Sharon R. Akabas

The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness

Nutrition is a recognized determinant in 3 (ie, diseases of the heart, malignant neoplasms, cerebrovascular diseases) of the top 4 leading causes of death in the United States. However, many health care providers are not adequately trained to address lifestyle recommendations that include nutrition and physical activity behaviors in a manner that could mitigate disease development or progression. This contributes to a compelling need to markedly improve nutrition education for health care professionals and to establish curricular standards and requisite nutrition and physical activity competencies in the education, training, and continuing education for health care professionals. This article reports the present status of nutrition and physical activity education for health care professionals, evaluates the current pedagogic models, and underscores the urgent need to realign and synergize these models to reflect evidence-based and outcomes-focused education.

Summary of the Presentations at the Conference on Preventing Childhood Obesity, December 8, 2003

Objective. Because of the rising rates of childhood obesity, we set out to determine what is known about its causes and what could be done to prevent additional increases. Methodology. A meeting was convened of experts in areas that bear on prevention of obesity development during intrauterine life, infancy, and very early childhood. They presented recent data and their interpretations of the stage of our current knowledge in related areas. They also proposed possible useful interventions and future directions for research. Findings. The speakers’ talks indicated that (1) breastfeeding as currently practiced seems to be significantly (albeit weakly) protective against obesity and should be encouraged as the preferred method of feeding infants for as long a duration as practical during the first year of life; (2) infant-feeding practices are changing in a way that may predispose to obesity (eg, soda and french fries are being fed to infants as young as 7 months of age), possibly altering taste preferences for foods and beverages that are energy dense and nutrient poor; (3) although little is known about parenting styles (eg, authoritative versus permissive), parenting style is likely to be a fruitful area of current research into childhood obesity etiology; and (4) the pattern of weight changes in the first few years of life may contribute to later risk of obesity. Conclusions. Children’s obesity will continue to be a growing problem unless we improve understanding of the key factors likely to be operative during intrauterine life, infancy, and very early childhood, identify those in whom intervention would have the greatest effect, design and evaluate preventive interventions, and promote those that are successful.

Nutrition education in medical school: a time of opportunity

Undergraduate medical education has undergone significant changes in development of new curricula, new pedagogies, and new forms of assessment since the Nutrition Academic Award was launched more than a decade ago. With an emphasis on a competency-based curriculum, integrated learning, longitudinal clinical experiences, and implementation of new technology, nutrition educators have an opportunity to introduce nutrition and diet behavior-related learning experiences across the continuum of medical education. Innovative learning opportunities include bridging personal health and nutrition to community, public, and global health concerns; integrating nutrition into lifestyle medicine training; and using nutrition as a model for teaching the continuum of care and promoting interprofessional team-based care. Faculty development and identification of leaders to serve as champions for nutrition education continue to be a challenge.

Whole Versus the Piecemeal Approach to Evaluating Soy

Soy has been singled out for attention among other legumes as a valuable source of nutrients, phytochemicals, and bioactive compounds. Early epidemiological studies established that whole soy and traditional soy foods were implicated in health-protective effects in Asian populations. The same benefits attributable to soy have not been consistently proven in Western populations that, for various reasons, opt to consume more processed soy foods or various soy components. Soy researchers continue to isolate soy components in search of identifying its salubrious components and whole soy remains relatively underinvestigated despite what we know of the health benefits it may confer to those regularly consuming it. Various dietary guidelines advocate the regular consumption of legumes that tend not to be included in our diets in sufficient quantities. This paper highlights the possibility that whole soy may have a more unique effect on health than a select soy component(s). It explores the rationale for focusing research on whole soy in an attempt to understand it better rather than trying to replicate the health benefits by targeting various soy components, which has been plagued by inconsistent results.

Nutrition Competencies in Health Professionals’ Education and Training: A New Paradigm

Most health care professionals are not adequately trained to address diet and nutrition-related issues with their patients, thus missing important opportunities to ameliorate chronic diseases and improve outcomes in acute illness. In this symposium, the speakers reviewed the status of nutrition education for health care professionals in the United States, United Kingdom, and Australia. Nutrition education is not required for educating and training physicians in many countries. Nutrition education for the spectrum of health care professionals is uncoordinated, which runs contrary to the current theme of interprofessional education. The central role of competencies in guiding medical education was emphasized and the urgent need to establish competencies in nutrition-related patient care was presented. The importance of additional strategies to improve nutrition education of health care professionals was highlighted. Public health legislation such as the Patient Protection and Affordable Care Act recognizes the role of nutrition, however, to capitalize on this increasing momentum, health care professionals must be trained to deliver needed services. Thus, there is a pressing need to garner support from stakeholders to achieve this goal. Promoting a research agenda that provides outcome-based evidence on individual and public health levels is needed to improve and sustain effective interprofessional nutrition education.

