- Email: [email protected]
Physician Attitudes and Practices Regarding the Role of the Registered Dietitian in the Nutrition Care of Obese Patients
SUNDAY, OCTOBER 22
Poster Session: Professional Skills; Nutrition Assessment & Diagnosis; Medical Nutrition Therapy Physician Attitudes and Practices Regarding the Role of the Registered Dietitian in the Nutrition Care of Obese Patients Author(s): K. Manuel1, A. Johnson2; 1University of the District of Columbia, 2Howard University
Learning Outcome: Learners will: 1. Identify how physicians perceive the RD’s level of competence in providing nutrition care to obese patients. 2. Gain knowledge on physician referral practices to the RD. 3. Obtain an appreciation of the critical need to continue efforts to integrate RD expertise into physician treatment practices for obesity.
Background: Several studies document that despite their important role in obesity treatment, physicians may not be equipped to adequately treat this disease. The results reported herein were part of a larger study to examine physician knowledge, attitudes and practices in the nutrition care of obese patients. This report describes physician attitudes regarding the roles of registered dietitians (RDs) in the nutrition care of obese patients. Methods: Eleven percent (240) of 2,363 questionnaires (including questions regarding knowledge of and attitudes toward obesity treatment, and treatment practices) mailed to primary care physicians in the Washington D.C metropolitan area were returned. Results: Physicians were not very knowledgeable of medical nutrition therapy for obesity (average knowledge score¼6.70.1, out of a possible score of 13). A small percentage of physicians (21.3%) employed RDs as part of their practices. The majority of physicians (72.6%) considered RDs competent to provide medical nutrition therapy for obese patients. Interestingly, less than half of the physicians in the sample (42.1%) felt that their practices could benefit greatly from having an RD on staff, with 6.7 % indicating no benefit at all. With regard to making referrals, the overwhelming majority of physicians (86.1%) agreed or strongly agreed that obese patients could benefit from referral to an RD. Only 18% indicated that they always referred obese patients to the RD.
Conclusion: Physicians in the study recognized the RD’s expertise in nutrition care of obese patients. Additional efforts are needed to integrate this level of expertise into routine physician treatment and referral practices.
Funding Disclosure: This study was funded in part by a grant from The Center for Minority Health Services Research at Howard University, through the support of the Agency for Healthcare Research and Quality.
Predisposing Risk Factors for Stress Fractures in Division I Cross Country Runners 1
1
2
1
Prevalence of Malnutrition among Outpatients in Ambulatory Clinic Author(s): A. Specht, H. Roosevelt, M. Mozer, D. Sowa, S. Peterson; Rush University Medical Center Learning Outcome: Differentiate between rates of malnutrition between various ambulatory clinics. Introduction: Disease-related malnutrition is associated with significant morbidity and mortality. Yet little information is available to describe the rate of malnutrition among the hospital ambulatory population. The objective was to determine the prevalence of malnutrition in outpatients in (gastrointestinal (GI), radiation and pulmonary clinics. Methods: The patient-generated subjective global assessment (PG-SGA) Short Form was administered over 6 months in three different ambulatory clinics (GI, radiation and pulmonary). All components (weight, food intake, GI symptoms and activity/function) of the PG-SGA tool were self-recorded by the patients and scored by the RDN. Malnutrition was defined as a PG-SGA score of 9. Chi-square and ANOVA were used to determine if malnutrition rates were different between clinics. Results: A total of 500 patients completed the PG-SGA (GI clinic: n¼226, radiation clinic: n¼176, pulmonary clinic: n¼ 98). The total prevalence of malnutrition was 29% across all three clinics. The rate of malnutrition was significantly different between clinics (radiation clinic: 41%, GI clinic: 26%, Pulmonary clinic: 15%; p<0.0001). Radiation clinic had the highest component scores for weight change, food intake, GI symptoms and activity/function compared to GI and pulmonary clinic (p¼0.001). Conclusions: Both radiation and GI clinics had significant prevalence of malnutrition among outpatients. In both of these populations, it is essential to identify malnutrition and establish appropriate nutrition intervention to attenuate the progression of decreased calorie intake, weight loss, and altered functional status. Funding Disclosure: None
Probiotics and Behavioral Modulation
Author(s): M. Valliant , K. Knight , M. Bass ; Department of Nutrition and Hospitality Management, University of Mississippi, 2The University of Mississippi, Department of Health, Exercise Science and Recreation Management
Author(s): J. Keating, L. Aceves Gonzalez, T. Bayrak, H. Kundargi, B. Patterson, R. Ritter Spier, C. Wiswell, C. LaSalle; San Jose State University
Learning Outcome: Participants will be able to apply knowledge of nutrition assessment and nutrition diagnosis to determine a runners potential risk for stress fracture development based on dietary intakes of calories, calcium and vitamin D.
