JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

HISTORY AND EVOLUTION OF A SUCCESSFUL CERTIFICATION PROGRAM IN NUTRITION SUPPORT: THE CNSD EXPERIENCE

SCHWARTZ DENISE BAIRD

As early as the 1970s, articles were published on the role of dietitians in nutrition support. Both the American Society for Parenteral and Enteral Nutrition and The American Dietetic Association addressed the issues of specialization and certification. Development of a specialty area credential requires a strong demand by practicing clinicians, a unique area of clinical practice with a distinct body of knowledge and the commitment to evolve with clinical practice. Numerous dietitians were involved in the inception, development, and leadership that brought forth certification in nutrition support. This article documents the efforts and participation of a dedicated group of professionals whose common goals resulted in the establishment of a successful, sustaining certification in a specialty area of clinical dietetics: certified nutrition support dietitian. The certified nutrition support dietitian program is now in its 15th year with 2,000 dietitians currently certified both nationally and internationally. A primary focus of the credential is to recognize minimum competency for dietitians practicing in the field of enteral and parenteral nutrition and to provide safe and effective nutrition support therapy. This article provides a framework for persons in other specialty areas attempting to develop certification programs. [PUBLICATION ABSTRACT] DIETITIANS, CERTIFICATION

PHYTOCHEMICALS IN NUTRITION AND HEALTH

Nebeling reviews 'Phytochemicals in Nutrition and Health' edited by Mark S. Meskin, Wayne R. Bidlack, Audra J. Davies, and Stanley T. Omaye. Favorable book review. NONFICTION, CHEMICALS, NUTRITION, HEALTH

A NEW FOOD GUIDE FOR NORTH AMERICAN VEGETARIANS

MESSINA VIRGINIA; MELINA VESANTO; MANGELS ANN REED

A new food guide for North American vegetarians was developed to establish a guide that would meet the needs of people following different types of vegetarian diets; to help vegetarians choose diets that would meet the most recent recommendations established by the Institute of Medicine; to include guidelines that focus on specific nutrients of particular interest in vegetarian diets; to include a wide variety of foods that are consumed by vegetarians; and to increase awareness about the availability of calcium from nondairy foods. VEGETARIANISM, DIET

POSITION OF THE AMERICAN DIETETIC ASSOCIATION AND DIETITIANS OF CANADA: VEGETARIAN DIETS

It is the position of the American Dietetic Association and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases. Approximately 2.5% of adults in the United States and 4% of adults in Canada follow vegetarian diets. A vegetarian diet is defined as one that does not include meat, fish, or fowl. Interest in vegetarianism appears to be increasing, with many restaurants and college foodservices offering vegetarian meals routinely. Substantial growth in sales of foods attractive to vegetarians has occurred, and these foods appear in many supermarkets. This position paper reviews the current scientific data related to key nutrients for vegetarians, including protein, iron, zinc, calcium, vitamin D, riboflavin, vitamin B-12, vitamin A, n-3 fatty acids, and iodine. A vegetarian, including vegan, diet can meet current recommendations for all of these nutrients. In some cases, use of fortified foods or supplements can be helpful in meeting recommendations for individual nutrients. Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits, including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fiber, magnesium, potassium, folate, and antioxidants such as vitamins C and E and phytochemicals. Vegetarians have been reported to have lower body mass indices than nonvegetarians, as well as lower rates of death from ischemic heart disease; vegetarians also show lower blood cholesterol levels; lower blood pressure; and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer. Although a number of federally funded and institutional feeding programs can accommodate vegetarians, few have foods suitable for vegans at this time. Because of the variability of dietary practices among vegetarians, individual assessment of dietary intakes of vegetarians is required. Dietetics professionals have a responsibility to support and encourage those who express an interest in consuming a vegetarian diet. They can play key roles in educating vegetarian clients about food sources of specific nutrients, food purchase and preparation, and any dietary modifications that may be necessary to meet individual needs. Menu planning for vegetarians can be simplified by use of a food guide that specifies food groups and serving sizes. [PUBLICATION ABSTRACT] VEGETARIANISM, DIET

