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Barriers and Motivators to Mentoring Dietetic Internship Students
TUESDAY, OCTOBER 18
Poster Session: Professional Skills; Nutrition Assessment; Medical Nutrition Therapy Association between the Dietary Inflammatory Index (DII) and Telomere Length from the National Health and Nutrition Examination Survey
Building High-fidelity Enteral Nutrition Protocol to Promote Macronutrient Delivery in the Neurosciences Intensive Care Unit
Author(s): N. Shivappa1, M. Wirth1, T. Hurley2, J. Hebert1; 1Connecting Health Innovations, LLC, 2Cancer Prevention and Control Program, University of South Carolina
Author(s): K. Lo1, M. Guanci1, D. Belcher1, J. Rosand1, S.A. Quraishi2; 1 Massachusetts General Hospital, 2Harvard University
Learning Outcome: In this study we report an inverse association between inflammatory potential of diet as measured by dietary inflammatory index and telomere length. These results indicate that a diet rich in anti-inflammatory components like fruits and vegetables result in healthy aging and prolonging longevity. More studies are required to further establish this association.
Learning Outcome: To identify the primary components of an enteral nutrition protocol and also the monitoring parameters for ongoing performance evaluation; to comprehend the benefit of the use of a high-fidelity enteral nutrition protocol for better nutrition delivery in NSICU patients.
Introduction: Leukocyte telomere length (LTL) is an important biomarker of aging, and various dietary factors have an impact on LTL through inflammation-related mechanisms. This study examined whether inflammatory potential of diet, as measured by the Dietary Inflammatory IndexTM (DII) has an impact on telomere shortening in the National Health and Nutrition Examination Survey (NHANES). We also carried out validation of the DII with C - reactive protein (CRP), a systemic indicator of inflammation.
Methods: Data came from the 1999-2002 two-year cycles of NHANES. LTL and CRP were assayed from DNA and blood specimens respectively. The DII, a literature derived dietary index, was calculated from the nutrients assessed using 24-hour dietary recalls per 1,000 calories consumed. Associations were examined using survey-based multivariable linear regression for log-transformed LTL.
Results: After multivariate adjustment, higher DII scores (i.e., relatively more pro inflammatory) were associated with shorter LTL both when used as continuous (b ¼ -0.003; 95% confidence interval [CI] ¼ -0.005, -0.0002) and as quartiles (bDIIquartile4vs1 ¼ -0.013; 95% CI ¼ -0.025, -0.001; Ptrend ¼ .03). In this same sample higher DII was also associated with CRP > 3mg/l (ORDIIcontinuous¼1.10; 95% CI¼1.06, 1.16).
Discussion: This study showed a cross-sectional association between inflammatory potential of diet, as measured by the DII, and telomere length, while also successfully validating the DII with CRP. These results suggest that diet might play a key role as a determinant of LTL through inflammatory mechanisms. Funding Disclosure: R44DK103377 from NIDDK
Introduction: Caloric deficit in critical illness is a potentially modifiable risk factor for undesirable clinical outcomes. The goal of this quality improvement (QI) project was to develop an enteral nutrition (EN) protocol for better nutrition delivery in the Neurosciences intensive care unit (NSICU) of a large teaching hospital in Boston, MA. Methods: We conducted a prospective QI study, using an EN protocol that included: 1) EN regimen with clear advancement scheme; 2) separate protein module; 3) gastric residual volume monitoring; 4) well-defined guideline for prokinetic usage; and 4) volume-based compensatory feeding. The protocol was finalized with input from Nutrition, Nursing, and Critical Care physicians. In-service was given to nursing and physician staff. To enhance compliance, nursing flowsheets were updated to document EN delivery as percentage of daily goal; the EN protocol was integrated into the standard patient admission template; and nutrition “snapshots” were introduced to monitor EN delivery monthly. Results: Within 14-month of implementation, monthly protocol ordering in eligible patients increased from 42% to 75% (chi-square¼22; p<0.001), documentation of daily percentage nutrition goal increased from 0% to 76% (chi-square¼161; p<0.001), median delivery of prescribed calories increased from 38%; IQR 27-64 to 76%; IQR 71-85 (Mann Whitney; p¼0.03), and volumebased compensatory feeding accounted for a 6% increase in daily caloric intake. Conclusion: The use of a high-fidelity EN protocol is associated with higher macronutrient delivery in NSICU patients. Future studies are needed to show if promoted EN delivery may improve patient clinical outcomes. Funding Disclosure: None
