- Email: [email protected]
Obesity in Adults Diagnosed with Type 2 Diabetes Mellitus, Lilongwe, Malawi
SUNDAY, OCTOBER 22
Poster Session: Professional Skills; Nutrition Assessment & Diagnosis; Medical Nutrition Therapy Feasibility of a Televideo Nutrition and Physical Activity Intervention for Adult Survivors of Childhood Cancer
Frequency of Capillary Blood Glucose (CBG) Testing for Adult Hospitalized Patients on Total Parenteral Nutrition (TPN): A Pilot Study
Author(s): C. Gibson1, J.L. Greene2, B. Lowry1, J. Lee3, R. Mount1, K. Alsman1, D. Sullivan4; 1 University of Kansas Medical Center, 2University of Kansas- Lawrence, 3Texas Tech University, 4Department of Dietetics and Nutrition, University of Kansas Medical Center
Author(s): C. Rohrmann1, J. Dellatte2, A. Loveless3, C. Gruss4, N. Rennert3; 1Morrison Healthcare/Norwalk Hospital, 2WCHN Internship, 3Western Connecticut Health NetworkNorwalk Hospital, 4Western Connecticut Medical Group
Learning Outcome: To describe the feasibility of an in-home televideo lifestyle health
Learning Outcome: To enhance safety practices surrounding glycemic control and glucose monitoring for adult hospitalized patients on total parenteral nutrition.
coaching intervention for adult survivors of childhood cancer.
Introduction: Adult survivors of childhood cancer are a rapidly growing patient population who are at life-long risk for secondary cancers and chronic disease but do not engage in healthy lifestyle behaviors at optimal rates. The purpose of this study was to test the feasibility of interactive in-home televideo health coaching to improve healthy eating and physical activity (PA) levels.
Methods: A 24 week randomized controlled feasibility trial was conducted with 16 survivors (13 female; mean age 3010.0 years). The intervention group (n¼7) participated in weekly 1-hour televideo health coaching sessions with a registered dietitian and adaptive PA expert for 12 weeks followed by 12 weeks of maintenance. The enhanced usual care group (n¼9) had access to written healthy lifestyle materials with no coaching. Survivors tracked healthy lifestyle behaviors (fruit, vegetable, whole grain, and water intake, PA minutes (min) and steps) and reported weekly for 24 weeks.
Results: All survivors completed the study with no dropouts and 100% compliance to weekly reporting and attendance at health coaching sessions. At week 12, the intervention group consumed significantly more fruit and vegetable servings (svg) compared to the usual care group (3.46 vs 2.62 svg; p¼0.029; Cohen’s d¼1.22) and sustained this change at week 24 (3.75 vs 2.58 svg; p¼ 0.012; Cohen’s d¼1.46). The intervention group also significantly increased their PA min from baseline to 24 weeks compared to the usual care group (41.46 vs 27.78 min; p¼0.025; Cohen’s d¼1.27).
Background: Hyperglycemia commonly occurs with TPN use and is associated with increased morbidity and mortality. CBG measurement is performed to monitor glycemic control and guide insulin use. However, no published guidelines exist for the frequency of testing. Often there is significant variability in timing of CBG testing during TPN once glucose has stabilized. We developed an electronic care set to standardize this process. We report our preliminary findings and recommendations for patients on TPN >36 hours. Methods: Our community teaching hospital’s Nutrition Committee developed an electronic care set with CBG Q6 hours while on TPN. We retrospectively reviewed 16 adults (5/ 16 with Type 2 diabetes and 1/16 critically ill) on TPN for > 36 hours. Hyperglycemia was defined as >180 mg/dL, consistent with published guidelines. Results: During the first 36 hours, most patients were on coverage insulin (none on standing doses). After 36 hours of TPN (range >36 hourse29 days), 6/16 had at least one episode of hyperglycemia. However, 4/6 had only one high value (range 185-225 mg/dL) and the other 2, both with diabetes, 1 of which was critically ill, had multiple high values which accounted for 90% of hyperglycemic events. Overall, after 36 hours, 88% of CBGs were <180 mg/dL and no hypoglycemia occurred. Conclusion: After 36 hours of TPN, we recommend decreasing testing to twice a day (AM
Conclusion: Results indicate televideo health coaching is feasible and encourages improvements in healthy eating habits and physical activity in survivors. Further investigation involving a larger sample and longer time period is being pursued.
serum glucose and CBG 12 hours later) in patients without preexisting diabetes and those stable medically. This may not be appropriate for the critically ill, those with stress hyperglycemia or those on medications that affect glucose metabolism. Reducing testing could decrease patient discomfort, staff workload and cost. Next steps include further data collection and revising our care set.
