Effects of Nutritional Knowledge of Informal Caregivers on Depression and Metabolic Outcomes of Hemodialysis Patients.

Chronic renal failure (CRF) makes significant changes in the life of patients and their families. A good family support has a positive effect on successful patients' adaptation to the treatment and compliance with dietary regimen. This study aimed to examine the effects of nutritional knowledge of informal caregivers on depression and metabolic outcomes of hemodialysis patients. This was a cross-sectional study conducted at Baskent University Hemodialysis Center with 116 hemodialysis patients and their informal caregivers. Findings revealed that the caregivers who were the couple of the patients had the highest nutritional knowledge level than the other caregivers (p < .05). The postgraduate caregivers were more likely to have high nutritional knowledge level than the others (p < .05). The inflammation marker of the patients was significantly lower in the group of caregivers with higher level (T3 group) of nutritional knowledge than the others (p < .05). The mean CES-D scores were also more likely to be low in T3 group than in the others (p < .05). These findings highlight that the nutritional knowledge of caregivers of hemodialysis patients may have an additional benefit on patients' nutritional management and metabolic outcomes.

Effect of Nutrition Education on Diet Quality, Sustainable Nutrition and Eating Behaviors among University Students.

Nutrition information is provided by proper nutrition education and nutrition education programs have a direct impact on nutrition knowledge and behavior. This study aims to determine the effect of nutrition education on diet quality, sustainable nutrition and eating behavior.Cross-sectional survey. PARTICIPANTS: The study was carried out on a total of 204 individuals, 21 males and 183 females, who were studying in the 3rd and 4th grades of Baskent University Faculty of Health Sciences.Mean Adequacy Ratio (MAR) score calculated with the Nutrient Adequacy Ratio (NAR) was used to evaluate the diet quality. 'Sustainable and Healthy Eating Behaviors Scale' was applied to measure sustainable and healthy eating behaviors.A questionnaire including personal information and anthropometric measurements of the individuals and a 24-hour dietary recall was taken. Food consumption records were evaluated using the Nutrition Information System. In order to evaluate the quality of the diet, the Mean Adequacy Ratio (MAR) score calculated with the Nutrient Adequacy Ratio (NAR) was used. 'Sustainable and Healthy Eating Behaviors Scale' was applied to measure sustainable and healthy eating behaviors. SPSS 20.0 package program was applied to evaluate the data.In the study, 47.5% of the individuals were educated in Nutrition and Dietetics program and 52.5% were in other programs. The diet quality of 44.8% of the individuals studying in the Nutrition and Dietetics program and 56.4% of the individuals studying in the other programs were determined as 'good' according to the MAR levels classification. No significant difference was found in terms of MAR levels of individuals according to the departments they read (p > 0.05). The average score of the 'Healthy and Balanced Nutrition' factor in the scale of sustainable and healthy eating behaviors was higher in individuals who were studying in the Nutrition and Dietetics program. The average scores of 'Seasonal Food' and 'Low Fat' factor were found to be significantly higher in girls studying in the Nutrition and Dietetics program (p < 0.05).It was determined that nutrition education is effective on sustainable and healthy eating behaviors. Considering the importance of nutrition education on the health of individuals and sustainable environment, it is of great importance in terms of public health to increase the awareness of the society on this issue.

Effect of adherence to carbohydrate counting on metabolic control in children and adolescents with type 1 diabetes mellitus.

