MyPyramid-omega-3 fatty acid nutrition education intervention may improve food groups and omega-3 fatty acid consumption in university middle-aged women.

This study was conducted to assess the impact of a nutrition education intervention on food groups and omega-3 (n-3) fatty acid consumption in middle-aged women. We hypothesized that participants who received educational materials about n-3 fatty acids would have a higher consumption of foods rich in n-3 fatty acids than the MyPyramid group. The first phase of this study used the qualitative method to identify the beliefs and interests of middle-aged women about the topic of nutrition. Data were collected using semistructured individual interviews. Phase 2 was a quantitative study to assess the effectiveness of MyPyramid to improve dietary intake and self-efficacy after a 6-week online nutrition education intervention using a blog for university middle-aged female staff. The impact of n-3 fatty acid education on food consumption and self-efficacy was also assessed. Eight female staff (aged 45-65 years) in a Midwestern university participated in the interviews. Data were coded, and 3 themes emerged: "health," "lifestyle," and "availability." Eighty-eight middle-aged women participated in the intervention study and were randomized into either an intervention group or a control group. The overall consumption of the food groups was lower than the MyPyramid recommendation, except in the meat and beans group. There was a trend that participants were less certain to include n-3 fatty acids than whole grains in their diets. Using MyPyramid and supplementary information about n-3 fatty acids did not significantly affect participants' dietary consumption or self-efficacy to increase consumption from the food groups or to increase n-3 fatty acid consumption. Blog-based nutrition education is acceptable for this target population.

Content validation of a standardized language diagnosis by certified specialists in gerontological nutrition.

Validation of the nutrition standardized language assures the language is accurate for use in practice, policy, and research, but few validation studies have been reported. The purpose of this descriptive study was to validate content of all components of the nutrition diagnostic term involuntary weight loss using experts providing care for older adults in health care settings. A Nutrition Diagnosis Validation Instrument was developed that contained the definition, etiologies, and signs and symptoms of the diagnosis plus items added from literature review. Questions on clarity and completeness of the language were included. The Nutrition Diagnosis Validation Instrument used a Likert-type scale for deriving a Diagnostic Content Validity (DCV) score for all items in the definition, etiology, and signs and symptoms components to define major, minor, and nonrelevant characteristics and a mean total DCV score for the term. In 2008, all Board Certified Specialists in Gerontological Nutrition (CSGs) were recruited by mail. CSGs (n=110, 73% response) reported 15±10 (mean±standard deviation) practice years in gerontological nutrition. The total DCV component scores were 0.80±0.17 (definition), 0.63±0.08 (etiology), and 0.69±0.12 (signs and symptoms). The mean total DCV score of the diagnostic term was 0.69±0.11. Cognitive decline, poor oral health, and impaired skin integrity were identified as missing language. In conclusion, the majority of the definition, etiologies, and signs and symptoms of the term were content-validated, including seven items derived from literature review. The validated items, including recommendations for added language, need to be retested using the same process.

Correlation of omega-3 fatty acids intakes with acculturation and socioeconomic status in midwestern Latinas.

BACKGROUND: Low socioeconomic status (SES) and acculturation of Latino immigrants in the U.S. are linked to a decrease in diet quality. METHODS: Interviews were conducted with 162 first generation Latinas to examine the association of SES and acculturation with intake of omega-3 (n - 3) fatty acids. Each participant provided dietary intake by use of a validated n - 3 food frequency questionnaire administered twice, 4 weeks apart, three 24-h recalls, sociodemographic information and completed the 5-item Short Acculturation Scale. RESULTS: Mean intakes of Total n - 3, α-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (g/d) were 1.2 ± 0.7, 1.1 ± 0.6, and 0.1 ± 0.1, respectively. After adjusting for energy intake, education was significantly correlated with EPA + DHA intakes, and acculturation was significantly correlated with Total n - 3, ALA and EPA + DHA intakes. Foods sources of EPA + DHA eaten by at least 50% of participants were chicken, shrimp, tuna and eggs. DISCUSSION: Given the beneficial cardiovascular effects of n - 3 fatty acids, it is important to understand sociocultural factors affecting adequate intake towards an improvement in diet quality in minorities.

