Incorporating Practice-Based Research into Dietetic Internship Curriculum

Incorporating Practice-Based Research into Dietetic Internship Curriculum

SUNDAY, OCTOBER 18 POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY Comparison Between Measured and Predicted Res...

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SUNDAY, OCTOBER 18

POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY Comparison Between Measured and Predicted Resting Metabolic Rate in Healthy College Adults Author(s): N. S. Sadat,1 D. J. Handu,1 C. Broeder2; 1Nutrition, Benedictine University, Lisle, IL, 2Clinical Exercise Physiology, Benedictine University, Lisle, IL Learning Outcome: To demonstrate how Calorie intake prediction equations correlate with measured resting metabolic rate. Objective: To compare measured resting metabolic rate (mRMR) and RMR prediction equations, through testing the frequency and degree of difference between measured and predicted RMR. Study Design: This study concentrated on measuring RMR (measured 2 times on each subject) through three different techniques. Measured RMR was correlated to RMR calculated by prediction equations (Harris Benedict, Mifflin, Owen and WHO equations). Outcome Measures: RMR, weight, height, body fat%, and body mass index (BMI). Subjects: 20 graduate student volunteers from Universities in the Chicagoland area. Statistical Analysis: Pearson correlations, Paired Samples T test were conducted to study the relationship between mRMR and predicting equations. Bland-Altman plots were conducted to see agreement between two methods. Results: Paired t-test findings indicated a significant difference in mean mRMR and predicted RMR from all the equations (p⬍.05), however a significant correlation was found between mRMR and all prediction equations (p⬍.01). Bland-Altman plot revealed large intra-individual differences though most of the data points fell within ⫾2SD. According to Owen, 15 subjects fell within 10% of mRMR where as only 10 subjects fell within 10% mRMR by Mifflin and HB. Conclusion: This study demonstrates that overall the equation that had the most ease of use is the HB equation, but users need to keep in mind that this prediction equation consistently overestimates caloric intake. Mifflin predicts caloric intake better than HB and can be used with ease. Calorie requirements from Owen are the closest to mRMR followed by WHO, but their use is limited due to lengthy formulas.

Resting Energy Expenditure in Amyotrophic Lateral Sclerosis Author(s): A. C. Ellis,1 J. Rosenfeld2; 1Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, 2Neurology, University of California at San Francisco, Fresno, CA Learning Outcome: Participants will be able to identify appropriate prediction equations to estimate resting energy expenditure in Amyotrophic Lateral Sclerosis. Background: The purpose of this study was to compare measured resting energy expenditure (REE) with estimates from 3 common prediction equations with the goal of determining which equation best estimates REE in Amyotrophic Lateral Sclerosis (ALS). Methods: In 56 men and women with ALS, REE measured by indirect calorimetry was compared to calculations from the Harris Benedict, Mifflin-St. Jeor, and Ireton-Jones equations. Additional measurements included pulmonary function testing, fat-free mass (FFM) by bioelectrical impedance, and anthropometrics. Pearson correlations, paired t-tests, and Bland Altman plots were used to compare measured REE with predictions from each equation, and multiple linear regression was used to determine the best predictor variables for REE. Results: Neither ventilator status nor measures of pulmonary function were associated with measured REE, but the strongest predictors of REE were FFM (p ⬍ 0.001), sex (p ⫽ 0.002), and age (p ⫽ 0.016). REE from each equation was significantly correlated with measured REE (p ⬍ 0.001); however, Bland Altman plots demonstrated better agreement for the Harris Benedict and Mifflin St. Jeor equations than for the IretonJones equation. Paired t-tests confirmed that the Ireton-Jones equation over-estimated REE by an average of 171 kilocalories (p ⬍ 0.001). Conclusions: Future studies are needed to develop equations specific to ALS. At present, clinicians should select equations that incorporate sex and age as predictor variables, such as the Harris Benedict and Mifflin St. Jeor equations, rather than the Ireton-Jones equation that considers ventilator status as a predictor. Funding Disclosure: The Amyotrophic Lateral Sclerosis Association (ALSA).

