- Email: [email protected]
ASPEN Guidelines and Subjective Global Assessment
SUNDAY, OCTOBER 4
Poster Session: Professional Skills; Nutrition Assessment; Medical Nutrition Therapy An Assessment of Selected Macro- and Micro-Nutrients Intakes among Patients with HIV/AIDS in Barbados Author(s): M. Webb, S. Murray, S. Bawa; Department of Agricultural Economics and Extension, The Univ. of the West Indies, St. Augustine, Trinidad and Tobago Learning Outcome: Participants will be able to communicate the dietary inadequacies among patients with HIV/AIDS. Background: Nutrition cannot prevent or cure infectious diseases. However, adequate intakes of all nutrients can help support the immune system. Furthermore, a better nutritional status is necessary for preventing malnutrition in patients with HIV/AIDS. Methods: A purposive sample of 106 respondents was recruited from an outpatient clinic and a National HIV/AIDS Food Bank. Data were collected using a structured questionnaire, including one-week-day 24-hour dietary recall to evaluate the intake of macronutrients and selected micronutrients among patients with HIV/AIDS in Barbados. ESHA nutrient analysis software was used to analyze the nutrient content of food. Results: Participants’ mean daily intakes of total calories (2437.02 672.22 kcal) and carbohydrates (321.13 70.09 g) were within the acceptable Recommended Dietary Allowances (RDA). However, protein (122.67 37.00 g) and fat (85.72 35.52 g) exceeded RDA. In terms of micronutrients, vitamin C (96.39 52.26 mg ), vitamin D (81.14 48.69 IU), vitamin B12 (5.96 2.44 g), iron (21.88 5.81 mg), zinc (13.93 4.83 mg), selenium (260.26 71.77 g) and vitamin E were all within the Dietary Reference Intakes (DRIs) values, but vitamin A (3269.23 2817.19 g) exceeded the tolerable upper intake level. Conclusion: The nutrition habits of the subjects in this study can be considered adequate. However, the intakes of vitamin A exceeded the tolerable upper intake levels, which probably was the result of excess consumption of protein. Funding Disclosure: None
The Prevalence of Obesity in Children with Narcolepsy Author(s): K. Lindsay, V. Tarn, K. Avis, M. Maddox; Nutrition Sciences, The Univ. of Alabama at Birmingham, Birmingham, AL Learning Outcome: The participants will be able to assess the current standard of nutritional care by determining rate and rise of Body-Mass-Index (BMI) of children with narcolepsy post diagnosis. Background: One of the consequences of narcolepsy is significant weight gain. It is hypothesized that nutritional intervention at diagnosis might slow the rate and rise in Body Mass Index post narcolepsy diagnosis. Objective: To assess the current standard of nutritional care by determining rate and rise of BMI of children with narcolepsy post diagnosis. Design: A quality improvement project which uses a retrospective chart review approach to analyzing the rate and rise of BMI in children with narcolepsy, by comparing their BMI at diagnosis with their BMI 12 months post diagnosis. These children were below 18 years of age so we used BMI percentiles to class them into underweight, normal, overweight and obese classes. A confirmed diagnosis of Narcolepsy was determined by a Median Sleep Latency Test of less than 8 minutes. Participants/Setting: 21 children < 18 years old from CoA in Birmingham, diagnosed with narcolepsy between 1/1/09 and 12/31/14. Patients with missing BMI data were excluded from the study. Main Outcome Measures: Weight class categories, as determined by BMI percentiles. Statistical Analyses Performed: SPSS and was used to provide population means with standard deviation as well as independent samples t-tests. Results: This is an ongoing research project which is set to be completed in 4/ 2015. Our Preliminary findings include the following: Overall, the standard of care protocol for children with narcolepsy has not been associated with significant changes in weight. Conclusions: Weight management is highly needed as part of multidisciplinary clinic services, addressing narcolepsy and nutrition. Funding Disclosure: None
Differences among Rates of Malnutrition Using AND/ASPEN Guidelines and Subjective Global Assessment
Fourth-Grade Children’s Accuracy for School-Breakfast Reports and School-Lunch Reports Obtained In 24-Hour Dietary Recalls: Effects of Retention Interval, Prompts, And Gender
Author(s): A. Coltman, S. Peterson, D. Sowa; Rush Univ. Med. Ctr., Chicago, IL