Validity and reliability of an omega-3 fatty acid food frequency questionnaire for first-generation Midwestern Latinas.

This study tested the hypothesis that a culturally developed omega-3 (n-3) fatty acid food frequency questionnaire (FFQ) could be an accurate instrument to capture n-3 fatty acid food intakes of first-generation Midwestern Latinas. The goal of the study was to assess validity and test-retest reliability of an FFQ to estimate total n-3 fatty acid (total n-3), α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) intakes. An n-3 FFQ was developed and pilot tested. Two FFQs and 3 nonconsecutive 24-hour recalls were collected from 162 participants. Pearson correlation and paired t test were used to test the hypothesis. Correlation of the 2 FFQs was 0.71 for total n-3, 0.65 for ALA, 0.74 for EPA, and 0.54 for DHA (P < .01). The means of the 2 FFQs and of the 24-hour recalls were not significantly different for total n-3 and ALA (P > .05), but were significantly different for EPA and DHA. The n-3 FFQ had acceptable reliability, validated only total n-3 and ALA, and provided relevant findings about the n-3 eating habits of Midwestern Latinas.

Clinical registered dietitians, employers, and educators are interested in advanced practice education and professional doctorate degrees in clinical nutrition.

A subset of registered dietitians (RDs) is known to practice at an advanced level, but a clear educational pathway supporting advanced medical nutrition therapy practice has not been identified. Thus, an electronic survey was designed to investigate interest of clinical RDs, employers, and educators in advanced practice competencies and professional doctorate degree programs in clinical nutrition. Usable responses were obtained from 440 of 978 (45%) RDs, 61 of 107 (57%) employers, and 76 of 114 (67%) educators. Mean interest (5 = very interested, 1 = very uninterested) in obtaining advanced practice education was highest among RDs (3.93+/-1.01) and was significantly different (P < 0.01) from employers (3.74 +/-1.28) and educators (2.76+/-1.33). Interest in completing a professional doctorate in clinical nutrition was significantly (P < 0.01) different among RDs (3.05+/-1.28), employers (3.18+/-1.30), and educators (2.3+/-1.34). Employers' mean interest score for hiring RDs with a professional doctorate in clinical nutrition was 4.02+/-0.93. A subset of clinical RDs appears to be interested in obtaining advanced practice competency and enrolling in professional doctorate degrees in clinical nutrition. Clinical nutrition managers in academic medical centers may be interested in hiring advanced practice clinical RDs with professional doctorate degrees. Opportunities exist for educators to develop advanced practice educational experiences and professional doctorate degree programs.

Using initiative to achieve autonomy: a model for advanced practice in medical nutrition therapy.

The purpose of this research was to generate a model of advanced medical nutrition therapy (MNT) practice based on descriptions of their clinical activities provided by advanced-level MNT practitioners. A qualitative approach using grounded theory methodology was employed. The model of advanced MNT practice was based on interviews with 21 credentialed advanced practice registered dietitians from across the United States and Canada. Verbatim transcripts of the interviews were coded for aggregation into themes and subthemes. The resulting model included a single overarching theme: using initiative to achieve autonomy. The five subthemes are aptitude, attitude, expertise, context, and approach. The model provides a richer picture of advanced MNT practice than was previously available and is presented for discussion and debate. Validation of the model is required before incorporation into education or practice.

Validity and reliability of a quantitative food frequency questionnaire measuring n-3 fatty acid intakes in cardiac patients in the Midwest: a validation pilot study.

The purpose of this pilot study was to test the validity and reliability of a quantitative n-3 fatty acid food frequency questionnaire (FFQ) for later use with larger groups of individuals. A convenience sample of heart patients provided dietary data via three 24-hour food recalls and FFQs. Participants were women (n=17) and men (n=11), 43 to 77 years of age. The association of mean daily intake of n-3 fatty acids obtained using food recalls and the FFQ was assessed by Pearson correlation. The reliability of the FFQ was assessed using coefficient alpha. Correlation of n-3 fatty acid intake using the food recalls and the FFQ was r=0.42 (P<0.05). The coefficient alpha for the test-retest of the FFQ was .83. The top two foods, walnuts and flaxseed, contributed 58% of the n-3 fatty acid intake, and the third food, salmon, contributed 5%. This quantitative n-3 FFQ is a valid instrument for use in place of food recalls for estimating n-3 fatty acid intakes in heart patients and is a reliable instrument to estimate n-3 fatty acid intakes from plant, animal, and seafood sources. The FFQ should be tested in a larger population. Registered dietitians can use this FFQ to screen for intakes, educate patients on food sources, and measure change in intakes after nutrition intervention.

