Advancing Nutrition Education, Training, and Research for Medical Students, Residents, Fellows, Attending Physicians, and Other Clinicians: Building Competencies and Interdisciplinary Coordination.

Nutrition plays an important role in health promotion and disease prevention and treatment across the lifespan. Physicians and other healthcare professionals are expected to counsel patients about nutrition, but recent surveys report minimal to no improvements in medical nutrition education in US medical schools. A workshop sponsored by the National Heart, Lung, and Blood Institute addressed this gap in knowledge by convening experts in clinical and academic health professional schools. Representatives from the National Board of Medical Examiners, the Accreditation Council for Graduate Medical Education, the Liaison Committee on Medical Education, and the American Society for Nutrition provided relevant presentations. Reported is an overview of lessons learned from nutrition education efforts in medical schools and health professional schools including interprofessional domains and competency-based nutrition education. Proposed is a framework for coordinating activities of various entities using a public-private partnership platform. Recommendations for nutrition research and accreditation are provided.

Modifying dietary risk behaviors to prevent obesity and dental caries in very young children: results of the Baby Steps to Health pediatric dental pilot.

OBJECTIVES: To describe the design, feasibility, and acceptability of a theory-informed obesity and dental caries prevention pilot study, Baby Steps to Health, conducted in an academic dental clinic among a primarily Asian immigrant population. METHODS: Baby Steps used self-determination theory and behavioral motivation strategies for a caregiver/child (6-36 months) nutrition and oral health behavior change intervention implemented in a pediatric dental clinic. Caregivers completed a dietary practice assessment to identify risk behaviors and potential courses of action. With assistance from dental providers, caregiver responses were matched to customized dietary behavioral guidance and a behavior change goal to reinforce caregivers' autonomous motivation to improve feeding practices. A 1-month, post-visit phone caregiver interview assessed adherence to the behavioral goal(s) and solicited qualitative input for further program development. RESULTS: Fifty caregivers (82 percent Asian) participated in the initial visit, and 46 (92 percent) participated in the follow-up interview. Reported obesogenic/cariogenic risk behaviors were prevalent: 57 percent of bottle-fed children consumed non-water beverages in bottles to aid sleep and 38 percent of parents offered snacks ad libitum. At follow-up, 93 percent of caregivers who selected goals reported positive behavior change and 91 percent said they would participate in a similar future program. CONCLUSIONS: Tailored guidance delivered in a program that uses self-determination theory may represent a strategic use of the dental encounter to impart actionable information and motivate health-related behavior change for families with very young children. Partnerships between dental and nutrition professionals offer opportunities to address key dietary behaviors that may prevent obesity and improve oral health, particularly among at-risk children.

Site-based data curation based on hot spring geobiology.

Site-Based Data Curation (SBDC) is an approach to managing research data that prioritizes sharing and reuse of data collected at scientifically significant sites. The SBDC framework is based on geobiology research at natural hot spring sites in Yellowstone National Park as an exemplar case of high value field data in contemporary, cross-disciplinary earth systems science. Through stakeholder analysis and investigation of data artifacts, we determined that meaningful and valid reuse of digital hot spring data requires systematic documentation of sampling processes and particular contextual information about the site of data collection. We propose a Minimum Information Framework for recording the necessary metadata on sampling locations, with anchor measurements and description of the hot spring vent distinct from the outflow system, and multi-scale field photography to capture vital information about hot spring structures. The SBDC framework can serve as a global model for the collection and description of hot spring systems field data that can be readily adapted for application to the curation of data from other kinds scientifically significant sites.

Association between Early Childhood Caries, Feeding Practices and an Established Dental Home.

PURPOSE: Early Childhood Caries (ECC) is a significant public health concern disproportionately affecting low-income children. The purpose of this study was to assess the association between the establishment of a dental home and ECC prevalence in a group of Medicaid-enrolled preschool children, and to explore feeding practices associated with an increased prevalence of ECC in Medicaid-enrolled preschool children with an established dental home was evaluated. METHODS: A cross-sectional survey was conducted among Medicaid-enrolled children (n=132) between 2 and 5 years of age with an established dental home and no dental home to compare feeding practices, parental knowledge of caries risk factors and oral health status. RESULTS: Children with an established dental home had lower rates of biofilm (p<0.05), gingivitis (p<0.05) and mean decayed, missing and filled teeth (DMFT) scores (p<0.05). Children with no dental home consumed more soda and juice (p<0.05) daily, and ate more sticky fruit snacks (p<0.05) than children with an established dental home. Establishment of a dental home had a strong protective effect on caries and DMFT index (odds ratio=0.22) in both univariate and confounding adjusted analyses. CONCLUSION: The results suggest establishment of a dental home, especially among high-risk, low-income populations, decreases the prevalence of ECC and reduces the practice of cariogenic feeding behaviors.