Author(s): S.D. Baxter1, A.F. Smith2, D.B. Hitchcock3, J.A. Royer4, C.H. Guinn1, M.P. Puryear1, K.L. Collins1, A.L. Smith1, K.K. Vaadi1, P.H. Miller5; 1College of Social Work, Institute for Families in Society, Univ. of South Carolina, Columbia, SC, 2Psychology, Cleveland State Univ., Cleveland, OH, 3 Statistics, Univ. of South Carolina, Columbia, SC, 4College of Social Work, Institute for Families in Society, Univ. of South Carolina and South Carolina Revenue and Fiscal Affairs Office - Hlth. and Demographics, Columbia, SC, 5Psychology, San Francisco State Univ., San Francisco, CA
Learning Outcome: Participants will be able to identify different parameters used to assess malnutrition and the effect on malnutrition rates in hospitalized patients. The Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed characteristics for malnutrition. Patients meeting two or more criteria (change in oral intake and weight, muscle/fat wasting, fluid accumulation, and decreased handgrip strength) are deemed malnourished; however, these characteristics have not yet been validated. Subjective Global Assessment (SGA), a validated tool, identifies malnutrition using similar criteria (change in intake, weight, and functional status, presence of gastrointestinal symptoms, muscle/fat wasting and presence of edema); however, clinicians may diagnose malnutrition regardless of number of criteria met. The purpose of this quality improvement project was to compare characteristics of malnourished patients using the AND/ASPEN guidelines and SGA. Subjects admitted over two 2-month time periods (n¼1009) were assessed using SGA and the AND/ASPEN guidelines. Descriptive statistics (counts and percentages) were used to describe the sample. In patients deemed malnourished by SGA but not by AND/ASPEN guidelines (n¼32), GI symptoms were the most frequently present criteria (50% of patients). Ninety-five percent of patients found to be malnourished using AND/ASPEN guidelines but not by SGA (n¼176), had inadequate handgrip strength as determined by AND standards while only 23% of these patients had decreased functional status according to SGA. Current AND/ASPEN handgrip guidelines may not accurately assess functional status of hospitalized patients. An ideal tool to determine malnutrition would use measures of functional status with high specificity and include presence of GI symptoms. Further research is needed to determine the most sensitive and specific tool to identify malnutrition. Funding Disclosure: None
Learning Outcome: Participants will be able to define the length in hours of retention interval (elapsed time between the to-be-reported meals and interview) for two retention intervals used in this study for breakfast and lunch; state whether accuracy was better for breakfast or lunch reports. We investigated retention interval ([RI]: [prior-24-hour recall obtained in afternoon (24A); hours between breakfast, lunch and recall¼5,1]; [previous-day recall obtained in morning (PDM); hours between breakfast, lunch and recall¼25, 21]), prompt (forward [distant-torecent], reverse [recent-to-distant], meal-name [breakfast, etc.], open [no instructions]), and gender effects on fourth-grade children’s accuracy for school-breakfast and school-lunch reports in 24-hour recalls. During 2011-2014, randomly-selected children (n¼480) were observed eating school-provided breakfast and lunch (consecutively), and interviewed using one of eight protocols (two RIs four prompts) [60 children (30 girls) per protocol]. For breakfast and lunch separately, linear models ascertained main effects and interactions on rates for omissions (forgotten items) and intrusions (falsely-reported items). Rates range from 0-100% (0% best). OMISSION RATE Breakfast (RI--prompt, P<0.0002; prompt--gender, P¼0.0007): Accuracy best for 24A-forward (36.3%) and 24A-reverse (36.4%), but PDM-mealname (54.8%) and PDM-forward (57.6%). Girls’ accuracy best with reverse, meal-name, and forward (48.0-50.4%) but boys’ with forward (43.5%). Lunch (RI--prompt--gender, P¼0.0136): Girls’ accuracy best with 24A-open (24.9%) but PDM-reverse (35.0%), whereas boys’ with 24A-open, 24A-reverse, and 24A-forward (23.6-27.6%) but PDM-reverse (44.9%). INTRUSION RATE Breakfast (RI--prompt--gender, P<0.0002): Girls’ accuracy best with 24A-reverse (15.5%) and 24A-forward (15.8%) but PDM-meal-name (27.6%), whereas boys’ with 24A-reverse (15.9%) and 24A-open (19.2%) but PDM-forward (34.9%) and PDM-reverse (38.7%). Lunch (RI--prompt--gender, P<0.0002): Girls’ accuracy similar with 24A across prompts (11.7-15.0%) but best with PDM-meal-name (18.9%), whereas boys’ with 24A-reverse (7.8%) and PDM-reverse (17.0%). Accuracy was better for lunch than breakfast, and 24A than PDM. Breakfast and lunch report accuracy varied by RI, prompt and gender. Funding Disclosure: Grant R01HL103737 (Principal Investigator e SD Baxter) from the National Heart, Lung, and Blood Institute of the National Institutes of Health
September 2015 Suppl 2—Abstracts Volume 115 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-21
