Riva Touger-Decker

Position of the American Dietetic Association: Oral health and nutrition.

It is the position of the American Dietetic Association that nutrition is an integral component of oral health. The American Dietetic Association supports the integration of oral health with nutrition services, education, and research. Collaboration between dietetics and dental professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between nutrition and the integrity of the oral cavity in health and disease. Oral health and nutrition have a synergistic bidirectional relationship. Oral infectious diseases, as well as acute, chronic, and terminal systemic diseases with oral manifestations, impact the functional ability to eat as well as diet and nutrition status. Likewise, nutrition and diet may affect the development and integrity of the oral cavity as well as the progression of oral diseases. As we advance in our discoveries of the links between oral and nutrition health, practitioners of both disciplines must learn to provide screening, baseline education, and referral to each other as part of comprehensive client/patient care. Dietetics practice requires registered dietitians to provide medical nutrition therapy that incorporates a persons total health needs, including oral health. Inclusion of both didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in both dental and dietetic education programs. Collaborative endeavors between dietetics and dentistry in research, education, and delineation of health provider practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.

Effect of Lactobacillus rhamnosus LGG® and Bifidobacterium animalis ssp. lactis BB-12® on health-related quality of life in college students affected by upper respiratory infections.

College students are susceptible to upper respiratory infections (URI) due to inadequate sleep, stress and close living quarters. Certain probiotic strains modulate immune function and may improve health-related quality of life (HRQL) during URI. The present study recruited apparently healthy college students and assessed the effect of probiotics on HRQL outcomes (i.e. self-reported duration, symptom severity and functional impairment of URI) in those who developed URI. Missed school and work days due to URI were also considered. Subjects (n 231) were apparently healthy college students living on campus in residence halls at the Framingham State University (Framingham, MA, USA), and were randomised to receive placebo (n 117) or probiotic-containing powder (daily dose of minimum 1 billion colony-forming units of each Lactobacillus rhamnosus LGG® (LGG®) and Bifidobacterium animalis ssp. lactis BB-12® (BB-12®); n 114) for 12 weeks. Subjects completed The Wisconsin Upper Respiratory Symptom Survey-21 to assess HRQL during URI. The final analyses included 198 subjects (placebo, n 97 and probiotics, n 101). The median duration of URI was significantly shorter by 2 d and median severity score was significantly lower by 34% with probiotics v. placebo (P,0·001), indicating a higher HRQL during URI. Number of missed work days was not different between groups (P=0·429); however, the probiotics group missed significantly fewer school days (mean difference = 0·2 d) compared to the placebo group (P=0·002). LGG® and BB-12® may be beneficial among college students with URI for mitigating decrements in HRQL. More research is warranted regarding mechanisms of action associated with these findings and the cost-benefit of prophylactic supplementation.

The Meaning of Food and Eating among Home Parenteral Nutrition–Dependent Adults with Intestinal Failure: A Qualitative Inquiry

Using content and interpretative phenomenological analysis, we explored the meaning of food and eating from the perspective of adults receiving home parenteral nutrition (PN). The aim of this research was to obtain a deeper understanding of how issues related to food and eating influence quality of life (QOL). Semistructured telephone interviews were conducted between May 2006 and January 2007 with 24 adults with intestinal failure and home PN dependency. The analysis revealed themes relevant to eating behaviors, hunger and thirst, strategies for dining in restaurants, and a perception of wasting money because of malabsorbed food. Three patterns of eating emerged: eating for survival, eating for health benefits, and eating for socialization. A proposed model illustrates how these eating patterns are linked to QOL. Being able to eat and enjoy food is an important ingredient for good self-reported QOL. Measurements of QOL for this population may be enhanced with inclusion of a food and eating domain. The social and emotional context of food and mealtimes is an important component to address in the nutrition care plan for PN-dependent adults.

Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition

It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship. Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individuals functional ability to eat and their nutrition status. Likewise, nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. As knowledge of the link between oral and nutrition health increases, dietetics practitioners and oral health care professionals must learn to provide screening, education, and referrals as part of comprehensive client/patient care. The provision of medical nutrition therapy, including oral and overall health, is incorporated into the Standards of Practice for registered dietitians and dietetic technicians, registered. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. Collaborative endeavors between dietetics, dentistry, medicine, and allied health professionals in research, education, and delineation of practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.

Physical Therapists’ Attitudes, Knowledge, and Practice Approaches Regarding People Who Are Obese

Background: Little is known about physical therapists’ attitudes, knowledge, and practice approaches regarding people who are obese. Objective: The objectives of this study were to determine physical therapists’ attitudes, knowledge, and practice approaches regarding obesity and to explore the relationships between attitudes and knowledge. Design: A prospective paper mail survey was designed to obtain demographic characteristics, attitudes, knowledge, and practice approaches regarding obesity. Participants were randomly selected members of the American Physical Therapy Association. Methods: Descriptive statistics were used to explore physical therapists’ attitudes, knowledge, and practice approaches regarding obesity. Pearson product moment and Spearman rank correlations were used to test the relationships between attitudes and knowledge. The a priori alpha value was set at .05. Results: The response rate was 34.5%. Physical therapists indicated that physical inactivity (92.8%, n=320) and overeating (78.5%, n=270) are the most important causes of obesity and that diet modifications and exercise are the most effective treatments. Respondents frequently recommended exercising more (87.4%, n=263) but rarely recommended changes in nutritional habits or referred clients to other health care disciplines. Attitude scores regarding obesity were neutral. The mean knowledge score was 6.7 (of 10). A significant correlation (r=.133, P=.043) was found between the respondents’ knowledge scores and attitudes regarding statements about obesity. Inverse correlations were seen between the respondents’ age and knowledge scores (r=−.195, P<.0005) and between years in practice and knowledge scores (r= −.216, P<.0005). Limitations: The descriptive nature of this study did not allow for further investigation. The survey questionnaire was adapted from a nonvalidated tool. Conclusions: The results suggested that physical therapists have neutral attitudes toward people who are obese. Physical therapists appropriately indicated that lack of physical activity and poor nutritional habits contribute to obesity. Younger respondents, who had recently entered the work force, had higher knowledge scores than respondents who were older and had worked longer. Improvements in physical therapists’ referral patterns may assist in the health care team approach to the treatment of obesity. Education to enhance physical therapists’ knowledge about obesity should be emphasized.

Nutrition and oral medicine.

I. Synergistic Relationships Between Nutrition and Health Impact of Dietary Quality and Nutrition on General Health Status Connie C. Mobley and Teresa Marshall Pregnancy, Child Nutrition, and Oral Health Connie C. Mobley and Elizabeth Reifsnider Age-Related Changes in Oral Health Status: Effects on Diet and Nutrition Carole A. Palmer Impact of the Environment, Ethnicity, and Culture on Nutrition and Health Joanne Kouba II. Synergistic Relationships Between Oral and General Health Bidirectional Impact of Oral Health and General Health Angela R. Kamer, David A. Sirois, and Maureen Huhmann Impacts and Interrelationships Between Medications, Nutrition, Diet, and Oral Health Miriam R. Robbins III. Relationship Between Nutrition and Oral Health Oral Consequences of Compromised Nutritional Well-Being Paula J. Moynihan and Peter Lingstrom Nutritional Consequences of Oral Conditions and Diseases A. Ross Kerr and Riva Touger-Decker Complementary and Alternative Medical Practices and Their Impact on Oral and Nutritional Health Ruth M. DeBusk and Diane Rigassio Radler Emerging Research and Practices Regarding Nutrition, Diet, and Oral Medicine Shelby Kashket and Dominick P. DePaola IV. Select Diseases and Conditions With Known Nutrition and Oral Health Relationships Diabetes Mellitus: Nutrition and Oral Health Relationships Riva Touger-Decker, David A. Sirois, and Anthony T. Vernillo Oral and Pharyngeal Cancer Douglas E. Morse Human Immunodeficiency Virus Anita Patel and Michael Glick Autoimmune Diseases David A. Sirois and Riva Touger-Decker Osteoporosis Elizabeth A. Krall Wound Healing Marion F. Winkler and Suzanne Makowski V. Education and Practice Approaches to Oral Nutrition Health Risk Assessment Riva Touger-Decker and David A. Sirois Oral Medicine and Nutrition Education Riva Touger-Decker and David A. Sirois Appendices Index

Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU.

Objective:To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU. Design:Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis. Setting:Ninety PICUs from 16 countries with eight or more beds. Patients:Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours. Measurements and Main Results:Data from 1,622 eligible patients, 54.8% men and mean (SD) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively. Conclusions:Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.

Feeding tube use in patients with head and neck cancer.

Use of a prophylactic feeding tube before concurrent chemotherapy and radiotherapy (CRT) for patients with head and neck cancer is often debated.

Workplace weight loss program; comparing live and internet methods.

Objective: To determine the effectiveness of the 12-week workplace intervention (WIP) on energy intake, weight, physical activity (PA) and cardiovascular disease (CVD) risk and the effect of delivery method on outcomes. Methods: A prospective clinical trial of a 12-week WIP comparing In-person and Internet-based delivery. All subjects received identical intervention with dietitian visits at baseline and weeks 6, 12 and 26. Subjects included overweight/obese academic health science center employees. Changes in weight, PA and CVD-risk were primary outcomes. Results: There was no significant treatment effect repeated-measure-ANOVA. Within subjects, significant main effects indicating improvement were noted at week-12 in weight, WC, body-fat, HRQOL and energy intake and at week-26 in weight, WC, body-fat, HRQOL, energy intake and systolic and diastolic BP. Conclusions: Improvements in some outcomes following a 12-week WIP were independent of delivery method.

Influence of Obesity on Clinical Outcomes in Hospitalized Children: A Systematic Review

IMPORTANCE Obesity is prevalent among hospitalized children. Knowledge of the relationship between obesity and outcomes in hospitalized children will enhance nutrition assessment and provide opportunities for interventions. OBJECTIVE To systematically review the existing literature concerning the impact of obesity on clinical outcomes in hospitalized children. EVIDENCE ACQUISITION PubMed, Web of Science, and EMBASE databases were searched for studies of hospitalized children aged 2 to 18 years with identified obesity and at least 1 of the following clinical outcomes: all-cause mortality, incidence of infections, and length of hospital stay. Cohort and case-control studies were included. Cross-sectional studies, studies of healthy children, and those without defined criteria for classifying weight status were excluded. The Newcastle-Ottawa Scale was used to assess study quality. RESULTS Twenty-eight studies (26 retrospective; 24 cohort and 4 case-control) were included. Of the 21 studies that included mortality as an outcome, 10 reported a significant positive relationship between obesity and mortality. The incidence of infections was assessed in 8 of the 28 studies; 2 reported significantly more infections in obese compared with nonobese patients. Of the 11 studies that examined length of stay, 5 reported significantly longer lengths of hospital stay for obese children. Fifteen studies (53%) had a high quality score. Larger studies observed significant relationships between obesity and outcomes. Studies of critically ill, oncologic or stem cell transplant, and solid organ transplant patients showed a relationship between obesity and mortality. CONCLUSIONS AND RELEVANCE The available literature on the relationship between obesity and clinical outcomes is limited by subject heterogeneity, variations in criteria for defining obesity, and outcomes examined. Childhood obesity may be a risk factor for higher mortality in hospitalized children with critical illness, oncologic diagnoses, or transplants. Further examination of the relationship between obesity and clinical outcomes in this subgroup of hospitalized children is needed.