PURPOSE: Carbohydrate counting provides better glycemic control and flexibility than other food planning methods. Consistent adherence to such a complex method is difficult, especially for youth. However, studies that determine adherence to this method and whether it alters metabolic control are limited. The aim of the current study was to determine adherence to this method and investigate its effect on metabolic control, anthropometric measurements, insulin dose, and energy intake. METHODS: In this prospective cross-sectional study, 53 children and adolescents with type 1 diabetes mellitus aged 2 to18 years and receiving intensive insulin therapy were trained and followed for 6 months. Demographics, anthropometrics, insulin requirements, hemoglobin A1c (HbA1c), fasting lipids, and food records at baseline and study conclusion were evaluated. At the end of the study patients were divided into adherer and nonadherer groups according to carbohydrate estimate deviations from standardized daily sample menus and calculations for accurate insulin doses. More than 10-g variation in daily consumed carbohydrate amount or failure to decide bolus insulin dose was defined as a nonadherer. RESULTS: The mean HbA1c, low-density lipoprotein cholesterol, and body mass index standard deviation score changed after the carbohydrate counting training while the mean HbA1c between groups was significant (P<0.05). Total daily insulin doses increased, and the mean high-density lipoprotein cholesterol levels decreased in both groups. There were significant correlations between HbA1c and carbohydrate deviation scores as well as HbA1c and caregiver's education level. CONCLUSION: Since adherence to carbohydrate counting may affect metabolic control, health professionals should evaluate and monitor carbohydrate counting skills of caregivers and patients in order to improve efficiency.

Challenges and needs of informal caregivers in elderly care: Qualitative research in four European countries, the TRACE project.

BACKGROUND: Providing informal care may affects caregivers' life in different ways. Determining the needs of caregivers and supporting them can improve both the quality of life of the caregivers, as well as the elderly they take care of. OBJECTIVE: To explore the experiences and needs of the informal caregivers in four countries. DESIGN: Qualitative research method was used in the study. METHODS: The qualitative data was collected through focus groups and individual interviews between December 2016-May 2017. In all countries interviews were conducted in the mother language of the informants. Informants of the qualitative research were adult people who take primary care of an individual with chronic diseases, aged 65 years or older. Data were collected from 72 informal caregivers from four European countries. Inductive content analysis was performed. RESULTS: Informal caregivers identified 2 themes, 5 subthemes, 19 categories and 7 subtcategories. The themes highlighted two major issues: informal caregiver's challenges and needs related to the management of care of elderly and caregivers' personal needs. CONCLUSION: The important and charming results of the present study are, difficulties of managing caregiver's own life, and coping with emotions are common in four countries. Identifying challenges and needs of informal caregivers enable healthcare professionals to develop care strategies and plan interventions focused to support and help to reduce the burden of care for elderly with chronic diseases.

Is training for informal caregivers and their older persons helpful? A systematic review.

BACKGROUND: The steady increase in the number of people suffering from chronic diseases and increasing life expectancy raises new demands on health care. At the same time, the need for informal caregivers is increasing. This study aims to perform a systematic review of the methodologies used to identify effect of different types of training on informal caregivers and their older persons. METHODS: MEDLINE (PubMed), CINAHL and Ovid were searched from December 2016 and April 2017. The following keywords were used; "informal caregiver", "training" "elderly", older persons". Identified publications were screened by using the following inclusion criteria; systematic reviews, randomized controlled trials, prospective cohort and multicentre studies, English language full text journals, samples or interventions that included caregivers of older persons and published in last 10 years. RESULTS: Twenty four studies (12 randomised control trials, 8 intervention studies and 4 systematic reviews) were included. Most of the randomized controlled trials involved both caregivers and elderly. Pretests and post-tests were used in intervention studies (5 out of the 8 studies). ICT-based, psychosocial interventions on family caregivers' education program for caregivers were applied. Caregivers following a supportive educative learning had a significantly better quality of life. CONCLUSIONS: The findings of this systematic review suggest that support interventions for caregivers can be effective in reducing caregivers' stress, with a consequent improvement of the quality of care. However, results are based on relatively small studies, reporting somewhat controversial findings supporting the need to perform further research in this field.

Assessment of Risk Factors of Obesity and Diet on Breast Cancer in Ankara, Turkey.

