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Comparing Different Clinic-Based Approaches to Promoting Adherence to a DASH Diet in Adolescents with Hypertension
SUNDAY, SEPTEMBER 25
POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY Overweight and Obese Patients’ Self-Efficacy toward Losing Weight to Control Blood Pressure Author(s): K. N. Wolf,1 C. A. Taylor,2 R. K. Wexler3; 1Medical Dietetics Division, The Ohio State University, Columbus, OH, 2Medical Dietetics Division and Department of Family Medicine, The Ohio State University, Columbus, OH, 3 Department of Family Medicine, The Ohio State University, Columbus, OH Learning Outcome: To describe the differences in the self-efficacy toward weight loss to control blood pressure by weight status in patients of a primary care network. Background: Self-efficacy is one of the primary intervening factors in patient readiness to change behaviors. Self-efficacy is specific to task to be accomplished; therefore it is imperative to understand obese patients’ selfefficacy toward weight loss, a common preventive and treatment regimen for hypertension. Methods: A descriptive research design utilizing a questionnaire identified primary care network patients’ self-efficacy toward healthy lifestyle behaviors, including weight loss, to control blood pressure. Socio-demographic differences were also identified including self-reported blood pressure status, and body mass index. To collect data, medical students were randomly assigned to one of three primary care clinics during a 2 month period of time to request patients to complete the questionnaires Participation by the patients was anonymous and voluntary. Questionnaires were complete for 901 patients. Results: The participants who were obese (n⫽349) were more likely to indicate significantly higher self-efficacy (p⫽0.002) that they could lose weight to control their blood pressure. Over half (51.9%) of obese patients indicated they were completely certain they could lose weight to control their blood pressure, and 22.6% of these patients indicated there was a good chance they could lose weight to control blood pressure. Seventy percent of overweight (n⫽290) participants indicated high self-efficacy (at least 75% chance) toward weight loss to control blood pressure. Conclusions: Obese patients have high self-efficacy levels toward weight loss to improve blood pressure, and therefore ready for nutrition education that supports weight loss. Further research may identify specific strategies that targets education to meet this populations’ readiness to learn. Funding Disclosure: Crisafi-Monte PrimaryCare Cardiopulmonary Grant Program
U.S. Obstetrics-Gynecology Resident Demographic and Professional Characteristics, Knowledge and Professional Practice Regarding Vitamin-Mineral Supplementation for Pregnancy Following Roux-en-Y Gastric Bypass Author(s): L. B. Lamport,1 J. S. Parrot,2 V. Klein,1 D. Rigassio-Radler,2 R. Touger-Decker2; 1North Shore University Hospital, Manhasset, NY, 2University of Medicine and Dentistry of New Jersey, Newark, NJ Learning Outcome: Understand the need for strategies for teaching obstetricsgynecology residents in order to increase their knowledge and prescription practices regarding vitamin-mineral supplementation in the treatment of pregnancy following bariatric surgery. Background: The purpose of the study was to determine the relationship between U.S. obstetrics-gynecology resident demographic and professional characteristics, knowledge and professional practices regarding vitamin-mineral supplementation for pregnancy following Roux-en-Y gastric bypass (RYGB). Methods: This prospective internet-based survey was sent to 247 U.S. obstetrics-gynecology program directors via email, with the request to forward to their obstetrics-gynecology residents (n⫽4943) for completion. Survey questions included demographic and professional characteristics and knowledge of and professional practices regarding vitamin-mineral supplementation for women during pregnancy, who have undergone RYGB, and for women who have undergone RYGB and become pregnant. Data were analyzed using SPSSv17.0; ␣ⱕ 0.05. Results: The response rate was 5% (n⫽230); of these, 85.2% (n⫽196) completed all question categories and were used for analysis. The mean knowledge score was 8.5 out of 12 (70.8% correct). Respondents who answered the questions correctly regarding a prenatal vitamin with DHA, vitamin D and Iron were significantly more likely to prescribe these supplements (p⬍0.001, p⫽0.009 and p⫽0.018 respectively, Fisher’s Exact) than those who answered the questions incorrectly. There was no significant relationship between knowledge of calcium and vitamin B12 needs and prescription practices as well as between gender, age and year/class of residency and knowledge of vitamin-mineral supplementation needs. Conclusion: Future research is needed to explore strategies for teaching obstetrics-gynecology residents in order to increase their knowledge and prescription practices regarding vitamin-mineral supplementation in the treatment of pregnant women that have previously undergone RYGB. Funding Disclosure: None
