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The Development of a Diet Quality Score
SUNDAY, OCTOBER 26
POSTER SESSION: PROFESSIONAL SKILLS/NUTRITION ASSESSMENT/MEDICAL NUTRITION THERAPY Title: INCORPORATING THE NUTRITION CARE PROCESS AND STANDARDIZED LANGUAGE INTO A DIDACTIC PROGRAM IN DIETETICS CURRICULUM Author(s): D. H. Holben, D. H. Murray; School of Human and Consumer Sciences, Ohio University, Athens, OH Learning Outcome: After this presentation, the learner will be able to state one strategy for incorporating the nutrition care process and standardized language into a didactic program in dietetics curriculum. Text: Relevance: Didactic Programs in Dietetics are challenged with introducing Nutrition Care Process (NCP) and standardized language (SL). One didactic program was modified to include NCP and SL. Our purpose is to review that strategy and its outcomes. Priority: Incorporating NCP and SL into dietetics curricula. Results: NCP and SL were incorporated into a 3-course series: Medical Nutrition Therapy (MNT) I (Jr. level: overweight/obesity, CVD, DM, renal), MNT II (Sr. level: GI, pulmonary, wasting diseases, enteral and parenteral nutrition), and Nutrition Counseling Practicum (Sr. level: hands-on outpatient care under direction of RD). Student resources utilized included International Dietetics & Nutrition Terminology (INDT) Reference Manual, as well as a diet therapy text and clinical pocket-style assessment and intervention references. In both MNT I and II, NCP and SL were integrated, and cases were developed (live standardized or problem-based) in order to teach both concepts related to disease, as well as NCP and SL. A medical record note written in ADI (Assess-Diagnose, Intervene/Monitor/Evaluate) style was submitted by students for evaluation and understanding of the case concepts. SOAP style was also superimposed to foster an understanding of the documentation style utilized by many facilities. In the practicum, each student was assigned a client. Using NCP under RD direction, students assessed, diagnosed, intervened, and monitored/evaluated their client during 4 sessions over a 10-week period and recorded that care using ADI after each session. Synthesis: Outcome data show that the process promotes an understanding of MNT and develops skills desired by post-graduate supervised practice program directors.
Title: NUTRITION EDUCATION NEEDS IDENTIFIED FOR PEOPLE WITH DIABETES USING EDUCATION ALGORITHM Author(s): S. M. Mahoney, R. L. Stone, M. T. Hucks, K. E. Duffy, S. S. Aton; Nutrition Services, Mayo Clinic, Jacksonville, FL Learning Outcome: Participant will be able to determine diabetes education needs using a diabetes risk assessment tool and effectively manage a patient using standardized diabetes pathways and curriculum. Text: Mayo Clinic in Jacksonville, Florida is an integrated academic medical center offering tertiary through primary care services. Prior to 2008 our hospital and clinic were located on separate campuses requiring two diabetes education program sites and separation of our CDE staff. The hospital, clinic and CDE staff recently moved to a single campus presenting an opportunity to improve the delivery of and participation of diabetes services. Currently there are three diabetes care pathways offered. These include one-on-one appointments, two survival skill classes taught in the same week, or a series of four classes, two and one half hours each. To facilitate a more cost effective and quality program, a newly proposed algorithm was developed. It incorporates a weighted and scored Diabetes Risk Assessment Tool completed for each patient. Risk stratification based on this tool determines the content and number of nutrition education sessions required for each patient. Choosing one of three options in the algorithm allows the practitioner to select the appropriate level of Medical Nutrition Therapy (MNT) and ensures that all of the standards for comprehensive diabetes education will be met regardless of the pathway ordered. A database has been developed to track MNT interventions and outcomes. Success of the proposed algorithm will be measured by increasing number of people with diabetes participating, cost effectiveness of delivering services and satisfaction of providers and patients. Using a standardized DSME algorithm and Diabetes Risk Assessment Tool offers quality options for delivering cost effective diabetes nutrition services. Funding Disclosure: None
