Lisa Hark

The bariatric surgery patient: a growing role for registered dietitians.

Between 1998 and 2004, the total number of bariatric procedures increased almost 10-fold, from 13,386 procedures in 1998 to 121,055 in 2004. Current estimates suggest the number of bariatric operations will exceed 220,000 in 2010. Bariatric surgery encompasses several surgical techniques classified as restrictive or malabsorptive, based on the main mechanism of weight loss. Clinical studies and meta-analyses show that bariatric surgery decreases morbidity and mortality when compared with nonsurgical treatments. A successful long-term outcome of bariatric surgery is dependent on the patients commitment to a lifetime of dietary and lifestyle changes. The registered dietitian (RD) is an important member of the bariatric team and provides critical instructions to help patients adhere to the dietary changes consistent with surgery. Referencing current literature, this article outlines the indications, contraindications, and types of bariatric surgery. The role of the RD for preoperative and postoperative nutrition assessment and medical nutrition therapy is highlighted. Management of long-term nutrition issues is also reviewed. The current recommendations include a multivitamin/mineral supplement plus vitamin B-12, calcium, vitamin D-3, iron, and folic acid. Given the increasing prevalence of obesity and bariatric surgery procedures, caring for patients who have undergone surgery will be an expanding role for the RD. Close postoperative follow-up and careful monitoring will improve the odds for successful surgical outcomes, and RDs play a very important part in this process.

Development of a case-based integrated nutrition curriculum for medical students

The Nutrition Education and Prevention Program at the University of Pennsylvania School of Medicine is a successful program that can be used as a model for the development and implementation of a case-based nutrition curriculum across the 4-y medical school experience. This article gives a broad overview of the development, implementation, evaluation, and dissemination processes used by the Nutrition Education and Prevention Program administration and core faculty group at the University of Pennsylvania School of Medicine. Beginning in 1990, the nutrition curriculum was initiated with the assistance of several funding sources. The program was structured using a multidisciplinary faculty group of physicians and registered dietitians from multiple departments, centers, and institutes. The outcome of this process is a textbook, Medical Nutrition and Disease, currently required by numerous medical schools, residency programs, and other health professional programs across the nation. With the use of data from the Association of American Medical Colleges All Schools Survey of Graduating Medical Students, perceptions of the adequacy of nutrition education were tracked over time. In 1991, 80% of University of Pennsylvania medical students felt that nutrition coverage was inadequate compared with 10% of medical students in 1998, a significant change resulting from the nutrition programs effect. The University of Pennsylvania School of Medicine has developed and implemented a successful nutrition curriculum, despite national trends. The case-based integrated curricular model presented in Medical Nutrition and Disease and on our Web site, www.med.upenn.edu/nutrimed, can be used by medical institutions and other health professionals.

The complete guide to nutrition in primary care

Editors. Contributors. Preface. Section 1 Nutrition as preventive medicine. 1 Nutrition and the primary care clinician: Darwin Deen (Albert Einstein College of Medicine) and Katherine Margo. 2 Changing the office culture to make it work: Arlo Kahn and Jane White. 3 Methods of weight control: Cathy Nonas and Jennifer Williams and Valentine J Burroughs. Section 2 Nutrition through the life-cycle. 4 Growing up healthy: Susan Konek and Diane Barsky. 5 Feeding the mother-to-be: James M Nicholson and Catherine Sullivan and Morghan B Holt. 6 Staying healthy in later life: Connie Watkins Bales and Heidi K White. Section 3 Improving health by changing diet and lifestyle behaviors. 7 Dyslipidemia, hypertension and metabolic syndrome: Frances Burke and Philippe Szapary. 8 Diabetes, pre-diabetes and hypoglycemia: Marion J Franz and Richard Wender. 9 Gastrointestinal disorders: Marianne Aloupis and Thomas Faust. 10 Everything else: Marion Vetter and Katherine Chauncey. Section 4 Vitamins, minerals, supplements and alternative nutrition. 11 Vitamins: Randee Silverman and Jeremy Brauer. 12 Minerals: Randee Silverman and Jeremy Brauer. 13 Dietary and nutritional supplements: Joel S Edman and Elizabeth Horvitz. 14 Considering the alternatives: Benjamin Kligler and Joel S Edman and Mary Beth Augustine. Section 5 Successful changes to the environment. 15 Its all about changing behaviors: Darwin Deen (Albert Einstein College of Medicine) and Alice Fornari. 16 Community counts: Kathryn M Kolasa. 17 Cultural considerations: Kim M Gans and Charles B Eaton. Appendices. Review questions. Review answers. Index

Proposed association between ileoanal j-pouch perforation and rapid consumption of a high-calorie, high-fiber meal: report of two cases.

PURPOSE: We report two cases of ileoanal J-pouch rupture after rapid consumption of high-fiber, high-calorie meals. METHOD: We review the food intake, presentation, laboratory and radiographic data, and course of two patients who developed ileoanal J-pouch perforation after rapid consumption of meals rich in fiber or calories or both. The potential association between food consumption and rupture is explored. RESULTS: The authors propose that the rapid ingestion of a high-fiber, high-calorie meal may lead to an acute intraluminal pressure elevation or a closed-loop obstruction. These effects may be the basis for an association between food ingestion patterns and perforation at the distal transection site in an ileoanal J-pouch. CONCLUSION: The authors hypothesize that the rapid ingestion of a high-fiber, high-calorie meal may be associated with J-pouch perforation. Further investigative efforts are needed to confirm this association and to evaluate whether a causal relationship is present. If causality is established, physicians may develop a higher index of suspicion for pouch rupture in patients who present with abdominal disturbances after the rapid ingestion of a high-fiber, high-calorie meal.

Position of the Academy of Nutrition and Dietetics: Interprofessional Education in Nutrition as an Essential Component of Medical Education

It is the position of the Academy of Nutrition and Dietetics that registered dietitian nutritionists (RDNs) should play a significant role in educating medical students, residents, fellows, and physicians in practice. The more physicians learn about the effectiveness of nutrition for the prevention and treatment of noncommunicable diseases, the more likely they are to consult with RDNs and refer patients for medical nutrition therapy. The more interprofessional education that occurs between medical students, other health professional students, and RDNs, the more likely all health care professionals will understand and value the role of the RDN in improving the quality of care provided to patients. The training and experience of RDNs make them uniquely qualified for the role of educating medical students about nutrition as it relates to health and disease. This position paper provides RDNs with the tools and language to emphasize to medical educators, course directors, curriculum committees, medical school deans, residency and fellowship directors, physicians, and other health professionals in training and practice how ongoing nutrition counseling and management, conducted by an RDN, can benefit their patients. Specific teaching settings and examples for RDNs to take a leadership role (paid and unpaid positions) in ensuring that future physicians discuss nutrition, healthy lifestyle, and physical activity with their patients, consult with RDNs, and refer patients for medical nutrition therapy are presented. This position paper supports interprofessional education in nutrition as an essential component of medical education.