- Email: [email protected]
The cornerstone to quality health care
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TUESDAY, OCTOBER23 ORIGINALCONTRIBUTIONS:CHRONICDISEASES--HEARTDISEASE1 DIABETES~OBESITY TITLE: LIFESTYLE AND WEIGHT OUTCOMES IN A STATE-WIDE STUDY OF MEDICAL NUTRITION THERAPY FOR HYPERLIPIDEMIA AUTHORS: M.S. Weintraub, ACSW, RD; C.A. Mandel, MS, RD; L. J. Weatherspoon, PhD, RD*; D.J. Handu, MS*; K.S. Rhodes, Phi), RD; University of Michigan Health System, Ann Arbor, MI and *Michigan State University, East Lansing, MI. LEARNING OUTCOME: To document weight, eating behavior, and quality of life outcomes of medical nutrition therapy (MNT) for hyperlipidemia. ABSTRACT TEXT: Accumulating evidence suggests that non-lipid effects of MNT have significant impact on cardiovascular risk. As part of a 10-site implementation of the hyperlipidemia protocol (MNTAcross the Continuum of Care, 2 ~ ed ) and standardization of data collection across a Midwest state, nonlipid outcomes of weight, food intake, and quality of life were documented for patients presenting over a six month period to 14 registered dietitians. Patients were included if 25-75 years of age with at-risk lipid profiles based on National Cholesterol Education Program Adult Treatment Panel II criteria or with triglyceddes >2.26 mmol/L. Exclusion criteria were: metabolic or medication changes since the lipid profile, triglycerides >11.3 retool/L, or morbid obesity. BMI at entry (n=156, mean age 49.5 + 11.6 years; 60% male, 40% female) was 30.56 -+4.74 kg/m2. Mean weight loss for all patients with at least one postintervention weight (n=82) was 0.69 + 1.01 lb. per week. Food intake was assessed by 24 hour recalls analyzed with Nutritionist V (First DataBank) and the Food Habits Questionnaire (FHQ) by Kristal (1990). Pre- and post-intervention 24 hour recalls were obtained for 61 patients. Energy intake decreased from 2147 + 866 kcal (mean -+ SD) to 1610 :L 550 kcal (p<0.01), percent of total calories from total fat decreased from 27.8 + 10.5 to 24.0 5:9.7 (p<0.01), percent of total calories from saturated fat from 8.8 + 4.6 to 7.0 + 3.6 (p<0.01), and dietary cholesterol from 201 -+ 176 mg to 143 -+ 117 mg (ns). The FHQ demonstrated significant reduction in fat intake (p<0.01, n=46) and assessed 80% of patients as reporting <30% of their calories from fat post-RD intervention. Quality of life, assessed with the SF-12, showed no significant changes. Change in fat intake and improvement in BMI have been associated with decreased mortality from cardiovascular disease independent of lipid changes. In this study MNT was associated with improvement in eating behaviors and weight. CONFLICT OF INTEREST: none.
TITLE: EVALUATION OF SATISFACTION AND USAGE OF AN INTERNET DIET MANAGEMENT SYSTEM IN OBESE SUBJECTS W1TH ,IMPAIRED FASTING GLUCOSE OR DIABETES 'AUTHOR(S): A. K. Ahrens, MS., R.D, L. W. Scott, MA., RD., and J. K. Dann, Ph.D., A. Balasubramanyam, M.D., C. M. Ballantyne, M.D. Baylor College of Medicine, Houston, TX LEARNING OUTCOME: To evaluate patient satisfaction with an lntemet ' Diet Management System to lower blood glucose levels. ABSTRACT TEXT: One of the challenges with medical nutrition therapy (MNT) and weight loss is to maintain positive lifestyle intervention over a long period of time. Use of and satisfaction with an Interact Diet Management System (IDMS) may help provide long-term MNT compliance. An IDMS was used over 30 weeks of active treatuaent in 19 obese subjects with fasting plasma glucose > 110 mg/dl (Impaired Fasting Glucose or frank diabetes). Subjects had access to a password-protected web site with personalized meal plans and menus, recipes, brand-name food lists, and diet information. Subjects entered their food intakes, weights, exercise and satiety levels daily into the IDMS. Plasma glucose values measured at home were transmitted via the Intemet to a dietitian, who sent daily messagesto the subjects and gave feedback on their progress. The subjects evaluated the IDMS at 6 scheduled measurement visits. The mean age was 49 years (25 - 68 y). Subjects accessed the IDMS on average 3.9_+2.6 (mean + SD) times per week. The most highly ranked components of the IDMS on a "value scale" were blood glucose monitoring (83% of subjeets), food records (67%), weight (50°/o), and exercise (39%). After 30 weeks of use, the subjects "liked most": website design (50%), convenience and ease of use (29%), and motivation (21%). Subjects achieved statistically significant decreases in body weight (19.9 + 12.9 lbs) and serum glucose (32.5 +_39.74 mg/dL). Thus, the IDMS is an ~effective and efficient tool for long-term medical nutrition therapy because it is convenient, motivational, and easy to use.
