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Medical Nutrition Therapy (MNT) for Pre-Diabetes Can Prevent or Delay Type 2 Diabetes
SUNDAY, SEPTEMBER 17
POSTER SESSION: PROFESSIONAL SKILLS/NUTRITION ASSESSMENT/MEDICAL NUTRITION THERAPY TITLE: HOW EFFECTIVE ARE WE AS DIETITIANS? AUTHOR(S): S.M. McGinley, MBA, RD, LDN; J. Tomesko, MS, RD, CNSD; L.B. Resurreccion, MS, RD, LDN, CNSD; C. DiamondGottlieb, RD LEARNING OUTCOME: To understand the effect and magnitude implementation barriers have on the nutrition care plan for hospitalized patients. TEXT: Registered Dietitians working in acute care hospitals lack the authority to initiate care plans developed for patients at nutrition risk. Regulations requiring a physician’s orders to provide nutritional interventions are a barrier leaving patients under-treated. Too often the patient’s care plan remains a recommendation awaiting a physician order. Systems created in past eras need to be updated to reflect the changing face of health care. Medical nutrition therapy is a glaring example of where the process is out of alignment. The scientific literature is filled with evidence that nutritional care during hospitalization reduces complications and enables the patient to better respond to other medical treatments. A preliminary retrospective, multi-centered closed chart review was conducted to quantify the percentages of recommendations initiated by RDs and physicians and those that were never implemented. The sample size included 269 records of patients discharged during January and February 2005 in 13 hospitals. Overall 65.2% of RD recommendations were implemented by either physicians or RDs. The top recommendations initiated by physicians were enteral 70%, swallowing evaluations 65%, and parenteral nutrition 62%. Medications were least likely to be initiated at 44%. At best when considering RD and Physician implementation supplements were 93%, enteral 73%, swallowing evaluations 65%, parenteral and diet orders 63% of the time. The R.D.’s nutrition care plan is almost completely dependent on the physician’s decision to implement it. A larger study is currently in progress and will evaluate the timeliness of the recommendations that are implemented. FUNDING DISCLOSURE: None received
TITLE: ADHERENCE TO THE AMERICAN HEART ASSOCIATION DIETARY GUIDELINES BY INDIVIDUALS LIVING WITH HIV INFECTION AUTHOR(S): K.M. Hendricks, DSc, RD; J.E. Barrentine, BS; R.F. Houser, PhD; C.A. Wanke, M.D.; Tufts University School of Medicine, Frances Stern Nutrition Center, New England Medical Center, School of Nutrition Science and Policy Tufts University, Boston MA LEARNING OUTCOME: To understand the importance of educating individuals living with HIV infection on the need to follow dietary guidelines for the reduction of coronary heart disease risk. TEXT: In the era of highly active antiretroviral therapy (HAART), the nutrition profile of individuals living with HIV infection frequently includes dyslipidemia and insulin resistance, increasing the risk for coronary heart disease (CHD). This study examined the diet of HIV infected individuals (n⫽287) for adherence to the American Heart Association (AHA) dietary guidelines. Three-day food records were analyzed using the Nutrition Data System. Almost half (47%) of the cohort did not meet a single AHA guideline, 7.7% met the sodium guideline, 9.1% met the fiber guideline, 20.6% and 24.7% met the total fat and saturated fat guidelines, and 35.5% met the cholesterol guideline. The mean percentage of calories from total fat was 35.3% and saturated fat 12.2%. Average cholesterol intake for men was 437.8 mg and for women was 329.5 mg. Mean fiber intake was 21.1 grams for men and 15.1 grams for women. Conditional logistic regression analysis found being female was significantly positively associated with following the cholesterol, fiber, and sodium guidelines (p⬍.05 for all). Being a college graduate was positively associated with following the cholesterol guideline (p⬍.05). Negative associations were found between smoking and following the saturated fat guideline and between poverty and following the fiber guideline (p⬍.05). A number of characteristics were inconsistent with expected findings including mode of HIV transmission, being nonwhite and being classified as hungry. Dietary improvements are needed for many individuals living with HIV. Individuals with HIV need education about the importance of diet for CHD prevention. FUNDING DISCLOSURE: None