Funding Disclosure: None

Incorporating Practice-Based Research into Dietetic Internship Curriculum Author(s): M. Hunsberger, T. Ryan-Borchers; Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR Learning Outcome: To describe how mentored research projects can be implemented into dietetic internships to meet established research competencies. Purpose: Dietetic education requires that dietetic interns are competent in scientific and evidenced-based practice upon completion of their internship. Competencies include the integration of scientific information and research into practice; the selection of appropriate indicators and measures; application of evidence-based guidelines; evaluation of emerging research; and the ability to conduct research projects using appropriate research methods, ethical procedures and statistical analysis. Setting: A large university-based dietetic internship with diverse community partners. Unique Characteristics of the Program: Students are given the opportunity to practice research skills with community partners. Students were introduced to research through a didactic research intensive course. This course covered research basics including: an introduction to research in dietetics; quantitative and qualitative research methods; and the internal review board process. After this introduction students were exposed to research mentors working in a wide variety of areas including: public health, clinical, research, and food service. Characteristics of Subjects Involved: Eighteen dietetic interns worked in pairs with nine mentors. Mentors included both current preceptors and community partners. Projects included a food frequency validation study, planning and recipe development for a dietary study with bionutritionists; investigation of the effectiveness of probiotics in the critical care setting; evaluation of menu-labeling requirements with the county public health department; and implementation of a dietetic intern-preceptor collaborative model to facilitate utilization of standardized language in clinical documentation. Evaluation: Projects culminate with student poster presentations at a district dietetic association meeting.

Oral Cholecalciferol Supplements Result in Improvement of Serum 25 Hydroxy Vitamin D Levels in Obese Hemodialysis Subjects Author(s): T. Jackson,1 L. Bollman,1 M. Boylan,1 L. Clement,2 S. Ahuja,1 C. Chen,3 J. Spallholz1; 1Nutritional Sciences, Texas Tech University, Lubbock, TX, 2South Plains Kidney Disease Center, Lubbock, TX, 3Pathology, Texas Tech University Health Sciences Center, Lubbock, TX Learning Outcome: After reviewing this poster, the participant should understand that oral cholecalciferol can be used to improve vitamin D status in obese hemodialysis subjects. Purpose: Below optimal serum 25 hydroxy (OH) D levels are common in hemodialysis (HD) and obese subjects. The purpose of this study was to evaluate the efficacy of an oral daily dose of cholecalciferol in improving serum 25 (OH) D levels in obese HD subjects with initial values below the 30 ng/mL level recommended by the National Kidney Foundation Clinical Practice Guidelines. Methods: Subjects were 32 obese (Body Mass Index⬎ 30) HD patients with baseline serum 25 (OH) D levels below 30 ng/mL. Subjects were instructed to take one tablet daily containing 1000 IU cholecalciferol (vitamin D3) and vitamin D levels were retested after 20 weeks of supplementation. Laboratory test results were obtained from the subjects’ medical records. Paired t tests were used to determine if pre- and post supplementation values were significantly different (p⬍0.05). Results: The mean serum 25 (OH) D level was 17.4⫾8.5 ng/mL at baseline. After supplementation the mean serum 25 (OH) D level rose to a significantly (p⬍0.0001) higher value of 41.3⫾18.2 ng/ mL. There was no significant difference in the serum phosphorus (pre-5.4⫾1.3mg/dL; post-5.7⫾1.4 mg/dL ) and there was a slight but significant decrease in serum calcium (pre-9.4⫾0.4 mg/dL; post9.1⫾0.6 mg/dL) after supplementation.

Proposed Use: Other dietetic internships may benefit from implementing mentored research projects.

Conclusion: Oral supplementation with cholecalciferol results in improvement of serum 25 (OH) D levels in obese HD subjects with initial values at less than optimal levels without causing elevation of serum phosphorus or calcium levels.

Funding Disclosure: None

Funding Disclosure: None

Journal of the AMERICAN DIETETIC ASSOCIATION / A-23