Funding Disclosure: The University of Kansas Cancer Center
Funding Disclosure: None
Food consumption and Overweight/ Obesity in Adults Diagnosed with Type 2 Diabetes Mellitus, Lilongwe, Malawi
Healthy Eating is a Family Affair: Family-Focused Nutrition Education Intervention Improves Child Eating Habits
Author(s): G. Mphwanthe1, F. Mtande2, L. Weatherspoon3; 1Michigan State University, 2Ministry of Health, Kamuzu Central Hospital, Malawi, 3 Michigan State University Department of Food Science and Human Nutrition
Author(s): B. Hannon, E. Villegas, V. Luna, A. Wiley, M. Teran-Garcia; University of Illinois at Urbana-Champaign
Learning Outcome: To determine dietary behavior and overweight/obesity associations among adults with type 2 diabetes mellitus (T2DM) in Malawi. Type 2 diabetes mellitus (T2DM) is a non-communicable disease of growing concern in Malawi. Healthy dietary behaviors and weight are critical for glycemic control (GC). To determine dietary behavior and overweight/obesity associations among adults with T2DM in Malawi, a cross-sectional study was conducted from September to October 2015 at Kamuzu Central hospital in Lilongwe. Demographic characteristics, the frequency of food consumption, physical activity level (PAL), and anthropometric measurements were collected from a convenience sample (N¼63) of adults diagnosed with T2DM via a structured interview. Data analysis included descriptive statistics, simple and multiple linear regression. Results showed frequently consumed foods were thick maize porridge (nsima) (95.2%) and green leafy vegetables (77.8%) at least two to three times a day. Protein rich foods such as fish (46%) and beans (31.7%) were consumed at least two to four times a week. Overall, 73% of respondents were overweight or obese. Overweight or obesity was significantly (p¼0.004) higher in females than males. Interestingly, education status was significantly and positively associated with overweight or obesity. In addition, about 58.7% of the overweight and obese respondents were physically active. PAL was negatively related to overweight or obesity, but not significant. Findings warrant more in-depth dietary assessment in this target population to better elucidate how nutritionists/dietitians in Malawi can help to inform food and nutrition policies and T2DM dietary interventions. It also forms a basis for a larger study to assess if and how dietary patterns and social environmental factors are associated with GC in Malawi. Funding Disclosure: Lilongwe University of Agriculture and Natural Resources (LUANAR), Department of Human Nutrition and Health
September 2017 Suppl 1—Abstracts Volume 117 Number 9
Learning Outcome: The objective of this study was to quantify the dietary changes that were made by participants enrolled in a family-focused nutrition education intervention to assess efficacy of the program. Hispanic children are at greater risk for obesity, in part due to poor dietary habits. Educational interventions for Hispanics have been successful in changing dietary habits if the whole family is targeted, due to the value Hispanic culture places on family and social interaction. Abriendo Caminos (AC2) is a multistate randomized intervention/control behavioral intervention program to prevent childhood obesity through family-targeted workshops and hands-on activities to promote healthy food choices. Mother-child dyads (n¼36) from the Illinois cohort with complete data are reported here. Surveys were collected at baseline (T0) before randomization, and postintervention (T1). The intervention consisted of two-hour classes for six weeks, where families learned about nutrition through interactive workshops combining lectures, games for children, and food demonstrations using traditional Hispanic foods. At baseline, 43% of all children, regardless of treatment group, consumed one or more sugar-sweetened beverages (SSB) a day. Children in the intervention group (n¼17) significantly decreased intake of SSB at T1 (p¼0.021), with 47% reporting not consuming any SSB in the past week, in contrast to the control group (n¼19). Although not significant, children in the intervention group also decreased the frequency of consumption at fast-food restaurants. Poor dietary choices, including SSB intake and fast food consumption, contribute to increasing childhood obesity rates. The AC2 intervention reduced incidence of obesogenic behaviors, an effect not seen in the control group. The hands-on learning activities, combined with inclusion of Hispanic culture, produced a culturally-tailored program that proved to be effective in improving child diet. Funding Disclosure: This research was supported by Agriculture and Food Research Initiative Competitive Grant no. 2015-68001-23248 from the USDA National Institute of Food and Agriculture.
