R. Roach

Caregiver and health care provider preferences of nutritional support in a hematopoietic stem cell transplant unit

Many pediatric oncology patients undergoing hematopoietic stem cell transplantation (HSCT) require nutritional support (NS) because of their inability to consume adequate caloric intake enough calories orally. Although NS can be provided either enteraly (EN) or parenteraly (PN), EN is the preferred method of NS as long as if the gastrointestinal tract is functioning. In this qualitative study, we determined the type of NS preferences and the reservations of caregivers of pediatric HSCT patients undergoing hematopoietic stem cell transplantation (HSCT) as well as those of health care (HC) providers working on the HSCT unit.

Nutrition Knowledge of Preschool Children Living in Transitional Housing or Stable Housing and the Nutrition Messages of their Mothers

Abstract DESIGN: Validated questionnaires 3 3Questionnaires were used to assess the early nutrition knowledge of preschool children and the parental nutrition knowledge and messages about foods and nutrition. SETTING/SUBJECTS: The study was conducted in a University preschool and a subsidized day care center. Twenty-two preschool children and their mothers completed the study. INTERVENTION: Open-ended questions were asked to each mother to derive the messages they give about food and nutrition. An objective test was given to the mothers to evaluate their nutrition knowledge. A questionnaire, developed specifically for age and developmental level, was given to each child to assess their nutrition knowledge. STATISTICAL ANALYSES PERFORMED: Various statistical tests were used to analyze data; frequency and correlation analysis. Independent T-tests, Pearsons Correlation, and Multivariate Analysis of Variance. The SPSS computer program with the University of Memphis Administrative Statistical Services was used for data analysis. RESULTS: There were differences in the nutrition knowledge of the children between the two groups. Likewise, differences were found in the mothers nutrition knowledge in both groups. Nutrition knowledge of mothers was significantly related to the nutrition knowledge of their children. Data suggests differences in the relationship of nutrition messages of mothers and the nutrition knowledge of their children between the two groups. APPLICATION: Nutrition education should be targeted to mothers of preschool children, especially those living in transitional housing. More work is needed to examine the difference in nutrition messages of parents living in transitional housing and of parents living in stable housing.

Comparison of Resting Energy Expenditure Assessment in Pediatric Oncology Patients

BACKGROUND Evaluation of energy requirements is an important part of the nutrition assessment of pediatric oncology patients. Adequate provision of energy in this population is of extreme importance because of the prevalence of malnutrition and its effect on growth, development, quality of life, morbidity, and mortality. Numerous methods are used in clinical practice for estimating the resting energy expenditures (REE), specifically indirect calorimetry and predictive equations. A relatively new instrument used to assess REE is the hand-held indirect calorimeter. The purpose of this quality improvement project was to compare the accuracy of REE measurements taken by a hand-held indirect calorimeter and predictive equations to that of a standard indirect calorimeter metabolic cart. METHODS Patients receiving therapy for pediatric cancer, aged 7-18 years, and having a weight ≥15 kg and scheduled for a REE nutrition assessment were eligible. Sequentially, the patients REE was assessed with the cart and the hand-held indirect calorimeter along with the predictive equation calculation. RESULTS Post hoc pairwise comparisons revealed that all 3 methods were significantly different from one another (P < .0001). When compared with the cart, the portable hand-held calorimeter was found to underestimate REE by 11.9%, whereas predictive equations overestimated REE by 12.4%. CONCLUSION Our quality improvement project suggests that the hand-held indirect calorimeter underestimated REE, and predictive equations overestimated REE in pediatric oncology nutrition assessment. Therefore, we recommend that these limitations in assessment be considered when assessing REE using a hand-held indirect calorimeter or predictive equations.

Relationship Between Dental Health and Nutrition Risk Factors in Homebound Older Adults