OBJECTIVE: To determine the risk factors of obesity and diet on breast cancer in Ankara, Turkey. METHODS: A case-controlled study was carried out on newly diagnosed 40 breast cancer patients [patient group (PC)] and 40 volunteer individuals [control group (CG)] with no diagnosis of cancer and history of cancer in the family with similar characteristics to the age and gender-matched patient group between March and July 2016. All the individuals were administered a questionnaire by face-to-face interview method. RESULTS: The mean menarche age, age at first birth and menopause age were 13.0±1.17, 22.6±3.78 and 44.33±2.39 years in PG and 12.3±0.95, 21.6±2.99, 46.71±2.41 years in CG, respectively. The mean BMI values were determined as 28.1±6.75 kg/m2 in PG and 30.1±6.18 kg/m2 in CG (p>0.05). It was determined that intake of vitamin C and fiber decreases the risk of breast cancer. Also, eating quickly and smoking were risk factors for breast cancer (p<0.05). CONCLUSION: This study indicated that there are relationships between menarche age, menopause age, and age at first birth, eating quickly, smoking and breast cancer. Conversely, there are significant negative relationships between dietary fiber, vitamin C intake and breast cancer. As a result, it can be said that there is a link between breast cancer and lifestyle factors and a reduction in the risk of developing breast cancer can be achieved through changes in diet, one of the lifestyle factors.

Is neck circumference measurement an indicator for abdominal obesity? A pilot study on Turkish Adults.

BACKGROUND: Neck circumference (NC) measurement is one of the simple screening measurements which can be used as an index of upper body fat distribution to identify obesity. OBJECTIVES: The aim of this study was to determine the relationship between neck circumferences and obesity. METHODS: A total 411 volunteer adults participated in this study (174 men, 237 women). A questionnaire which consisted of anthropometric measurements and demographic features was used. Patients with NC ≥37 cm for men and ≥34 cm for women require evaluation of overweight status. RESULTS: The percentages of the men and women with BMI ≥ 25 kg/m(2) were 55.2% and 27.0% respectively and with high neck circumferences were 85.1% and 38.8%, respectively. The percentages of the men and women with high waist circumference were 31.6% and 79.3%, respectively. In both gender there were positive significant correlations between neck circumference, body weight (men, r=0.576; women, r=0.702; p=0.000), waist circumferences (men, r=0.593; women r=0.667; p=0.000), hip circumferences (men, r=0.568; women, r=0.617; p=0.000) and BMI (men, r=0.587; women, r=0.688; p=0.000). CONCLUSIONS: This study indicates that NC was associated with body weight, BMI, waist and hip circumferences and waist/hip ratio for men and women. A significant association was found between NC and conventional overweight and obesity indexes. NC was associated with waist/hip ratio for men and women.

Kitchen safety in hospitals: practices and knowledge of food handlers in istanbul, Turkey.

This study was designed to identify the practices and knowledge of food handlers about workplace safety in hospital kitchens (four on-premises and eight off-premises) in Istanbul. A kitchen safety knowledge questionnaire was administered and a kitchen safety checklist was completed by dietitians. The mean total scores of the on-premise and off-premise hospital kitchens were 32.7 ± 8.73 and 37.0 ± 9.87, respectively. The mean scores for the items about machinery tools, electricity, gas, and fire were lower in off-premise than on-premise hospital kitchen workers. The kitchen safety knowledge questionnaire had five subsections; 43.7% of the food handlers achieved a perfect score. Significant differences were found in the knowledge of food handlers working in both settings about preventing slips and falls (p < .05). Significant relationships were found between marital status, education level, and kitchen safety knowledge of the food handlers (p < .05).

Obesity-related abnormal eating behaviors in Type 2 diabetic patients.

