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ISSUES INVOLVED WITH NUTRITIONAL ASSESSMENT OF CHILDREN WITH AUTISM
Journal of the American Dietetic Association Online
acceptability among professionals as well as consumers. The current study extends earlier findings by providing a weight management program in groups over the phone to increase efficiency and group support. The telephone program is based on a well-established, structured, clinic-based weight management program (The HMR7® Program for Weight ManagementTM). The program consists of an orientation call, an introductory call, and six weekly telephone group meetings led by an experienced health educator coach. A mid-week check-in initiated by the participant is also required each week. Currently, participants with certain co-morbidities are excluded from joining. In the program, participants are instructed to use a minimum of 5 meal replacements daily (3 shakes, 2 pre-packaged entrees), consume at least 5 servings of vegetables and fruits daily, and do a minimum of 2,000 kcals of physical activity weekly. The average starting weight of all those enrolled was 222.1 lbs (n=33). For those completing the 6-week program (75.8%), the average weight loss was 17.2 lbs. (7.5% of initial body weight), average physical activity kcals were 1,794 per week and average servings of vegetables and fruits were 38.2 per week. Participants continuing in the program for a total of 10 weeks of weight loss lost an average of 21 lbs. (9.52% of initial body weight). A maintenance program is now being offered and longer-term data is being collected. In summary, dietitians and other health professionals can deliver structured telephone coaching efficiently in groups as an option for individuals unable or unwilling to participate in face-to-face weight management treatment. TITLE: ISSUES INVOLVED WITH NUTRITIONAL ASSESSMENT OF CHILDREN WITH AUTISM AUTHOR(S): B.B. Hires, MS, RD; H.W. Forsythe, PhD, RD; Graduate Center for Nutritional Sciences and Department of Nutrition and Food Science, University of Kentucky LEARNING OUTCOME: Assimilate strategies for overcoming limitations in current nutritional assessment practices by developing assessment protocols for children with autism. TEXT: Autism is a neurodevelopmental disorder with three core components of impairment in socialization, impairment in verbal and non-verbal communication, and restrictive and repetitive patterns of behavior. Actual incidence rate of autism in the United States is currently unknown with an estimated rate of 2 to 6 in 1,000 individuals. The etiology of autism has been hypothesized as a genetic disorder or environmental insult. Nutrition has been implicated in autism development through brain studies, and gastrointestinal system research. Nutrition is also a treatment modality for some autistic symptoms. With an increasing incidence rate and proposed nutrition connections, more dietitians will be contacted with referrals for nutritional assessment of children with autism. The core components of autism, direct resulting behaviors expressed in the children, and coexisting medical conditions related to autism can be problematic to conduction of a nutritional assessment. Dietitians must be aware of several factors when counseling a family with a child with autism including: Multiple medications with serious nutritional implications, serious sensory integration issues that make obtaining anthropometric measurements difficult, specialized diet patterns containing foods often not covered in standard dietary analysis software, impaired communication skills that require reliance on parents for information, parental skepticism of traditional nutrition advice when traditional medicine has generally not proven helpful, and parental subscription to multiple sources of medical advice that may provide them with alternative and non-traditional nutritional therapies. This culmination of factors and
http://www2.us.elsevierhealth.com/inst/serve?article=jjada0310309ab01&arttype=full (68 of 117) [3/21/2008 8:45:19 AM]
Journal of the American Dietetic Association Online
practical strategies for nutritional assessment of pediatric patients with autism will be discussed. Ms. Hires is supported by National Institutes of Health Grant #T32DK0778. TITLE: APPLICATION OF THE HOMOCYSTEINE THEORY: A SURVEY OF U.S. CARDIOVASCULAR SPECIALISTS AUTHOR(S): S. Sunna and S.T. Hawkins, PhD, RD, Indiana State University, Terre Haute, IN LEARNING OUTCOME: To determine the application of the homocysteine theory by cardiovascular specialists. TEXT: Cardiovascular disease (CVD) remains the major cause of mortality in the United States. Recent studies have shown that elevated blood homocysteine level is related to a higher risk of CVD. The purpose of this study is to determine the application of the homocysteine theory by cardiovascular specialists. The study surveyed a