JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

A RIPPLE THAT BECAME A TSUNAMI

SMITH RON

For the American Dietetic Association and its members, the ramifications or consequences of the 2002 elections, in which Republicans gained the majority in Congress, may be far-reaching. In 2002, the ADA Board of Directors identified six federal priorities issues: aging or long-term care, obesity, Medicare cardiovascular medical nutrition therapy, nutrition monitoring, Child Nutrition Act reauthorization (includes the school lunch program and WIC), and nutrition research funding. DIETITIANS, FEDERAL LEGISLATION, POLITICAL PARTIES, CONGRESSIONAL ELECTIONS

COCOA AND CHOCOLATE FLAVONOIDS: IMPLICATION FOR CARDIOVASCULAR HEALTH

STEINBERG FRANCENE M; BEARDEN MONICA M; KEEN CARL L

This paper offers a review of current scientific research regarding the potential cardiovascular health benefits of flavonoids found in cocoa and chocolate. Recent reports indicate that the main flavonoids found in cocoa, flavan-3-ols and their oligomeric derivatives, procyanidins, have a variety of beneficial actions, including antioxidant protection and modulation of vascular homeostasis. These findings are supported by similar research on other flavonoid-rich foods. Other constituents in cocoa and chocolate that may also influence cardiovascular health are briefly reviewed. The lipid content of chocolate is relatively high; however, one third of the lipid in cocoa butter is composed of the fat stearic acid, which exerts a neutral cholesterolemic response in humans. Cocoa and chocolate contribute to trace mineral intake, which is necessary for optimum functioning of all biologic systems and for vascular tone. Thus, multiple components in chocolate, particularly flavonoids, can contribute to the complex interplay of nutrition and health. Applications of this knowledge include recommendations by health professionals to encourage individuals to consume a wide range of phytochemcal-rich foods, which can include dark chocolate in moderate amounts. CHOCOLATE, COCOA, NUTRITION, CARDIOVASCULAR DISEASE

CONSUMER PERCEPTION OF RISK ASSOCIATED WITH EATING GENETICALLY ENGINEERED SOYBEANS IS LESS IN THE PRESENCE OF A PERCEIVED CONSUMER BENEFIT

BROWN J LYNNE; PING YANCHAO

Objective To determine whether perceived benefit alters personal risk perception associated with eating genetically engineered soybeans, consumer desire for labeling, preferred phrase on a label symbol, and desired information in an educational brochure. Design Comparison of responses of two consumer groups who completed one of two survey versions. Subjects/settings One hundred fifty supermarket shoppers, age 21 years and older, for each survey or n=300 total. Focus groups and a pilot test were used to develop the final survey in which consumers read a description of a genetically engineered soybean with either no obvious consumer benefit or an obvious consumer benefit and then completed a set of attitude questions and evaluated a voluntary label design and educational brochure content. Main outcome measures were mean opinion scores of personal risk and desire for labeling and ranking of desired label phrase and brochure topics. Statistical analyses X sup 2 and t Tests were used. Results Consumers reading about the soybean with obvious consumer benefit were significantly more comfortable eating these than those reading about the soybean with no obvious consumer benefit (2.9 +/- 1.1 vs 3.4 +/- 1.0, respectively; P<=.001). However, the groups did not differ in desire for labeling of foods made with these soybeans or preferred brochure content. They did differ significantly in preferred phrase on the symbol (P<=.05). Applications/conclusions Dietitians can use descriptions of genetic engineering applications such as those in this study to help consumers assess these applications. Dietitians can play a critical role in explaining labeling terms and designing educational materials when the FDA finalizes voluntary labeling regulations for genetically engineered foods. SOYBEANS, GENETIC ENGINEERING, CONSUMER ATTITUDES

EXPANDING PORTION SIZES IN THE US MARKETPLACE; IMPLICATIONS FOR NUTRITION COUNSELING

YOUNG LISA R; NESTLE MARION

The greater energy content of larger food portions could be contributing to the increasing prevalence of overweight. Prevention guidelines recommend 'sensible' portion sizes but do not define them. The US Department of Agriculture (USDA) defines standard serving sizes for dietary guidance, and the Food and Drug Administration (FDA) defines standard servings for food labels. To use these standards in counseling, nutritionists must know the sizes of portions available in the marketplace. We determined marketplace portion sizes, identified changes in these sizes with time, and compared current marketplace portions with federal standards. Most marketplace portions exceed standard serving sizes by at least a factor of 2 and sometimes 8-fold. Portions have increased over time; those offered by fast-food chains, for example, often are 2 to 5 times larger than the original size. The discrepancy between marketplace portions and standard servings suggests the need for greater emphasis on the relationship of portion size to energy intake as a factor in weight maintenance. FOOD, WEIGHT CONTROL, RESTAURANTS, NUTRITION

