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Evaluating the nutrition screening initiative checklist as a screening and an educational tool in an elderly population
MONDAY, OCTOBER 17 ORIGINAL CONTRIBUTIONS: YEAR 2000 HEALTH OBJECTIVES FACTORS ASSOCIATED WITH SELF-CHANGE IN DIETARY FAT REDUCTION TO 30% OF CALORIES OR LESS. G.W. Greene, PhD, RD, R.C. Laforge, PhD, and S.R. Rossi, PhD, Cancer Prevention Research Center, University of Rhode Island, Kingston, RI Although Americans have been reducing their fat intake, most fail to meet the Year 2000 We goal of dietary fat < 30% of kcal. initiated a longitudinal study to better understand factors associated with self-change in dietary fat reduction. Subjects were recruited by mail from a random sample of nonsmoking adults; 484 subjects with dietary fat intake exceeding 30% kcal (M=37.5% kcal) were enrolled in the study. A total of 420 completed 12-month follow up (87% response rate). Subjects (N=85) who met the goal of dietary fat intake < 30% kcal at follow up (LF) had a lower intake at baseline (M=34.5+3.6) and follow up (M=26.4+2.8) than subjects (N=335) failing to meet the goal at follow up (baseline Baseline M=38.3+4.5; follow up M=36.8+4.4). variables associated with meeting the goal at follow up included stage of readiness to change 2 fat intake (X=22.9, p<.001), gender (X2=5.8, 2 low-fat p<.05), income (X=5.2, p.05), use of 2 techniques such as reading labels (X=11.2, p<.01) and eating low-fat lunches (X2=26.4, pc.001) and fat reduction behaviors such as avoiding fat as a seasoning (X2=16.5, p<.001) 2 and modifying meat to reduce fat (X=13.0, p<.001). Baseline stage of change predicted 12 month fat intake when adjusted for baseline fat intake, gender, and income using analysis of In conclusion, LF covariance (F=2.4, p<.05). subjects were more likely to be ready for action and utilizing action-oriented strategies at baseline than HF subjects; dietitians might consider tailoring strategies to the patient's stage of readiness to change.
AN EDUCATIONAL MODEL FOR PROMOTING DIETARY ADHERENCE TO A HEART DISEASE REVERSAL PROTOCOL. GD Krag, MA, RD; JC Rogers, DO; D Durbin BAA. Downriver Cardiology Consultants, Trenton, Ml Using the dietary protocol established by Dean Ornish, MD, (10% fat vegetarian) an educational model for heart disease reversal was developed and utilized with patients with coronary artery disease. The purpose was to to evaluate if a group of typical cardiac patients could learn how to follow the regime and if these patients would experience changes in lipids, weight, body fat, and thallium stress tests. The educational model was modified from Dean Omish's Program for Reversing Heart Disease (Random House, 1990) and the Low-fat Eating Plan (JADA,Vol. 90, no. I)The model includes units on counting fat grams, preparing foods, modifying recipes, shopping, eating out, and adjusting to the protocol. The model was taught as part of a total reversal effort including aerobic exercise, yoga, stress control, and group support. Patients did not discontinue medications when starting program. Currently there are 90 patients enrolled in the program. 14 have completed a year or more. Data on these 14 demonstrate a mean weight loss of 14 pounds, a mean cholesterol drop of 16 mg/dl, and no significant change in mean triglycerides or mean high density lipoprotein. Percent body fat decreased by 3 points. Ten of the patients have had repeat thallium stress tests with six demonstrating increased blood flow to the heart muscle, three having the same results as last year, and one having decreased blood flow. Five of the 14 patients initially demonstrated angina. All have experienced cessation based on a total of 41 episodes during the first month to a total of 0 episodes experienced during the 12th month. Results of questionnaires show that patients have an improved sense of well-being, feel they have more stamina, and feel more in control of their disease. To encourage nutritional adequacy, patients were taught tojudge their food records by comparing them to a daily food guide. Food records from the 12th month demonstrated a better balance of foods than those of the first month. Patients kept an average of 37 weekly food records per year. Compliance to the low-fat regime was excellent with most patients consuming less than 10N% of their calories from fat. At 12 months many patients have been able to decrease medications. The majority of patients are from blue collar backgrounds and live in a highly industrialized area near Detroit, MI. All but one of the 14 are continuing to attend the program. The one who is not attending continues to follow the lifestyle changes. This program demonstrates that patients using the model develop the skill and are motivated to follow a strict vegetarian diet. Many experience health benefits in 12 months when following the protocol.
