- Email: [email protected]
Routine Supplementation of Calcium and Vitamin D in Nursing Homes Increases Daily Intake in Residents
SUNDAY, OCTOBER 7
Poster Session: Professional Skills; Nutrition Assessment; Medical Nutrition Therapy Vitamin D Status of Home Care Patients Author(s): S. P. Foley,1 A. Taetzsch,2 K. Jablonski,1 L. Munoz1; 1Nutrition and Food Services, Hines VA Hospital, Hines, IL, 2Nutrition and Food Services, Hines VA Hospital, Hines,, IL Learning Outcome: To understand the prevalence of vitamin D deficiency in the Home Care population and the association between Vitamin D and falls/fractures in these patients. Purpose: To determine: 1) the prevalence of inadequate serum vitamin D levels in a home care (HC) population, 2) the association between vitamin D status and frequency of falls/ fractures in these patients, and 3) the difference in nutrition markers in patients with vitamin D insufficiency/deficiency responding or failing to respond to vitamin D supplementation. Methods: A retrospective descriptive study design was used. This study was approved by the hospital IRB. Analysis: Descriptive statistics, chi-square analysis, and paired t-tests were used in the analysis. Significance level was set at p⬍0.05. Results: There were 252 (70%) patients included in the study and 69% of these patients had insufficient/deficient serum 25(OH)D levels. The mean serum 25(OH)D was 24.9⫾10.7ng/ ml. There were 21 (8%) subjects who experienced a fracture and 90 (36%) who experienced a fall. There was a significant association between fractures and vitamin D status (p ⫽ 0.047) and no association between vitamin D status and falls (p⫽0.61). There was significant improvement in serum 25(OH)D after vitamin D supplementation (p⬍0.001). Patients who failed to respond to vitamin D supplementation had significantly higher levels of serum vitamin B12 than patients who responded to supplementation (p⫽0.044). Conclusion: Vitamin D levels should be drawn in HC patients to determine degree of insufficiency and in attempt to minimize risk of falls. Supplemental vitamin D can help restores vitamin D levels in this population. Funding Disclosure: None.
Training Pediatric Registered Dietitians to Obtain Alternate Height Measurements Author(s): R. C. Meyers, S. Konek, S. Boyden; Clinical Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA Learning Outcome: After reading our poster the participants will understand that there are alternate methods for obtaining height/length measurements that can be taught to clinical staff. These measurements are non-invasive, easy to obtain and reproducible. Obtaining height/length measurements for children treated in a pediatric setting is often difficult. Obtaining height/length measurements on children who cannot stand is a particular challenge. Accurate measurements of stature are needed not only for nutrition and growth assessment but often for dosing medications. At the Children’s Hospital of Philadelphia (CHOP) we have attempted to meet this challenge by training our registered dietitians (RD) to obtain alternate height measurements for children who are unable to stand. The literature provides references for use of height proxies used to estimate height/length for children who cannot stand. (Hibbert 1998, Stevenson 1995, Chumlea 1994, Torres 2003, Hogan 1999)These measurements are non-invasive, easy to obtain, and reproducible. Many of the measurements can be done without specialized equipment. The Department of Clinical Nutrition at CHOP developed a competency to teach the clinical staff to measure stature and to obtain alternate height measurements. The measurements chosen were: recumbent length, arm span, tibia length, knee height. A curriculum was developed with details for obtaining these measurements. All RDs were given the competency information to review observed each measurement technique and returned demonstration for each technique. A program to assure continued competence has been developed. Alternate height measurements can be used for children with neuromuscular diseases such as: Muscular Dystrophy, Cerebral Palsy, Spina Bifida as well children who are immobile in critical care units. Funding Disclosure: None.