Funding Disclosure: None
Title: VALIDATION OF A SCHOOL FOOD DIARY TO ASSESS DIETARY INTAKES OF MIDDLE-SCHOOL STUDENTS Author(s): K. M. O’Connell,1 R. E. Miller,2 M. K. McIntosh2; 1Center for Nutrition Policy and Promotion, United States Department of Agriculture, Alexandria, VA, 2Department of Nutrition, The University of North Carolina at Greensboro, Greensboro, NC Learning Outcome: Understand how the School Food Diary was validated for use in evaluating the impact of school cafeteria environments on dietary intakes. Text: The objective of this study was to validate the School Food Diary (SFD) for assessing dietary intakes of middle-school students at lunch. The SFD uses aspects of the school food environment to enhance the details of reported food intake. Validity was assessed by comparing intake reported on the SFD to observed intake and to the Harvard Youth and Adolescent Food Frequency Questionnaire (HYAQ). Students (n⫽489, 12.7 y, 55% female, 59% white, 27% low income) from six randomly selected middle schools in Guilford County, NC completed the SFD and HYAQ. Thirty-five students were observed at lunch and completed SFD reports to identify exact matches and omissions. The SFD was tested to determine if differences in dietary intake could be detected between two groups expected to differ. To do this, servings of fruits, vegetables, and milk products (FVM) reported by students purchasing National School Lunch Program (NSLP) meals where compared to those of students not purchasing NSLP meals using analysis of variance. Thirty-two SFD were exact matches and only 3 diaries had missing foods. As expected, students purchasing NSLP meals had significantly higher intakes of FVM compared to those who did not (NSLP/non-NSLP) at 0.43/0.33 (p⫽0.05), 0.24/0.10 (p⬍0.001), and 0.89/0.36 (p⬍0.001) servings, respectively. SFD and HYAQ reports were correlated for fruits (r⫽0.18, p⫽0.003) and milk products (r⫽0.13, p⫽0.003), but not for vegetables. The SFD provides valuable detail regarding the eating behaviors of students in the school-cafeteria environment. Additional research may be warranted to further investigate the validity and reliability of the SFD. Funding Disclosure: Grant funding from the North Carolina Healthy Weight Initiative, USDA Team Nutrition, and the Moses Cone Wesley Long Health Foundation
Title: THE DEVELOPMENT OF A DIET QUALITY SCORE Author(s): C. M. Zars, C. C. Tangney, K. S. Keim, A. J. Domas, T. Sher; Rush University, Chicago, IL Learning Outcome: The participant will be able to identify a quick way to measure how well a patient adheres to a diet rich in fruits, vegetables and fiber while limiting fat, alcohol and added sugars and increasing physical activity. Text: Background: Various tools have been developed to help an individual’s adherence to a “high quality” diet based on a set of dietary targets Objective: To develop and validate a diet quality scoring (DQS) tool employing nutrition recommendations regarding intakes of fruits and vegetables, fat, fiber, alcohol, sugar and physical activity. Methods: The DQS was developed using repeated recalls from participants in an 18 month theory based intervention trial. At baseline and six months, three nonconsecutive telephone dietary recalls from the 56 patients were selected to test the validity of the dietary score and scored by the same clinician (CZ). Previously, nutrient analysis of recalls was performed using the University of Minnesota Nutrition Data Systems, version 4.3. Correlations were run between DQS components and corresponding nutrients for each recall using SPSS, version 13. Results: Recalls were acquired from 49 men and 7 women, mean age of 60 y and BMI, 32.5. Subjects were 66% Caucasian, 20% African American, 11% Hispanic and 3% Asian/Pacific. In terms of criterion related validity, correlations between DQS/component scores and nutrients (-carotene, natural folate, potassium, dietary fiber, and percent of calories from total and saturated fat) from analyses of recalls ranged from ⫺0.26 to 0.90. Scoring of 30 recalls by two persons yielded inter-rater reliability coefficient of 0.96. Conclusion: This tool is a quick and easy way for an individual to track how well he or she is following a particular diet that is based on the aforementioned targets by obtaining a diet quality score. Funding Disclosure: None
