Dietary Micronutrient Intake of Participants in a "Partners Together in Health" Cardiac Rehabilitation Intervention.

PURPOSE: Current guidelines for cardiovascular health emphasize a "dietary pattern" approach that could be expected to increase intakes of micronutrients in addition to altering the macronutrient profile. However, the effect of interventions such as cardiac rehabilitation on the micronutrient quality of the diet has not been evaluated. Therefore, the goal of this study was to investigate changes in micronutrient intake of cardiac rehabilitation participants over time. METHODS: This was a secondary analysis of data from a randomized clinical trial that assessed the effects of the Partners Together in Health intervention on physical activity and healthy eating behaviors. The intake of 9 micronutrients important in cardiovascular health was assessed using 3-d food records. A micronutrient adequacy score was evaluated at 3 time points (baseline, 3 and 6 mo). Changes over time in micronutrient intake were assessed using a general linear model. RESULTS: Sixty-eight participants who were enrolled in the Partners Together in Health interventional trial completed the study. There was no significant difference in the mean micronutrient score at any time point. Intake of individual micronutrients did not improve over the 6-mo time frame with the exception of vitamin E, (8.7 mg vs 6.5 mg for at 6 vs 3 mo, P = .02). The proportion of participants with intakes meeting the Dietary Recommended Intake for each nutrient also remained the same over time. CONCLUSION: Although cardiac rehabilitation programs may be effective in altering the macronutrient composition, improvements to overall diet quality may be tempered by a lack of improvement in intake of micronutrients.

Effects of partners together in health intervention on physical activity and healthy eating behaviors: a pilot study.

BACKGROUND: Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later. OBJECTIVE: The objective of this feasibility study was to test the Partners Together in Health (PaTH) intervention versus usual care in improving physical activity and healthy eating behaviors in coronary artery bypass graft surgery patients and their spouses. METHODS: An experimental, 2-group (n = 17 couples/group), repeated-measures design was used. Coronary artery bypass surgery patients in both groups participated in phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients did. Spouses in the usual care attended educational classes with patients. It was theorized that "2 persons would be better than 1" at making changes and sticking with them in the long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), at 3 months (post-CR), and at 6 months. Changes over time were examined using Mann-Whitney U statistics and effect sizes. RESULTS: The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and usual care patients or spouses at 3 or 6 months in the number of minutes per week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥150 min/wk at >3 metabolic equivalents). CONCLUSIONS: The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR.

Intervention fidelity in a translational study: lessons learned.

This article examined the intervention fidelity strategies used and lessons learned in a translational study. In this study, the behavioral intervention was delivered within an existing clinical practice environment, outpatient cardiac rehabilitation (CR). The primary lessons learned were that the fidelity components of design, training, and delivery of the intervention were the most different from fidelity strategies used in typical intervention studies. The design component needed to take into account the unique characteristics of the clinical environments where the study was conducted and build these unique differences into the study design. Training and delivery of the intervention was different because existing CR staff delivered the intervention in this study; which is unlike typical intervention studies where research staff are trained to deliver the intervention. Monitoring receipt and enactment fidelity components were similar to monitoring in usual intervention studies probably because these components focus on monitoring the behaviors of the research participant. Translational research presents unique challenges and requires the development of a flexible and novel intervention fidelity plan tailored to a particular study.

Physicians ask for more problem-solving information to promote and support breastfeeding.

Physicians (n=262) were surveyed about their breastfeeding promotion practices, knowledge, and areas in which they need more information in order to be more influential with patients in the initiation and duration of the process. Over half (51%) reported no or limited education in breastfeeding, whereas only 9% reported adequate education. A knowledge assessment indicated almost half (42%) did not know certain viruses can be transmitted through breast milk. There were also mixed responses to the need for vitamin D supplementation. Promotion practices included most (82%) thinking the physician has a primary role in the feeding decision, and most did discuss the benefits with patients; however, only 54% would recommend breastfeeding to a patient who had decided to bottle-feed. Problem-solving was the main area physicians reported needing more education. Partnerships with dietetics professionals may fill the gaps in the support needed to increase rates of breastfeeding.

Half of rural girls aged 8 to 17 years report weight concerns and dietary changes, with both more prevalent with increased age.

OBJECTIVE: Determine body image satisfaction, weight concerns and dieting behaviors, Tanner index, and dietary adequacy in young women and girls. DESIGN: A cross-sectional, self-selected comparative survey was completed. SUBJECTS/SETTING: Rural white women and girls (N=333) aged 8 to 17 years, completed a weight concerns and dieting behavior questionnaire, a body image assessment, and a self-rating of sexual maturity, and 230 subjects completed 3-day diet diaries. ANALYSES PERFORMED: Correlational analysis identified relationships between variables among age groups (8 to 10 years, 11 to 14 years, and 15 to 17 years). Analysis of variance examined differences among variables. Multiple regression analysis measured the influence of variables on diet quality. A mean adequacy ratio (MAR) was computed to express dietary adequacy. RESULTS: More than half (52%) of the subjects reported 1 or more weight concerns and dieting behaviors. This pattern increased with age. Friends dieting positively influenced scores (P=.0001) for 8- to 14-year olds, and a dieting family member meant higher scores (P=.04) for all ages studied. Although most wanted to be smaller, there was little body image dissatisfaction. Girls (aged 11 to 17 years) who dieted had greater body dissatisfaction (P=.0001) and significantly lower (P=.002), but adequate diets (MAR=76) compared to those who did not diet (MAR=81). Inverse relationships were found for the 11- to 14-year olds with diet adequacy and the following variables: body image dissatisfaction (-2.7, P<.01) and weight concerns and dieting behaviors (-3.7, P<.001). These variables accounted for 34% (P=.0001) of the variance in the MAR. APPLICATIONS/CONCLUSIONS: Dietitians, partnering with school and health clinic personnel, need to educate girls younger than age 11 years about attaining the dietary adequacy needed to support expected growth. This age is important because it appears that actual weight and dieting concerns begin earlier, and by age 11 years, negatively affect diet quality.