OBJECTIVES: To determine the obesity-related abnormal eating behaviors in Type 2 diabetic patients. METHODOLOGY: It was a cross-sectional study involving 120 Type 2 diabetic patients. Body weight and height of the individuals were measured and body mass index (BMI) was calculated. Bulimic Investigatory Test-Edinburg (BITE) was used to measure binge eating attitudes. Night eating symptoms were defined as consuming >25% of daily energy after suppertime. To determine the glycaemic control, HbA1c levels were analyzed. Data analyzed by SPSS 13.0 for Windows. RESULTS: The mean age of the patients was 55.3±9.29 years. The mean diabetes duration was 11.1±2.04 years. The 50% of the patients had a BMI higher than 25kg/m(2). The obese diabetic patients were more likely to have diabetic complications than non-obese subjects (x (2) = 8.588, p=0.040). The percentages of the diabetic patients who met the criteria for binge eating and night eating were 17.2% and 42% respectively. Half of the patients were skipping a main meal per day. The frequencies of obesity-related abnormal eating behaviors were not statistically different in obese patients versus non-obese participants (p>0.05). The mean HbA1c levels were higher in diabetic patients than biochemical references and there was a significant difference between obese and non-obese patients (p<0.05). CONCLUSIONS: Obesity-related abnormal eating behaviors were prevalent in Type 2 diabetic patients and related with diabetic complications and glycaemic control.

Nutritional status and anthropometric measurements of patients with multiple sclerosis.

OBJECTIVE: To determine the nutritional status and anthropometric measurements of patients with multiple sclerosis (MS). METHODS: This research was conducted on 37 (15 men, 22 women) new diagnosed MS patients who applied to Ankara Numune Education and Research Hospital, Ankara Turkey, from June to August 2011. The nutritional status of patients was determined by a 3-day and 24-hour dietary record and a food frequency questionnaire. Body composition was analyzed by bioelectrical impedance analyzer, and body mass index was calculated. The Nutrient Data Base (BEBIS) program was used to evaluate the energy and nutrient intakes of patients and compared with Dietary Reference Intakes recommendations. Blood samples were collected and serum glucose, lipid profiles, total protein, albumin, total calcium, magnesium, vitamin B12, and vitamin D levels were analyzed. RESULTS: Approximately 5.4% of patients were underweight, 54.1% were normal weight, 24.3% were overweight and 16.2% were obese. Daily mean energy intakes were 2730+/-840.97 kcal in men and 1967+/-647.24 kcal in women. The percentage of the carbohydrates was 46.9%, proteins was 14.6%, and fats of the total energy was 38.4%. Approximately 16.7% of the patients' serum vitamin D, and 6.7% of the patients' serum vitamin B12 levels were below than the reference ranges. CONCLUSION: Multiple sclerosis patients have high body mass index values and poor nutritional status. It was verified that life style modification with adequate and balanced nutritional habits is very important in MS patients.

Nutrition-related cardiovascular risk factors in hemodialysis patients.

OBJECTIVE: This study sought to determine nutrition-related cardiovascular risk factors in hemodialysis patients. DESIGN: This was a cross-sectional study. SETTING: This study included outpatients from the Hemodialysis Unit of Baskent University Ankara Hospital. PATIENTS: This study was conducted on 93 endstage chronic renal-failure patients (50 male and 43 female) aged between 18 and 65 years. Patients undergoing hemodialysis three times weekly with 4 hours of standardized bicarbonate hemodialysis were included. Patients with cardiovascular disease were excluded. MAIN OUTCOME MEASURE: A questionnaire was administered to patients regarding demographic and disease information. The nutritional status of patients was determined by a food-frequency questionnaire, a 3-day, 24-hour dietary record, and subjective global assessment. Several biochemical parameters were analyzed, and body weight was measured. RESULTS: Percentages of patients' serum total cholesterol, low-density lipoprotein cholesterol, triglyceride, and total cholesterol/low-density lipoprotein cholesterol levels that were higher than National Kidney Foundation (NKF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) criteria amounted to 7.5%, 4.3%, 43%, and 10.8%, respectively. The percentage of patients' serum high-density lipoprotein cholesterol levels that were lower than NKF and NCEP/ATP III criteria reached 41.9%. According to serum albumin levels, 44.1% of patients were malnourished. In terms of patients' dietary total fat intake, 98.9% were higher than NKF and NCEP/ATP III criteria, and all patients' dietary saturated fatty acids intake were higher than recommended. For 87.1% of patients, the dietary polyunsaturated fatty acids/saturated fatty acids ratio was <1. Moreover, in terms of NKF recommendations, the percentages of patients with insufficient dietary folate and vitamin B(12) intake reached 100% and 61.3%, respectively. CONCLUSION: Hemodialysis patients should be considered at high risk for developing cardiovascular disease. Therefore, when planning diets of endstage renal disease patients, it is important to consider nutrition-related cardiovascular-disease risk factors for the sake of quality of life and survival.