Journal of the AMERICAN DIETETIC ASSOCIATION / A-21
POSTER SESSION: PROFESSIONAL SKILLS/NUTRITION ASSESSMENT/MEDICAL NUTRITION THERAPY Title: INCORPORATING THE NUTRITION CARE PROCESS AND STANDARDIZED LANGUAGE INTO A DIDACTIC PROGRAM IN DIETETICS CURRICULUM Author(s): D. H. Holben, D. H. Murray; School of Human and Consumer Sciences, Ohio University, Athens, OH Learning Outcome: After this presentation, the learner will be able to state one strategy for incorporating the nutrition care process and standardized language into a didactic program in dietetics curriculum. Text: Relevance: Didactic Programs in Dietetics are challenged with introducing Nutrition Care Process (NCP) and standardized language (SL). One didactic program was modified to include NCP and SL. Our purpose is to review that strategy and its outcomes. Priority: Incorporating NCP and SL into dietetics curricula. Results: NCP and SL were incorporated into a 3-course series: Medical Nutrition Therapy (MNT) I (Jr. level: overweight/obesity, CVD, DM, renal), MNT II (Sr. level: GI, pulmonary, wasting diseases, enteral and parenteral nutrition), and Nutrition Counseling Practicum (Sr. level: hands-on outpatient care under direction of RD). Student resources utilized included International Dietetics & Nutrition Terminology (INDT) Reference Manual, as well as a diet therapy text and clinical pocket-style assessment and intervention references. In both MNT I and II, NCP and SL were integrated, and cases were developed (live standardized or problem-based) in order to teach both concepts related to disease, as well as NCP and SL. A medical record note written in ADI (Assess-Diagnose, Intervene/Monitor/Evaluate) style was submitted by students for evaluation and understanding of the case concepts. SOAP style was also superimposed to foster an understanding of the documentation style utilized by many facilities. In the practicum, each student was assigned a client. Using NCP under RD direction, students assessed, diagnosed, intervened, and monitored/evaluated their client during 4 sessions over a 10-week period and recorded that care using ADI after each session. Synthesis: Outcome data show that the process promotes an understanding of MNT and develops skills desired by post-graduate supervised practice program directors.
Title: NUTRITION EDUCATION NEEDS IDENTIFIED FOR PEOPLE WITH DIABETES USING EDUCATION ALGORITHM Author(s): S. M. Mahoney, R. L. Stone, M. T. Hucks, K. E. Duffy, S. S. Aton; Nutrition Services, Mayo Clinic, Jacksonville, FL Learning Outcome: Participant will be able to determine diabetes education needs using a diabetes risk assessment tool and effectively manage a patient using standardized diabetes pathways and curriculum. Text: Mayo Clinic in Jacksonville, Florida is an integrated academic medical center offering tertiary through primary care services. Prior to 2008 our hospital and clinic were located on separate campuses requiring two diabetes education program sites and separation of our CDE staff. The hospital, clinic and CDE staff recently moved to a single campus presenting an opportunity to improve the delivery of and participation of diabetes services. Currently there are three diabetes care pathways offered. These include one-on-one appointments, two survival skill classes taught in the same week, or a series of four classes, two and one half hours each. To facilitate a more cost effective and quality program, a newly proposed algorithm was developed. It incorporates a weighted and scored Diabetes Risk Assessment Tool completed for each patient. Risk stratification based on this tool determines the content and number of nutrition education sessions required for each patient. Choosing one of three options in the algorithm allows the practitioner to select the appropriate level of Medical Nutrition Therapy (MNT) and ensures that all of the standards for comprehensive diabetes education will be met regardless of the pathway ordered. A database has been developed to track MNT interventions and outcomes. Success of the proposed algorithm will be measured by increasing number of people with diabetes participating, cost effectiveness of delivering services and satisfaction of providers and patients. Using a standardized DSME algorithm and Diabetes Risk Assessment Tool offers quality options for delivering cost effective diabetes nutrition services. Funding Disclosure: None