To the Editor: Adequate nutrition intake is vital for elderly individuals in order for them to maintain good health. With the ever-increasing number of older adults signing up for government-funded nutrition programs such as Meals on Wheels, it is thought that the health of the general population may be deteriorating. One program specifically, Metropolitan Inter-Faith Association (MIFA) Meals on Wheels, located in Memphis, Tennessee, provides elderly individuals with one meal each day that meets at least one-third of the daily recommended nutrient requirements. There are several barriers to an elderly person receiving optimal nutrition, such as the inability to consume enough fruits and vegetables, which may be due to poor dental health or inadequate dentition. Several articles have reported that elderly individuals commonly have numerous health problems, specifically oral health, including missing teeth, mastication difficulties, and gingivitis. If homebound elderly individuals are not receiving adequate oral health care, they could be at risk for severe malnutrition and vitamin deficiencies. Older adults have been found to have micronutrient deficiencies consisting of 33% to 55% of their Dietary Reference Intakes. One study working with a new Meals on Wheels program found that only 11% of screened participants were well nourished. The purpose of this project was to determine whether there is any correlation between dental health and nutrition risk for homebound older adults who participate in Meals on Wheels programs. A quantitative survey was designed to address questions regarding the dental health of elderly homebound individuals (independent variable) receiving homebound meals and relate it to their nutrition risk (dependent variable) (Table 1). The first questionnaire, the “Nutritional Counseling Mini Assessment,” was used to assess participants’ risk of malnutrition. It included questions regarding how many fruits and vegetables they consumed daily and whether respondents were physically able to shop or cook for themselves. Valerie King, the Aging Commission of Tennessee state dietitian, modified this questionnaire. The second questionnaire, which one of the researchers developed, was used to assess the overall dental health of participants in the program. Fifty Meals on Wheels clients were randomly selected and added to 50 previously assessed clients following the same guidelines. Participants included men (n = 14) and women (n = 36) aged 60 and older. The clients used for this study received one meal a day at home. Participants were ineligible for the study if they were younger than 60, were bed ridden, or had severe dementia and were not capable of answering questions. The researcher conducting the study, was also the MIFA-registered dietitian, who completed the interviews. At the end of both questionnaires, total scores were calculated. The independent variable, dental health, was used to determine whether nutrition status affects overall dentition. The questions asked were pertinent because many older adults participating in the MIFA Meals on Wheels program are on Medicare or Medicaid, which do not cover dental treatment. This can be a major barrier for older adults in need of dentures or a replacement of dentures because of improper fit. The number of teeth also tends to decrease with age, so missing teeth may lead to further problems with chewing raw foods, which tend to be nutrient rich. Fruit and vegetable intake is another dependent variable that is used to observe how many fruits and vegetables are consumed daily. Financial difficulty is one main barrier to obtaining fruits and vegetables, although the focus of the study was to observe the direct relationship between dental health and fruit and vegetable intake. No significant relationship was found between nutrition and dental health (correlation coefficient = 0.262, P = .07), although the results indicated this relationship approached significance. A correlation was used to assess for a significant relationship between nutrition and dental health, but the results were not significant (P = .48). T-tests did not show a significant difference between men and women in dental health (P = .61) of nutrition status (P = .22). The literature supports that malnutrition is an increasing risk factor for individuals aged 60 and older. If these individuals do not receive proper oral health care, this may lead to further problems leading to malnutrition. Table 1. Participant Nutritional and Dental Risk Factors

A Culturally Tailored, Faith-Based Approach to Reducing Pediatric Obesity in Minority Families: Strong Me!

Ruth Williams1*, Michelle B Stockton1,2, K. Brooke Beck1,3, Robin Roach1,4, Marian Levy5 and Janice Pride-Boone6 1Health and Sports Science, Field House 106,The University of Memphis, Memphis, USA 2Associate Professor, The University of Memphis, Memphis, USA 3Clinical Dietitian, The Church Health Center, Memphis, USA 4Associate Professor, The University of Memphis, Memphis, USA 5Associate Professor and MPH Director, School of Public Health, The University of Memphis, USA 6Medical Director of Strong Me, USA

Resting Energy Expenditure and Nutritional Status in Children with Sickle Cell Disease after Glutamine Supplementation

Abstract Objective: To determine whether glutamine supplementation has an effect on resting energy expenditure (REE) and nutritional status in children with sickle cell disease (SCD). Design Subjects were supplemented orally with glutamine (600 mg/kg/day) for 12 weeks. Nutritional parameters, which included REE, weight, height, albumin, and calorie and protein intakes, were collected at baseline and after 12 weeks of glutamine supplementation. REE was measured by indirect calorimetry under standard conditions. The Harris-Benedict equations were used to calculate predicted energy needs. Subjects Five children with SCD (HbSS) (4 boys and I girl), aged 5 to 15 years, participated in the study. Statistical analysis performed Descriptive statistics were used to describe the study population. Dependent samples t-test was performed to determine whether pre-treatment and post-treatment measurements differed. Pearson correlation coefficients were used to determine the relationship between variables. Results No significant difference was found between pre-treatment and post-treatment REE measurements. At baseline, the mean REE was 18% higher than the predicted formula. The mean albumin level after the supplemental period was significantly lower than the baseline level; however, albumin levels remained within normal limits. A significant negative correlation was found between baseline protein intake and baseline albumin level. Application/conclusion These data support findings that children with SCD may be hypermetabolic and have enhanced energy requirements. A larger study is needed to determine the effect glutamine supplementation has on REE and nutritional status in children with SCD.