Risk of abnormal eating attitudes among Turkish dietetic students.

The purpose of this study was to determine the prevalence of abnormal eating attitudes among Turkish dietetic students and the relations between nutrition education and eating attitudes. The study population was 568 female university students (248 dietetic students, 320 non-dietetic students). Two scales were used: Eating Attitudes Test (EAT-26) and Bulimic Investigatory Test-Edinburg (BITE). Psychological factors were measured with the Rosenberg Self-esteem Scale (RSE) and the State-trait Anxiety Inventory (STAI). The mean eating attitudes first scores, bulimic investigatory test scores, and Rosenberg self-esteem scores were similar in both groups. Only the STAI score was significantly higher in dietetic students than non-dietetic students. Skipping breakfast was significantly higher in non-dietetic students. Unhealthy weightloss methods were used more by the non-dietetic students than dietetic students. There were no significant effects of nutrition education on BMI and eating attitudes of the students.

Relations among weight control behaviors and eating attitudes, social physique anxiety, and fruit and vegetable consumption in Turkish adolescents.

This study examined the relationship among dieting, eating attitudes, social physique anxiety, and fruit and vegetable consumption among Turkish adolescents. Abnormal eating behavior (EAT-26 > or =20) was found in 32.8% of the total sample; this included 26.4% of the males and 38.7% of the females. Weight-control and weight-related behaviors are associated with high fruit and vegetable consumption in adolescents. Dieting was significantly associated with types of consumption in female adolescents. In addition, EAT-26 scores were significantly positively correlated with high fruit and vegetable consumption, but this association was not observed in SPAS scores among adolescents. Adolescents who engage in dieting behaviors seem to consume more fruit and vegetables than do other adolescents. Female adolescents may be more likely to display abnormal eating attitudes and dieting behaviors than do males. Although some weight-control behaviors may be risky, adolescents who were practicing dieting behaviors engaged in the positive dietary behavior of consuming more servings of fruit and vegetables than did non-dieters.

Prevalence of bulimic behaviors and trends in eating attitudes among Turkish late adolescents.

The eating attitudes and the prevalence of bulimic behaviors in a group of 300 late adolescents were investigated using the key questions from the Bulimia Investigatory Test, Edinburgh (BITE), and additional questions. Only four subjects (1.3%) scored above the cut-off point on the BITE, and prevalence rates of males and females were the same. Results showed that higher symptom scale scores were associated with the emergence of binge eating behavior and high energy intake. Females were less likely than males to see themselves as normal eaters and more likely to feel "miserable" when they binge. Higher score groups evidenced more dieting behavior than other groups and also more abnormal eating behavior. It was concluded that the prevalence of bulimic behaviors in Turkish late adolescents was low, but there was an increasing risk since they share Western ideals of slimness and engage in dieting.

Dietary intake and nutritional status of Turkish pregnant women during Ramadan.