TITLE: ELEVATED BLOOD TOTAL HOMOCYSTEINE IN OLDER WOMEN WITH RHEUMATOID ARTHRITIS
TITLE:
AUTHOR(S): K. Woolf, MS, RD, Arizona State University (ASU), Tempe, AZ & Chandler-Gilbert Community College, Chandler, AZ~ M.M. Manore, PhD, RD, L.A. Vaughan, Phi), RD, FADA, ASU East, Mesa, A Z
AUTHOR(S):
LEARNING OUTCOME: To demonstrate the relationship between nutritional status, blood homocysteine, and cardiovascular risk in older women with rheumatoid arthritis.
LEARNING OUTCOME:
ABSTRACT TEXT: Arthritis is the most frequent and disabling chronic illness for older adults, especially women. Individuals with rheumatoid arthritis (RA) have an increased risk of early death from cardiovascular disease (CVD); however, blood Lipids are similar or lower than individuals without RA. Elevated blood homoeysteine (tHcy) has recently been documented as an independent risk factor for CVD. The purpose of this study was to examine blood they and nutritional status in older women (66_+7y;BMI=26.4_+5.5 kg/mz) (mean -+SD) with and without RA. Utilizing a cross-sectional design, subjects were classified as either RA (n=32; 22 y with RA) or healthy control (HC) (n=35). Subjects with RA met the American College of Rhettmatology criteria for RA; all subjects were free living and refrained from using a Bvitamin supplement for one month before the study. Subjects completed 7-d food records, which were analyzed using Food Processor®. Fasting blood was detemuned for pyridoxal phosphate (PLP), folate, red blood cell relate, vitamin B12, blood lipids, and tHcy. Differences between the groups for diet and blood variables were determined using t-tests; P values <0.05 were considered significant. No differences were found between the groups for energy intake or dietary fat, protein, cholesterol, vitamin B6, vitamin B12, and relate; however, blood total cholesterol, LDL-cholesterol, and PLP were significantly lower in the RA versus the HC group (4.84-+1.14 vs. 5.64_+0.91 mmol/L, 2.77-+0.93 vs. 3.57-+0,78 mmol/L, 18.5-+15.4 vs. 47.228.7 umol/L, respectively), while blood tHey was significantly higher in the RA group (13.7-+7.3 vs. 8.6-+3.0 pmol/L). No significant differences were seen for blood relate, RBC relate, and vitamin B12. These results suggest that poor vitamin B6 status (low serum PLP) and elevated blood tHey may help explain why individuals with RA have an increased risk of cardiovascular disease.
THE CORNERSTONE TO QUALITY HEALTH CARE
C.A. Metheny, MS, RD, CDE, CLC, Illinois Diabetes Control Program, Marion, IL To track quality diabetes health care indicators in Illinois by using the statewide Cornerstone computer network to monitor participants' diabetes care and education.
ABSTRACT TEXT:
The diabetes module was developed and tested in Winter of 1999 with funding provided through the Comprehensive Diabetes Grant from the Centers for Disease Control and Prevention. The first local health departments began field testing at the end of February 1999. A total of 18 community health centers or health departments were trained and ready to use the program by February 2000. The computer system generates individualized care plans based on the clients response to questions concerning their diabetes management. Once the care plan is developed, staff can assist cTients with referrals for recommended services. Local agency staff arrange follow-up appointments with their clients as needed to facilitate access to appropriate medical services. After the first year of utilizing the program, additional screens and assessment questions were added to facilitate monitoring diabetes medications, foot care and sensory assessments, cardiovascular risk and pregnancy. Utilization ofthe computer generated data it will provide increased awareness of the importance of diabetes management. Through increased awareness, clients should be better informed and able to communicate more clearly with their primary health care provider to receive the services and education necessary to achieve and maintain improved blood glucose control. The data generated could be utilized in attempts to secure additional funding for continued and additional services. This presentation will provide a demonstration of the software, review data collected and the implications for future application.
