JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

ACHIEVING A DIVERSE PROFESSION THROUGH ACADEMIC RECRUITMENT

TAYLOR EVELYN; RASOR-GREENHALGH SUE; HUDAK SANDRA; STOMBAUGH ISABELLE

National studies of the student diversity of Family and Consumer Sciences programs reveal that there is consistently a limited number of underrepresented students. This is also true for the dietetics profession. The need for diversity extends into other aspects of health care. HIGHER EDUCATION, MULTICULTURALISM & PLURALISM, NUTRITION EDUCATION, PROFESSIONS

CHILD AND ADOLESCENT OBESITY: CAUSES AND CONSEQUENCES, PREVENTION AND MANAGEMENT

Child and Adolescent Obesity: Causes and Consequences, Prevention and Management edited by W. Burniat, T.J. Cole, I. Lissau and E.M.E. Poskitt is reviewed. Favorable book review. NONFICTION, CHILDREN & YOUTH, OBESITY

COMPARISON OF ESTIMATED RENAL NET ACID EXCRETION FROM DIETARY INTAKE AND BODY SIZE WITH URINE PH

MICHAUD DOMINIQUE S; TROIANO RICHARD P; SUBAR AMY F; RUNSWICK SHIRLEY

Objective: The aim of this study was to examine whether estimated net acid excretion (NAE) from two dietary assessment instruments can predict urine pH in healthy volunteers. Application/conclusions: Our findings suggest that FFQs provide adequate dietary data to estimate renal NAE and could be used as a surrogate for urinary pH levels in large epidemiologic studies. ACIDS, DIET, KIDNEYS, URINE

CONTINUOUS IMPROVEMENT IN DIETETICS EDUCATION WITH A REGIONAL ADVISORY BOARD: A MODEL THAT WORKS

MARTIN ROSE L

Continuous improvement has been a focus of business and health care for years. The Commission on Accreditation for Dietetics Education has also identified the need for continuous improvement in dietetics education programs and requires them to seek outside counsel to help accomplish it. Most dietetics education programs develop advisory boards to provide this outside counsel, but finding individuals to commit to an ongoing advisory board can be challenging. Dietetics internship directors from dietetics practicum programs throughout Arizona created the Arizona Dietetic Practicum Advisory Committee (AzDPAC), which uses suggestions from preceptors, interns, and committee members to generate ideas for improvement. Since the conception of AzDPAC both tangible and intangible outcomes have occurred. Tangible outcomes include better coordination among programs, development of a combined annual affiliate meeting, standardization of forms, creation of a combined 'Clinical Bootcamp,' development of a Web page describing all programs, and better networking among interns from different programs. In addition, AzDPAC improved cooperation and sharing of expertise and created an available group of peers for new directors. An advisory committee of regional program directors is a model that works in providing dietetics education programs with ongoing outside counsel and ideas for continuous improvement. DIETITIANS, MODELS, NUTRITION EDUCATION, QUALITY OF EDUCATION

DIETARY INTAKE A USEFUL, BUT NOT FOOLPROOF, ALTERNATIVE IN DETERMINING RENAL NET ACID EXCRETION

BROWN DAMON

In their study, researchers Michaud, Troiano, Subar, Runswick, Bingham Kipnis, and Schatzkin use dietary intake measures instead of urine pH analysis to determine patients' estimated renal net acid excretion (NAE). Participants were given two food frequency questionnaires (FFQs) and two 24-hour recalls in three-month intervals while simultaneously giving two 24-hour urine samples. They found comparable results, with the biggest advantage of FFQs being 'that collecting multiple urine samples in a large epidemiologic study would be expensive and burdensome to patients.' ACIDS, DIET, KIDNEYS, URINE

ETHNIC DIFFERENCES IN THE NUTRIENT INTAKE ADEQUACY OF PREMENOPAUSAL US WOMEN: RESULTS FROM THE THIRD NATIONAL HEALTH EXAMINATION SURVEY

ARAB LENORE; CARRIQUIRY ALICIA; STECK-SCOTT SUSAN; GAUDET MIA M

This article provides evidence that a high proportion of premenopausal US women are underconsuming a variety of nutrients. Dietary intakes alone are not currently adequate to meet the new recommended intakes. Nutritional supplement use is widespread and effective, but does not eliminate the concerns for at-risk populations. Awareness of the general inadequacies in intakes of vitamin E and folic acid at large, and in many women vitamin C as well, can help direct individual dietary recommendations and place the emphasis in group counseling on nutrients that are of widespread concern. In addition, foods rich in vitamins B-6 and of general nutritional benefit should be emphasized among African American women in the United States as a substantial proportion of this group is still showing inadequate intakes from foods. DIET, MINORITY & ETHNIC GROUPS, NUTRITION, WOMEN