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-25
Poster Session: Professional Skills; Nutrition Assessment & Diagnosis; Medical Nutrition Therapy Feasibility of a Televideo Nutrition and Physical Activity Intervention for Adult Survivors of Childhood Cancer
Frequency of Capillary Blood Glucose (CBG) Testing for Adult Hospitalized Patients on Total Parenteral Nutrition (TPN): A Pilot Study
Author(s): C. Gibson1, J.L. Greene2, B. Lowry1, J. Lee3, R. Mount1, K. Alsman1, D. Sullivan4; 1 University of Kansas Medical Center, 2University of Kansas- Lawrence, 3Texas Tech University, 4Department of Dietetics and Nutrition, University of Kansas Medical Center
Author(s): C. Rohrmann1, J. Dellatte2, A. Loveless3, C. Gruss4, N. Rennert3; 1Morrison Healthcare/Norwalk Hospital, 2WCHN Internship, 3Western Connecticut Health NetworkNorwalk Hospital, 4Western Connecticut Medical Group
Learning Outcome: To describe the feasibility of an in-home televideo lifestyle health
Learning Outcome: To enhance safety practices surrounding glycemic control and glucose monitoring for adult hospitalized patients on total parenteral nutrition.
coaching intervention for adult survivors of childhood cancer.
Introduction: Adult survivors of childhood cancer are a rapidly growing patient population who are at life-long risk for secondary cancers and chronic disease but do not engage in healthy lifestyle behaviors at optimal rates. The purpose of this study was to test the feasibility of interactive in-home televideo health coaching to improve healthy eating and physical activity (PA) levels.
Methods: A 24 week randomized controlled feasibility trial was conducted with 16 survivors (13 female; mean age 3010.0 years). The intervention group (n¼7) participated in weekly 1-hour televideo health coaching sessions with a registered dietitian and adaptive PA expert for 12 weeks followed by 12 weeks of maintenance. The enhanced usual care group (n¼9) had access to written healthy lifestyle materials with no coaching. Survivors tracked healthy lifestyle behaviors (fruit, vegetable, whole grain, and water intake, PA minutes (min) and steps) and reported weekly for 24 weeks.
Results: All survivors completed the study with no dropouts and 100% compliance to weekly reporting and attendance at health coaching sessions. At week 12, the intervention group consumed significantly more fruit and vegetable servings (svg) compared to the usual care group (3.46 vs 2.62 svg; p¼0.029; Cohen’s d¼1.22) and sustained this change at week 24 (3.75 vs 2.58 svg; p¼ 0.012; Cohen’s d¼1.46). The intervention group also significantly increased their PA min from baseline to 24 weeks compared to the usual care group (41.46 vs 27.78 min; p¼0.025; Cohen’s d¼1.27).
Background: Hyperglycemia commonly occurs with TPN use and is associated with increased morbidity and mortality. CBG measurement is performed to monitor glycemic control and guide insulin use. However, no published guidelines exist for the frequency of testing. Often there is significant variability in timing of CBG testing during TPN once glucose has stabilized. We developed an electronic care set to standardize this process. We report our preliminary findings and recommendations for patients on TPN >36 hours. Methods: Our community teaching hospital’s Nutrition Committee developed an electronic care set with CBG Q6 hours while on TPN. We retrospectively reviewed 16 adults (5/ 16 with Type 2 diabetes and 1/16 critically ill) on TPN for > 36 hours. Hyperglycemia was defined as >180 mg/dL, consistent with published guidelines. Results: During the first 36 hours, most patients were on coverage insulin (none on standing doses). After 36 hours of TPN (range >36 hourse29 days), 6/16 had at least one episode of hyperglycemia. However, 4/6 had only one high value (range 185-225 mg/dL) and the other 2, both with diabetes, 1 of which was critically ill, had multiple high values which accounted for 90% of hyperglycemic events. Overall, after 36 hours, 88% of CBGs were <180 mg/dL and no hypoglycemia occurred. Conclusion: After 36 hours of TPN, we recommend decreasing testing to twice a day (AM
Conclusion: Results indicate televideo health coaching is feasible and encourages improvements in healthy eating habits and physical activity in survivors. Further investigation involving a larger sample and longer time period is being pursued.
serum glucose and CBG 12 hours later) in patients without preexisting diabetes and those stable medically. This may not be appropriate for the critically ill, those with stress hyperglycemia or those on medications that affect glucose metabolism. Reducing testing could decrease patient discomfort, staff workload and cost. Next steps include further data collection and revising our care set.
