Paula D.N. Dworatzek

Food and Dietary Pattern-Based Recommendations: An Emerging Approach to Clinical Practice Guidelines for Nutrition Therapy in Diabetes

Clinical practice guidelines (CPGs) for the nutritional management of diabetes mellitus have evolved considerably over the last 25 years. As major diabetes associations have focussed on the individualization of nutrition therapy, there has been a move toward a broader more flexible macronutrient distribution that emphasizes macronutrient quality over quantity. There is now a call for the integration of food- and dietary pattern-based approaches into diabetes association CPGs. The main argument has been that an approach that focuses on nutrients alone misses important nutrient interactions oversimplifying the complexity of foods and dietary patterns, both of which have been shown to have a stronger influence on disease risk than nutrients alone. Although cancer and heart associations have begun to integrate this approach into their dietary guidelines, diabetes associations have not yet adopted this approach. We provide a rationale for the adoption of this approach for The Canadian Diabetes Association (CDA) 2013 CPGs for nutrition therapy. The systematic review for the development of these guidelines revealed emerging evidence to support the use of vegetarian, Mediterranean, and Dietary Approaches to Stop Hypertension (DASH) dietary patterns as well as specific foods such as dietary pulses and nuts in people with diabetes. Popular and conventional weight loss diets were also found to have similar advantages in people with diabetes, although poor dietary adherence remains an issue with these diets. The CDA 2013 CPGs will support an even greater individualization of nutrition therapy for people with diabetes and appeal to a broader range of practice styles of health professionals.

Development and implementation of FRESH – a post-secondary nutrition education program incorporating population strategies, experiential learning and intersectoral partnerships

OBJECTIVES: The FRESH (Food Resources and Education for Student Health) peer nutrition education program engages undergraduate and graduate students in experiential learning to improve the campus food and nutrition environment and promote healthy behaviours among university students.TARGET POPULATION: University students in general, and graduate and undergraduate food and nutrition students as program designers and peer educators, respectively.SETTING: Large university campus in southwestern Ontario.INTERVENTION: A peer nutrition education program, utilizing multiple population strategies and intersectoral partnerships, was created by and for university students with faculty and food service personnel as mentors. The population health strategies employed were building awareness and program branding; developing personal skills through peer nutrition education and hands-on cooking demonstrations; and creating supportive environments through incentive programs for fruit and dairy as well as point-of-purchase menu labelling.OUTCOMES: The program has reached students, staff and faculty through over 60 interactive FRESH displays and education sessions. Website and social media have also had a significant reach with over 4,000 website visits and 277 Facebook “likes”. FRESH has also improved the food environment for over 5,000 students in residence, e.g., 1,931 FRESH Fruit/Dairy Cards have been returned for free fruit/milk cartons. Graduate students in Foods and Nutrition continue to participate every year (cumulative n=60) in ongoing program development. Peer educators have developed enhanced leadership, public speaking and group facilitation skills, and the ability to creatively apply what they have learned in the classroom to new contexts.CONCLUSION: Increased nutrition knowledge and an improved food environment could, over the long term, support improved university student health.RésuméOBJECTIFS : Le programme FRESH (Food Resources and Education for Student Health) d’éducation alimentaire par les pairs propose à des étudiants de premier cycle et de cycles supérieurs un apprentissage expérientiel pour améliorer l’alimentation et l’environnement nutritionnel sur le campus et promouvoir des comportements sains dans la population étudiante universitaire.POPULATION CIBLE : Les étudiants d’université en général, et les étudiants de premier cycle et des cycles supérieurs des programmes d’alimentation et de nutrition, ainsi qu’en tant qu’éducateurs auprès des pairs et que concepteurs du programme, respectivement.LIEU: Un vaste campus universitaire dans le sud-ouest de l’Ontario.INTERVENTION : Un programme d’éducation alimentaire par les pairs, utilisant un éventail de stratégies populationnelles et de partenariats intersectoriels, a été créé par et pour des étudiants d’université, mentorés par le corps professoral et le personnel des services alimentaires. Les stratégies de santé des populations employées ont été la sensibilisation et le design global du programme; le perfectionnement des compétences personnelles par l’éducation alimentaire par les pairs et par des démonstrations culinaires pratiques; et la création de milieux favorables au moyen de programmes d’incitation à consommer des fruits et des laitages, ainsi que l’étiquetage nutritionnel des menus sur le lieu de vente.RÉSULTATS : Le programme FRESH a joint les étudiants, le personnel et le corps professoral par l’entremise de plus de 60 présentoirs interactifs et séances de sensibilisation. Le site Web et les médias sociaux ont aussi eu un auditoire important: plus de 4 000 visites du site Web et 277 « J’aime » sur Facebook. Le programme a par ailleurs amélioré l’environnement alimentaire de plus de 5 000 étudiants en résidence; entre autres, 1 931 fiches de fruits et de laitages FRESH ont été échangées pour des fruits frais ou des berlingots de lait. Les étudiants diplômés des programmes d’alimentation et de nutrition (cumulativement n=60) continuent de participer chaque année au développement du programme. Les éducateurs auprès des pairs perfectionnent leurs techniques de leadership, d’art oratoire et de facilitation sociale et leur capacité d’appliquer avec créativité dans de nouveaux contextes ce qu’ils apprennent en classe.CONCLUSION: Des connaissances nutritionnelles accrues et un environnement alimentaire amélioré pourraient, à long terme, favoriser la santé des étudiants d’université.