The connection between “dysbiosis” (microbial imbalance) and behavioral abnormalities mediated by the central nervous system has led many researchers to test the effectiveness of administering probiotics as a method of modulating behavior. The mechanistic factors behind this connection is thought to be in relation to the ability for specific probiotic strains to improve epithelial barrier integrity which reduces the likelihood of bacterial translocation and aids in restoration of serum metabolite levels.
Competitive cross-country running requires an increased training volume which can lead to overuse injuries. The most common of these is stress fractures. The purpose of this study was to explore risk factors associated with increased stress fracture development in a NCAA Division I collegiate cross-country team. Participants included forty-two (20 males, 22 females) collegiate cross-country runners ranging in age from 18 to 24 years. Height and weight were measured and Body Mass Index (BMI) calculated. Bone mineral density (BMD) was assessed using duel x-ray absorptiometry (DXA). A 3-day diet record was analyzed for total calorie, calcium and vitamin D intakes using Nutrient Data Systems for Research and coded as either “met” or “unmet” individual needs. The majority of the runners’ BMI were classified as Healthy (n ¼ 38, 90.5%) with 4 females being classified as Under Weight. Overall, 38% (n ¼ 16) of the runners had low BMD (either osteopenia or osteoporosis). Seven (35%) of the male runners and 9 (40.9%) of the female runners reported experiencing a stress fracture during their running career. Chi-square analysis was performed to assess the association of stress fracture incidences with BMI, BMD and intakes of calories, calcium, and vitamin D. Significant associations were found with “unmet” caloric requirement (X 2 ¼ 17.58, p ¼ .00), calcium (X 2 ¼ 30.19, p ¼ .000) and Vitamin D (X 2 ¼ 34.46, p ¼ .00). This study suggests that occurrence of stress fractures may be associated with inadequate caloric, calcium, and/or vitamin D intakes. Funding Disclosure: None
Learning Outcome: Participants will be able describe the relationship between probiotics and behavioral modulation.
Purpose: To review current literature and determine, which, if any, probiotics (genus/species) show consistent efficacy within the ability to influence behavior. Methods: Online search via Google Scholar and ScienceDirect for systematic reviews, meta-analysis, and individual studies assessing use of probiotics as a means for influencing behavior abnormalities in humans. Results: The specific probiotic genus-types associated most often with behavioral modification (pertaining to gut permeability, microbial diversity, metabolite regulation, and bacterial translocation) were Lactobacillus, Bifidobacterium, and Bacteroides Fragilis. While specific probiotic genus types capable of affect were identified, the specific genus species used varied greatly between studies and methods of gastrointestinal affect. Discussion: While the association between probiotic supplementation and behavioral modification showed efficacy amongst current studies, the differences pertaining to genus species, probiotic dosage amounts, and experimental methodology prevents the ability to make any clinical advisements until more standardized research is completed. Conclusion: Research with standardized protocol pertaining to genus species, dosage amounts, and experimental methodology is needed. Funding Disclosure: None
September 2017 Suppl 1—Abstracts Volume 117 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-31
Poster Session: Professional Skills; Nutrition Assessment & Diagnosis; Medical Nutrition Therapy Physician Attitudes and Practices Regarding the Role of the Registered Dietitian in the Nutrition Care of Obese Patients Author(s): K. Manuel1, A. Johnson2; 1University of the District of Columbia, 2Howard University
Learning Outcome: Learners will: 1. Identify how physicians perceive the RD’s level of competence in providing nutrition care to obese patients. 2. Gain knowledge on physician referral practices to the RD. 3. Obtain an appreciation of the critical need to continue efforts to integrate RD expertise into physician treatment practices for obesity.