LOWER BONE MASS DETECTED AT FEMORAL NECK AND LUMBAR SPINE IN LOWER-WEIGHT VS NORMAL-WEIGHT SMALL-BONED WOMEN

ROLLINS DEE; IMRHAN VICTORINE; CZAJKA-NARINS DORISE MARIE; NICHOLS DAVID L

Sixty-one nonsmoking, healthy, young, menstruating women aged 18 to 30 years generally considered at peak skeletal bone mass were screened for diseases and drugs known to adversely affect bone mineral density (BMD). Anthropometric measures, BMD of the lumbar spine (LS) and femoral neck (FN), exercise time, selected nutrient, and energy intake were compared. The women were categorized by frame size and body mass index (BMI), with the upper range for normal weight (NW) being BMI 23.0 to 25.9 (n=30) and lower weight (LW) being BMI 16.0-19.9 (n=31). Multivariate t tests, Pearson correlations, and independent sample t tests were used for statistical analysis. Ten of 21 in the LW group, all with small frames, had varying degrees of low BMD of the LS and/or FN. The amount of exercise time was greater in the NW group. Energy and nutrient intakes did not differ significantly between groups. [PUBLICATION ABSTRACT] SPINE, WEIGHT, WOMEN

AN OVERVIEW OF METHODOLOGIES, PROFICIENCIES, AND TRAINING RESOURCES FOR CONTROLLED FEEDING STUDIES

MOST MARLENE M; ERSHOW ABBY G; CLEVIDENCE BEVERLY A

Dietary intervention studies of human beings produce valuable information regarding dietary effects on biological processes and risk factors for chronic diseases. Using the well-controlled feeding approach, participants consume only foods that have been precisely prepared in a research kitchen, whereas in behavioral counseling studies, participants self-select their foods within guidelines. Because controlled feeding studies meticulously control experimental diets, they are intellectually and logistically challenging to conduct. They afford exciting opportunities for dietetic professionals in designing protocols, developing budgets, and collaborating in multidisciplinary research teams. Research dietitians use food composition data and chemical analysis of menus to prepare research diets with precision. They determine the energy requirements of subjects and adjust diets as required, most often for weight maintenance, throughout the study. All people involved in research must be attentive to the ethical treatment of the study participants while motivating them to adhere to the protocol requirements. Dietitians possess many of these skills, but may require training specific to well-controlled feeding studies. Information related to the conduct of controlled feeding studies has recently become more accessible. We provide an overview of well-controlled feeding study methodologies, proficiencies for planning and implementing these studies, and training resources. [PUBLICATION ABSTRACT] DIET, RESEARCH

DEVELOPING HEALTH MESSAGES: QUALITATIVE STUDIES WITH CHILDREN, PARENTS, AND TEACHERS HELP IDENTIFY COMMICATIONS OPPORTUNITIES FOR HEALTHFUL LIFESTYLES AND THE PREVENTION OF OBESITY

BORRA SUSAN T; KELLY LISA; SHIRREFFS MICHAEL B; NEVILLE KERRY; GEIGER CONSTANCE J

Childhood overweight is at an all-time high in the United States. In an effort to better understand children's, parents', and teachers' attitudes, perceptions, and behaviors about preventing overweight in childhood and to explore potential avenues for communicating overweight prevention messages, we conducted qualitative research with these three groups in 2000. Our research consisted of three progressive phases, each building on information obtained from the previous phase: Phase 1, 16 focus groups (N=112); Phase 2, in-home observations, in-depth interviews, and diaries (N=6 families); Phase 3, 10 qualitative interview sessions (N=46). Both parents and children indicated that encouragement and 'small victories' to sustain involvement in getting more fit were critical to success. The findings also suggest that children need direct messages to motivate them to change their exercise and eating habits, as well as tips on cooperating with their parents to achieve fitness goals. Parents need to learn how to talk about eating and exercise habits with their children in positive and encouraging ways and to learn how to help their children maintain efforts to get fit. Teachers consider it essential that parents support healthful lifestyles at home. Parents and children need positive, realistic approaches to getting fit, such as answers to questions about healthful lifestyles; ideas for physical games and activities the family can enjoy together; attainable goals and small steps to healthful eating; healthful meal, snack, and recipe suggestions; incentive ideas for getting kids active; and referral services for local support groups. Parents and children need to work together in addressing the overweight prevention issue and need effective tools to facilitate this cooperative effort. [PUBLICATION ABSTRACT] CHILDREN & YOUTH, OBESITY, LIFESTYLES

RELATIVE VALIDATION OF A BEVERAGE FREQUENCY QUESTIONNAIRE IN CHILDREN AGES 6 MONTHS THROUGH 5 YEARS USING 3-DAY FOOD AND BEVERAGE DIARIES