Barriers and Motivators to Mentoring Dietetic Internship Students Author(s): C. Arnold, M. Amescua, R. Bulifant, M. Burton, D. Grotto, S. Kazimi, K. Parsons, T. Smithson; Benedictine University Learning Outcome: Gain awareness of need for preceptors, perceived benefits of precepting, and resources to serve as a preceptor. Background: Discovering ways to increase dietitians’ willingness to embrace the role of precepting dietetic interns is needed. Methods: Registered Dietitians (RDs) were recruited to complete a selfadministered online survey examining reliable constructs of self-efficacy, barriers, intrinsic and extrinsic benefits, and rewards of precepting. Results: Most of the 1,550 RD participants were female (96.1%), White (88.2%), 41.55 years (sd¼12.88) of age, members of the AND (81.4%), and representing all USA Regions. Most participants (70.8%) served as a preceptor then or in the past, while 25.8% reported never being asked to serve. Those serving three or more years as a preceptor reported higher self-efficacy in knowledge, skills, and communication/interaction (p<.01). Inadequate time was perceived as a barrier (p<.01) among all groups. Females agreed that stress was a greater barrier than did males (p<.01). Compared to RDs 35 years and older, younger RDs valued intangible rewards more (p<.01) and the extrinsic benefit of professional enhancement (p<.01). Younger RDs and non-preceptors agreed more that lack of appreciation, negative experiences, and lack of support were deterrents to serving. Preceptors valued benefits of satisfaction and altruism more than non-preceptors (p<.01). Non- preceptors favored compensation as a benefit more than preceptors (p<.01). Conclusions: Developing knowledge and skills through programs, such as the free online Dietetics Preceptor Training module by CDR or other institutional preceptor-mentoring programs, may reduce barriers while increasing selfefficacy and awareness of the intangible awards derived through precepting. Funding Disclosure: None
Cardiac Rehabilitation Participants Receiving Nutrition Therapy on Mediterranean Dietary Pattern Significantly Improve Eating Behaviors Author(s): B.A. Fay, K. Rhodes, S. Meyers, J. Bryant, M. Rubenfire; University of Michigan Health System Learning Outcome: The learner will describe nutrition-related behavior changes between beginning and end of Cardiac Rehabilitation (CR) and identify how monitoring of dietary intake can guide nutrition interventions in a CR program. Background: New cardiovascular guidelines stress the importance of a nutrient-dense dietary pattern. A brief Food Frequency Assessment (FFA) tool assessing overall cardio-protective dietary pattern can identify changes in eating behavior and guide interventions. Methods: Participants completed a fifteen question FFA at entry and exit of CR. Higher scores indicated eating behaviors more consistent with a Mediterranean dietary pattern. Registered Dietitian Nutritionists (RDNs) individualized recommendations for a Mediterranean dietary pattern and encouraged participants to set specific goals. Single-topic interactive group nutrition sessions were provided weekly by RDNs. Results: A sample of 213 CR participants (66% male; Body Mass Index (BMI) 29.15.5 kg/m2) completed an entry and exit FFA. Individuals with BMI 25 kg/m2 had a mean reduction in BMI (p<0.001). Participants achieved a mean reduction in triglycerides (p¼0.015). Total FFA scores increased from 7.112.19 to 8.042.14 (P<0.001). Scores on each individual question showed increased adherence to the Mediterranean dietary pattern with differences in degree of change. Less than 30% of participants initially reported eating recommended amounts of legumes, vegetables, fish, whole grains and fruit. During course of CR, largest improvement was in fruit intake. Conclusions: Participants receiving group medical nutrition therapy integrated into the CR program progressed toward a cardio-protective eating pattern. Further nutrition intervention would be beneficial. Additional strategies to facilitate increased intake of legumes, vegetables, fish and whole grains could benefit participants. Funding Disclosure: None
September 2016 Suppl 1—Abstracts Volume 116 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-73
Poster Session: Professional Skills; Nutrition Assessment; Medical Nutrition Therapy Association between the Dietary Inflammatory Index (DII) and Telomere Length from the National Health and Nutrition Examination Survey
Building High-fidelity Enteral Nutrition Protocol to Promote Macronutrient Delivery in the Neurosciences Intensive Care Unit
Author(s): N. Shivappa1, M. Wirth1, T. Hurley2, J. Hebert1; 1Connecting Health Innovations, LLC, 2Cancer Prevention and Control Program, University of South Carolina
Author(s): K. Lo1, M. Guanci1, D. Belcher1, J. Rosand1, S.A. Quraishi2; 1 Massachusetts General Hospital, 2Harvard University
Learning Outcome: In this study we report an inverse association between inflammatory potential of diet as measured by dietary inflammatory index and telomere length. These results indicate that a diet rich in anti-inflammatory components like fruits and vegetables result in healthy aging and prolonging longevity. More studies are required to further establish this association.