Poster Session: Professional Skills; Nutrition Assessment; Medical Nutrition Therapy An Assessment of Selected Macro- and Micro-Nutrients Intakes among Patients with HIV/AIDS in Barbados Author(s): M. Webb, S. Murray, S. Bawa; Department of Agricultural Economics and Extension, The Univ. of the West Indies, St. Augustine, Trinidad and Tobago Learning Outcome: Participants will be able to communicate the dietary inadequacies among patients with HIV/AIDS. Background: Nutrition cannot prevent or cure infectious diseases. However, adequate intakes of all nutrients can help support the immune system. Furthermore, a better nutritional status is necessary for preventing malnutrition in patients with HIV/AIDS. Methods: A purposive sample of 106 respondents was recruited from an outpatient clinic and a National HIV/AIDS Food Bank. Data were collected using a structured questionnaire, including one-week-day 24-hour dietary recall to evaluate the intake of macronutrients and selected micronutrients among patients with HIV/AIDS in Barbados. ESHA nutrient analysis software was used to analyze the nutrient content of food. Results: Participants’ mean daily intakes of total calories (2437.02 672.22 kcal) and carbohydrates (321.13 70.09 g) were within the acceptable Recommended Dietary Allowances (RDA). However, protein (122.67 37.00 g) and fat (85.72 35.52 g) exceeded RDA. In terms of micronutrients, vitamin C (96.39 52.26 mg ), vitamin D (81.14 48.69 IU), vitamin B12 (5.96 2.44 g), iron (21.88 5.81 mg), zinc (13.93 4.83 mg), selenium (260.26 71.77 g) and vitamin E were all within the Dietary Reference Intakes (DRIs) values, but vitamin A (3269.23 2817.19 g) exceeded the tolerable upper intake level. Conclusion: The nutrition habits of the subjects in this study can be considered adequate. However, the intakes of vitamin A exceeded the tolerable upper intake levels, which probably was the result of excess consumption of protein. Funding Disclosure: None
The Prevalence of Obesity in Children with Narcolepsy Author(s): K. Lindsay, V. Tarn, K. Avis, M. Maddox; Nutrition Sciences, The Univ. of Alabama at Birmingham, Birmingham, AL Learning Outcome: The participants will be able to assess the current standard of nutritional care by determining rate and rise of Body-Mass-Index (BMI) of children with narcolepsy post diagnosis. Background: One of the consequences of narcolepsy is significant weight gain. It is hypothesized that nutritional intervention at diagnosis might slow the rate and rise in Body Mass Index post narcolepsy diagnosis. Objective: To assess the current standard of nutritional care by determining rate and rise of BMI of children with narcolepsy post diagnosis. Design: A quality improvement project which uses a retrospective chart review approach to analyzing the rate and rise of BMI in children with narcolepsy, by comparing their BMI at diagnosis with their BMI 12 months post diagnosis. These children were below 18 years of age so we used BMI percentiles to class them into underweight, normal, overweight and obese classes. A confirmed diagnosis of Narcolepsy was determined by a Median Sleep Latency Test of less than 8 minutes. Participants/Setting: 21 children < 18 years old from CoA in Birmingham, diagnosed with narcolepsy between 1/1/09 and 12/31/14. Patients with missing BMI data were excluded from the study. Main Outcome Measures: Weight class categories, as determined by BMI percentiles. Statistical Analyses Performed: SPSS and was used to provide population means with standard deviation as well as independent samples t-tests. Results: This is an ongoing research project which is set to be completed in 4/ 2015. Our Preliminary findings include the following: Overall, the standard of care protocol for children with narcolepsy has not been associated with significant changes in weight. Conclusions: Weight management is highly needed as part of multidisciplinary clinic services, addressing narcolepsy and nutrition. Funding Disclosure: None
Differences among Rates of Malnutrition Using AND/ASPEN Guidelines and Subjective Global Assessment
Fourth-Grade Children’s Accuracy for School-Breakfast Reports and School-Lunch Reports Obtained In 24-Hour Dietary Recalls: Effects of Retention Interval, Prompts, And Gender
Author(s): A. Coltman, S. Peterson, D. Sowa; Rush Univ. Med. Ctr., Chicago, IL
Author(s): S.D. Baxter1, A.F. Smith2, D.B. Hitchcock3, J.A. Royer4, C.H. Guinn1, M.P. Puryear1, K.L. Collins1, A.L. Smith1, K.K. Vaadi1, P.H. Miller5; 1College of Social Work, Institute for Families in Society, Univ. of South Carolina, Columbia, SC, 2Psychology, Cleveland State Univ., Cleveland, OH, 3 Statistics, Univ. of South Carolina, Columbia, SC, 4College of Social Work, Institute for Families in Society, Univ. of South Carolina and South Carolina Revenue and Fiscal Affairs Office - Hlth. and Demographics, Columbia, SC, 5Psychology, San Francisco State Univ., San Francisco, CA