Background: Several studies document that despite their important role in obesity treatment, physicians may not be equipped to adequately treat this disease. The results reported herein were part of a larger study to examine physician knowledge, attitudes and practices in the nutrition care of obese patients. This report describes physician attitudes regarding the roles of registered dietitians (RDs) in the nutrition care of obese patients. Methods: Eleven percent (240) of 2,363 questionnaires (including questions regarding knowledge of and attitudes toward obesity treatment, and treatment practices) mailed to primary care physicians in the Washington D.C metropolitan area were returned. Results: Physicians were not very knowledgeable of medical nutrition therapy for obesity (average knowledge score¼6.70.1, out of a possible score of 13). A small percentage of physicians (21.3%) employed RDs as part of their practices. The majority of physicians (72.6%) considered RDs competent to provide medical nutrition therapy for obese patients. Interestingly, less than half of the physicians in the sample (42.1%) felt that their practices could benefit greatly from having an RD on staff, with 6.7 % indicating no benefit at all. With regard to making referrals, the overwhelming majority of physicians (86.1%) agreed or strongly agreed that obese patients could benefit from referral to an RD. Only 18% indicated that they always referred obese patients to the RD.
Conclusion: Physicians in the study recognized the RD’s expertise in nutrition care of obese patients. Additional efforts are needed to integrate this level of expertise into routine physician treatment and referral practices.
Funding Disclosure: This study was funded in part by a grant from The Center for Minority Health Services Research at Howard University, through the support of the Agency for Healthcare Research and Quality.
Predisposing Risk Factors for Stress Fractures in Division I Cross Country Runners 1
1
2
1
Prevalence of Malnutrition among Outpatients in Ambulatory Clinic Author(s): A. Specht, H. Roosevelt, M. Mozer, D. Sowa, S. Peterson; Rush University Medical Center Learning Outcome: Differentiate between rates of malnutrition between various ambulatory clinics. Introduction: Disease-related malnutrition is associated with significant morbidity and mortality. Yet little information is available to describe the rate of malnutrition among the hospital ambulatory population. The objective was to determine the prevalence of malnutrition in outpatients in (gastrointestinal (GI), radiation and pulmonary clinics. Methods: The patient-generated subjective global assessment (PG-SGA) Short Form was administered over 6 months in three different ambulatory clinics (GI, radiation and pulmonary). All components (weight, food intake, GI symptoms and activity/function) of the PG-SGA tool were self-recorded by the patients and scored by the RDN. Malnutrition was defined as a PG-SGA score of 9. Chi-square and ANOVA were used to determine if malnutrition rates were different between clinics. Results: A total of 500 patients completed the PG-SGA (GI clinic: n¼226, radiation clinic: n¼176, pulmonary clinic: n¼ 98). The total prevalence of malnutrition was 29% across all three clinics. The rate of malnutrition was significantly different between clinics (radiation clinic: 41%, GI clinic: 26%, Pulmonary clinic: 15%; p<0.0001). Radiation clinic had the highest component scores for weight change, food intake, GI symptoms and activity/function compared to GI and pulmonary clinic (p¼0.001). Conclusions: Both radiation and GI clinics had significant prevalence of malnutrition among outpatients. In both of these populations, it is essential to identify malnutrition and establish appropriate nutrition intervention to attenuate the progression of decreased calorie intake, weight loss, and altered functional status. Funding Disclosure: None
Probiotics and Behavioral Modulation
Author(s): M. Valliant , K. Knight , M. Bass ; Department of Nutrition and Hospitality Management, University of Mississippi, 2The University of Mississippi, Department of Health, Exercise Science and Recreation Management
Author(s): J. Keating, L. Aceves Gonzalez, T. Bayrak, H. Kundargi, B. Patterson, R. Ritter Spier, C. Wiswell, C. LaSalle; San Jose State University
Learning Outcome: Participants will be able to apply knowledge of nutrition assessment and nutrition diagnosis to determine a runners potential risk for stress fracture development based on dietary intakes of calories, calcium and vitamin D.