Journal of THE AMERICAN DIETETIC ASSOCIATION / A-95
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TUESDAY, OCTOBER23 ORIGINALCONTRIBUTIONS:CHRONICDISEASES--HEARTDISEASE1 DIABETES~OBESITY TITLE: LIFESTYLE AND WEIGHT OUTCOMES IN A STATE-WIDE STUDY OF MEDICAL NUTRITION THERAPY FOR HYPERLIPIDEMIA AUTHORS: M.S. Weintraub, ACSW, RD; C.A. Mandel, MS, RD; L. J. Weatherspoon, PhD, RD*; D.J. Handu, MS*; K.S. Rhodes, Phi), RD; University of Michigan Health System, Ann Arbor, MI and *Michigan State University, East Lansing, MI. LEARNING OUTCOME: To document weight, eating behavior, and quality of life outcomes of medical nutrition therapy (MNT) for hyperlipidemia. ABSTRACT TEXT: Accumulating evidence suggests that non-lipid effects of MNT have significant impact on cardiovascular risk. As part of a 10-site implementation of the hyperlipidemia protocol (MNTAcross the Continuum of Care, 2 ~ ed ) and standardization of data collection across a Midwest state, nonlipid outcomes of weight, food intake, and quality of life were documented for patients presenting over a six month period to 14 registered dietitians. Patients were included if 25-75 years of age with at-risk lipid profiles based on National Cholesterol Education Program Adult Treatment Panel II criteria or with triglyceddes >2.26 mmol/L. Exclusion criteria were: metabolic or medication changes since the lipid profile, triglycerides >11.3 retool/L, or morbid obesity. BMI at entry (n=156, mean age 49.5 + 11.6 years; 60% male, 40% female) was 30.56 -+4.74 kg/m2. Mean weight loss for all patients with at least one postintervention weight (n=82) was 0.69 + 1.01 lb. per week. Food intake was assessed by 24 hour recalls analyzed with Nutritionist V (First DataBank) and the Food Habits Questionnaire (FHQ) by Kristal (1990). Pre- and post-intervention 24 hour recalls were obtained for 61 patients. Energy intake decreased from 2147 + 866 kcal (mean -+ SD) to 1610 :L 550 kcal (p<0.01), percent of total calories from total fat decreased from 27.8 + 10.5 to 24.0 5:9.7 (p<0.01), percent of total calories from saturated fat from 8.8 + 4.6 to 7.0 + 3.6 (p<0.01), and dietary cholesterol from 201 -+ 176 mg to 143 -+ 117 mg (ns). The FHQ demonstrated significant reduction in fat intake (p<0.01, n=46) and assessed 80% of patients as reporting <30% of their calories from fat post-RD intervention. Quality of life, assessed with the SF-12, showed no significant changes. Change in fat intake and improvement in BMI have been associated with decreased mortality from cardiovascular disease independent of lipid changes. In this study MNT was associated with improvement in eating behaviors and weight. CONFLICT OF INTEREST: none.
TITLE: EVALUATION OF SATISFACTION AND USAGE OF AN INTERNET DIET MANAGEMENT SYSTEM IN OBESE SUBJECTS W1TH ,IMPAIRED FASTING GLUCOSE OR DIABETES 'AUTHOR(S): A. K. Ahrens, MS., R.D, L. W. Scott, MA., RD., and J. K. Dann, Ph.D., A. Balasubramanyam, M.D., C. M. Ballantyne, M.D. Baylor College of Medicine, Houston, TX LEARNING OUTCOME: To evaluate patient satisfaction with an lntemet ' Diet Management System to lower blood glucose levels. ABSTRACT TEXT: One of the challenges with medical nutrition therapy (MNT) and weight loss is to maintain positive lifestyle intervention over a long period of time. Use of and satisfaction with an Interact Diet Management System (IDMS) may help provide long-term MNT compliance. An IDMS was used over 30 weeks of active treatuaent in 19 obese subjects with fasting plasma glucose > 110 mg/dl (Impaired Fasting Glucose or frank diabetes). Subjects had access to a password-protected web site with personalized meal plans and menus, recipes, brand-name food lists, and diet information. Subjects entered their food intakes, weights, exercise and satiety levels daily into the IDMS. Plasma glucose values measured at home were transmitted via the Intemet to a dietitian, who sent daily messagesto the subjects and gave feedback on their progress. The subjects evaluated the IDMS at 6 scheduled measurement visits. The mean age was 49 years (25 - 68 y). Subjects accessed the IDMS on average 3.9_+2.6 (mean + SD) times per week. The most highly ranked components of the IDMS on a "value scale" were blood glucose monitoring (83% of subjeets), food records (67%), weight (50°/o), and exercise (39%). After 30 weeks of use, the subjects "liked most": website design (50%), convenience and ease of use (29%), and motivation (21%). Subjects achieved statistically significant decreases in body weight (19.9 + 12.9 lbs) and serum glucose (32.5 +_39.74 mg/dL). Thus, the IDMS is an ~effective and efficient tool for long-term medical nutrition therapy because it is convenient, motivational, and easy to use.