Comparing Different Clinic-Based Approaches to Promoting Adherence to a DASH Diet in Adolescents with Hypertension
Transplant Dietitians: Job Characteristics and Standards Used to Define Obesity in Kidney Transplant Candidates
Author(s): S. C. Couch,1 K. L. Kampman,2 S. Zheng,2 B. E. Saelens,3 E. M. Urbina,4 M. M. Mitsnefes,4 S. R. Daniels5; 1Nutritional Sciences, University of Cincinnati, Cincinnati, OH, 2University of Cincinnati, Cincinnati, OH, 3 University of Washington, Seattle, WA, 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 5University of Colorado, Denver, CO
Author(s): P. Haskell,1 B. Sansone,2 M. P. McCarthy1; 1Food and Nutrition Services, Oregon Health & Science University, Portland, OR, 2 Morrison Management Specialists, Woodland Hills, CA
Learning Outcome: Participants will learn about different clinic-based approaches to promoting adherence to the Dietary Approaches to Stop Hypertension (DASH) diet among adolescents with hypertension.
Learning Outcome: To describe broad characteristics of kidney transplant dietitians’ practice and to identify standards used to define obesity as a contraindication for kidney transplant.
The DASH diet is being advocated by leading health experts to treat high blood pressure in youth. However the optimal intervention delivery format to promote DASH adherence in youth has not been ascertained. The purpose of this study was to compare a 6-month clinic- and phone/mail-based behavioral nutrition intervention (DASH) to routine hospital-based nutrition care (RC) on degree of adherence to a DASH diet. Sixty-four adolescents, ages 11-18 years, with pre-/ hypertension were randomized to DASH (n⫽33) or RC (n⫽31). All participants were counseled x 2 by a registered dietitian on standard guidelines for blood pressure management, including the DASH diet. In addition, DASH participants received a DASH manual that included 10-modules on DASH food servings, lists, tips, and behavioral strategies, 15 behavioral counseling phone calls by a trained interventionist and biweekly mailings. Dietary intake was assessed by 3-day diet recall. Adherence to the DASH diet was determined with an index that included 8 DASH food groups and sodium; a maximum score of 10 was assigned when a DASH food group recommendation was met; lower intakes were scored proportionately. In a completer analysis, DASH was associated with greater change in DASH score (p⬍.01) after adjustment for demographics, energy and BMI z-score. Change in DASH component scores for fruit and low fat dairy and sodium were greater in DASH versus RC (p for all ⬍.01). These findings suggest greater efficacy of a clinic and phone/mail-based nutrition intervention compared to routine care for promoting adherence to a DASH diet among adolescents with hypertension.
Among kidney transplant teams in the United States there is no standardization regarding 1) how to define obesity or 2) when obesity becomes a relative or absolute contraindication to transplant. The aims of this study are to identify which published weight norms are used to define obesity in transplant candidates. Transplant dietitians were contacted through email to complete a questionnaire regarding demographics, basic job functions, methods used to measure obesity in transplant candidates, and standards used to define cut-off points. Results from 55 respondents indicate that most transplant dietitians apply body mass index (BMI) to determine obesity; other anthropometric measurements, such as waist and hip circumferences, are less frequently used. The majority of centers view BMI ⬎ or ⫽ 35 as a relative contraindication for transplant (83% of respondents) and 41% absolutely exclude a candidate from consideration for transplant for BMI ⬎ or ⫽ 40. 67% of the respondents participate in pre-transplant evaluations; 55% provide medical nutrition therapy (MNT) in the immediate post-transplant period; and 22% offer MNT for diabetes and heart healthy nutrition in the one-to-twelve month post-operative period. Future research will further examine how obesity is evaluated in kidney transplant candidates and will compare transplant outcomes at different levels of obesity. This will provide needed evidence in this practice area for future revisions of Chronic Kidney Disease Guidelines by the Evidence Analysis Library.