MARSHALL TERESA A; GILMORE JULIE M EICHENBERGER; BROFFITT BARBARA; LEVY STEVEN M; STUMBO PHYLLIS J

Objective To determine the relative validity of a quantitative beverage frequency questionnaire in assessing beverage, calcium, and vitamin D intakes using 3-day food diaries for reference. Design Parents were asked to complete questionnaires for the preceding week and diaries for the following week for their children. Calcium and vitamin D intakes were estimated from human milk, infant formulas, and cow's milk ('beverages') for questionnaires and diaries and from 'all foods and beverages' for diaries. Data collected at 6 and 12 months and 3 and 5 years of age as part of the Iowa Fluoride Study (N=700) were analyzed cross-sectionally. Subjects Children (N =240); 60 randomly selected from each quartile of energy intake at 6 months of age. Statistical analyses Spearman correlation coefficients, weighted kappa statistics, and percentages of exact agreement were used to assess associations between tools. Results Correlations between mean daily beverage intakes estimated from questionnaires and diaries ranged from 0.95-0.99 for human milk, 0.84-0.85 for infant formula, 0.63-0.86 for cow's milk, 0.54-0.69 for juice/drinks, 0.26-0.59 for liquid soft drinks, 0.35-0.74 for powdered soft drinks and 0.54-0.70 for water. Correlations between mean daily nutrient intakes estimated from questionnaires and diaries 'beverages' ranged from 0.64-0.74 for calcium and 0.60-0.80 for vitamin D; and between questionnaires and diaries 'all foods and beverages' ranged from 0.41-0.63 for calcium and 0.43-0.80 for vitamin D. Applications A quantitative beverage frequency questionnaire can provide a relative estimate of beverage, calcium, and vitamin D intakes. [PUBLICATION ABSTRACT] BEVERAGES, FOOD, DIET, CHILDREN & YOUTH

WHAT ARE SOME RESOURCES THAT CAN HELP MY CLIENTS SORT THROUGH THE CONFLICTING INFORMATION ON DIETARY SUPPLEMENTS?

MARCASON WENDY

The sales of dietary supplements in the United States during the year 2001 reached an estimated 17.74 billion. The US Food and Drug Administration estimates that more than 29,000 supplements are on the market and this number continues to grow each day. It is the role of the dietetics professional to advocate for and promote sound, science-based nutrition information to the public, and actively counter and correct food and nutrition misinformation. DIETARY SUPPLEMENTS, DIETITIANS

BASELINE FAT-RELATED DIETARY BEHAVIORS OF WHITE, HISPANIC, AND BLACK PARTICIPANTS IN A CHOLESTEROL SCREENING AND EDUCATION PROJECT IN NEW ENGLAND

GANS KIM M; BURKHOLDER GARY J; RISICA PATRICIA M; LASATER THOMAS M

Objective To examine baseline fat-related dietary behaviors of white, Hispanic, and black participants in Minimal Contact Education for Cholesterol Change, a National Institutes for Health-funded cholesterol screening and education project conducted in New England. Subjects A sample of 9,803 participants who joined the study at baseline (n=7,817 white; n=1,425 Hispanic; and n=561 black). Methods Participants completed baseline questionnaires that included demographic and psychosocial items as well as the Food Habits Questionnaire, a dietary assessment tool measuring fat-related dietary behaviors. They also had their blood cholesterol level and height and weight measured. Statistical analyses Analysis of variance (ANOVA) was used to compare racial/ethnic groups on continuous demographic variables, and the X sup 2 test of association was used to compare groups on demographic categorical variables. Multivariate analysis of variance (MANOVA) was used to compare mean differences between racial/ethnic groups on six behavioral subscales (Fat Factors) differentiating domains of behavior related to fat intake and to compare 27 individual fat-related dietary behaviors. Results After adjusting for sex, age, marital status, education, employment status, and percent time lived in the United States, white participants had the lowest Food Habits Questionnaire summary score (2.44) (indicating a lower fat diet), followed by Hispanic (2.61) and black (2.68) participants. The three ethnic groups also differed on the prevalence of Fat Factors and specific fat-related dietary behaviors. White participants were more likely to use lower-fat alternatives, to avoid frying, to replace meat, and to modify meat to make it lower in fat. However, they were least likely to eat fruits and vegetables for snacks and desserts. Hispanic participants were more likely to engage in fat-avoidance behaviors and to eat fruits and vegetables for snacks and desserts. Black participants were less likely to eat meatless meals and modify meats to make them lower in fat. Black and Hispanic participants were more likely than white participants to fry foods. Hispanics were less likely to read food labels for nutrition information. The most and least prevalent fat-related behaviors also differed by each ethnic group, showing that different behaviors were more and less easily implemented by each ethnic group. Conclusions/applications The results of this study suggest that there is a need for improvement in dietary behaviors related to fat intake, especially for blacks and Hispanics, and that the specific dietary behavior issues differ widely by ethnicity. These results can be used by nutrition educators and researchers to help them decide what messages to emphasize in dietary counseling, nutrition education programs, and materials. The results can also be used to help design better dietary assessment tools and more effective interventions for culturally diverse populations. [PUBLICATION ABSTRACT] DIET, WEIGHT CONTROL, BEHAVIOR, WHITES, HISPANIC AMERICANS, AFRICAN AMERICANS