Learning Outcome: To identify the primary components of an enteral nutrition protocol and also the monitoring parameters for ongoing performance evaluation; to comprehend the benefit of the use of a high-fidelity enteral nutrition protocol for better nutrition delivery in NSICU patients.
Introduction: Leukocyte telomere length (LTL) is an important biomarker of aging, and various dietary factors have an impact on LTL through inflammation-related mechanisms. This study examined whether inflammatory potential of diet, as measured by the Dietary Inflammatory IndexTM (DII) has an impact on telomere shortening in the National Health and Nutrition Examination Survey (NHANES). We also carried out validation of the DII with C - reactive protein (CRP), a systemic indicator of inflammation.
Methods: Data came from the 1999-2002 two-year cycles of NHANES. LTL and CRP were assayed from DNA and blood specimens respectively. The DII, a literature derived dietary index, was calculated from the nutrients assessed using 24-hour dietary recalls per 1,000 calories consumed. Associations were examined using survey-based multivariable linear regression for log-transformed LTL.
Results: After multivariate adjustment, higher DII scores (i.e., relatively more pro inflammatory) were associated with shorter LTL both when used as continuous (b ¼ -0.003; 95% confidence interval [CI] ¼ -0.005, -0.0002) and as quartiles (bDIIquartile4vs1 ¼ -0.013; 95% CI ¼ -0.025, -0.001; Ptrend ¼ .03). In this same sample higher DII was also associated with CRP > 3mg/l (ORDIIcontinuous¼1.10; 95% CI¼1.06, 1.16).
Discussion: This study showed a cross-sectional association between inflammatory potential of diet, as measured by the DII, and telomere length, while also successfully validating the DII with CRP. These results suggest that diet might play a key role as a determinant of LTL through inflammatory mechanisms. Funding Disclosure: R44DK103377 from NIDDK
Introduction: Caloric deficit in critical illness is a potentially modifiable risk factor for undesirable clinical outcomes. The goal of this quality improvement (QI) project was to develop an enteral nutrition (EN) protocol for better nutrition delivery in the Neurosciences intensive care unit (NSICU) of a large teaching hospital in Boston, MA. Methods: We conducted a prospective QI study, using an EN protocol that included: 1) EN regimen with clear advancement scheme; 2) separate protein module; 3) gastric residual volume monitoring; 4) well-defined guideline for prokinetic usage; and 4) volume-based compensatory feeding. The protocol was finalized with input from Nutrition, Nursing, and Critical Care physicians. In-service was given to nursing and physician staff. To enhance compliance, nursing flowsheets were updated to document EN delivery as percentage of daily goal; the EN protocol was integrated into the standard patient admission template; and nutrition “snapshots” were introduced to monitor EN delivery monthly. Results: Within 14-month of implementation, monthly protocol ordering in eligible patients increased from 42% to 75% (chi-square¼22; p<0.001), documentation of daily percentage nutrition goal increased from 0% to 76% (chi-square¼161; p<0.001), median delivery of prescribed calories increased from 38%; IQR 27-64 to 76%; IQR 71-85 (Mann Whitney; p¼0.03), and volumebased compensatory feeding accounted for a 6% increase in daily caloric intake. Conclusion: The use of a high-fidelity EN protocol is associated with higher macronutrient delivery in NSICU patients. Future studies are needed to show if promoted EN delivery may improve patient clinical outcomes. Funding Disclosure: None