Routine Supplementation of Calcium and Vitamin D in Nursing Homes Increases Daily Intake in Residents
Impact of Supplemental Nasogastric Tube Feeds on Pediatric Crohn's Disease Patients
Author(s): C. M. Ridley,1 M. Truitt Hoffman,2 M. Sawicki,1 H. Israel,3 A. Galzki1; 1Nutrition and Dietetics, Saint Louis Univ., Saint Louis, MO, 2Lutheran Senior Services, Saint Louis, MO, 3 Orthopaedic Surgery, Saint Louis Univ., Saint Louis, MO
Author(s): D. Lee,1 K. E. Kachelries,1 K. Gupta,1 M. Lorusso,2 K. M. Whitehead,1 R. M. Herskovitz,1 R. N. Baldassano,1 M. B. Leonard1; 1Pediatrics, The Children’s Hosp. of Philadelphia, Philadelphia, PA, 2Pediatrics, Meyer Children’s Hosp. of Florence, Florence, Italy
Learning Outcome: The participant will be able to state the impact of a nursing home policy to routinely supplement residents with vitamin D and calcium compared to a nursing home without routine supplementation to boost vitamin D and calcium intake. Background: Studies involving adults in long-term care facilities report inadequate intakes of calcium and vitamin D. The study purpose was to compare calcium and vitamin D intakes between two long-term care facilities in which one facility (RS) gave routine supplementation of calcium and vitamin D to their residents and another facility (NoRS) did not provide routine supplementation. Methods: The routinely supplemented (RS) residents (n⫽26) were given 500 mg calcium and 200 IU vitamin D3 each day, and the other group of residents (n⫽24) was not routinely supplemented (NoRS) with calcium or vitamin D. Calcium and vitamin D intakes were analyzed from one-day plate waste studies. Results: There were significant differences between the two facilities with regard to calcium supplementation (p⫽.039), vitamin D3 supplementation (p⫽.018), total calcium intake (p⫽.029), and total vitamin D intake (p⫽.008). Very few residents at either facility were able to achieve the Recommended Dietary Allowance (RDA) for calcium and vitamin D from dietary sources alone. Individuals who were supplemented increased their total calcium and vitamin D intakes, but many were still unable to meet the RDA for these nutrients. Conclusion: Registered dietitians should collaborate with dietary managers and foodservice employees to find innovative ways to encourage residents to increase intake of calcium and vitamin D containing foods. The provision of diets high in food sources of calcium and vitamin D as well as routine supplementation are recommended for residents in long-term care facilities to help them meet current nutrient recommendations and promote optimal health status. Funding Disclosure: None.
September 2012 Suppl 3—Abstracts Volume 112 Number 9
Learning Outcome: The learner should become familiar with the use and benefits of nutritional supplementation in pediatric patients with Crohn’s Disease. Background and Aims: Growth delay and poor nutritional status are common problems in pediatric Crohn’s disease (CD). It is important to preserve normal growth and development in this population. The aim of this study was to assess nasogastric tube (NG) nutritional supplementation on height and weight in pediatric CD. The secondary aim was to assess the impact of nutritional supplementation on laboratory markers. Methods: Data was used from a prospectively studied cohort of 138 pediatric CD patients. Inclusion criteria: confirmed diagnosis of CD for at least 6 months and bone mineral density z-scores less than the 25th percentile. We defined 2 groups of subjects: those receiving a higher level of NG supplementation (NG feeds for at least 6 months), and those receiving either lower/no supplementation. Wilcoxon rank-sum analysis was performed. Results: At the initial visit, patients on higher NG supplemental feeds had significantly lower mean height z-scores (⫺1.44 ⫹/⫺ 1.04 vs. ⫺0.73 ⫹/⫺ 0.99; p⫽ 0.008) and mean weight z-scores (⫺1.35 ⫹/⫺ 1.51 vs. ⫺0.49 ⫹/⫺1.09; p⫽ 0.02). At the 12 month visit, there was no significant difference in height or weight z-scores between these two groups. There were no significant differences in average albumin, sedimentation rate, or hematocrit. Conclusion: NG supplemental feeds are associated with the correction in height and weight differences in pediatric CD patients. Supplemental nutrition may play a key role in the management of growth in pediatric CD. Funding Disclosure: NIH Grant RO1DK073946; CTRC Grant UL1-RR-024134.