Learning Outcome: Participants will be able to identify different parameters used to assess malnutrition and the effect on malnutrition rates in hospitalized patients. The Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed characteristics for malnutrition. Patients meeting two or more criteria (change in oral intake and weight, muscle/fat wasting, fluid accumulation, and decreased handgrip strength) are deemed malnourished; however, these characteristics have not yet been validated. Subjective Global Assessment (SGA), a validated tool, identifies malnutrition using similar criteria (change in intake, weight, and functional status, presence of gastrointestinal symptoms, muscle/fat wasting and presence of edema); however, clinicians may diagnose malnutrition regardless of number of criteria met. The purpose of this quality improvement project was to compare characteristics of malnourished patients using the AND/ASPEN guidelines and SGA. Subjects admitted over two 2-month time periods (n¼1009) were assessed using SGA and the AND/ASPEN guidelines. Descriptive statistics (counts and percentages) were used to describe the sample. In patients deemed malnourished by SGA but not by AND/ASPEN guidelines (n¼32), GI symptoms were the most frequently present criteria (50% of patients). Ninety-five percent of patients found to be malnourished using AND/ASPEN guidelines but not by SGA (n¼176), had inadequate handgrip strength as determined by AND standards while only 23% of these patients had decreased functional status according to SGA. Current AND/ASPEN handgrip guidelines may not accurately assess functional status of hospitalized patients. An ideal tool to determine malnutrition would use measures of functional status with high specificity and include presence of GI symptoms. Further research is needed to determine the most sensitive and specific tool to identify malnutrition. Funding Disclosure: None
Learning Outcome: Participants will be able to define the length in hours of retention interval (elapsed time between the to-be-reported meals and interview) for two retention intervals used in this study for breakfast and lunch; state whether accuracy was better for breakfast or lunch reports. We investigated retention interval ([RI]: [prior-24-hour recall obtained in afternoon (24A); hours between breakfast, lunch and recall¼5,1]; [previous-day recall obtained in morning (PDM); hours between breakfast, lunch and recall¼25, 21]), prompt (forward [distant-torecent], reverse [recent-to-distant], meal-name [breakfast, etc.], open [no instructions]), and gender effects on fourth-grade children’s accuracy for school-breakfast and school-lunch reports in 24-hour recalls. During 2011-2014, randomly-selected children (n¼480) were observed eating school-provided breakfast and lunch (consecutively), and interviewed using one of eight protocols (two RIs four prompts) [60 children (30 girls) per protocol]. For breakfast and lunch separately, linear models ascertained main effects and interactions on rates for omissions (forgotten items) and intrusions (falsely-reported items). Rates range from 0-100% (0% best). OMISSION RATE Breakfast (RI--prompt, P<0.0002; prompt--gender, P¼0.0007): Accuracy best for 24A-forward (36.3%) and 24A-reverse (36.4%), but PDM-mealname (54.8%) and PDM-forward (57.6%). Girls’ accuracy best with reverse, meal-name, and forward (48.0-50.4%) but boys’ with forward (43.5%). Lunch (RI--prompt--gender, P¼0.0136): Girls’ accuracy best with 24A-open (24.9%) but PDM-reverse (35.0%), whereas boys’ with 24A-open, 24A-reverse, and 24A-forward (23.6-27.6%) but PDM-reverse (44.9%). INTRUSION RATE Breakfast (RI--prompt--gender, P<0.0002): Girls’ accuracy best with 24A-reverse (15.5%) and 24A-forward (15.8%) but PDM-meal-name (27.6%), whereas boys’ with 24A-reverse (15.9%) and 24A-open (19.2%) but PDM-forward (34.9%) and PDM-reverse (38.7%). Lunch (RI--prompt--gender, P<0.0002): Girls’ accuracy similar with 24A across prompts (11.7-15.0%) but best with PDM-meal-name (18.9%), whereas boys’ with 24A-reverse (7.8%) and PDM-reverse (17.0%). Accuracy was better for lunch than breakfast, and 24A than PDM. Breakfast and lunch report accuracy varied by RI, prompt and gender. Funding Disclosure: Grant R01HL103737 (Principal Investigator e SD Baxter) from the National Heart, Lung, and Blood Institute of the National Institutes of Health
September 2015 Suppl 2—Abstracts Volume 115 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-21