The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness.

Nutrition is a recognized determinant in 3 (ie, diseases of the heart, malignant neoplasms, cerebrovascular diseases) of the top 4 leading causes of death in the United States. However, many health care providers are not adequately trained to address lifestyle recommendations that include nutrition and physical activity behaviors in a manner that could mitigate disease development or progression. This contributes to a compelling need to markedly improve nutrition education for health care professionals and to establish curricular standards and requisite nutrition and physical activity competencies in the education, training, and continuing education for health care professionals. This article reports the present status of nutrition and physical activity education for health care professionals, evaluates the current pedagogic models, and underscores the urgent need to realign and synergize these models to reflect evidence-based and outcomes-focused education.

Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action.

Understanding and applying nutrition knowledge and skills to all aspects of health care are extremely important, and all health care professions need basic training to effectively assess dietary intake and provide appropriate guidance, counseling, and treatment to their patients. With obesity rates at an all-time high and the increasing prevalence of diabetes projected to cost the Federal government billions of dollars, the need for interprofessional nutrition education is paramount. Physicians, physician assistants, nurses, nurse practitioners, pharmacists, dentists, dental hygienists, occupational therapists, physical therapists, speech and language pathologists, and others can positively affect patient care by synchronizing and reinforcing the importance of nutrition across all specialty areas. Although nutrition is a critical component of acute and chronic disease management, as well as health and wellness across the health care professions, each profession must reevaluate its individual nutrition-related professional competencies before the establishment of meaningful interprofessional collaborative nutrition competencies. This article discusses gaps in nutrition education and training within individual health professions (ie, nursing, pharmacy, dentistry, and dietetics) and offers suggestions for educators, clinicians, researchers, and key stakeholders on how to build further capacity within the individual professions for basic and applied nutrition education. This "gaps methodology" can be applied to all health professions, including physician assistants, physical therapists, speech and language pathologists, and occupational therapists.

Capacity building in nutrition science: revisiting the curricula for medical professionals.

The current nutrition education curricula for students in U.S. medical schools, and schools of other health professions, such as nursing and oral health, do not provide enough opportunity to gain knowledge of the interactions among micro- and macronutrients, their role in maintaining optimal body functions, factors that interfere with these interactions, or, importantly, how to integrate this knowledge into medical practice. There is a need to better prepare healthcare professionals for identifying nutrition risk and managing hospitalized patients, especially those with chronic conditions, using an interprofessional, team-based approach. A major goal of this report is to revisit current nutrition training programs for physicians and other healthcare professionals in order to explore opportunities for providing healthcare providers with the essential tools of preventative and therapeutic nutrition intervention strategies. The issues addressed include whether a consensus exists on how to integrate basic and applied nutrition into the general healthcare professional curriculum, and if so, at which stages of training and at what depth should these integrations occur; how nutrition education is dealt with and achieved throughout all the health professions; and whether current nutrition education models are sufficient. To help address these issues, the report will review current nutrition education practices-their strengths and weaknesses-as well as evaluate promising new initiatives, and offer proposals for new directions for nutrition education training of future generation of medical practitioners.

Dietary intake and severe early childhood caries in low-income, young children.

Evidence suggests that risk for early childhood caries (ECCs), the most common chronic infectious disease in childhood, is increased by specific eating behaviors. To identify whether consumption of added sugars, sugar-sweetened beverages (SSBs), and 100% fruit juice, as well as eating frequency, are associated with severe ECCs, cross-sectional data collected from a sample of low-income, racially diverse children aged 2 to 6 years were used. Four hundred fifty-four children with severe ECCs and 429 caries-free children were recruited in 2004-2008 from three pediatric dental clinics in Columbus, OH; Cincinnati, OH; and Washington, DC. Dietary data were obtained from one parent-completed 24-hour recall and an interviewer-administered food frequency questionnaire (FFQ). Multivariate logistic regression analyses were conducted to assess associations between severe ECCs and dietary variables. On average, children with severe ECCs consumed 3.2-4.8 fl oz more SSBs (24-hour recall=1.80 vs 1.17; P< 0.001; FFQ=0.82 vs 0.39; P<0.001) and reported significantly more daily eating occasions (5.26 vs 4.72; P<0.0001) than caries-free children. After controlling for age, sex, race/ethnicity, maternal education, recruitment site, and family size, children with the highest SSB intake were 2.0 to 4.6 times more likely to have severe ECCs compared with those with the lowest intake, depending on dietary assessment method (24-hour recall odds ratio 2.02, 95% CI 1.33 to 3.06; FFQ odds ratio 4.63, 95% CI 2.86 to 7.49). The relationship between eating frequency and severe ECC status was no longer significant in multivariate analyses. Specific dietary guidance for parents of young children, particularly regarding SSB consumption, could help reduce severe ECC prevalence.