The connection between “dysbiosis” (microbial imbalance) and behavioral abnormalities mediated by the central nervous system has led many researchers to test the effectiveness of administering probiotics as a method of modulating behavior. The mechanistic factors behind this connection is thought to be in relation to the ability for specific probiotic strains to improve epithelial barrier integrity which reduces the likelihood of bacterial translocation and aids in restoration of serum metabolite levels.
Competitive cross-country running requires an increased training volume which can lead to overuse injuries. The most common of these is stress fractures. The purpose of this study was to explore risk factors associated with increased stress fracture development in a NCAA Division I collegiate cross-country team. Participants included forty-two (20 males, 22 females) collegiate cross-country runners ranging in age from 18 to 24 years. Height and weight were measured and Body Mass Index (BMI) calculated. Bone mineral density (BMD) was assessed using duel x-ray absorptiometry (DXA). A 3-day diet record was analyzed for total calorie, calcium and vitamin D intakes using Nutrient Data Systems for Research and coded as either “met” or “unmet” individual needs. The majority of the runners’ BMI were classified as Healthy (n ¼ 38, 90.5%) with 4 females being classified as Under Weight. Overall, 38% (n ¼ 16) of the runners had low BMD (either osteopenia or osteoporosis). Seven (35%) of the male runners and 9 (40.9%) of the female runners reported experiencing a stress fracture during their running career. Chi-square analysis was performed to assess the association of stress fracture incidences with BMI, BMD and intakes of calories, calcium, and vitamin D. Significant associations were found with “unmet” caloric requirement (X 2 ¼ 17.58, p ¼ .00), calcium (X 2 ¼ 30.19, p ¼ .000) and Vitamin D (X 2 ¼ 34.46, p ¼ .00). This study suggests that occurrence of stress fractures may be associated with inadequate caloric, calcium, and/or vitamin D intakes. Funding Disclosure: None
Learning Outcome: Participants will be able describe the relationship between probiotics and behavioral modulation.
Purpose: To review current literature and determine, which, if any, probiotics (genus/species) show consistent efficacy within the ability to influence behavior. Methods: Online search via Google Scholar and ScienceDirect for systematic reviews, meta-analysis, and individual studies assessing use of probiotics as a means for influencing behavior abnormalities in humans. Results: The specific probiotic genus-types associated most often with behavioral modification (pertaining to gut permeability, microbial diversity, metabolite regulation, and bacterial translocation) were Lactobacillus, Bifidobacterium, and Bacteroides Fragilis. While specific probiotic genus types capable of affect were identified, the specific genus species used varied greatly between studies and methods of gastrointestinal affect. Discussion: While the association between probiotic supplementation and behavioral modification showed efficacy amongst current studies, the differences pertaining to genus species, probiotic dosage amounts, and experimental methodology prevents the ability to make any clinical advisements until more standardized research is completed. Conclusion: Research with standardized protocol pertaining to genus species, dosage amounts, and experimental methodology is needed. Funding Disclosure: None
September 2017 Suppl 1—Abstracts Volume 117 Number 9
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-31