TITLE: ELEVATED BLOOD TOTAL HOMOCYSTEINE IN OLDER WOMEN WITH RHEUMATOID ARTHRITIS
TITLE:
AUTHOR(S): K. Woolf, MS, RD, Arizona State University (ASU), Tempe, AZ & Chandler-Gilbert Community College, Chandler, AZ~ M.M. Manore, PhD, RD, L.A. Vaughan, Phi), RD, FADA, ASU East, Mesa, A Z
AUTHOR(S):
LEARNING OUTCOME: To demonstrate the relationship between nutritional status, blood homocysteine, and cardiovascular risk in older women with rheumatoid arthritis.
LEARNING OUTCOME:
ABSTRACT TEXT: Arthritis is the most frequent and disabling chronic illness for older adults, especially women. Individuals with rheumatoid arthritis (RA) have an increased risk of early death from cardiovascular disease (CVD); however, blood Lipids are similar or lower than individuals without RA. Elevated blood homoeysteine (tHcy) has recently been documented as an independent risk factor for CVD. The purpose of this study was to examine blood they and nutritional status in older women (66_+7y;BMI=26.4_+5.5 kg/mz) (mean -+SD) with and without RA. Utilizing a cross-sectional design, subjects were classified as either RA (n=32; 22 y with RA) or healthy control (HC) (n=35). Subjects with RA met the American College of Rhettmatology criteria for RA; all subjects were free living and refrained from using a Bvitamin supplement for one month before the study. Subjects completed 7-d food records, which were analyzed using Food Processor®. Fasting blood was detemuned for pyridoxal phosphate (PLP), folate, red blood cell relate, vitamin B12, blood lipids, and tHcy. Differences between the groups for diet and blood variables were determined using t-tests; P values <0.05 were considered significant. No differences were found between the groups for energy intake or dietary fat, protein, cholesterol, vitamin B6, vitamin B12, and relate; however, blood total cholesterol, LDL-cholesterol, and PLP were significantly lower in the RA versus the HC group (4.84-+1.14 vs. 5.64_+0.91 mmol/L, 2.77-+0.93 vs. 3.57-+0,78 mmol/L, 18.5-+15.4 vs. 47.228.7 umol/L, respectively), while blood tHey was significantly higher in the RA group (13.7-+7.3 vs. 8.6-+3.0 pmol/L). No significant differences were seen for blood relate, RBC relate, and vitamin B12. These results suggest that poor vitamin B6 status (low serum PLP) and elevated blood tHey may help explain why individuals with RA have an increased risk of cardiovascular disease.
THE CORNERSTONE TO QUALITY HEALTH CARE
C.A. Metheny, MS, RD, CDE, CLC, Illinois Diabetes Control Program, Marion, IL To track quality diabetes health care indicators in Illinois by using the statewide Cornerstone computer network to monitor participants' diabetes care and education.
ABSTRACT TEXT:
The diabetes module was developed and tested in Winter of 1999 with funding provided through the Comprehensive Diabetes Grant from the Centers for Disease Control and Prevention. The first local health departments began field testing at the end of February 1999. A total of 18 community health centers or health departments were trained and ready to use the program by February 2000. The computer system generates individualized care plans based on the clients response to questions concerning their diabetes management. Once the care plan is developed, staff can assist cTients with referrals for recommended services. Local agency staff arrange follow-up appointments with their clients as needed to facilitate access to appropriate medical services. After the first year of utilizing the program, additional screens and assessment questions were added to facilitate monitoring diabetes medications, foot care and sensory assessments, cardiovascular risk and pregnancy. Utilization ofthe computer generated data it will provide increased awareness of the importance of diabetes management. Through increased awareness, clients should be better informed and able to communicate more clearly with their primary health care provider to receive the services and education necessary to achieve and maintain improved blood glucose control. The data generated could be utilized in attempts to secure additional funding for continued and additional services. This presentation will provide a demonstration of the software, review data collected and the implications for future application.
Journal of THE AMERICAN DIETETIC ASSOCIATION / A-95