Louise Peck

Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is the diagnosis used to describe children who are inattentive, impulsive, and hyperactive. ADHD is a widespread condition that is of public health concern. In most children with ADHD the cause is unknown, but is thought to be biological and multifactorial. Several previous studies indicated that some physical symptoms reported in ADHD are similar to symptoms observed in essential fatty acid (EFA) deficiency in animals and humans deprived of EFAs. We reported previously that a subgroup of ADHD subjects reporting many symptoms indicative of EFA deficiency (L-ADHD) had significantly lower proportions of plasma arachidonic acid and docosahexaenoic acid than did ADHD subjects with few such symptoms or control subjects. In another study using contrast analysis of the plasma polar lipid data, subjects with lower compositions of total n-3 fatty acids had significantly more behavioral problems, temper tantrums, and learning, health, and sleep problems than did those with high proportions of n-3 fatty acids. The reasons for the lower proportions of long-chain polyunsaturated fatty acids (LCPUFAs) in these children are not clear; however, factors involving fatty acid intake, conversion of EFAs to LCPUFA products, and enhanced metabolism are discussed. The relation between LCPUFA status and the behavior problems that the children exhibited is also unclear. We are currently testing this relation in a double-blind, placebo-controlled intervention in a population of children with clinically diagnosed ADHD who exhibit symptoms of EFA deficiency.

Calcium intake of Asian, Hispanic and white youth.

Objective: To examine calcium intake and food sources among Asian, white and Hispanic youth, in order to develop and target interventions to improve calcium intake. Methods: Cross-sectional survey with two 24-hour dietary recalls one week apart. Calcium intake was evaluated in 167 male and female adolescents of Asian, Hispanic and white ethnicity, ages 10–18 years, from six states. Main outcome measures were mean daily calcium intake (mg/day). Statistical analyses performed: t tests, Chi-square and analysis of variance for differences by age, ethnicity and gender, multiple regression of factors influencing calcium intake. Results: Overall median calcium intake was 938 mg/day with 868 mg/day for Asians, 1180 mg/day for whites and 896 mg/day for Hispanics. Daily milk intake was the primary predictor of calcium intake with Asian ethnicity and female gender each showing a negative association to calcium intake in multiple regression models. Conclusions: Milk intake was the primary factor positively influencing calcium intake, while Asian ethnicity and female gender negatively influenced calcium intake. Thus, interventions to improve calcium intake should focus on improving milk intake of Asians and females.

Computer-Based Simulations Enhance Clinical Experience of Dietetics Interns

OBJECTIVE To determine the impact of computer-based simulations on the performance of dietetics interns in initial clinical rotations. DESIGN Interns used either a simulation program (Care Planning Simulation System CPSS[) or a computer-based tutorial (Nutrition Care Planning Tutorial NCPT[) during their orientation. Performance of these interns on nutrition care skills was evaluated during their initial clinical rotations. SUBJECTS/SETTING Participants were 108 dietetics interns from 8 different programs. Each internship had at least 8 interns, and none of the internships awarded a graduate degree. INTERVENTION Subjects in the experimental group completed nutrition assessment and care planning activities for 3 simulated patients. Subjects in the control group completed a tutorial on assessment and care planning. MAIN OUTCOME MEASURES Likert scale ratings of 31 behaviors were recorded by clinical preceptors. Behavior statements were grouped into 8 categories and average ratings for each category were determined. STATISTICAL ANALYSIS Repeated-measures analysis of variance and linear regression were used to compare performance ratings between groups. RESULTS There were no differences in overall evaluations of the simulation and tutorial groups for the 8-week period. Interns who started clinical rotations immediately after orientation (CPSS-I and NCPT-I groups) were rated lower in all categories than those who began their clinical rotations later (CPSS-D and NCPT-D groups). Maturation and acquisition of general skills likely influenced ratings of interns with delayed clinical rotations. For most categories of behavior the rate of improvement in rating scores was greatest for interns who used CPSS. APPLICATIONS Computer-based simulations are a promising supplement to current techniques in didactic instruction and may be useful in both didactic and practice settings. Computer-based simulations can provide more varied practice experiences to didactic students and interns in preparation for more skilled entry-level positions in dietetics.

