self-management education and support (DSME/S) have repeatedly been shown to improve clinical, behavioral, and psychosocial outcomes (12–14). In addition, DSME/S are reported to reduce the onset or advancement of diabetes complications (15), improve quality of life (16,17), enhance self-efficacy and empowerment (18,19), increase healthy coping (20), and decrease the presence of diabetes-related distress (21,22) and depression (23, …