Funding Disclosure: The University of Kansas Cancer Center
Funding Disclosure: None
Food consumption and Overweight/ Obesity in Adults Diagnosed with Type 2 Diabetes Mellitus, Lilongwe, Malawi
Healthy Eating is a Family Affair: Family-Focused Nutrition Education Intervention Improves Child Eating Habits
Author(s): G. Mphwanthe1, F. Mtande2, L. Weatherspoon3; 1Michigan State University, 2Ministry of Health, Kamuzu Central Hospital, Malawi, 3 Michigan State University Department of Food Science and Human Nutrition
Author(s): B. Hannon, E. Villegas, V. Luna, A. Wiley, M. Teran-Garcia; University of Illinois at Urbana-Champaign
Learning Outcome: To determine dietary behavior and overweight/obesity associations among adults with type 2 diabetes mellitus (T2DM) in Malawi. Type 2 diabetes mellitus (T2DM) is a non-communicable disease of growing concern in Malawi. Healthy dietary behaviors and weight are critical for glycemic control (GC). To determine dietary behavior and overweight/obesity associations among adults with T2DM in Malawi, a cross-sectional study was conducted from September to October 2015 at Kamuzu Central hospital in Lilongwe. Demographic characteristics, the frequency of food consumption, physical activity level (PAL), and anthropometric measurements were collected from a convenience sample (N¼63) of adults diagnosed with T2DM via a structured interview. Data analysis included descriptive statistics, simple and multiple linear regression. Results showed frequently consumed foods were thick maize porridge (nsima) (95.2%) and green leafy vegetables (77.8%) at least two to three times a day. Protein rich foods such as fish (46%) and beans (31.7%) were consumed at least two to four times a week. Overall, 73% of respondents were overweight or obese. Overweight or obesity was significantly (p¼0.004) higher in females than males. Interestingly, education status was significantly and positively associated with overweight or obesity. In addition, about 58.7% of the overweight and obese respondents were physically active. PAL was negatively related to overweight or obesity, but not significant. Findings warrant more in-depth dietary assessment in this target population to better elucidate how nutritionists/dietitians in Malawi can help to inform food and nutrition policies and T2DM dietary interventions. It also forms a basis for a larger study to assess if and how dietary patterns and social environmental factors are associated with GC in Malawi. Funding Disclosure: Lilongwe University of Agriculture and Natural Resources (LUANAR), Department of Human Nutrition and Health
September 2017 Suppl 1—Abstracts Volume 117 Number 9
Learning Outcome: The objective of this study was to quantify the dietary changes that were made by participants enrolled in a family-focused nutrition education intervention to assess efficacy of the program. Hispanic children are at greater risk for obesity, in part due to poor dietary habits. Educational interventions for Hispanics have been successful in changing dietary habits if the whole family is targeted, due to the value Hispanic culture places on family and social interaction. Abriendo Caminos (AC2) is a multistate randomized intervention/control behavioral intervention program to prevent childhood obesity through family-targeted workshops and hands-on activities to promote healthy food choices. Mother-child dyads (n¼36) from the Illinois cohort with complete data are reported here. Surveys were collected at baseline (T0) before randomization, and postintervention (T1). The intervention consisted of two-hour classes for six weeks, where families learned about nutrition through interactive workshops combining lectures, games for children, and food demonstrations using traditional Hispanic foods. At baseline, 43% of all children, regardless of treatment group, consumed one or more sugar-sweetened beverages (SSB) a day. Children in the intervention group (n¼17) significantly decreased intake of SSB at T1 (p¼0.021), with 47% reporting not consuming any SSB in the past week, in contrast to the control group (n¼19). Although not significant, children in the intervention group also decreased the frequency of consumption at fast-food restaurants. Poor dietary choices, including SSB intake and fast food consumption, contribute to increasing childhood obesity rates. The AC2 intervention reduced incidence of obesogenic behaviors, an effect not seen in the control group. The hands-on learning activities, combined with inclusion of Hispanic culture, produced a culturally-tailored program that proved to be effective in improving child diet. Funding Disclosure: This research was supported by Agriculture and Food Research Initiative Competitive Grant no. 2015-68001-23248 from the USDA National Institute of Food and Agriculture.
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-25