FOLATE INTAKES AND AWARENESS OF FOLATE TO PREVENT NEURAL TUBE DEFECTS: A SURVEY OF WOMEN LIVING IN VANCOUVER, CANADA

FRENCH MELISSA R; BARR SUSAN I; LEVY-MILNE RYNA

Objective To estimate folate intake and knowledge in womer of childbearing age, in relation to risk of neural tube defects. Subjects/setting One hundred forty-eight women (aged 18 to 45 years) in the Vancouver area of British Columbia, Canada. Design Using an interviewer-administered survey, we examined women for folate knowledge and the relation of folate knowledge to intake in a random sample. Contribution of folate from food, fortified grain products, and supplements was assessed by validated semiquantitative food frequency questionnaire. Statistical analyses performed Descriptive statistics, t tests, chi2, Pearson correlation analysis. Results Mean daily folate intake from food, fortified foods, and supplementation was 812 +/- 710 Dietary Folate Equivalents (DFE)/day. Fortification of bread and grain products contributed 104 +/- 68 (mu)g synthetic folic acid-(SFA)/day (equal to 174 +/- 114 DFE), and supplements contributed 205 +/- 388 (mu)g SFA/day. Although 86% of women met the Estimated Average Requirement (320 DFE/day) for folate, only 26% met the recommendation (400 (mu)g SFA/day) for women capable of becoming pregnant. Most (95%) of the women had heard of folate, but only 25% knew that it could prevent birth defects. One-fourth of the women had good or very good knowledge of folate-rich foods. However, folate knowledge was not related to its intake. The most common sources of folate information were magazines/newspapers, doctors, and television/ radio. Lack of awareness of the importance of folate was the most common reason given for choosing not to use folic acid supplements before pregnancy. However, 78% of the women indicated that, with knowledge of the benefits of folate, they would use supplemental folic acid daily to reduce the risk of birth defects. Applications/conclusions Educational strategies are required to increase folate awareness among women and to promote the benefits of periconceptional folic acid supplementation. Targeting physicians to educate women on the importance of folate could be a potentially successful route. WOMEN, REPRODUCTIVE SYSTEM, MEDICAL DISORDERS, VITAMIN B

HETEROGENEITY IN THE PREVALENCE OF METHYLENETETRAHYDROFOLATE REDUCTASE GENE POLYMORPHISMS IN WOMEN OF DIFFERENCT ETHNIC GROUP

ESFAHANI SETAREH TORABIAN; COGGER EDWARD A; CAUDILL MARIE A

Objective To determine the prevalence of methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms in women of different ethnic groups and to relate these common mutations to plasma homocysteine, red cell folate, and serum folate. Design A one-time fasting blood sample was obtained for MTHFR genotype (C677T and A1298C) determinations (n=433). Serum folate, red cell folate, and homocysteine analyses were performed in nonfolic acid supplement users (n=215). Subjects/setting This study involved 433 women from four ethnic groups, including 193 Hispanic women of Mexican descent, 139 white women, 53 Asian women of mixed descent, and 48 African American women. Statistical Analyses Performed X, t Test, and analysis of variance were used. Results Mexican women (IS. 18.1%) had a higher frequency of the 677 TT genotype compared with white (7.2%), Asian (3.8%), and African American (0%) women. White women (7.9%) had a higher frequency of the 1298 CC genotype than the other ethnic groups (range= 1.9% to 2.6%). The frequency of compound heterozygosity (677 CT + 1298 AC) was higher in Mexican (17.6%) and white (15.1%) women than Asian and African American (-4% to 6%) women. In the era of folic acid fortification, neither genotype, independently or together, was associated with homocysteine or blood folate concentrations when ethnic groups were combined. In Mexican women, however, a linear trend (P-.05) was detected for the C677T variants with the lowest red cell folate in the TT genotype. Applications/conclusions These data demonstrate ethnic differences in genetic polymorphisms that are diet responsive and may be useful when investigating ethnic variations in chronic disease, developmental anomalies, and folate requirements. MINORITY & ETHNIC GROUPS, WOMEN, GENES, MUTATION

MOTIVATIONAL INTERVIEWING AND DIETARY BEHAVIOR CHANGE

THORPE MELISSA

Motivational interviewing (MI) is considered to be an effective tool for those working with people who display addictive or compulsive behavior. As numerous compulsions and addictions are associated with food, nutrition, and diet (from eating disorders to obesity), it is logical that dietitians would benfit from learning the techniques of motivational interviewing, specifically how it is applicable and effective in implementing dietary behavior change. DIET, BEHAVIOR, MOTIVATION, INTERVIEWS, DIETITIANS

NUTRITION IN CLINICAL PRACTICE (A COMPREHENSIVE, EVIDENCE-BASED MANUAL FOR THE PRACTITIONER)

Beyer reviews 'Nutrition in Clinical Practice (A Comprehensive, Evidence-Based Manual for the Practitioner)' by David L. Katz. Favorable book review. NONFICTION, NUTRITION, DIETITIANS

PHYSICAL ACTIVITY: HOW MUCH IS ENOUGH?

