Daily and intermittent oral ibandronate normalize bone turnover and provide significant reduction in vertebral fracture risk: results from the BONE study.

Increasing evidence suggests that a high rate of bone turnover is associated with low bone mineral density (BMD) and is strongly linked to fracture risk. Measurement of biochemical markers of bone turnover is therefore becoming a more widely used endpoint in clinical trials in postmenopausal osteoporosis. This multinational double-blind, fracture-prevention study enrolled 2946 postmenopausal women with osteoporosis. Patients were randomized to receive placebo or oral ibandronate administered daily (2.5 mg/day) or intermittently (20 mg every other day for 12 doses every 3 months). The primary endpoint was the incidence of new vertebral fractures after 3 years. Secondary outcome measures included changes in the rate of bone turnover as assessed by biochemical markers and increases in spinal and hip BMD. Daily and intermittent oral ibandronate significantly reduced the risk of vertebral fractures by 62% and 50%, respectively, and produced significant and sustained reductions in all the measured biochemical markers of bone turnover. By 3 months, the rate of bone turnover was reduced by approximately 50-60%, and this level of suppression was sustained throughout the remainder of the study. In summary, oral ibandronate, given daily or with a between-dose interval of >2 months, normalizes the rate of bone turnover, provides significant increases in BMD and a marked reduction in the incidence of vertebral fractures. Thus, intermittent ibandronate has potential to become an important alternative to currently licensed bisphosphonates in postmenopausal osteoporosis.

Dietary intake and health outcomes among young children attending 2 urban day-care centers.

OBJECTIVE: To assess the impact of the Child and Adult Care Food Program (CACFP) on diet and 3 health outcomes--weight-for-height status, dental caries (tooth decay) score, and number of days of illness--among preschool children attending 2 urban day care centers. DESIGN: Dietary intake and health outcome measures were assessed and compared for children attending 2 day-care centers in an urban community. Data were obtained for 14 days of dietary intake, which were analyzed for energy and 15 nutrients and 6 food groups; anthropometric measures, including weight-for-height; dental caries; and days of illness. SUBJECTS/SETTING: Forty 3- to 5-year-old black children from 2 day-care centers participated. One center participates in the CACFP. At the other center, children bring all meals and snacks from home. STATISTICAL ANALYSES PERFORMED: Data from the 2 groups of children were compared using parameteric and nonparametric t tests. RESULTS: Children receiving CACFP meals at day care had significantly higher mean daily intakes of vitamin A (804 +/- 191 vs 595 +/- 268 retinol equivalents), riboflavin (1.45 +/- 0.32 vs 1.21 +/- 0.22 mg), and calcium (714 +/- 180 vs 503 +/- 143 mg) than the children who brought all of their meals and snacks from home. Children who received CACFP meals also consumed significantly more servings of milk (2.9 +/- 0.9 servings vs 1.5 +/- 0.7) and vegetables (1.8 +/- 0.5 vs 1.2 +/- 0.5 servings) and significantly fewer servings of fats/sweets (4.6 +/- 1.3 vs 5.4 +/- 1.1 servings) than children who brought their meals. Weight-for-height status and dental caries scores did not differ between the 2 groups. Children from the center participating in the CACFP have significantly fewer days of illness (median 6.5 vs 10.5 days) than children from the nonparticipating center. APPLICATIONS: Nutritious meals provided by the CACFP can improve diets and may promote health among young, urban children. Registered dietitians can contribute to food assistance programs by intervening to enhance the quality of meals served and by examining the impact of participation on measures of diet quality and diet-related health outcomes.

Nutrition and health status assessment of community-residing elderly in New York City: a pilot study.