Outcome Measures to Determine the Importance of Dietitians in Diabetes Care in a Primary Care Setting

Abstract The effect of nutrition intervention by a dietitian on patient outcomes, and whether the number of visits impacted these outcomes were studied in a retrospective analysis of one hundred forty seven patient charts of a family practice center over forty years of age with a diagnosis of NIDDM. Patients were divided into experimental group (n=77), who received nutrition intervention, and control group (n=70), who received no nutrition intervention. Main outcomes, measured at baseline, one year from baseline, and most recent outcomes available in the chart, included height, weight, body mass index (BMI), glycosylated hemoglobin (HgbA 1c ), number of physician, dietitian, and nurse educator visits, and hospitalizations. Data was analyzed using descriptive statistics, chi-square analysis, one-way analysis of variance and paired t -tests. No significant differences were found in age, race, and height between groups. Group means were significantly different in weight ( p =0.04) and BMI ( p =0.01) at baseline and most recent points ( p =0.04; p =0.004, respectively), and also, in HgbA 1c ( p =0.02) at one year. Although not statistically significant, the experimental group had a two pound mean weight loss, and the control group had a five pound mean weight gain from baseline to one year. The experimental group also showed a 13% decline in mean blood glucose from baseline to most recent points. A significant decrease in HgbA 1c ( p =0.03) between mean baseline values and mean one-year values was also found in the experimental group. Highly significant differences were found in weight ( p ≤0.0001), BMI ( p ≤0.0001), blood glucose ( p ≤0.0001), and HgbA 1c ( p ≤0.0001) at mean one year and mean most recent values for the experimental group when number of nutrition visits were compared to each outcome. The results of this study suggest that diabetes education including nutrition intervention by a dietitian can result in an improvement in patient outcomes over time in this setting. The frequency of education appears to have a considerable effect on improvement of outcomes.

Assessment of The Household Food Habits and Dietary Patterns of Rural Belize

Abstract OBJECTIVE: Document general demographic data and meal/snack patterns of household members and food preparers; assess dietary variety, dietary quantity, and dietary diversity of food preparers; determine and compare differences in demographic data, dietary scores, and meal/snack patterns among five geographical districts and the six most common ethnicities in rural households. DESIGN: Rural villages and households were randomly selected. Subjects completed in-home interviews conducted by nursing students using a previously developed survey. Demographic data for individual household members and previous 24-hour dietary intake were recorded for each household food preparer. SUBJECTS: Two hundred food preparers and 1219 household members from rural areas in five districts in Belize, Central America. STATISTICAL ANALYSIS: Descriptive statistics; mean differences between groups were assessed by analysis of variance. RESULTS: Dietary variety scores throughout Belize ranged from one to 14 foods, with a mean of 6.57 different foods. Dietary diversity and dietary quantity scores were greatest in the staples and animal food groups. Dietary variety, mean diversity and dietary quantity between districts and ethnicities were not found to differ significantly. Meal/snack patterns chosen most frequently throughout Belize, in each district, and in each ethnicity was three meals per day. APPLICATIONS/CONCLUSIONS: Dietary scores suggest rural Belizeans do not consume a variety of foods and frequently do not select foods from every food group, particularly those items in fruit, vegetable, and fat groups. The study results will be added to the developed database designed to provide information in developing national Food Guidelines.

Clinical Indicators Predicting Weight Loss in Nursing Home Residents

Abstract Monthly weights of 175 residents were reviewed during the four month study. Eighty three residents lost weight and became the subjects for the study. Sixty one residents had significant weight loss during one out of the four months. Twenty two residents has significant weight loss in two or more months during the study. The pre-selected variables were gathered through a chart review on the subjects which had significant unintentional weight loss. Descriptive statistics and frequencies were used to compare the variables. Chi-square (P⩽.05) was used to determine the relationships between monthly weight loss and the independent variables. Eleven combinations were found significant toward weight loss in the 61 subjects who experienced weight loss in one month: puree diet and missing teeth (P=0.004); regular diet and dentures (P=0.004); puree diet and assistance (P=0.000); regular diet and independent (P=0.000); lounge and assistance (P=0.000); puree diet and lounge (P=0.000); regular diet and dining room (P=0.000); anxiety and paxil (P=0.000); depression and paxil (P=0.008); dementia and depakote (P=0.03); and depression and personal room (P=0.048). Five combinations were found significant in the 22 subjects with repeated weight loss: independence and personal room (P=0.002); supervision and dining room (P=0.002); independence and regular diet (P=0.000); assistance and puree diet (P=0.000); and puree diet and missing teeth (P=0.023). This study has revealed that combinations of clinical indicators contribute toward weight loss in nursing home residents. The majority of the indicators are treatable through therapy and proper screening and re-screening techniques. More research is needed on functional skills, dental health, cognitive diagnoses, psychotropic medications, and reasons behind dining alone.