TITLE: MEDICAL NUTRITION THERAPY (MNT) FOR PREDIABETES CAN PREVENT OR DELAY TYPE 2 DIABETES AUTHOR(S): E.C. Bonometti, MS, RD, LD, CDE LEARNING OUTCOME: To understand the impact of early nutrition and lifestyle education for the person diagnosed with prediabetes in preventing or delaying the onset of type 2 diabetes. TEXT: As compared with the estimated 10.8 million people with diabetes, there are 41 million people with pre-diabetes in the US. The Diabetes Prevention Program revealed a 58% reduction in the progression to diabetes for individuals with glucose intolerance that made modest lifestyle changes in weight loss and increased activity. In a primary care setting, group and follow-up individual instruction on lifestyle management of pre-diabetes was provided to adult patients, with fasting blood glucose levels between 100-125 mg/dL. The initial group instruction provided two hours of information that included: risk reduction, increasing physical activity, weight management and meal planning. Individualized counseling was offered after group instruction. For six months, an average of 10-15 patients per month attended the class session, and 40-50% of class attendees received individualized follow-up counseling. Hemoglobin A1c and weight were tracked at the onset of instruction and at three months and one year after the initial instruction. Groups identified for comparison purposes included patients attending class and individual instruction and patients attending class instruction only. For the group receiving class and individualized counseling, 88% had a reduction or stabilization in HgbA1c and 83% had reduced weight by 2-10 pounds or maintained a healthy weight. For the group receiving class instruction only, 50% showed a reduction or stabilization of HgbA1c and 66% had reduced weight by 2-10 pounds or maintained a healthy weight. The benefit of MNT is clearly indicated in this preliminary data analysis of individuals receiving initial counseling or initial plus individualized follow-up counseling for pre-diabetes. FUNDING DISCLOSURE: None
A-30 / August 2006 Suppl 2—Abstracts Volume 106 Number 8
TITLE: CHANGE IN WEIGHT AND OTHER ANTHROPOMETRIC MEASURES AMONG FRESHMEN DURING THEIR FIRST SEMESTER OF COLLEGE AT UTAH STATE UNIVERSITY AUTHOR(S): H.J. Wengreen, RD, PhD; C. Moncur, RD; M.A. Austin; Department of Nutrition and Food Sciences, Utah State University, Logan, UT LEARNING OUTCOME: To identify the first year of college as a period of time when obesity prevention strategies may decrease risk of obesity and related health problems later in life. TEXT: College freshmen face drastic changes in environment and circumstance that may impact behavior related to risk for obesity. The objective of this study was to track changes in weight, height, BMI, % body fat, blood pressure, waist and hip circumference among freshmen during their first semester of college. In addition, associations between environmental factors and incidence of overweight/obesity or weight gain were examined. College freshmen were recruited to participate in the study during the summer of 2005. During the first week of the 2005 fall semester 67 men and 118 women completed a detailed risk factor survey and were weighed and measured. Participants completed a second survey and were reweighed and measured during the last two weeks of the same semester. 25% of men and 18% of women had BMI’s ⱖ 25 at the beginning of fall semester and were classified as overweight/obese. Positive correlations were observed between BMI and body weight, waist and hip circumference, % body fat, and systolic blood pressure (p ⱕ 0.023). 36% (n⫽54) of participants gained more than 2 kg during fall semester (average amount gained ⫽ 3.8 kg). Among men, being overweight/obese at baseline was associated with first semester weight gain (p⫽0.005); no similar association was observed among women. Weight gain during the first semester of college may be associated with identifiable and in some cases modifiable risk factors. Strategies aimed at preventing overweight/obesity and weight gain among college Freshmen may decrease risk of obesity and related health problems later in life. FUNDING DISCLOSURE: This project was funded by the Agriculture Experiment Station and the Vice President for Research office of Utah State University.