Ninety-five percent of persons over the age of 65 years live in the community and benefit from community-based health and nutrition services. The purpose of this project was to evaluate diet, function, and mental health in 40 men and women aged 65 years and older who were residing in a large metropolitan community. Nutritional status was assessed using two 24-hour recalls, 5 days of food records, a food frequency, and anthropometric measurements. Participants responded to standardized activities of daily living and instrumental activities of daily living instruments and an investigator-developed, performance-based appraisal of food preparation and management. Cognition and mood were assessed using the Folstein Mini-Mental Examination and the Yesavage Depression Scale. The nutrient intakes for individuals were compared with the Recommended Dietary Allowances (RDAs) and the Food Guide Pyramid. Mean energy intake was 1,625 kcal (range = 787 to 2,910 kcal); 7 persons consumed more than 2,000 kcal. The mean vitamin and mineral intake for participants met the RDAs except for calcium, vitamin D, zinc, and magnesium intakes. The average percentages of carbohydrate, protein, and fat were 53%, 16%, and 30%, respectively. Nutritional assessments of subjects with and without congregate meals were contrasted. Six of the 13 congregate-meal participants were at nutritional risk, compared with 6 of 27 not receiving congregate meals. The interrelationships of diet, functional status, and mental health factors were examined along with recommendations for future data collection in similar studies.

Benefits of training dietetics students in preprofessional practice programs: a comparison with dietetic internships.

OBJECTIVE: To conduct a nationwide study on the opinions of dietitian preceptors regarding the intangible benefits to hospitals and medical centers of training dietetics students in approved preprofessional practice programs (AP4s) and to compare the findings with a similar survey of dietetic internships. DESIGN: A questionnaire was adapted from a 1990 study of preceptors in dietetic internships to investigate the benefits of training dietetics students in AP4s. SAMPLE: Program directors and dietitians who supervise and teach students in the 117 preprofessional programs approved by The American Dietetic Association were sent pretested questionnaires. Responses to the survey were received from 312 dietitians who supervise students in 74 practice programs. STATISTICAL ANALYSIS: Descriptive statistics were used to calculate frequency of response. t Tests were used to compare mean differences between the opinions of preceptors in AP4s and internships. Analysis of variance and Scheffe post-hoc test were used to determine the demographic characteristics related to the dietitians' opinions of benefits. RESULTS: Strongest agreement (agree to strongly agree) was found for three items: sense of satisfaction from seeing students develop as professionals (4.34); belief that teaching students makes the job more interesting (4.17); and real sense of achievement in working with students (4.05). Significant differences were found between the groups on six items and, in all but one instance, the internship preceptors were more in agreement with the statements on intangible benefits than the AP4 preceptors. APPLICATIONS/CONCLUSIONS: The preceptors generally agreed that intangible benefits exist for departments that are AP4 sites and the professionals that work in them. As programs develop from AP4s into accredited internships, examination of intangible and monetary benefits may affect the continuation of dietetics training programs.

Attitudes and opinions of dietetics professionals toward cost-benefit and cost-effectiveness analyses.

OBJECTIVE: To compare the attitudes and opinions of dietitians and dietary managers in regard to cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA). DESIGN: A questionnaire was sent nationwide to a sample of 1,074 dietitians and 454 dietary managers. SUBJECTS/SAMPLES: The dietitians were randomly selected from three dietetic practice groups of The American Dietetic Association that have practitioners with administrative responsibilities in health care: Clinical Nutrition Management, Consultant Dietitians in Health Care Facilities, and Management in Healthcare Systems. The random sample of dietary managers was drawn from the membership list of the Dietary Managers Association. MAIN OUTCOME MEASURES: We hypothesized that there would be a difference between the dietitians and dietary managers in their attitudes about, and experiences in conducting CBA and CEA. STATISTICAL ANALYSES: Data analysis incorporated frequencies, means, and standard deviations to describe the respondents. Pearson's pairwise correlations and analysis of variance examined the significance of the relationships among the variables of the study. Scheffe's test was conducted to identify which variables related closely to each other. RESULTS: Seven hundred twenty-two usable questionnaires were returned, which gave an overall response rate of 47%. Although both professional groups had experience with reducing costs at their jobs, they did not think it important to conduct CBA and CEA. Neither group could distinguish between CBA and CEA. Dietitians, who were more positive toward using CBA and CEA, saw them as important techniques that could justify the value of dietetics services. Dietitians were also more likely than the dietary managers to use the techniques in the future. Dietitians were beginning to explore the techniques, but they did not feel that good sources of information were available for conducting CBA and CEA studies. APPLICATIONS/CONCLUSIONS: Our findings suggest a strong need to educate dietitians and dietary managers in the techniques and proper use of CBA and CEA in practice settings. Dietitians need to be guided to appropriate teaching materials and educational programs, and dietary managers first have to be educated about the importance and the benefits of using the techniques.