Funding Disclosure: NHLBI R01 HL088567-01
Funding Disclosure: None
Journal of the AMERICAN DIETETIC ASSOCIATION / A-37
POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY Overweight and Obese Patients’ Self-Efficacy toward Losing Weight to Control Blood Pressure Author(s): K. N. Wolf,1 C. A. Taylor,2 R. K. Wexler3; 1Medical Dietetics Division, The Ohio State University, Columbus, OH, 2Medical Dietetics Division and Department of Family Medicine, The Ohio State University, Columbus, OH, 3 Department of Family Medicine, The Ohio State University, Columbus, OH Learning Outcome: To describe the differences in the self-efficacy toward weight loss to control blood pressure by weight status in patients of a primary care network. Background: Self-efficacy is one of the primary intervening factors in patient readiness to change behaviors. Self-efficacy is specific to task to be accomplished; therefore it is imperative to understand obese patients’ selfefficacy toward weight loss, a common preventive and treatment regimen for hypertension. Methods: A descriptive research design utilizing a questionnaire identified primary care network patients’ self-efficacy toward healthy lifestyle behaviors, including weight loss, to control blood pressure. Socio-demographic differences were also identified including self-reported blood pressure status, and body mass index. To collect data, medical students were randomly assigned to one of three primary care clinics during a 2 month period of time to request patients to complete the questionnaires Participation by the patients was anonymous and voluntary. Questionnaires were complete for 901 patients. Results: The participants who were obese (n⫽349) were more likely to indicate significantly higher self-efficacy (p⫽0.002) that they could lose weight to control their blood pressure. Over half (51.9%) of obese patients indicated they were completely certain they could lose weight to control their blood pressure, and 22.6% of these patients indicated there was a good chance they could lose weight to control blood pressure. Seventy percent of overweight (n⫽290) participants indicated high self-efficacy (at least 75% chance) toward weight loss to control blood pressure. Conclusions: Obese patients have high self-efficacy levels toward weight loss to improve blood pressure, and therefore ready for nutrition education that supports weight loss. Further research may identify specific strategies that targets education to meet this populations’ readiness to learn. Funding Disclosure: Crisafi-Monte PrimaryCare Cardiopulmonary Grant Program
U.S. Obstetrics-Gynecology Resident Demographic and Professional Characteristics, Knowledge and Professional Practice Regarding Vitamin-Mineral Supplementation for Pregnancy Following Roux-en-Y Gastric Bypass Author(s): L. B. Lamport,1 J. S. Parrot,2 V. Klein,1 D. Rigassio-Radler,2 R. Touger-Decker2; 1North Shore University Hospital, Manhasset, NY, 2University of Medicine and Dentistry of New Jersey, Newark, NJ Learning Outcome: Understand the need for strategies for teaching obstetricsgynecology residents in order to increase their knowledge and prescription practices regarding vitamin-mineral supplementation in the treatment of pregnancy following bariatric surgery. Background: The purpose of the study was to determine the relationship between U.S. obstetrics-gynecology resident demographic and professional characteristics, knowledge and professional practices regarding vitamin-mineral supplementation for pregnancy following Roux-en-Y gastric bypass (RYGB). Methods: This prospective internet-based survey was sent to 247 U.S. obstetrics-gynecology program directors via email, with the request to forward to their obstetrics-gynecology residents (n⫽4943) for completion. Survey questions included demographic and professional characteristics and knowledge of and professional practices regarding vitamin-mineral supplementation for women during pregnancy, who have undergone RYGB, and for women who have undergone RYGB and become pregnant. Data were analyzed using SPSSv17.0; ␣ⱕ 0.05. Results: The response rate was 5% (n⫽230); of these, 85.2% (n⫽196) completed all question categories and were used for analysis. The mean knowledge score was 8.5 out of 12 (70.8% correct). Respondents who answered the questions correctly regarding a prenatal vitamin with DHA, vitamin D and Iron were significantly more likely to prescribe these supplements (p⬍0.001, p⫽0.009 and p⫽0.018 respectively, Fisher’s Exact) than those who answered the questions incorrectly. There was no significant relationship between knowledge of calcium and vitamin B12 needs and prescription practices as well as between gender, age and year/class of residency and knowledge of vitamin-mineral supplementation needs. Conclusion: Future research is needed to explore strategies for teaching obstetrics-gynecology residents in order to increase their knowledge and prescription practices regarding vitamin-mineral supplementation in the treatment of pregnant women that have previously undergone RYGB. Funding Disclosure: None
Comparing Different Clinic-Based Approaches to Promoting Adherence to a DASH Diet in Adolescents with Hypertension
Transplant Dietitians: Job Characteristics and Standards Used to Define Obesity in Kidney Transplant Candidates
Author(s): S. C. Couch,1 K. L. Kampman,2 S. Zheng,2 B. E. Saelens,3 E. M. Urbina,4 M. M. Mitsnefes,4 S. R. Daniels5; 1Nutritional Sciences, University of Cincinnati, Cincinnati, OH, 2University of Cincinnati, Cincinnati, OH, 3 University of Washington, Seattle, WA, 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 5University of Colorado, Denver, CO
Author(s): P. Haskell,1 B. Sansone,2 M. P. McCarthy1; 1Food and Nutrition Services, Oregon Health & Science University, Portland, OR, 2 Morrison Management Specialists, Woodland Hills, CA
Learning Outcome: Participants will learn about different clinic-based approaches to promoting adherence to the Dietary Approaches to Stop Hypertension (DASH) diet among adolescents with hypertension.