random sample of 1000 cardiovascular specialists. Results, based on the 137 returned surveys, showed that there were significant correlations between belief in the usefulness of obtaining the blood homocysteine level and frequency of ordering initial (p<0.001) and follow-up homocysteine tests (p<0.001). Physicians who believed B-vitamins help to reduce CVD risk were also those who reported having found that increased intake of those vitamins was associated with lower homocysteine levels (r=0.35; p=0.001). Almost 60% of the physicians rarely or never recommend that patients with elevated homocysteine levels consult a dietitian; however, there were significant correlations between frequency of obtaining a diet history and use of the diet history in combination with blood homocysteine level to assess CVD patients (p<0.001) and also with recommendations to consult a dietitian (p=0.02). There was a negative correlation between physicians' length of time in practice and consultation with a dietitian, with physicians who had spent 20 years referring to dietitians more frequently than did older physicians. In conclusion, the study showed that although there is awareness of the homocysteine theory among U.S. physicians, practical application to nutrition therapy was limited. Patients should benefit from more referrals by physicians to dietitians. TITLE: DIETARY CAROTENOIDS REDUCE PLASMA TOTAL AND LDL CHOLESTEROL CONCENTRATIONS AND LDL OXIDATION AUTHOR(S): M-L. Silaste, MSc, RD; G. Alfthan, PhD; A. Aro, MD, PhD; Y.A. Kesäniemi, MD, PhD; S. Hörkkö, MD, PhD LEARNING OUTCOME: To explore the effects of dietary lycopene and other carotenoids on the plasma lipid concentrations and on the susceptibility of LDL to oxidation. TEXT: Tomato and tomato products are rich in dietary carotenoids, such as lycopene, beta-carotene, and gamma-carotene. Lycopene has a significant antioxidant potential in vitro and may play a role in preventing cardiovascular diseases in humans. We studied the effects of tomato products rich in dietary carotenoids on the plasma lipid concentrations and LDL oxidation in 21 healthy, non-smoking men and women. The subjects followed their habitual diets throughout the study. After the baseline period (2 weeks), they avoided consuming any tomatoes and tomato-foods for 3 weeks (a low tomato diet). After the low tomato diet, they consumed 400 ml of tomato juice and 35 g of tomato ketchup daily http://www2.us.elsevierhealth.com/inst/serve?article=jjada0310309ab01&arttype=full (69 of 117) [3/21/2008 8:45:19 AM]
acceptability among professionals as well as consumers. The current study extends earlier findings by providing a weight management program in groups over the phone to increase efficiency and group support. The telephone program is based on a well-established, structured, clinic-based weight management program (The HMR7® Program for Weight ManagementTM). The program consists of an orientation call, an introductory call, and six weekly telephone group meetings led by an experienced health educator coach. A mid-week check-in initiated by the participant is also required each week. Currently, participants with certain co-morbidities are excluded from joining. In the program, participants are instructed to use a minimum of 5 meal replacements daily (3 shakes, 2 pre-packaged entrees), consume at least 5 servings of vegetables and fruits daily, and do a minimum of 2,000 kcals of physical activity weekly. The average starting weight of all those enrolled was 222.1 lbs (n=33). For those completing the 6-week program (75.8%), the average weight loss was 17.2 lbs. (7.5% of initial body weight), average physical activity kcals were 1,794 per week and average servings of vegetables and fruits were 38.2 per week. Participants continuing in the program for a total of 10 weeks of weight loss lost an average of 21 lbs. (9.52% of initial body weight). A maintenance program is now being offered and longer-term data is being collected. In summary, dietitians and other health professionals can deliver structured telephone coaching efficiently in groups as an option for individuals unable or unwilling to participate in face-to-face weight management treatment. TITLE: ISSUES INVOLVED WITH NUTRITIONAL ASSESSMENT OF CHILDREN WITH AUTISM AUTHOR(S): B.B. Hires, MS, RD; H.W. Forsythe, PhD, RD; Graduate Center for Nutritional Sciences and Department of Nutrition and Food Science, University of Kentucky LEARNING OUTCOME: Assimilate strategies for overcoming limitations in current nutritional assessment practices by developing assessment protocols for children with autism. TEXT: Autism is a neurodevelopmental disorder with three core components of impairment in socialization, impairment in verbal and non-verbal communication, and restrictive and repetitive patterns of behavior. Actual incidence rate of autism in the United States is currently unknown with an