OBJECTIVE: To determine the effects of Ramadan fasting on dietary intakes, nutritional status and biochemical parameters of Turkish pregnant women. METHODS: We carried out this study at Dr. Zekai Tahir Burak Women's Health Care and Research Hospital, Ankara, Turkey from October 15th to November 13th 2004. Forty-nine fasting group and 49 non-fasting group (control group) voluntarily enrolled for the study. We analyzed the blood biochemical parameters of pregnant women and obtained the dietary intakes from the groups. RESULTS: Compared to the control group, weight gain and energy intake (p<0.05 for second and third trimesters) was less in the fasting group. The percentage of protein (p<0.05 for first and second trimesters) and carbohydrates (p<0.05 for all trimesters) from total energy was higher in the fasting group than in the control group. We noticed a slight increase in the fasting blood glucose, serum total cholesterol high-density lipoprotein-cholesterol and triglycerides (p<0.05 for first trimester) concentrations in the fasting group during Ramadan. However, we found decreased levels in the plasma urea, total cholesterol, triglycerides, low-density lipoprotein-cholesterol and total protein and albumin levels of the fasting group in comparison with the control group. Dietary mineral and vitamin intakes were lower than the recommended daily allowance, except vitamin A and vitamin C in both groups. CONCLUSION: Based on the results of the present study, Ramadan fasting had no significant adverse effect on the health of pregnant women.

Vegetarianism and eating disorders: association between eating attitudes and other psychological factors among Turkish adolescents.

The purpose of this study was to determine whether differences exist in eating attitudes, self-esteem, social trait anxiety and social physique anxiety of self-reported vegetarian and nonvegetarian Turkish adolescents. The sample for the Turkish University' students is designed to provide the estimates of vegetarian indicators and prevalence. The participants were 608 females and 597 males, in total 1205 adolescents aged between 17 and 21 years. Disturbed eating behaviors (EAT-26> or =20) was found in 45.2% (14 of vegetarian) of the total vegetarian sample; which included two of the male vegetarians and 12 of the female vegetarians. The mean BMI was 19.78+/-1.49 kg/m(2) for female vegetarians and 20.78+/-2.46 kg/m(2) for female nonvegetarians (p<0.05). Male vegetarians had significantly higher score than male nonvegetarians on EAT-26 (17.25+/-11.18 for male vegetarians and 9.38+/-6.60 for male nonvegetarians), dieting (6.50+/-7.65 for male vegetarians and 2.55+/-3.87 for male nonvegetarians) and oral control (6.13+/-4.67 for male vegetarians and 3.20+/-3.19 for male nonvegetarians) scores (p<0.05). Besides, female vegetarians had significantly higher score than female nonvegetarians on EAT-26 (22.04+/-13.62 for female vegetarians and 11.38+/-8.28 for female nonvegetarians), dieting (10.35+/-9.58 for female vegetarians and 4.41+/-5.30 for female nonvegetarians), oral control (7.78+/-5.13 for female vegetarians and 3.33+/-3.51 for female nonvegetarians) and STAI (51.39+/-7.28 for female vegetarians and 47.29+/-5.13 for female nonvegetarians) scores (p<0.05). As a conclusion, the present study indicated abnormal eating attitudes, low self-esteem, high social physique anxiety, and high trait anxiety in Turkish vegetarian adolescents. The vegetarian adolescents may be more likely to display disordered eating attitudes and behaviors than nonvegetarians.

Eating attitudes and their psychological correlates among Turkish adolescents.

This study examined the eating attitudes and psychological characteristics of Turkish late adolescents. Seven hundred eighty-three university students were administered the Eating Attitudes Test, Rosenberg Self-Esteem Scale, State-Trait Anxiety Inventory, and Social Physique Anxiety Scale. More than one in ten (9.2% of the males and 13.1% of the females) had abnormal eating attitude scores. Chi-square analysis revealed that there were no significant differences in the prevalance of abnormal eating behaviors based on gender. Analysis of covariance indicated that participants who had disturbed eating attitudes had lower self-esteem, higher social physique anxiety, and higher trait anxiety than those who had normal eating attitudes. It was concluded that the prevalence of disturbed eating attitudes was high among these Turkish late adolescents, and that disturbed eating attitudes were related to several psychological characteristics.