Editors’ Overview of the Conference on Preventing Childhood Obesity

This overview is intended to provide an integrated and interpretive view of the material presented at the conference on Preventing Childhood Obesity. It also expresses the editors’ viewpoints and their recommendations and caveats. The overview was developed after examination and comparison of all of the speakers’ presentations and materials and consideration of comments made during the question-and-answer periods that followed each session. Material from the literature that addressed some unresolved issues raised during the conference is included. The overview follows a chronological sequence from intrauterine life to adult life and integrates, within each section, material from any of the presentations that touched on that topic. Research needs, public health messages, and caveats that were suggested to the editors by the conference presentations and discussions are also included. Several speakers presented data showing the rapid increases in the rates of obesity and overweight that have occurred in the past few decades in the United States, as well as other countries. Obesity and overweight are increasingly prevalent among adults, but similar problems are affecting progressively younger children. Overweight among children 6 to 11 years of age in the United States increased from ∼4% in the early 1970s to 15% in 1999–2000. The speakers explored changes that have occurred in the past few decades that are likely to have contributed to the increasing rates of obesity. The prenatal period, infancy, and early childhood may be stages of particular vulnerability to obesity development, because they are unique periods for cellular differentiation and development. This unique vulnerability might make it possible for actions taken at these stages to determine the future course of adiposity. Two speakers focused on whether in utero factors might affect later obesity development. The evidence presented by Dr Gillman indicated that infants with low birth weight might be especially vulnerable to …

Are we really fixing up the food supply

Twenty years ago, in response to a general conviction that nutrition education had failed, many nutrition professionals supported fortification of the food supply with vitamins and minerals. Although the nutrition problems of most concern today are the result of macronutrient excesses, not micronutrient deficiencies, once again there is an effort to correct these problems by altering the food supply. This article reviews the arguments used to justify widespread micronutrient fortification in the years after World War II. Micronutrient fortification was undertaken without sufficient evidence of need; however, evidence is lacking that it was ineffective nutritionally. Assuming that the goal of the dietetics profession is to teach the public to select healthful diets, the energy-reduced fat substitutes, designer starches, nonnutritive sweets, and various fibers now being added to the food supply are unlikely to help nutritionists achieve that goal.

Relationship between cardiovascular disease knowledge and race/ethnicity, education, and weight status.

Inadequate cardiovascular disease (CVD) knowledge has been cited to account for the imperfect decline in CVD among women over the last 2 decades.

Total Usual Intake of Shortfall Nutrients Varies With Poverty Among US Adults

Objective To examine shortfall nutrient intakes (ie, calcium, folate, potassium, magnesium, and vitamins A, C, D, and E) by poverty‐to‐income ratio (PIR). Design National Health and Nutrition Examination Survey 2011–2012, a nationally representative, cross‐sectional survey. Participants US adults with complete data on poverty status and diet were included (n = 4,524). Analysis The National Cancer Institute method was used to estimate total usual micronutrient intakes from foods, beverages, medications, and dietary supplements reported on 2 24‐hour dietary recalls using measurement error correction. Main Outcome Measures Calcium, folate, potassium, magnesium, and vitamins A, C, D, and E across 3 PIR categories: <130%, 130% to 350%, and ≥350%. Results Mean intakes of folate, vitamin C, and vitamin D were significantly greater in men, and magnesium in women, across all PIR categories. Except for calcium in men and vitamin C in women, the highest PIR category had significantly higher mean total usual intakes of all remaining shortfall micronutrients. Importantly, men and women in the highest PIR category (≥350%) were significantly less likely to have intakes below the Estimated Average Requirement across all micronutrients compared with those in the lower PIR categories. Conclusions and Implications Even with dietary supplements, large proportions of US adults have micronutrient intakes below the Estimated Average Requirement. Adults at the highest adjusted income have higher micronutrient intakes and lower risk of inadequacy than those with lower incomes.

Fiber Intake Varies by Poverty-Income Ratio and Race/Ethnicity in the US Adults

Fiber has been identified as both a ‘shortfall nutrient’ and a ‘nutrient of public health concern.’ However, little is known about dietary fiber intake relative to poverty-income ratio (PIR) and race/ethnicity in US adults. We examined usual intakes of dietary fiber and compliance with the adequate intake (AI) in US adults (≥19 years) using National Health and Nutrition Examination Survey 2011 to 2012 by PIR and race/ethnicity. Among both men and women, significantly higher fiber intake was observed among those in the highest PIR category (men, 22 [SE, 0.8]; women, 18 [SE, 0.6]) compared with those in the lowest category (men, 20 [SE, 0.7]; women, 15 [SE, 0.4]) and the middle category (men, 19 [SE, 0.7]; women, 15 [SE, 0.6]). Although men had higher intake of fiber across all PIR and race/ethnic groups, women had higher prevalence of intake above the AI. Among men, non-Hispanic blacks (17 [SE, 0.8]) had significantly lower intake; whereas among women non-Hispanic blacks (14 [SE, 0.4]) and Hispanic and Mexican Americans (16 [SE. 0.8]) had significantly lower intake compared with the other race/ethnic groups. Asian American women have the highest likelihood of fiber intake that exceeds the AI recommendation. Overall, fiber intake of US adults remains below federal recommendations. Systematic differences in fiber intake occur by PIR and race. Therefore, it is particularly salient to target intervention and education efforts to increase intake of dietary fiber in these groups.