Learning Outcome: To describe broad characteristics of kidney transplant dietitians’ practice and to identify standards used to define obesity as a contraindication for kidney transplant.
The DASH diet is being advocated by leading health experts to treat high blood pressure in youth. However the optimal intervention delivery format to promote DASH adherence in youth has not been ascertained. The purpose of this study was to compare a 6-month clinic- and phone/mail-based behavioral nutrition intervention (DASH) to routine hospital-based nutrition care (RC) on degree of adherence to a DASH diet. Sixty-four adolescents, ages 11-18 years, with pre-/ hypertension were randomized to DASH (n⫽33) or RC (n⫽31). All participants were counseled x 2 by a registered dietitian on standard guidelines for blood pressure management, including the DASH diet. In addition, DASH participants received a DASH manual that included 10-modules on DASH food servings, lists, tips, and behavioral strategies, 15 behavioral counseling phone calls by a trained interventionist and biweekly mailings. Dietary intake was assessed by 3-day diet recall. Adherence to the DASH diet was determined with an index that included 8 DASH food groups and sodium; a maximum score of 10 was assigned when a DASH food group recommendation was met; lower intakes were scored proportionately. In a completer analysis, DASH was associated with greater change in DASH score (p⬍.01) after adjustment for demographics, energy and BMI z-score. Change in DASH component scores for fruit and low fat dairy and sodium were greater in DASH versus RC (p for all ⬍.01). These findings suggest greater efficacy of a clinic and phone/mail-based nutrition intervention compared to routine care for promoting adherence to a DASH diet among adolescents with hypertension.
Among kidney transplant teams in the United States there is no standardization regarding 1) how to define obesity or 2) when obesity becomes a relative or absolute contraindication to transplant. The aims of this study are to identify which published weight norms are used to define obesity in transplant candidates. Transplant dietitians were contacted through email to complete a questionnaire regarding demographics, basic job functions, methods used to measure obesity in transplant candidates, and standards used to define cut-off points. Results from 55 respondents indicate that most transplant dietitians apply body mass index (BMI) to determine obesity; other anthropometric measurements, such as waist and hip circumferences, are less frequently used. The majority of centers view BMI ⬎ or ⫽ 35 as a relative contraindication for transplant (83% of respondents) and 41% absolutely exclude a candidate from consideration for transplant for BMI ⬎ or ⫽ 40. 67% of the respondents participate in pre-transplant evaluations; 55% provide medical nutrition therapy (MNT) in the immediate post-transplant period; and 22% offer MNT for diabetes and heart healthy nutrition in the one-to-twelve month post-operative period. Future research will further examine how obesity is evaluated in kidney transplant candidates and will compare transplant outcomes at different levels of obesity. This will provide needed evidence in this practice area for future revisions of Chronic Kidney Disease Guidelines by the Evidence Analysis Library.
Funding Disclosure: NHLBI R01 HL088567-01
Funding Disclosure: None
Journal of the AMERICAN DIETETIC ASSOCIATION / A-37