EVALUATING THE NUTRITION SCREENING INITIATIVE CHECKLIST AS A SCREENING AND AN EDUCATIONAL TOOL IN AN ELDERLY POPULATION. N.R. Sahyoun, MS,RD, P.F. Jacques, PhD, and R.M. Russell, MD. USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
DIFFERENCES IN DIETARY INTAKE ANDHEALTH PERSPECTIVE AMONG NURSES V.J. Wall, PhD, RD, and M.H. Gravely, MS,College of ON SHIFTWORK. Human Resources, Virginia Polytechnic Institute and State University, Blacksburg, VA. Over ten million people in the United States work other than the traditional daytime hours. Most studies of shiftworkers are on blue collar males and focus on health, family life and performance. Few studies include the effect of shiftwork on diets, and even fewer consider the effect on women. This study investigated differences in dietary intakes, meal patterns and health satisfaction among nurses working day (controls), evening, night, and rotating shifts. One hundred eighty full-time subjects, selected from two military and two private hospitals, completed a 24-hour food recall and a detailed survey regarding meal patterns, health satisfaction and work history. Food intakes were calculated using the Nutritionist IV Version 2.0 computer program and average daily intakes of 14 nutrients were compared to the RDA. Food cholesterol and kilocalories from fat were compared to U.S. Dietary Guidelines. Numerical scores were used to derive summated scores on health questions. Analysis of Variance, Multiple Comparison Procedures, Chi-square and T-tests were used with appropriate data variables to determine differences among schedule groups. No significant differences were found among the schedule groups for dietary intake of 14 nutrients, fat, carbohydrate, cholesterol and kilocalories. Each group had intakes of Vitamin D that were significantly lower than the RDA; the Day group had lower calcium, iron and zinc; the Evening group had lower calcium; and the Night and Rotating groups had lower magnesium, iron and zinc. There were somesignificant differences amongthe groups in meal consumption patterns; meannumber of meals per day, meals eaten at work, and time allowed for meats; place meals were eaten; and snack consumption. Usually the experimental groups differed from the controls, but also differed from each other on some behaviors. Significant differences were noted on health perspectives amonggroups with Day shift nurses being most satisfied with effect of schedule on health and the ability to maintain health. Results did not show that diets of shiftworking nurses were less adequate than day nurses; with few exceptions, the four groups were adequate. Day nurses eat more meals each day, consume fewer snacks, and have more time for meals at work than nurses on other schedules. Shiftwork was viewed by the experimental groups as impacting health. Conclusions are that professional groups such as nurses whoare in health care may be more responsive to practices that have adverse affect on health. However, shiftwork negatively affects health satisfaction, maintenance of health, and possibly the participation in activities that impacts behaviors supporting good health.