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-31
Poster Session: Professional Skills; Nutrition Assessment; Medical Nutrition Therapy Vitamin D Status of Home Care Patients Author(s): S. P. Foley,1 A. Taetzsch,2 K. Jablonski,1 L. Munoz1; 1Nutrition and Food Services, Hines VA Hospital, Hines, IL, 2Nutrition and Food Services, Hines VA Hospital, Hines,, IL Learning Outcome: To understand the prevalence of vitamin D deficiency in the Home Care population and the association between Vitamin D and falls/fractures in these patients. Purpose: To determine: 1) the prevalence of inadequate serum vitamin D levels in a home care (HC) population, 2) the association between vitamin D status and frequency of falls/ fractures in these patients, and 3) the difference in nutrition markers in patients with vitamin D insufficiency/deficiency responding or failing to respond to vitamin D supplementation. Methods: A retrospective descriptive study design was used. This study was approved by the hospital IRB. Analysis: Descriptive statistics, chi-square analysis, and paired t-tests were used in the analysis. Significance level was set at p⬍0.05. Results: There were 252 (70%) patients included in the study and 69% of these patients had insufficient/deficient serum 25(OH)D levels. The mean serum 25(OH)D was 24.9⫾10.7ng/ ml. There were 21 (8%) subjects who experienced a fracture and 90 (36%) who experienced a fall. There was a significant association between fractures and vitamin D status (p ⫽ 0.047) and no association between vitamin D status and falls (p⫽0.61). There was significant improvement in serum 25(OH)D after vitamin D supplementation (p⬍0.001). Patients who failed to respond to vitamin D supplementation had significantly higher levels of serum vitamin B12 than patients who responded to supplementation (p⫽0.044). Conclusion: Vitamin D levels should be drawn in HC patients to determine degree of insufficiency and in attempt to minimize risk of falls. Supplemental vitamin D can help restores vitamin D levels in this population. Funding Disclosure: None.
Training Pediatric Registered Dietitians to Obtain Alternate Height Measurements Author(s): R. C. Meyers, S. Konek, S. Boyden; Clinical Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA Learning Outcome: After reading our poster the participants will understand that there are alternate methods for obtaining height/length measurements that can be taught to clinical staff. These measurements are non-invasive, easy to obtain and reproducible. Obtaining height/length measurements for children treated in a pediatric setting is often difficult. Obtaining height/length measurements on children who cannot stand is a particular challenge. Accurate measurements of stature are needed not only for nutrition and growth assessment but often for dosing medications. At the Children’s Hospital of Philadelphia (CHOP) we have attempted to meet this challenge by training our registered dietitians (RD) to obtain alternate height measurements for children who are unable to stand. The literature provides references for use of height proxies used to estimate height/length for children who cannot stand. (Hibbert 1998, Stevenson 1995, Chumlea 1994, Torres 2003, Hogan 1999)These measurements are non-invasive, easy to obtain, and reproducible. Many of the measurements can be done without specialized equipment. The Department of Clinical Nutrition at CHOP developed a competency to teach the clinical staff to measure stature and to obtain alternate height measurements. The measurements chosen were: recumbent length, arm span, tibia length, knee height. A curriculum was developed with details for obtaining these measurements. All RDs were given the competency information to review observed each measurement technique and returned demonstration for each technique. A program to assure continued competence has been developed. Alternate height measurements can be used for children with neuromuscular diseases such as: Muscular Dystrophy, Cerebral Palsy, Spina Bifida as well children who are immobile in critical care units. Funding Disclosure: None.