FOLATE INTAKE ASSESSMENT: VALIDATION OF NEW APPROACH

YEN JELIN; ZOUMAS-MORSE CHRISTINE; PAKIZ BILGE; ROCK CHERYL L

Objective: To describe the performance characteristics and validate a folate-specific focused recall approach to estimating folate intake. Design: In a cross-sectional study, folate-specific recalls were used to estimate subjects' average daily folate intake from seven days of dietary recall over a one-month period. This estimate was compared to an estimate of the average daily folate intake obtained using the Fred Hutchinson Cancer Research Center Food Frequency Questionnaire (FFQ) and to plasma folate and homocysteine concentrations. DIET, NUTRITION, VITAMIN B

HAVE YOU VISITED THE ADA WEB SITE LATELY?

GRAHAM LAUREL K

The long-awaited, much-anticipated American Dietetic Association Web site is here! Dependent on one's screen dimensions, the Web site is anywhere from 12 inches to 15 feet in diameter and off the innovation growth charts for comparable food and nutrition Web sites. Our address is the same (www.eatright.org), but our new look and attitude reflect the ever-evolving world of food and nutrition research. NUTRITION, WEB SITES

INTRODUCING A PROBLEM-BASED UNIT INTO A LIFESPAN NUTRITION CLASS USING A RANDOMIZED DESIGN PRODUCES EQUIVOCAL OUTCOMES

LOHSE BARBARA; NITZKE SUSAN; NEY DENISE M

Problem-based learning (PBL) is a tutorial, student-centered, problem-driven educational strategy adopted by medical and allied health educators to positively influence self-directed learning, critical thinking, and learning behavior. PBL was examined in dietetics education through random assignment of 32 undergraduate dietetics students for two weeks to either a problem-based or a lecture-based case format for the infant and elderly units of a 16-week lifespan nutrition course. Random assignment followed stratification for gender and earlier course examination performance. Expert validation of PBL curricular components and noted differences in discussion structure and information resources verified curriculum distinctiveness. Main outcome measures were preand post-Cognitive Behavior Survey scores for memorization, reflection, and positive learning experience scales, unit and course evaluations and unit examination scores. Students in problem-based modules demonstrated greater gains in reflective thinking with stable memorization, suggesting improved critical thinking skills. Tenets that problem-based learning promotes knowledge retention and provides a more positive learning experience were not upheld. Knowledge acquisition was not hindered by a problem-based approach. We conclude that gains in reflective thinking and evidence of increased self-directed learning argue for inclusion of PBL in dietetics curricula and that a problem-based education will help dietitians successfully respond to professional development needs. LEARNING, NUTRITION EDUCATION, PROBLEM SOLVING

NUTRITIONAL COFACTOR TREATMENT IN MITOCHONDRIAL DISORDERS

MARRIAGE BARBARA; CLANDININ M THOMAS; GLERUM MOIRA

Mitochondrial disorders are degenerative diseases characterized by a decrease in the ability of mitochondria to supply cellular energy requirements. Substantial progress has been made in defining the specific biochemical defects and underlying molecular mechanisms, but limited information is available about the development and evaluation of effective treatment approaches. The goal of nutritional cofactor therapy is to increase mitochondrial adenosine 5'-triphosphate production and slow or arrest the progression of clinical symptoms. Accumulation of toxic metabolites and reduction of electron transfer activity have prompted the use of antioxidants, electron transfer mediators (which bypass the defective site), and enzyme cofactors. Metabolic therapies that have been reported to produce a positive effect include Coenzyme Q!sub 10! (ubiquinone); other antioxidants such as ascorbic acid, vitamin E, and lipoic acid; riboflavin; thiamin; niacin; vitamin K (phylloquinone and menadione); creatine; and carnitine. A literature review of the use of these supplements in mitochondrial disorders is presented. DIETARY SUPPLEMENTS, MEDICAL DISORDERS, NUTRITION