Funding Disclosure: None
Title: VALIDATION OF A SCHOOL FOOD DIARY TO ASSESS DIETARY INTAKES OF MIDDLE-SCHOOL STUDENTS Author(s): K. M. O’Connell,1 R. E. Miller,2 M. K. McIntosh2; 1Center for Nutrition Policy and Promotion, United States Department of Agriculture, Alexandria, VA, 2Department of Nutrition, The University of North Carolina at Greensboro, Greensboro, NC Learning Outcome: Understand how the School Food Diary was validated for use in evaluating the impact of school cafeteria environments on dietary intakes. Text: The objective of this study was to validate the School Food Diary (SFD) for assessing dietary intakes of middle-school students at lunch. The SFD uses aspects of the school food environment to enhance the details of reported food intake. Validity was assessed by comparing intake reported on the SFD to observed intake and to the Harvard Youth and Adolescent Food Frequency Questionnaire (HYAQ). Students (n⫽489, 12.7 y, 55% female, 59% white, 27% low income) from six randomly selected middle schools in Guilford County, NC completed the SFD and HYAQ. Thirty-five students were observed at lunch and completed SFD reports to identify exact matches and omissions. The SFD was tested to determine if differences in dietary intake could be detected between two groups expected to differ. To do this, servings of fruits, vegetables, and milk products (FVM) reported by students purchasing National School Lunch Program (NSLP) meals where compared to those of students not purchasing NSLP meals using analysis of variance. Thirty-two SFD were exact matches and only 3 diaries had missing foods. As expected, students purchasing NSLP meals had significantly higher intakes of FVM compared to those who did not (NSLP/non-NSLP) at 0.43/0.33 (p⫽0.05), 0.24/0.10 (p⬍0.001), and 0.89/0.36 (p⬍0.001) servings, respectively. SFD and HYAQ reports were correlated for fruits (r⫽0.18, p⫽0.003) and milk products (r⫽0.13, p⫽0.003), but not for vegetables. The SFD provides valuable detail regarding the eating behaviors of students in the school-cafeteria environment. Additional research may be warranted to further investigate the validity and reliability of the SFD. Funding Disclosure: Grant funding from the North Carolina Healthy Weight Initiative, USDA Team Nutrition, and the Moses Cone Wesley Long Health Foundation
Title: THE DEVELOPMENT OF A DIET QUALITY SCORE Author(s): C. M. Zars, C. C. Tangney, K. S. Keim, A. J. Domas, T. Sher; Rush University, Chicago, IL Learning Outcome: The participant will be able to identify a quick way to measure how well a patient adheres to a diet rich in fruits, vegetables and fiber while limiting fat, alcohol and added sugars and increasing physical activity. Text: Background: Various tools have been developed to help an individual’s adherence to a “high quality” diet based on a set of dietary targets Objective: To develop and validate a diet quality scoring (DQS) tool employing nutrition recommendations regarding intakes of fruits and vegetables, fat, fiber, alcohol, sugar and physical activity. Methods: The DQS was developed using repeated recalls from participants in an 18 month theory based intervention trial. At baseline and six months, three nonconsecutive telephone dietary recalls from the 56 patients were selected to test the validity of the dietary score and scored by the same clinician (CZ). Previously, nutrient analysis of recalls was performed using the University of Minnesota Nutrition Data Systems, version 4.3. Correlations were run between DQS components and corresponding nutrients for each recall using SPSS, version 13. Results: Recalls were acquired from 49 men and 7 women, mean age of 60 y and BMI, 32.5. Subjects were 66% Caucasian, 20% African American, 11% Hispanic and 3% Asian/Pacific. In terms of criterion related validity, correlations between DQS/component scores and nutrients (-carotene, natural folate, potassium, dietary fiber, and percent of calories from total and saturated fat) from analyses of recalls ranged from ⫺0.26 to 0.90. Scoring of 30 recalls by two persons yielded inter-rater reliability coefficient of 0.96. Conclusion: This tool is a quick and easy way for an individual to track how well he or she is following a particular diet that is based on the aforementioned targets by obtaining a diet quality score. Funding Disclosure: None
Journal of the AMERICAN DIETETIC ASSOCIATION / A-21