POSTER SESSION: PROFESSIONAL SKILLS/NUTRITION ASSESSMENT/MEDICAL NUTRITION THERAPY TITLE: HOW EFFECTIVE ARE WE AS DIETITIANS? AUTHOR(S): S.M. McGinley, MBA, RD, LDN; J. Tomesko, MS, RD, CNSD; L.B. Resurreccion, MS, RD, LDN, CNSD; C. DiamondGottlieb, RD LEARNING OUTCOME: To understand the effect and magnitude implementation barriers have on the nutrition care plan for hospitalized patients. TEXT: Registered Dietitians working in acute care hospitals lack the authority to initiate care plans developed for patients at nutrition risk. Regulations requiring a physician’s orders to provide nutritional interventions are a barrier leaving patients under-treated. Too often the patient’s care plan remains a recommendation awaiting a physician order. Systems created in past eras need to be updated to reflect the changing face of health care. Medical nutrition therapy is a glaring example of where the process is out of alignment. The scientific literature is filled with evidence that nutritional care during hospitalization reduces complications and enables the patient to better respond to other medical treatments. A preliminary retrospective, multi-centered closed chart review was conducted to quantify the percentages of recommendations initiated by RDs and physicians and those that were never implemented. The sample size included 269 records of patients discharged during January and February 2005 in 13 hospitals. Overall 65.2% of RD recommendations were implemented by either physicians or RDs. The top recommendations initiated by physicians were enteral 70%, swallowing evaluations 65%, and parenteral nutrition 62%. Medications were least likely to be initiated at 44%. At best when considering RD and Physician implementation supplements were 93%, enteral 73%, swallowing evaluations 65%, parenteral and diet orders 63% of the time. The R.D.’s nutrition care plan is almost completely dependent on the physician’s decision to implement it. A larger study is currently in progress and will evaluate the timeliness of the recommendations that are implemented. FUNDING DISCLOSURE: None received
TITLE: ADHERENCE TO THE AMERICAN HEART ASSOCIATION DIETARY GUIDELINES BY INDIVIDUALS LIVING WITH HIV INFECTION AUTHOR(S): K.M. Hendricks, DSc, RD; J.E. Barrentine, BS; R.F. Houser, PhD; C.A. Wanke, M.D.; Tufts University School of Medicine, Frances Stern Nutrition Center, New England Medical Center, School of Nutrition Science and Policy Tufts University, Boston MA LEARNING OUTCOME: To understand the importance of educating individuals living with HIV infection on the need to follow dietary guidelines for the reduction of coronary heart disease risk. TEXT: In the era of highly active antiretroviral therapy (HAART), the nutrition profile of individuals living with HIV infection frequently includes dyslipidemia and insulin resistance, increasing the risk for coronary heart disease (CHD). This study examined the diet of HIV infected individuals (n⫽287) for adherence to the American Heart Association (AHA) dietary guidelines. Three-day food records were analyzed using the Nutrition Data System. Almost half (47%) of the cohort did not meet a single AHA guideline, 7.7% met the sodium guideline, 9.1% met the fiber guideline, 20.6% and 24.7% met the total fat and saturated fat guidelines, and 35.5% met the cholesterol guideline. The mean percentage of calories from total fat was 35.3% and saturated fat 12.2%. Average cholesterol intake for men was 437.8 mg and for women was 329.5 mg. Mean fiber intake was 21.1 grams for men and 15.1 grams for women. Conditional logistic regression analysis found being female was significantly positively associated with following the cholesterol, fiber, and sodium guidelines (p⬍.05 for all). Being a college graduate was positively associated with following the cholesterol guideline (p⬍.05). Negative associations were found between smoking and following the saturated fat guideline and between poverty and following the fiber guideline (p⬍.05). A number of characteristics were inconsistent with expected findings including mode of HIV transmission, being nonwhite and being classified as hungry. Dietary improvements are needed for many individuals living with HIV. Individuals with HIV need education about the importance of diet for CHD prevention. FUNDING DISCLOSURE: None