Essential Fatty Acid Deficiency in Renal Failure: Can Supplements Really Help?

Abnormal fatty acid metabolism may contribute to clinical problems such as itching, abnormal perspiration, susceptibility to infection, delayed wound healing, anemia, and increased hemolysis, as seen in patients with chronic renal failure. A double-blind study of patients on hemodialysis who received either fish oil, olive oil, or safflower oil documented that patients may have increased levels of the proinflammatory prostaglandin PGE2 and that fish oil intervention may decrease these levels, change the fatty acid profile, improve hematocrit levels, and improve patient perception of symptoms of pruritus.

Phosphate-binding capacity of ferrihydrite versus calcium acetate in rats

Calcium salts, such as calcium carbonate and calcium acetate, are the principal compounds used as phosphate binders in patients with chronic renal failure. The dose required is three to six times the normal requirement for calcium. Use of these large doses of calcium salts in the diet can result in hypercalcemia. Other compounds have been investigated as phosphate binders with varying degrees of success. Synthetic ferrihydrite (5Fe(2)O(3).9H(2)O) has a high adsorptive capacity for phosphate and may be an effective phosphate binder. The phosphate-binding capacity of ferrihydrite was compared with that of calcium acetate in 250-g male Sprague Dawley rats. After an overnight fast, rats (n = 5 per group) were gavaged with an American Institute of Nutrition (AIN) 76 formula containing one third the daily phosphorus intake labeled with phosphorus-32 ((32)P). Either two levels of calcium acetate, representing three (1/2X) or six (1X) times the usual calcium intake for one third of the day, or equivalent amounts of ferrihydrite were added to the diet. An additional group received two times (2X) the larger dose, and a sixth control group received no binder in the diet. Phosphorus absorption curves were determined from (32)P appearance in the serum. The 1/2X dose of ferrihydrite reduced (32)P by approximately one half, and the 2X dose nearly completely suppressed (32)P absorption, similar to the 1X dose of calcium acetate. The advantage of using a ferrihydrite binder would be to avoid the hypercalcemia resulting from the use of high-dose calcium salts. An added advantage may result from the small amounts of iron absorbed in these chronically iron-deficient patients.

Age Differences in Milk Consumption as a Snack and by Eating Occasion

This article is based on findings of the W-191 Regional Research Project, Motivators and Barriers to the Consumption of Calcium-rich Foods, which was partially funded by the Agriculture Experiment Stations in Arizona, California, Colorado, Hawaii, Idaho, Indiana, Montana, New Mexico, Nevada, Utah, Washington, and Wyoming. The authors wish to acknowledge the assistance of Dr. Carol Boushey, Assistant Professor, Purdue University, in the preparation and editing of this manuscript. Snacking frequency has risen in the past decade. Adolescents may obtain up to one-third of their calories from snacks. Consequently, snacking may have a significant impact on overall, as well as, individual nutrient intake. Calcium intake is a concern for adolescents because of its potential to affect long term bone health. As part of a larger study, researchers in 10 states gathered focus group data on motivators and barriers to calcium-rich snack choices in preadolescents (11–12 years old) and adolescents (16–17 years old). Age was found to influence calcium-rich snack choices. Milk was a less common snack choice for older adolescents. For both age groups, soda/soft drink consumption often replaced milk as a beverage and consequently was a barrier to calcium nutriture. Eating away from home was associated with a lower intake of both milk and other calcium-rich foods.