MCCAFFREE JIM

To prevent weight gain as well as to accrue additional, weight-independent health benefits of physical activity, 60 minutes of daily moderate-intensity physical activity (eg, walking/jogging at 4 to 5 mph) is recommended by the Institute of Medicine, in addition to the activities required by a sedentary lifestyle. Many people wonder where they will find the time and whether they are still at risk for disease related to inactivity. Many dietetics professionals may wonder if these recommendations will prompt a consumer backlash. EXERCISE, PHYSICAL FITNESS

REPORT ON THE ADA 2002 DIETETICS COMPENSATION AND BENEFITS SURVEY

ROGERS DICK

A survey sought to measure compensation for dietetics-related employment, which was purposely conceived broadly. By way of example, respondents were referred to an enclosure naming and briefly describing 58 core dietetics positions. These positions included not only traditional dietetics jobs, such as clinical dietitian, outpatient dietitian, and WIC nutritionist, but also jobs in areas such as consulting, sales, and communications. DIETITIANS, JOB DESCRIPTIONS, COMPENSATION, EMPLOYEE BENEFITS, POLLS & SURVEYS

THE NEED FOR A NUTRITION-RELATED QUALITY-OF-LIFE MEASURE

BARR JUDITY T; SCHUMACHER GERALD E

To maximize quality of life involving food or to conduct research to document quality-of-life outcomes for individuals receiving medical nutritional therapy (MNT), a nutrition-related quality-of-life (NQOL) survey must be developed to measure, in routine clinical practice as well as in patient-centered outcomes research, the unique impact of MNT on patients' quality of life. NUTRITION, QUALITY OF LIFE, POLLS & SURVEYS

WHERE CAN I FIND RESOURCES ON FOOD LABELING IN A RESTAURANT SETTING?

CUMMINGHAM ELEESE

Restaurants are not required by law to put nutrition labels on their menus. However, if an item makes a nutrient claim, eg high fiber, the Food and Drug Administration (FDA) does require that the restaurant display the nutrition information for that particular nutrient. RESTAURANTS, NUTRITION, LABELING

POSITION PAPER UPDATE FOR 2003

An updated list of papers stating current positions of the American Dietetic Association on such subjecst as aging, child nutrition, and food safety, is presented. DIET, NUTRITION

HONORARY ADA MEMBER VICTOR HERBERT PASSES

Victor Herbert, an honorary member of the American Dietetic Association, died on Nov 19, 2002 at the age of 75. Herbert was known for his folic acid research and active part in dismissing health fads. DEATHS, SCIENTISTS, PERSONAL PROFILES

ARE HEALTH PLANS CHANGING THEIR VIEWS ON NUTRITION SERVICE COVERAGE?

FITZNER KAREN; MYERS ESTHER F; CAPUTO NADINE; MICHAEL PAM

Health insurers and managed care organizations are changing their coverage and reimbursement strategies, in large part because of cost pressures and consumer demand, with greater attention being paid to evidence-based medicine. Dietetics professionals as well as other health professionals can benefit from understanding these shifts within the current organizational structure of the US healthcare system. With this knowledge, they can better formulate their own strategic responses to coverage in the evolving managed healthcare environment. HEALTH INSURANCE, MANAGED CARE, NUTRITION, INSURANCE COVERAGE

FATTY ACIDS: PHYSIOLOGICAL AND BEHAVIORAL FUNCTIONS

Kris-Etherton reviews 'Fatty Acids: Physiological and Behavioral Functions' edited by David I. Mostofsky, Shlomo Yehuda, and Norman Salem Jr. Favorable book review. NONFICTION, FATTY ACIDS