estimated rate of 2 to 6 in 1,000 individuals. The etiology of autism has been hypothesized as a genetic disorder or environmental insult. Nutrition has been implicated in autism development through brain studies, and gastrointestinal system research. Nutrition is also a treatment modality for some autistic symptoms. With an increasing incidence rate and proposed nutrition connections, more dietitians will be contacted with referrals for nutritional assessment of children with autism. The core components of autism, direct resulting behaviors expressed in the children, and coexisting medical conditions related to autism can be problematic to conduction of a nutritional assessment. Dietitians must be aware of several factors when counseling a family with a child with autism including: Multiple medications with serious nutritional implications, serious sensory integration issues that make obtaining anthropometric measurements difficult, specialized diet patterns containing foods often not covered in standard dietary analysis software, impaired communication skills that require reliance on parents for information, parental skepticism of traditional nutrition advice when traditional medicine has generally not proven helpful, and parental subscription to multiple sources of medical advice that may provide them with alternative and non-traditional nutritional therapies. This culmination of factors and
http://www2.us.elsevierhealth.com/inst/serve?article=jjada0310309ab01&arttype=full (68 of 117) [3/21/2008 8:45:19 AM]
Journal of the American Dietetic Association Online
practical strategies for nutritional assessment of pediatric patients with autism will be discussed. Ms. Hires is supported by National Institutes of Health Grant #T32DK0778. TITLE: APPLICATION OF THE HOMOCYSTEINE THEORY: A SURVEY OF U.S. CARDIOVASCULAR SPECIALISTS AUTHOR(S): S. Sunna and S.T. Hawkins, PhD, RD, Indiana State University, Terre Haute, IN LEARNING OUTCOME: To determine the application of the homocysteine theory by cardiovascular specialists. TEXT: Cardiovascular disease (CVD) remains the major cause of mortality in the United States. Recent studies have shown that elevated blood homocysteine level is related to a higher risk of CVD. The purpose of this study is to determine the application of the homocysteine theory by cardiovascular specialists. The study surveyed a random sample of 1000 cardiovascular specialists. Results, based on the 137 returned surveys, showed that there were significant correlations between belief in the usefulness of obtaining the blood homocysteine level and frequency of ordering initial (p<0.001) and follow-up homocysteine tests (p<0.001). Physicians who believed B-vitamins help to reduce CVD risk were also those who reported having found that increased intake of those vitamins was associated with lower homocysteine levels (r=0.35; p=0.001). Almost 60% of the physicians rarely or never recommend that patients with elevated homocysteine levels consult a dietitian; however, there were significant correlations between frequency of obtaining a diet history and use of the diet history in combination with blood homocysteine level to assess CVD patients (p<0.001) and also with recommendations to consult a dietitian (p=0.02). There was a negative correlation between physicians' length of time in practice and consultation with a dietitian, with physicians who had spent 20 years referring to dietitians more frequently than did older physicians. In conclusion, the study showed that although there is awareness of the homocysteine theory among U.S. physicians, practical application to nutrition therapy was limited. Patients should benefit from more referrals by physicians to dietitians. TITLE: DIETARY CAROTENOIDS REDUCE PLASMA TOTAL AND LDL CHOLESTEROL CONCENTRATIONS AND LDL OXIDATION AUTHOR(S): M-L. Silaste, MSc, RD; G. Alfthan, PhD; A. Aro, MD, PhD; Y.A. Kesäniemi, MD, PhD; S. Hörkkö, MD, PhD LEARNING OUTCOME: To explore the effects of dietary lycopene and other carotenoids on the plasma lipid concentrations and on the susceptibility of LDL to oxidation. TEXT: Tomato and tomato products are rich in dietary carotenoids, such as lycopene, beta-carotene, and gamma-carotene. Lycopene has a significant antioxidant potential in vitro and may play a role in preventing cardiovascular diseases in humans. We studied the effects of tomato products rich in dietary carotenoids on the plasma lipid concentrations and LDL oxidation in 21 healthy, non-smoking men and women. The subjects followed their habitual diets throughout the study. After the baseline period (2 weeks), they avoided consuming any tomatoes and tomato-foods for 3 weeks (a low tomato diet). After the low tomato diet, they consumed 400 ml of tomato juice and 35 g of tomato ketchup daily http://www2.us.elsevierhealth.com/inst/serve?article=jjada0310309ab01&arttype=full (69 of 117) [3/21/2008 8:45:19 AM]