The Effects of a Nutrition Intervention on Body Weight and Body Composition of HIV-Infected Individuals at Risk of Wasting Syndrome

Abstract Wasting syndrome is an opportunistic disease associated with HIV infection, and is characterized by a loss of lean body mass. The purpose of this study was to employ a non-experimental nutrition intervention in order to stop or reverse the wasting process. Thirteen free-living individuals were examined in a community setting, and all subjects were screened to be at risk for wasting syndrome based on parameters of nutritional and economic risk. The intervention consisted of individualized nutrition counseling and access to a food pantry with groceries and nutritional supplements. Body composition was measured with bioelectncal impedance analysis (BIA). Measurements at baseline indicated that many (54% to 62%) of the subjects were malnourished based on standards for percent of ideal body weight (%IBW), body mass index (BMI), percent of ideal body cell mass (%1BCM), and phase angle. Results showed that most (64% to 85%) of the subjects increased in total weight, %IBW, BMI, %IBCM, phase angle, and body fat mass. The mean difference for all thirteen subjects was an increase of 5.5 pounds of total weight, 3.8% of %IBW, 0.28 degrees of phase angle; and 0.84kg/m 2 of BMI (p

Dietary Intake in Relation to Children with Attention-Deficit/Hyperacttvity Disorder

Abstract Subjects were fifty children with clinically diagnosed Attention-Deficit/Hyperactivity Disorder (ADHD) that reported frequent symptoms of essential fatty acid deficiency (EFA) and twenty-four children without AD/HD and reporting few EFA deficiency symptoms. Subjects were required to do three-day food records that were analyzed for nutrient content using the Minnesota Nutrient Database System. The intake records were analyzed to determine 1) whether intake of EFAs was sufficient, 2) whether intake of LCPUFA differed between groups, and 3) whether nutrient intake in the diets differed between ADHD children and the control group. The results of the diet record analysis indicated that the intake of total fat, total protein, sodium, and mono-unsaturated fatty acids was significantly higher in the ADHD group as compared to the control group. Conversely, caffeine intake was greater in the control group. No differences between ^the two groups were observed with respect to intake of EFA and LCPUFAs, indicating that primary deficiency of EFA was not the cause for their reported higher frequency of symptoms.

Dietetic Interns Using Computer Simulations Model Care Planning Strategies of Registered Dietitians

Abstract Fifty-five dietetic interns from eight different programs used three computer-based simulations of patients with cardiovascular disease during the orientation phase of the internship. Users were asked to assess each patient and develop a nutrition care plan. The simulations included a medical record and other information typically available for a newly hospitalized patient. A main menu of eight choices was available at the start of the simulation, and could be accessed from any point in the program. These choices were: A. Visit patient, B. Visit at mealtime, C. Review chart, D. Calculate kcal/protein needs, E. See patients menu, F. Review nutrition screening, G. Prepare care plan, and H. Finished with assessment. Users could move freely through the simulation, viewing data in each section as desired. Upon completion of the nutrition care plan to the users satisfaction, a series of feedback screens was shown. These screens showed the nutrition-related problems identified by the user, and the pathway (sequence of choices) used to complete the care plan. In addition, feedback informed the user of how a panel of experienced dietitians had approached care planning with this patient. At the end of the feedback section, users continued with the next simulation. Menu choices of dietetic interns were rank-ordered and compared across simulations using Friedmans chi-square test. The choice of F (Review Screening) was progressively earlier (2.8 for simulation 1, 1.6 for simulation 2, and 1.4 for simulation 3, p

Computer-Based Clinical Simulations Enhance Care Planning Skills of Dietetic Interns

Abstract A computer-based simulation system (CPSS) was developed to include three realistic scenarios of patients with cardiovascular disease. Beginning dietetic interns used either these simulations or an alternative computer tutorial (NCPT) during their internship orientation. During the subsequent eight weeks of clinical rotations, interns were evaluated weekly by their clinical preceptors. Performance ratings were collected using a 31-item rating form and a five-point Likert scale (1=Unacceptable performance, 5=Outstanding performance). Four categories of behaviors represented the nutrition care planning process: A=Obtaining Data; B=Interviewing Client; C=Analyzing Data; D=Developing Plan. Over the eight weeks of evaluation, linear regression analysis revealed a faster rate of improvement (p