Perceptions of clinical decision making by dietitians and physicians.

Role delineation is an ongoing process and must be evaluated within the health care team framework. The specific interactions between dietitians and physicians in the nutrition care of patients is one aspect that needs to be more clearly defined. This study examined selected practice issues by surveying physicians and dietitians to identify perceptions of ideal and actual performance. Role disparity was found between the responses of the dietitians and those of the physicians. Dietitian respondents identified themselves as the primary decision makers more than 50% of the time in all circumstances queried. In contrast, 10% or less of the MDs saw the dietitians as the primary decision makers in any area except selection of caloric supplements. In the ideal setting, the dietitian desired a greater degree of autonomy than the physician was willing to grant. Our findings were not explained by demographic differences. Perhaps faulty communication between the physician and the dietitian or unclear medical-legal issues may explain our findings of perceived role disparity.

Teaching self-management skills to cystic fibrosis patients and its effect on their caloric intake.

This study was undertaken to examine whether cystic fibrosis patients who received nutrition counseling based on self-management skills had an increased caloric intake and enhanced body mass index (kg/m2) values. Thirty-seven patients, aged 4 to 29 years, were placed on a nonrestricted nutrition program for a study period of 4 years. Bandura's self-management principles were applied in counseling patients to meet their nutrition needs. The results showed significant increases in energy intake and body mass index values (p less than .001). The mean energy intake increased from 93.6 +/- 16.9% of the Recommended Dietary Allowance to 125.8 +/- 24.1% of the RDA, and mean body mass index value increased from 16.9 +/- 2.3 to 18.8 +/- 2.5. Pulmonary functions remained unchanged during the counseling period. Four to six counseling sessions were required before the mean caloric intake of the patients increased to the desired goal of 115% of the RDA. During the remainder of the study period, the mean caloric intake rose to 125% of the RDA. The results of this study suggest that cystic fibrosis patients are able to increase their caloric intake significantly with counseling.

Nutrition assessment: a management tool for providing quality care.

When planning nutrition intervention programs in a health care facility or the community, an analysis of the service population is necessary to determine the levels of care than can be provided. The use of screening and monitoring techniques will maximize the resources that are available and increase the amount of care that can be given. By using baseline nutrition assessment data, health outcomes can be measured over time and cost-effectiveness of the program can be evaluated. Examples of studies that measure effectiveness of nutrition services and programs are reviewed. Specific steps are suggested to simplify the documentation of the process and outcomes of nutrition intervention.

Role functions of dietitians in New York State nursing homes.

The purpose of this study was to ascertain whether there is consensus among dietitians and administrators on the role functions of dietitians in New York State nursing homes. The study examined role expectations and reported role performance by full-time and part-time dietitians. Responses were received from a total of 535 individuals in 273 nursing homes (32%) constituting three distinct groups: 210 administrators, 200 full-time dietitians, and 125 part-time dietitians. Results indicated that all three groups exhibited consensus on 36 of the 47 role functions that should be performed by dietitians.

A nutrition fair cosponsored by dietitians and legislators.

A nutrition fair was held in New York City through the cooperative efforts of the local Consulting Nutritionists in Private Practice, the Greater New York Dietetic Association, and two state assembly members. This event was undertaken to market the services of registered dietitians and to enhance the dietitian's role in the local legislative arena. The three-hour fair provided a forum at which the public could obtain direct information and educational materials on various nutrition topics and receive referrals for further consultation. The attendees were mostly women (72%); 63% were in the 21 to 50 age group; and 32% were more than 50 years old. The public response was positive, and the majority of attendees found answers to specific questions. The collaboration of the dietitians and the legislators was also positive. The two assembly members were able to communicate with their constituents and to see how dietitians practice.