PREDICTORS AND CONSEQUENCES OF FOOD NEOPHOBIA AND PICKINESS IN YOUNG GIRLS

GALLOWAY AMY T; LEE YOONNA; BIRCH LEANN L

Vegetable intake among children is well below recommended levels. We assessed whether food neophobia and pickiness contribute to low vegetable intake in school-aged girls and if there are distinct predictors for neophobia and pickiness. Children with food neophobia are reluctant to eat new foods whereas picky children resist eating many familiar foods. Participants were 192 7-year-old girls and their parents, recruited for a study of girls' nutrition and development. We examined relationships between food neophobia and pickiness and assessed whether these variables predicted girls' vegetable consumption and predictors of food neophobia and pickiness. The data were analyzed using a two-step process. First, we used a two-way analysis of variance to assess whether girls who scored high or low on food neophobia and pickiness measures had different levels of vegetable consumption. We used multiple regression analysis to determine predictors of food neophobia and pickiness in the girls.Girls with both food neophobia and pickiness consumed fewer vegetables (1.1 +/-0.1) than girls with neither neophobia nor pickiness (1.6+/- 0.1). Neophobia and pickiness were modestly related in this sample, but had different predictors. Girls with food neophobia were more anxious and had mothers with food neophobia. Picky girls had mothers with less variety in their vegetable intake (r= -0.22) and mothers who perceived their family to have little time to eat healthful foods (r=0.36). In addition, picky eaters were breastfed for fewer than 6 months (r=-0.25). Pickiness was predicted primarily by environmental or experiential factors subject to changes; neophobia was predicted by more enduring and dispositional factors. Applications Because food neophobia and pickiness negatively influence vegetable intake, intervention strategies to increase vegetable intake should focus on predictors of neophobia and pickiness, especially those subject to change. [PUBLICATION ABSTRACT] FOOD, FEAR & PHOBIAS, GIRLS

FOOD BIOSECURITY

BRUEMMER BARBARA

Food is an element of daily life, but, in our complex culture, we often overlook the role of food in basic survival. The threat of a bioterrorist attack on our food supply is an issue that we need to evaluate and analyze at every level of preparedness planning. BIOLOGICAL & CHEMICAL TERRORISM, FOOD SUPPLY, EMERGENCY PREPAREDNESS

AGING ISSUES MOVING MAINSTREAM

DAUSCH JUDITH G

The lack of an overall, comprehensive plan to address the multitude of aging issues is a barrier to formulating appropriate policy recommendations and ensuring the health and food security of America's aging population. The purpose of this article is to examine some of the nutrition-related factors that should be considered in developing a national policy to improve the health care of older adults. OLDER PEOPLE, HEALTH CARE

THE FOOD & NUTRITION CONFERENCE & EXPO: IT CAN HELP YOUR CAREER

MCCAFFREE JIM

Last year's Food and Nutrition Conference and Expo (FNCE) was one of the best-attended in the American Dietetic Association's history. Attending FNCE as well as state and local meetings can be one of the best things dietitians can do for their career and practice. CONFERENCES, DIETITIANS

DIETITIANS AND EXERCISE: TRAINING AND PRACTICE

THORPE MELISSA

The importance of dietetics professionals understanding the role of exercise in relation to diet is multifold and various. Dietitians can discuss with their clients the importance of nutrition and exercise on overall health, disease management, and disease prevention. Recognizing when dietetics practitioners should refer clients/patients to an exercise physiologist for detailed exercise prescriptions and training programs is important and can lead to improvements in the individual's care through multidisciplinary intervention. DIETITIANS, TRAINING, NUTRITION, EXERCISE

NEW WEB SITE FIGHTS CHILDHOOD OBESITY WITH FUN

With the number of American overweight children rising dramatically over the past ten years, the dietetics profession and other health groups have been focused on finding solutions to the national epidemic. One promising solution, spearheaded by the International Food Information Council (IFIC), is to incorporate healthy food messages to tech-savvy kids through a colorful educational Web site called Kidnetic (http://www.kidnetic.com). WEB SITES, CHILDREN & YOUTH, OBESITY

THE BEST OF OUR PROFESSION: INTRODUCTING MARIANNE SMITH EDGE, MS, RD, LD, FADA

BREEDING CAROLYN

This month, Marianne Smith Edge became the 78th President of the American Dietetic Association. This achievement is the culmination of a remarkable career and is a testament to her strong, tireless spirit and determination. PERSONAL PROFILES, DIETITIANS