NUTRITION CARE PROCESS AND MODEL: ADA ADOPTS ROAD MAP TO QUALITY CARE AND OUTCOMES MANAGEMENT

LACEY KAREN; PRITCHETT ELLEN

This article describes the four steps of ADA's Nutrition Care Process and the overarching framework of the Nutrition Care Model that illustrates the context within which the Nutrition Care Process occurs. In addition, this article provides the rationale for a standardized process by which nutrition care is provided, distinguishes between the Nutrition Care Process and Medical Nutrition Therapy (MNT), and discusses future implications for the profession. HEALTH CARE, MODELS, NUTRITION

PRACTICE POINTS: MEASURING FOLATE INTAKE: NEW TOOL FOR DIETITIANS

THORPE MELISSA

Amidst the myriad reports and interest is the study 'Folate Intake Assessment: Validation of a New Approach,' published in this month's Journal. The results of this study show the possible use of a new method of collecting data on folate intake in women using a focused dietary recall approach. DATA COLLECTION, DIET, NUTRITION, VITAMIN B

PREVENTION OF CHILDHOOD OBESITY: SOCIOCULTURAL AND FAMILIAL FACTORS

BRUSS MOZHDEH B; MORRIS JOSEPH; DANNISON LINDA

This study examined sociocultural and familial factors related to the prevention of childhood obesity. Primary caregivers of 6- to 10-year-old children representing several ethnic populations in Saipan participated in 4 focus groups (N= 32). Trained moderators used semi-structured interviews and qualitative methods were used in data analysis. A central theme with several related factors emerged. The theme was a conflict expressed by the primary caregiver between sociocultural values, family expectations, traditional dietary beliefs and attitudes, and knowledge about food and disease. These findings have important implications for designing culturally sensitive interventions for prevention of childhood obesity. CHILDREN & YOUTH, OBESITY, PREVENTION

SUGARS AND HEALTH: IS THERE AN ISSUE?

JONES JULIE M; ELAM KAREN

Recognizing the existence of such confusion well before the release of the IOM report, the Carbohydrate Technical Committee of the North American branch of the International Life Sciences Institute convened a workshop to address the latest scientific issues relating to sugars and health. The review papers from that workshop, the Sugars and Health Workshop, have been accepted for publication as a supplement to the American Journal of Clinical Nutrition. The following article provides a summary of the workshop process and findings. CARBOHYDRATES, DIET, NUTRITION

THE ASSOCIATION BETWEEN VITAMIN C AND VITAMIN E SUPPLEMENT USE BEFORE HEMATOPOIETIC STEM CELL TRANSPLANT AND OUTCOMES TO TWO YESARS

BREUEMMER BARBARA; PATTERSON RUTH E; CHENEY CARRIE; AKER SAUNDRA N; WITHERSPOON ROBERT P

Objective: To examine the prevalence of supplement use in persons before receiving hematopoietic step cell transplant (HSCT) and the association of select supplements with outcomes. Applications/conclusions: Though this work was observational, the results suggest supplemental vitamin C before therapy may be beneficial in persons with breast cancer but both vitamin C and vitamin E may increase risk in persons with acute leukemia receiving HSCT. Practitioners should document supplement use in subjects receiving therapy for cancer. CLINICAL OUTCOMES, CORRELATION ANALYSIS, DIETARY SUPPLEMENTS, STEM CELLS, TRANSPLANTS & IMPLANTS, VITAMIN C, VITAMIN E

THE LENNA FRANCIS COOPER MEMORIAL LECTURE-THE FUTURE OF DIETETICS: EVIDENCE, OUTCOMES, AND REIMBURSEMENT

FRANZ MARION J

Medical nutrition therapy must be delivered in a scientific and effective manner and the outcomes of MNT measured. Providing follow-up and applying behavioral change concepts and support can result in improved patient outcomes and is essential. However, to justify and improve reimbursement, dietitians must act on outcome data and play an active role in disease management by making recommendations to the health care team and referring providers based on the data. Effectiveness of our services must be promoted to patients, other health care providers, insurance and managed-care companies, and government agencies. DIETITIANS, NUTRITION, PROFESSIONS

EMPOWERMENT: A COMMITMENT, NOT A BUZZWORD

EDGE MARIANNE SMITH

Empowering members to compete in the 21st century is one of the main goals of ADA's 2003-06 strategic plan. It is our mission to help members develop and prosper as dietetics professionals. During the coming months, I will focus on practical applications of each strategic goal and how they are all vital to advancing our Association and profession. DIETITIANS, PROFESSIONS