The Nutrition Screening Initiative(NSI) developed the DETERMINE checklist to identify community-dwelling elderly people at high nutritional risk. The checklist was developed as an awareness and educational tool; however, it is also being used as a screening tool. This study was undertaken to evaluate the checklist as a screening and an educational tool. The Nutritional Status Survey (NSS) which was conducted between 1981 and 1984 and which collected nutrition assessment information was used as the data base for this study. The vital status of the NSS subjects was subsequently collected as of January, 1993. Using Cox's proportional hazard survival analysis modeling, the 10 questions of the checklist were examined individually and as a score using data of 581 NSS subjects with mortality as the outcome variable. The results show that a score of 6 or more representing individuals at high nutritional risk is predictive of mortality among the female subjects (RR=1.12 p<0.002) but not among the male subjects (RR=1.05 p<0.29). The following variables were significantly associated with mortality among male subjects: problems biting, chewing or swallowing (p<0.01) and medical or other factors affecting or interfering with shopping and cooking (p<0.0002). The following variables were significantly associated with mortality among female subjects: Medical or 7 other conditions interfering with appetite and eating habits (p<0.0 ), eating most meals alone (p < 0.05), taking 3 or more drugs per day (p < 0.0001) and medical or other factors affecting or interfering with shopping and cooking (p<0.0001). Sensitivity and specificity are two measures of the validity of a screening test. The sensitivity of the tool was 39% and 31.2% for males and females, respectively, and the specificity was 70.9% for both sexes. The attributable risk percent which reports the percent of deaths that can be delayed if risk factors are eliminated was 9% and 24.6% for males and females respectively. The results indicate that the NSI checklist is not very sensitive as a screening tool and classifies a large number of people at high nutritional risk. However, the attributable risk percent suggests that the tool when used as an educational instrument could have a major public health impact on the mortality of community-dwelling elderly people.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / A-13
AN EDUCATIONAL MODEL FOR PROMOTING DIETARY ADHERENCE TO A HEART DISEASE REVERSAL PROTOCOL. GD Krag, MA, RD; JC Rogers, DO; D Durbin BAA. Downriver Cardiology Consultants, Trenton, Ml Using the dietary protocol established by Dean Ornish, MD, (10% fat vegetarian) an educational model for heart disease reversal was developed and utilized with patients with coronary artery disease. The purpose was to to evaluate if a group of typical cardiac patients could learn how to follow the regime and if these patients would experience changes in lipids, weight, body fat, and thallium stress tests. The educational model was modified from Dean Omish's Program for Reversing Heart Disease (Random House, 1990) and the Low-fat Eating Plan (JADA,Vol. 90, no. I)The model includes units on counting fat grams, preparing foods, modifying recipes, shopping, eating out, and adjusting to the protocol. The model was taught as part of a total reversal effort including aerobic exercise, yoga, stress control, and group support. Patients did not discontinue medications when starting program. Currently there are 90 patients enrolled in the program. 14 have completed a year or more. Data on these 14 demonstrate a mean weight loss of 14 pounds, a mean cholesterol drop of 16 mg/dl, and no significant change in mean triglycerides or mean high density lipoprotein. Percent body fat decreased by 3 points. Ten of the patients have had repeat thallium stress tests with six demonstrating increased blood flow to the heart muscle, three having the same results as last year, and one having decreased blood flow. Five of the 14 patients initially demonstrated angina. All have experienced cessation based on a total of 41 episodes during the first month to a total of 0 episodes experienced during the 12th month. Results of questionnaires show that patients have an improved sense of well-being, feel they have more stamina, and feel more in control of their disease. To encourage nutritional adequacy, patients were taught tojudge their food records by comparing them to a daily food guide. Food records from the 12th month demonstrated a better balance of foods than those of the first month. Patients kept an average of 37 weekly food records per year. Compliance to the low-fat regime was excellent with most patients consuming less than 10N% of their calories from fat. At 12 months many patients have been able to decrease medications. The majority of patients are from blue collar backgrounds and live in a highly industrialized area near Detroit, MI. All but one of the 14 are continuing to attend the program. The one who is not attending continues to follow the lifestyle changes. This program demonstrates that patients using the model develop the skill and are motivated to follow a strict vegetarian diet. Many experience health benefits in 12 months when following the protocol.
EVALUATING THE NUTRITION SCREENING INITIATIVE CHECKLIST AS A SCREENING AND AN EDUCATIONAL TOOL IN AN ELDERLY POPULATION. N.R. Sahyoun, MS,RD, P.F. Jacques, PhD, and R.M. Russell, MD. USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.