Development of a pediatric cariogenicity index.

OBJECTIVES: This study was designed to develop food and liquid cariogenicity indices and to preliminarily test their utility using dietary data from a study of children with and without severe early childhood caries (S-ECC), defined as 3 + smooth surface carious lesions, including at least one pulpally involved tooth. METHODS: Data were collected in a diverse cohort of low-income preschool-aged children made up of 454 children with S-ECC and 429 caries-free children who presented for care at pediatric dental clinics in Washington, DC, Columbus, OH, and Cincinnati, OH. The cariogenicity indices were used to score dietary data from a Food Frequency Questionnaire (FFQ) and a 24-hour recall (24HR). RESULTS: There were no statistically significant differences in mean food cariogenicity scores between groups. The liquid cariogenicity score was higher in the S-ECC group as compared with caries-free children (24HR: 5.28 versus 4.66, respectively, P < 0.001; FFQ: 5.03 versus 4.38, P < 0.001). The food cariogenicity score did not discriminate between those with and without S-ECC, while the liquid cariogenicity score did differentiate between the two groups (24HR: OR: 1.2; 95 percent CI: 1.1, 1.3; FFQ: 1.7; 95 percent CI 1.4, 2.0). The liquid cariogenicity score was also associated with number of carious lesions. CONCLUSIONS: The liquid cariogenicity index has potential in research and clinical settings to provide a liquid cariogenicity score and help quickly identify modifiable risk factors within a child's diet. Further research is needed to test its utility in clinical and public health settings.

Position of the Academy of Nutrition and Dietetics: the impact of fluoride on health.

It is the position of the Academy of Nutrition and Dietetics to support optimal systemic and topical fluoride as an important public health measure to promote oral health and overall health throughout life. Fluoride is an important element in the mineralization of bone and teeth. The proper use of topical and systemic fluoride has resulted in major reductions in dental caries and its associated disability. Dental caries remains the most prevalent chronic disease in children and affects all age groups of the population. The Centers for Disease Control and Prevention has named fluoridation of water as one of the 10 most important public health measures of the 21st century. Currently, >72% of the US population that is served by community water systems benefits from water fluoridation. However, only 27 states provide fluoridated water to more than three quarters of the state's residents on public water systems. Fluoride also plays a role in bone health. However, at this time, use of high doses of fluoride for osteoporosis prevention is considered experimental only. Dietetics practitioners should routinely monitor and promote the use of fluorides for all age groups.

Childhood dental caries and childhood obesity. Different problems with overlapping causes.

PURPOSE: To review and summarize the current literature on the issues contributing to the increased prevalence of childhood obesity and dental caries and to provide direction and guidelines for dental practitioners as well as other health professionals for interventions that may help stem the tide of both conditions. METHODS: Through a review of the recent literature, the most recent research on the nutritional issues in common to both childhood caries and childhood obesity are reported, as well as clinical interventions which are considered appropriate in dental practice. RESULTS: Factors contributing to both childhood caries and childhood obesity are psychosocial as well as nutritional. Family patterns, lifestyle issues, and school-based issues all play a role. The literature shows that many of the same issues contribute to both childhood caries and childhood obesity, and that it is within the scope of responsibility of dental practitioners to provide guidance for the prevention and reduction of both.

Effect of omega-3 and vitamin E supplementation on dry mouth in patients with Sjögren's syndrome.

To determine whether omega-3 (n-3) increases saliva production in patients with Sjögren's syndrome, 61 patients with Sjögren's received either wheat germ oil (n = 23) or n-3 supplement (TheraTears Nutrition®) (n = 38) in a prospective, randomized, double-masked trial. The outcomes assessed were salivary secretion and markers for oral inflammation. The differences between the n-3 group and wheat germ oil group were not statistically significant for either unstimulated (US) or stimulated (SS) salivary secretion (p= 0.38 and p= 0.346, respectively) nor for the number of sites with probing depth (PD) ≥ 4 mm (p= 0.834). In this pilot study, supplementation with n-3 was not found to be significantly better than wheat germ oil in stimulating saliva production in patients with Sjögren's syndrome.

Data sharing, small science and institutional repositories.

Results are presented from the Data Curation Profiles project research, on who is willing to share what data with whom and when. Emerging from scientists' discussions on sharing are several dimensions suggestive of the variation in both what it means 'to share' and how these processes are carried out. This research indicates that data curation services will need to accommodate a wide range of subdisciplinary data characteristics and sharing practices. As part of a larger set of strategies emerging across academic institutions, institutional repositories (IRs) will contribute to the stewardship and mobilization of scientific research data for e-Research and learning. There will be particular types of data that can be managed well in an IR context when characteristics and practices are well understood. Findings from this study elucidate scientists' views on 'sharable' forms of data-the particular representation that they view as most valued for reuse by others within their own research areas-and the anticipated duration for such reuse. Reported sharing incidents that provide insights into barriers to sharing and related concerns on data misuse are included.