POSITION OF THE WORLD DIETETIC ASSOCIATION: ADDRESSING WORLD HUNGER, MALNUTRITION, AND FOOD INSECURITY

It is the position of the American Dietetic Association (ADA) that access to adequate amounts of safe, nutritious, and culturally appropriate food at all times is a fundamental human right. Hunger continues to be a worldwide problem of staggering proportions. The Association supports programs and encourages practices that combat hunger and malnutrition, produce food security, promote self-sufficiency, and are environmentally and economically sustainable. The Association is aware that hunger exists in a world of plenty and that poverty, gender inequity, ethnocentrism, racism, and the lack of political will are key constraints to solving the problems of global hunger and malnutrition. Recognizing that simplistic approaches are inadequate, the ADA identifies sustainable development as the long-term strategy to ending world hunger and achieving food security. Sustainable development requires political, economic, and social changes that include empowering the disenfranchised, widening access to assets and other resources, narrowing the gap between rich and poor, and adjusting consumption patterns so as to foster good stewardship of nature. Additionally, because the health status of future generations is related to the well-being of their mothers, achieving food security will also require increased access for women to education, adequate health care and sanitation, and economic opportunities. This position paper reviews the complex issues of global food insecurity and discusses long-term solutions for achieving world food security. Achieving the end of world hunger has been and is now within our grasp. There is sufficient food to feed everyone, and solutions can be realized now that will benefit all of humanity. As noted in the paper, most people who examine the costs of ending versus not ending world hunger are bewildered by the question of why humanity did not solve the problem a long time ago. The Association supports programs and encourages practices that combat hunger and malnutrition, produce food security, promote self-sufficiency, respect local cultures, and are environmentally and economically sustainable. The ADA recognizes that decisions and actions that dietetics professionals make as practitioners and consumers can help reduce the extent of poverty and hunger both here and abroad. This paper provides information, resources, and strategies to assist dietetics professionals in improving the public's understanding of key issues, becoming advocates of the poor, and influencing the political will to end world hunger. FOOD SUPPLY, HUNGER, MALNUTRITION

PREVALENCE OF OUTSOURCING AND PERCEPTION OF CLINICAL NUTRITION MANAGERS ON PEFORMANCE OF HEALTH CARE DIETETICS SERVICES

KWON JUNEHEE; YOON BARBARA J H

A nationwide survey of clinical dietitians and clinical nutrition managers was conducted to assess the prevalence of outsourcing in health care dietetics services and to evaluate perceived performance of dietetics services. A questionnaire was developed, validated by an expert panel, and pilot tested prior to data collection. Members of the Clinical Nutrition Management Dietetic Practice Group (N= 1,668) were selected as the study sample. Of 431 respondents, 152 (35.3%) indicated that management of both patient and cafeteria foodservices was outsourced. When mean scores of perceived performance ratings were compared using t test, respondents from self-operated facilities rated several items related to patient and cafeteria food quality and material and human resource utilization higher than respondents at contract-managed facilities. No significant differences were found in performance related to decision-making process, buying power, or training programs. Results suggest that careful weighing of advantages and disadvantages of outsourcing is needed before making decisions regarding outsourcing dietetics services. DIETITIANS, HEALTH SERVICES, OUTSOURCING, PERCEPTIONS

DIETARY INTAKE AND FOOD SOURCES OF WHOLE GRAINS AMONG US CHILDREN AND ADOLESCENTS: DATA FROM THE 1994-1996 CONTINUING SURVEY OF FOOD INTAKES BY INDIVIDUALS

HARNACK LISA; WALTERS SHELLEY-ANN H; JACOBS DAVID R JR

This study characterizes whole grain consumption among a nationally representative sample of US children and adolescents. Given the apparent low level of whole grain intake among most children and adolescents in the United States, interventions are needed to increase intake of whole-grain foods. CHILDREN & YOUTH, DIET, GRAIN, NUTRITION

BABY WEIGHINGS AND VILLAGE FOLKLORE GROUPS

DETWEILER CHRISTINE LINDELL

What do monthly baby weighings, conveying health messages via village folklore groups, and promoting treated mosquito nets have in common? These and other activities are part of an integrated health program operating in a rural province of Benin, a small country in sub-Saharan Africa. In an area of the world where a child dies from malaria every 30 seconds, where significant numbers of children are often chronically undernourished or malnourished, and where infant mortality is around 150 per 1,000 live births, improving nutrition well-being is not just a matter of nutrition. RURAL AREAS, WELLNESS PROGRAMS