Orientation to nutrition care process standards improves nutrition care documentation by nutrition practitioners.

OBJECTIVE: To compare documentation of two groups of clinical nutrition practitioners for evidence of the nutrition care process. DESIGN: This study used a comparative descriptive design. A retrospective chart review was conducted on all nutrition documentation in closed patient records. Documentation of two groups of nutrition practitioners (institution A=practitioners who received initial orientation and routine reinforcement in use of nutrition care process standards; institution B=practitioners who received orientation in use of a further assessment and medical nutrition therapy intervention procedure) was compared for evidence of a six-step nutrition care process. SAMPLE/SETTING: The sample consisted of randomly selected patient records (N=60). A total of 15 oncology and 15 chronic renal failure patient records from each of two Midwestern tertiary-care hospitals were reviewed. MAIN OUTCOME MEASURES: Outcome measures were number of nutrition care process steps documented, appropriate relationships among documented steps in the nutrition care process, and the number of complete, incomplete, and interrupted chains. STATISTICAL ANALYSES: Two-sample t tests and chi(2) analyses were used. RESULTS: Nutrition practitioners at institution A documented approximately three times as many nutrition care process steps per patient per chain that demonstrated appropriate relationships as did nutrition practitioners at institution B (2.69+/-1.15 and 0.80+/-0.62, respectively [mean+/-standard deviation]) (P<.001). There were no outcome judgments related to goals documented in chains at either institution and because of this there were no completed nutrition care process chains at either institution. CONCLUSIONS: Nutrition practitioners with orientation to nutrition care process standards documented more related nutrition care process steps than practitioners without this orientation. Providing nutrition practitioners with ongoing education and clinical experiences in use and documentation of the nutrition care process and a standardized language may be indicated to increase the number of completed nutrition care process chains and improve documentation of nutrition care and patient outcomes.

A look at the educational preparation of the health-diagnosing and treating professions: do dietitians measure up?

Basic educational requirements for dietitians were developed almost 80 years ago and remain largely unchanged. In the interim, other health professions have increased their academic standards. A review of the educational preparation of 16 health-diagnosing and treating professions was undertaken to better understand the standards for dietetics education within a larger context. Educational standards for each profession were obtained and reviewed for types of degrees; duration of post-secondary, college-level education; division of didactic and clinical education; and presence of accredited post-professional education. Findings reveal that at least 11 of the professions studied offer first professional degrees. Differences were noted in duration and sequencing of undergraduate education, didactic or classroom education, and especially supervised practice. Models to facilitate comparison between educational standards were developed. The current educational model in dietetics is designed to prepare entry-level practitioners and academics who comprise less than 20% of the profession. This review supports the need to investigate educational opportunities for beyond-entry-level dietitians, and to develop educational programs that amplify the existing models for educating dietitians.

A standardized nutrition care process and language are essential components of a conceptual model to guide and document nutrition care and patient outcomes.

Documentation of clinical services within health care systems has become increasingly significant because greater amounts of information are now required by accrediting agencies, third-party payers, researchers, and others in their evaluation of patient care and because of the increasing emphasis on patient outcomes. Given the multiple users who depend on health care information in the patient record, it is imperative that clinical nutrition practitioners implement a standardized nutrition care process and language to document comprehensively and communicate meaningful information concerning their role in improving patient outcomes. A body of work has led to the development and adoption of a standardized nutrition care process for the dietetics profession. A standardized nutrition care process consistent with the scientific method and a standardized language are two essential components required to articulate a conceptual model for clinical nutrition practice and documentation and distinguish clinical dietetics' unique body of knowledge. The conceptual model serves as an organizing framework to standardize and guide nutrition practitioners' clinical judgments or critical thinking processes and document information linking nutrition care to patient outcomes.