Strategic reading, ontologies, and the future of scientific publishing.

The revolution in scientific publishing that has been promised since the 1980s is about to take place. Scientists have always read strategically, working with many articles simultaneously to search, filter, scan, link, annotate, and analyze fragments of content. An observed recent increase in strategic reading in the online environment will soon be further intensified by two current trends: (i) the widespread use of digital indexing, retrieval, and navigation resources and (ii) the emergence within many scientific disciplines of interoperable ontologies. Accelerated and enhanced by reading tools that take advantage of ontologies, reading practices will become even more rapid and indirect, transforming the ways in which scientists engage the literature and shaping the evolution of scientific publishing.

Biological information specialists for biological informatics.

Data management and integration are complicated and ongoing problems that will require commitment of resources and expertise from the various biological science communities. Primary components of successful cross-scale integration are smooth information management and migration from one context to another. We call for a broadening of the definition of bioinformatics and bioinformatics training to span biological disciplines and biological scales. Training programs are needed that educate a new kind of informatics professional, Biological Information Specialists, to work in collaboration with various discipline-specific research personnel. Biological Information Specialists are an extension of the informationist movement that began within library and information science (LIS) over 30 years ago as a professional position to fill a gap in clinical medicine. These professionals will help advance science by improving access to scientific information and by freeing scientists who are not interested in data management to concentrate on their science.

Information preferences and practices among people living with HIV/AIDS: results from a nationwide survey.

OBJECTIVES: This study was designed to reach many segments of the diverse HIV/AIDS community and broaden understanding of how information can better assist people living with HIV/AIDS. METHODS: Data were collected through a self-administered mail survey distributed nationwide at clinics, drug treatment centers, and other AIDS service organizations. RESULTS: The 662 respondents preferred getting information from people--including health professionals, family, and friends--and considered people the most trustworthy, useful, understandable, and available information sources. Forty-three percent selected doctors as their most preferred source. The Internet was not rated highly overall but was preferred by those with more education or living in metropolitan areas. Seventy-two percent said they actively search for HIV/AIDS-related information, and 80% said they give advice or tell others where to get such information. However, 71% agreed that it is easy to feel overwhelmed by information, and 31% agreed that not seeking information can be beneficial. CONCLUSIONS: Overall, information seeking is an important activity for this sample of people living with HIV/AIDS. Many sources are widely available to them but, together, can be overwhelming. They rely on health professionals far more than print or media sources and receive encouragement and support from family and friends.

Position of the American Dietetic Association: the impact of fluoride on health.

The American Dietetic Association reaffirms that fluoride is an important element for all mineralized tissues in the body. Appropriate fluoride exposure and usage is beneficial to bone and tooth integrity and, as such, has an important, positive impact on oral health as well as general health throughout life. Fluoride is an important element in the mineralization of bone and teeth. The proper use of topical and systemic fluoride has resulted in major reductions in dental caries (tooth decay) and its associated disability. The Centers for Disease Control and Prevention have named fluoridation of water as one of the 10 most important public health measures of the 20th century. Nearly 100 national and international organizations recognize the public health benefits of community water fluoridation for preventing dental caries. However, by the year 2000, over one third of the US population (over 100 million people) were still without this critical public health measure. Fluoride also plays a role in bone health. However, the use of high doses of fluoride for prevention of osteoporosis is considered experimental at this point. Dietetics professionals should routinely monitor and promote the use of systemic and topical fluorides, especially in children and adolescents. The American Dietetic Association strongly reaffirms its endorsement of the appropriate use of systemic and topical fluorides, including water fluoridation, at appropriate levels as an important public health measure throughout the life span.

Gerodontic nutrition and dietary counseling for prosthodontic patients.

The older dental patient can be at risk of poor nutrition for a variety of reasons including physiologic, oral, psychosocial, functional, and medical factors. Any decline in the ability to eat increases the risk of malnutrition. Oral impairments can affect diet and nutrition because of chances in the ability and desire to taste, bite, chew, and swallow foods. The dental team must be aware of these potential detrimental effects of dental treatment and provide counteractive dietary guidance. Problems vary with the patient and the dental condition, so suggestions must be tailored to meet the patient's specific needs. Caregivers should: Screen patients to determine whether there are risk factors that could compromise nutrition. Provide diet guidance to prepare patients for any changes in eating ability. Promote diet adequacy by suggesting appropriate choices from each food group in the Food Guide Pyramid. Consult with and refer clients to a registered dietitian whenever possible.