Routine Supplementation of Calcium and Vitamin D in Nursing Homes Increases Daily Intake in Residents
Impact of Supplemental Nasogastric Tube Feeds on Pediatric Crohn's Disease Patients
Author(s): C. M. Ridley,1 M. Truitt Hoffman,2 M. Sawicki,1 H. Israel,3 A. Galzki1; 1Nutrition and Dietetics, Saint Louis Univ., Saint Louis, MO, 2Lutheran Senior Services, Saint Louis, MO, 3 Orthopaedic Surgery, Saint Louis Univ., Saint Louis, MO
Author(s): D. Lee,1 K. E. Kachelries,1 K. Gupta,1 M. Lorusso,2 K. M. Whitehead,1 R. M. Herskovitz,1 R. N. Baldassano,1 M. B. Leonard1; 1Pediatrics, The Children’s Hosp. of Philadelphia, Philadelphia, PA, 2Pediatrics, Meyer Children’s Hosp. of Florence, Florence, Italy
Learning Outcome: The participant will be able to state the impact of a nursing home policy to routinely supplement residents with vitamin D and calcium compared to a nursing home without routine supplementation to boost vitamin D and calcium intake. Background: Studies involving adults in long-term care facilities report inadequate intakes of calcium and vitamin D. The study purpose was to compare calcium and vitamin D intakes between two long-term care facilities in which one facility (RS) gave routine supplementation of calcium and vitamin D to their residents and another facility (NoRS) did not provide routine supplementation. Methods: The routinely supplemented (RS) residents (n⫽26) were given 500 mg calcium and 200 IU vitamin D3 each day, and the other group of residents (n⫽24) was not routinely supplemented (NoRS) with calcium or vitamin D. Calcium and vitamin D intakes were analyzed from one-day plate waste studies. Results: There were significant differences between the two facilities with regard to calcium supplementation (p⫽.039), vitamin D3 supplementation (p⫽.018), total calcium intake (p⫽.029), and total vitamin D intake (p⫽.008). Very few residents at either facility were able to achieve the Recommended Dietary Allowance (RDA) for calcium and vitamin D from dietary sources alone. Individuals who were supplemented increased their total calcium and vitamin D intakes, but many were still unable to meet the RDA for these nutrients. Conclusion: Registered dietitians should collaborate with dietary managers and foodservice employees to find innovative ways to encourage residents to increase intake of calcium and vitamin D containing foods. The provision of diets high in food sources of calcium and vitamin D as well as routine supplementation are recommended for residents in long-term care facilities to help them meet current nutrient recommendations and promote optimal health status. Funding Disclosure: None.
September 2012 Suppl 3—Abstracts Volume 112 Number 9
Learning Outcome: The learner should become familiar with the use and benefits of nutritional supplementation in pediatric patients with Crohn’s Disease. Background and Aims: Growth delay and poor nutritional status are common problems in pediatric Crohn’s disease (CD). It is important to preserve normal growth and development in this population. The aim of this study was to assess nasogastric tube (NG) nutritional supplementation on height and weight in pediatric CD. The secondary aim was to assess the impact of nutritional supplementation on laboratory markers. Methods: Data was used from a prospectively studied cohort of 138 pediatric CD patients. Inclusion criteria: confirmed diagnosis of CD for at least 6 months and bone mineral density z-scores less than the 25th percentile. We defined 2 groups of subjects: those receiving a higher level of NG supplementation (NG feeds for at least 6 months), and those receiving either lower/no supplementation. Wilcoxon rank-sum analysis was performed. Results: At the initial visit, patients on higher NG supplemental feeds had significantly lower mean height z-scores (⫺1.44 ⫹/⫺ 1.04 vs. ⫺0.73 ⫹/⫺ 0.99; p⫽ 0.008) and mean weight z-scores (⫺1.35 ⫹/⫺ 1.51 vs. ⫺0.49 ⫹/⫺1.09; p⫽ 0.02). At the 12 month visit, there was no significant difference in height or weight z-scores between these two groups. There were no significant differences in average albumin, sedimentation rate, or hematocrit. Conclusion: NG supplemental feeds are associated with the correction in height and weight differences in pediatric CD patients. Supplemental nutrition may play a key role in the management of growth in pediatric CD. Funding Disclosure: NIH Grant RO1DK073946; CTRC Grant UL1-RR-024134.
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
A-31