EATING DIFFICULTIES IN GIRLS WITH RETT SYNDROME COMPARED WITH OTHER DEVELOPMENTAL DISABILITIES

ISAACS JANET SUGARMAN; MURDOCK MARIANNE; PERCY JANE LANE ALAN K

Rett syndrome arises from a mutation on the X chromosome and occurs with prevalence in the general population in 1:10,000 women. Its major nutritional consequences require that health providers recognize early signs of eating difficulties and slowing of growth parameters. Retrospective record review of 44 girls, in two equal-sized groups matched by age, showed that the Rett syndrome group was significantly different, with lower body weights, more respiratory difficulties, more gastrointestinal symptoms interfering with eating, more swallowing problems, less self-feeding, and lower texture tolerance for chewy and crunchy foods compared with the developmental disability group. Microcephaly was noted for half of the Rett syndrome group compared with seven in the developmental disability group. Parents expressed concern about their child's difficulties in eating; eight of the Rett syndrome girls and 13 of the girls in the developmental disability group were reported to have a poor appetite. Distinctive features of Rett syndrome consistent with those in the literature were documented reasonably well in the nutrition assessment records. Detailed food intake information was analyzed for food texture characteristics to recognize early eating and texture tolerance problems. Recommendations were offered for conducting a thorough nutrition assessment of Rett syndrome patients, including analysis of the texture of consumed foods. Additional recommendations for improving nutrition services to those with Rett syndrome and other developmental disabilities include ruling out microcephaly, early identification of eating difficulties, with modifications in food texture as appropriate, and self-feeding goals. GIRLS, EATING DISORDERS, GENES, MUTATION

DEVELOPMENT AND RECOGNITION: EVOLVING PRACTICE IN AN EVOLVING PROFESSION

MAILLET JULIE O'SULLIVAN

For dietitians, professional development and recognition are the keys to staying ahead of the curve, and the American Dietetic Association (ADA) is doing much to increase members' opportunities in these areas. One way to meet the continuing education requirement of ADA's membership is through the Commission on Dietetic Registration's self-assessment offerings and the Professional Development Portfolio process. DIETITIANS, PROFESSIONAL DEVELOPMENT, CONTINUING EDUCATION, ASSOCIATIONS

GENETICS AND ETHNICITY WILL PLAY BIGGER ROLES IN DIETETICS

BROWN DAMON

A recent study found that women of Mexican descent may have increased susceptibility of obstetrical complication and chronic diseases compared to other ethnic groups. The increased susceptibility was because women of Mexican descent were found to have higher folate requirements and, therefore, have a harder time getting them met. For nutritionists, this is a sign that ethnic background needs to be taken seriously. WOMEN, HISPANIC AMERICANS, PREGNANCY, CHRONIC ILLNESSES, VITAMIN B, NUTRITION

DIETITIANS AS MULTIDEPARTMENT MANAGERS IN HEALTHCARE SETTINGS

CANTER DEBORAH D; NETTLES MARY FRANCES

The purpose of a study was to explore the prevalence of multidepartment management in healthcare operations among members of the Management in Food and Nutrition Systems dietetic practice group (DPG). Researchers sought to determine the knowledge and skills needed to be an effective multidepartment manager and to gain recommendations from respondents related to training needs, professional development, and implications for dietetics education. DIETITIANS, MANAGEMENT, HEALTH FACILITIES

REPRODUCIBILITY AND VALIDITY OF THE SECONDARY LEVEL SCHOOL-BASED NUTRITION MONITORING STUDENT QUESTIONNAIRE

HOELSCHER DEANNA M; DAY R SUE; KELDER STEVEN H; WARD JERRI L

Objective To evaluate the reproducibility and validity of the School-Based Nutrition Monitoring (SBNM) secondary level student questionnaire. Design Reproducibility was evaluated using a test-retest study design by administering the questionnaire on the same day (morning and afternoon, n=254) and, when appropriate, 9 to 14 days apart (n=259). Validity was assessed by comparing foods selected on the questionnaire with foods reported from a single 24-hour recall covering the same referent period (yesterday) in 209 students. Subjects/setting Eighth grade students in middle schools from central Texas were used: male and female, approximately 75% white, for the reproducibility study, with 15% Hispanic, 6% African American; for the validation study, approximately 38% white, 41% Hispanic, and 17% African American. Statistical analysis Spearman rank order correlation, rc statistic, and percentage agreement were used for both reproducibility and the validation. Results For the reproducibility study, agreement for questions about food intake 'yesterday' were 70% to 98%, with K statistics ranging from 0.54 to 0.93 and correlations between 0.66 and 0.97. Questions on recent physical activity had high agreement (66% to 89%) as did 'usual' physical activity items, weight loss, and food selection behaviors. Nutrition knowledge items showed relatively weaker reliability: agreements ranged from 47% to 92%, with K statistics between 0.30 and 0.56. Attitude questions had weaker agreement (50% to 87%), x statistics (0.27 to 0.52), and correlations (0.33 to 0.63). For the validation study, correlation coefficients ranged from 0.32 for breads to 0.68 for milk and beans. Percentage agreement ranged from 38% for breads to 89% for gravy. Applications/conclusions Most questions on the SBNM secondary questionnaire were found to have acceptable reproducibility, whereas validation of food choice behaviors showed results similar to or better than other dietary assessment instruments for this age group. This questionnaire is a useful epidemiologic tool for surveillance, assessing broad intervention effects among groups or providing needs assessment data on selected nutrition and physical activity-related constructs. NUTRITION, SECONDARY SCHOOL STUDENTS, QUESTIONNAIRES