Barriers and Motivators to Mentoring Dietetic Internship Students Author(s): C. Arnold, M. Amescua, R. Bulifant, M. Burton, D. Grotto, S. Kazimi, K. Parsons, T. Smithson; Benedictine University Learning Outcome: Gain awareness of need for preceptors, perceived benefits of precepting, and resources to serve as a preceptor. Background: Discovering ways to increase dietitians’ willingness to embrace the role of precepting dietetic interns is needed. Methods: Registered Dietitians (RDs) were recruited to complete a selfadministered online survey examining reliable constructs of self-efficacy, barriers, intrinsic and extrinsic benefits, and rewards of precepting. Results: Most of the 1,550 RD participants were female (96.1%), White (88.2%), 41.55 years (sd¼12.88) of age, members of the AND (81.4%), and representing all USA Regions. Most participants (70.8%) served as a preceptor then or in the past, while 25.8% reported never being asked to serve. Those serving three or more years as a preceptor reported higher self-efficacy in knowledge, skills, and communication/interaction (p<.01). Inadequate time was perceived as a barrier (p<.01) among all groups. Females agreed that stress was a greater barrier than did males (p<.01). Compared to RDs 35 years and older, younger RDs valued intangible rewards more (p<.01) and the extrinsic benefit of professional enhancement (p<.01). Younger RDs and non-preceptors agreed more that lack of appreciation, negative experiences, and lack of support were deterrents to serving. Preceptors valued benefits of satisfaction and altruism more than non-preceptors (p<.01). Non- preceptors favored compensation as a benefit more than preceptors (p<.01). Conclusions: Developing knowledge and skills through programs, such as the free online Dietetics Preceptor Training module by CDR or other institutional preceptor-mentoring programs, may reduce barriers while increasing selfefficacy and awareness of the intangible awards derived through precepting. Funding Disclosure: None
Cardiac Rehabilitation Participants Receiving Nutrition Therapy on Mediterranean Dietary Pattern Significantly Improve Eating Behaviors Author(s): B.A. Fay, K. Rhodes, S. Meyers, J. Bryant, M. Rubenfire; University of Michigan Health System Learning Outcome: The learner will describe nutrition-related behavior changes between beginning and end of Cardiac Rehabilitation (CR) and identify how monitoring of dietary intake can guide nutrition interventions in a CR program. Background: New cardiovascular guidelines stress the importance of a nutrient-dense dietary pattern. A brief Food Frequency Assessment (FFA) tool assessing overall cardio-protective dietary pattern can identify changes in eating behavior and guide interventions. Methods: Participants completed a fifteen question FFA at entry and exit of CR. Higher scores indicated eating behaviors more consistent with a Mediterranean dietary pattern. Registered Dietitian Nutritionists (RDNs) individualized recommendations for a Mediterranean dietary pattern and encouraged participants to set specific goals. Single-topic interactive group nutrition sessions were provided weekly by RDNs. Results: A sample of 213 CR participants (66% male; Body Mass Index (BMI) 29.15.5 kg/m2) completed an entry and exit FFA. Individuals with BMI 25 kg/m2 had a mean reduction in BMI (p<0.001). Participants achieved a mean reduction in triglycerides (p¼0.015). Total FFA scores increased from 7.112.19 to 8.042.14 (P<0.001). Scores on each individual question showed increased adherence to the Mediterranean dietary pattern with differences in degree of change. Less than 30% of participants initially reported eating recommended amounts of legumes, vegetables, fish, whole grains and fruit. During course of CR, largest improvement was in fruit intake. Conclusions: Participants receiving group medical nutrition therapy integrated into the CR program progressed toward a cardio-protective eating pattern. Further nutrition intervention would be beneficial. Additional strategies to facilitate increased intake of legumes, vegetables, fish and whole grains could benefit participants. Funding Disclosure: None
September 2016 Suppl 1—Abstracts Volume 116 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-73