DIFFERENCES IN DIETARY INTAKE ANDHEALTH PERSPECTIVE AMONG NURSES V.J. Wall, PhD, RD, and M.H. Gravely, MS,College of ON SHIFTWORK. Human Resources, Virginia Polytechnic Institute and State University, Blacksburg, VA. Over ten million people in the United States work other than the traditional daytime hours. Most studies of shiftworkers are on blue collar males and focus on health, family life and performance. Few studies include the effect of shiftwork on diets, and even fewer consider the effect on women. This study investigated differences in dietary intakes, meal patterns and health satisfaction among nurses working day (controls), evening, night, and rotating shifts. One hundred eighty full-time subjects, selected from two military and two private hospitals, completed a 24-hour food recall and a detailed survey regarding meal patterns, health satisfaction and work history. Food intakes were calculated using the Nutritionist IV Version 2.0 computer program and average daily intakes of 14 nutrients were compared to the RDA. Food cholesterol and kilocalories from fat were compared to U.S. Dietary Guidelines. Numerical scores were used to derive summated scores on health questions. Analysis of Variance, Multiple Comparison Procedures, Chi-square and T-tests were used with appropriate data variables to determine differences among schedule groups. No significant differences were found among the schedule groups for dietary intake of 14 nutrients, fat, carbohydrate, cholesterol and kilocalories. Each group had intakes of Vitamin D that were significantly lower than the RDA; the Day group had lower calcium, iron and zinc; the Evening group had lower calcium; and the Night and Rotating groups had lower magnesium, iron and zinc. There were somesignificant differences amongthe groups in meal consumption patterns; meannumber of meals per day, meals eaten at work, and time allowed for meats; place meals were eaten; and snack consumption. Usually the experimental groups differed from the controls, but also differed from each other on some behaviors. Significant differences were noted on health perspectives amonggroups with Day shift nurses being most satisfied with effect of schedule on health and the ability to maintain health. Results did not show that diets of shiftworking nurses were less adequate than day nurses; with few exceptions, the four groups were adequate. Day nurses eat more meals each day, consume fewer snacks, and have more time for meals at work than nurses on other schedules. Shiftwork was viewed by the experimental groups as impacting health. Conclusions are that professional groups such as nurses whoare in health care may be more responsive to practices that have adverse affect on health. However, shiftwork negatively affects health satisfaction, maintenance of health, and possibly the participation in activities that impacts behaviors supporting good health.
The Nutrition Screening Initiative(NSI) developed the DETERMINE checklist to identify community-dwelling elderly people at high nutritional risk. The checklist was developed as an awareness and educational tool; however, it is also being used as a screening tool. This study was undertaken to evaluate the checklist as a screening and an educational tool. The Nutritional Status Survey (NSS) which was conducted between 1981 and 1984 and which collected nutrition assessment information was used as the data base for this study. The vital status of the NSS subjects was subsequently collected as of January, 1993. Using Cox's proportional hazard survival analysis modeling, the 10 questions of the checklist were examined individually and as a score using data of 581 NSS subjects with mortality as the outcome variable. The results show that a score of 6 or more representing individuals at high nutritional risk is predictive of mortality among the female subjects (RR=1.12 p<0.002) but not among the male subjects (RR=1.05 p<0.29). The following variables were significantly associated with mortality among male subjects: problems biting, chewing or swallowing (p<0.01) and medical or other factors affecting or interfering with shopping and cooking (p<0.0002). The following variables were significantly associated with mortality among female subjects: Medical or 7 other conditions interfering with appetite and eating habits (p<0.0 ), eating most meals alone (p < 0.05), taking 3 or more drugs per day (p < 0.0001) and medical or other factors affecting or interfering with shopping and cooking (p<0.0001). Sensitivity and specificity are two measures of the validity of a screening test. The sensitivity of the tool was 39% and 31.2% for males and females, respectively, and the specificity was 70.9% for both sexes. The attributable risk percent which reports the percent of deaths that can be delayed if risk factors are eliminated was 9% and 24.6% for males and females respectively. The results indicate that the NSI checklist is not very sensitive as a screening tool and classifies a large number of people at high nutritional risk. However, the attributable risk percent suggests that the tool when used as an educational instrument could have a major public health impact on the mortality of community-dwelling elderly people.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / A-13