Factors that influence excessive gestational weight gain: moving beyond assessment and counselling.

Abstract One in four Canadian adults is obese, and more women are entering pregnancy with a higher body mass index (BMI) than in the past. Pregnant women who are overweight or obese have a higher risk of pregnancy-related complications than women of normal weight. Gestational weight gain (GWG) is also associated with childhood obesity. Although the factors influencing weight gain during pregnancy are multifaceted, little is known about the social inequality of GWG. This review will address some of the socioeconomic factors and maternal characteristics influencing weight gain and the impact that excessive GWG has on health outcomes such as post-partum weight retention. The effects of an overweight or obese pre-pregnancy BMI on GWG and neonatal outcomes will also be addressed. The timing of weight gain is also important, as recommendations now include trimester-specific guidelines. While not conclusive, preliminary evidence suggests that excessive weight gain during the first trimester is most detrimental.

Socioeconomic status and adverse birth outcomes: A population-based canadian Sample

This study assessed the strength of the association between socioeconomic status (SES) and low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario. Utilizing perinatal and neonatal databases at the London Health Science Centre, maternal postal codes were entered into a Geographic Information System to determine home neighbourhoods. Neighbourhoods were defined by dissemination areas (DAs). Median household income for each DA was extracted from the latest Canadian Census and linked to each mother. All singleton infants born between February 2009 and February 2014 were included. Of 26,654 live singleton births, 6.4% were LBW and 9.7% were PTB. Top risk factors for LBW were: maternal amphetamine use, chronic hypertension and maternal marijuana use (OR respectively: 17.51, 3.18, 2.72); previously diagnosed diabetes, maternal narcotic use and insulin-controlled gestational diabetes predicted PTB (OR respectively: 17.95, 2.69, 2.42). Overall, SES had little impact on adverse birth outcomes, although low maternal education increased the likelihood of a LBW neonate (OR: 1.01).

Students’ Food Intake from Home-Packed Lunches in the Traditional versus Balanced School Day

PURPOSE To assess the type and quantity of foods children brought and consumed at school in the balanced school day (BSD), with two 20-minute eating periods, versus the traditional schedule (TS), with one 20-minute lunch. METHODS Direct observation identified food items and amounts in BSD and TS lunches of grade 3 and 4 students (n = 321). RESULTS The mean (SD) servings of foods packed in BSD lunches were significantly higher than the TS lunches for milk and alternatives (0.69 (0.70) vs 0.47 (0.49), P = 0.02), sugar-sweetened beverages (SSBs; 0.91 (1.24) vs 0.57 (0.99), P = 0.01), and snacks (2.74 (1.55) vs 2.24 (1.48), P < 0.01). Regardless of schedule, only 40.8% of students had vegetables packed in their lunch, whereas 92.8% had snacks. When comparing foods eaten, SSBs and snacks remained significantly higher in the BSD (0.75 (1.02) vs 0.48 (0.83), P = 0.03; 2.37 (1.44) vs 1.93 (1.36), P = 0.01, respectively). The proportion of children (%) whose consumption met one-third of Canadas Food Guide recommendations for vegetables and fruit was low (27.5% BSD, 31.0% TS). CONCLUSIONS The BSD may have unintended negative consequences on the type and amount of foods packed in school lunches. Support for families should focus on encouraging more vegetables and fruit and fewer SSBs and snacks in packed lunches.

Impact of the Balanced School Day on Glycemic Control in Children with Type 1 Diabetes

OBJECTIVE The balanced school day (BSD) is an alternative elementary school schedule whereby children have 2 20-minute eating periods instead of 1 20-minute lunch, as is found in the traditional schedule (TS). We assessed the glycated hemoglobin (A1C) levels of children with type 1 diabetes in the TS vs. the BSD because 2 eating periods have the potential to impact blood glucose control. METHODS A1C levels representative of the summer months (SumA1C) and A1C levels occurring at least 3 months after the start of the school year (SchA1C) were obtained retrospectively. A parental survey of perceptions of lunch planning, activity levels and diabetes management at school was also completed. RESULTS Our sample included 97 students (TS=42, BSD=55). The mean age ± SD was 10.9±2.6 and 10.1±2.8 years in the TS and BSD, respectively (p=0.12). Sex distribution was not statistically different; 54% were female in TS vs. 36% in BSD; p=0.08. SumA1C was similar in the 2 groups (TS: 8.3±1.1% vs. BSD: 8.0±0.8%; p=0.08). There was a significant within-group increase from SumA1C to SchA1C in the BSD group only (p=0.001), with mean A1C values increasing from 8.0%±0.8% to 8.5%±1.0% in the BSD group compared to no significant increase in the TS group. Parental perceptions of lunch planning, physical activity and diabetes management were similar, regardless of school schedule. CONCLUSIONS Children with type 1 diabetes in the BSD appear to have worse diabetes control during the school year compared to the summer, which is not evident in children in the TS. Additional school supports may assist students in the BSD.