TITLE: MEDICAL NUTRITION THERAPY (MNT) FOR PREDIABETES CAN PREVENT OR DELAY TYPE 2 DIABETES AUTHOR(S): E.C. Bonometti, MS, RD, LD, CDE LEARNING OUTCOME: To understand the impact of early nutrition and lifestyle education for the person diagnosed with prediabetes in preventing or delaying the onset of type 2 diabetes. TEXT: As compared with the estimated 10.8 million people with diabetes, there are 41 million people with pre-diabetes in the US. The Diabetes Prevention Program revealed a 58% reduction in the progression to diabetes for individuals with glucose intolerance that made modest lifestyle changes in weight loss and increased activity. In a primary care setting, group and follow-up individual instruction on lifestyle management of pre-diabetes was provided to adult patients, with fasting blood glucose levels between 100-125 mg/dL. The initial group instruction provided two hours of information that included: risk reduction, increasing physical activity, weight management and meal planning. Individualized counseling was offered after group instruction. For six months, an average of 10-15 patients per month attended the class session, and 40-50% of class attendees received individualized follow-up counseling. Hemoglobin A1c and weight were tracked at the onset of instruction and at three months and one year after the initial instruction. Groups identified for comparison purposes included patients attending class and individual instruction and patients attending class instruction only. For the group receiving class and individualized counseling, 88% had a reduction or stabilization in HgbA1c and 83% had reduced weight by 2-10 pounds or maintained a healthy weight. For the group receiving class instruction only, 50% showed a reduction or stabilization of HgbA1c and 66% had reduced weight by 2-10 pounds or maintained a healthy weight. The benefit of MNT is clearly indicated in this preliminary data analysis of individuals receiving initial counseling or initial plus individualized follow-up counseling for pre-diabetes. FUNDING DISCLOSURE: None
A-30 / August 2006 Suppl 2—Abstracts Volume 106 Number 8
TITLE: CHANGE IN WEIGHT AND OTHER ANTHROPOMETRIC MEASURES AMONG FRESHMEN DURING THEIR FIRST SEMESTER OF COLLEGE AT UTAH STATE UNIVERSITY AUTHOR(S): H.J. Wengreen, RD, PhD; C. Moncur, RD; M.A. Austin; Department of Nutrition and Food Sciences, Utah State University, Logan, UT LEARNING OUTCOME: To identify the first year of college as a period of time when obesity prevention strategies may decrease risk of obesity and related health problems later in life. TEXT: College freshmen face drastic changes in environment and circumstance that may impact behavior related to risk for obesity. The objective of this study was to track changes in weight, height, BMI, % body fat, blood pressure, waist and hip circumference among freshmen during their first semester of college. In addition, associations between environmental factors and incidence of overweight/obesity or weight gain were examined. College freshmen were recruited to participate in the study during the summer of 2005. During the first week of the 2005 fall semester 67 men and 118 women completed a detailed risk factor survey and were weighed and measured. Participants completed a second survey and were reweighed and measured during the last two weeks of the same semester. 25% of men and 18% of women had BMI’s ⱖ 25 at the beginning of fall semester and were classified as overweight/obese. Positive correlations were observed between BMI and body weight, waist and hip circumference, % body fat, and systolic blood pressure (p ⱕ 0.023). 36% (n⫽54) of participants gained more than 2 kg during fall semester (average amount gained ⫽ 3.8 kg). Among men, being overweight/obese at baseline was associated with first semester weight gain (p⫽0.005); no similar association was observed among women. Weight gain during the first semester of college may be associated with identifiable and in some cases modifiable risk factors. Strategies aimed at preventing overweight/obesity and weight gain among college Freshmen may decrease risk of obesity and related health problems later in life. FUNDING DISCLOSURE: This project was funded by the Agriculture Experiment Station and the Vice President for Research office of Utah State University.