Experiences of New Visitors With Low Food Security Seeking Food Assistance During the COVID-19 Pandemic.

OBJECTIVE: To describe the experiences of first-time visitors with low food security seeking food assistance during the coronavirus disease 2019 pandemic. DESIGN: A qualitative study. SETTING: Emergency food distribution sites in West Central Florida. PARTICIPANTS: Adults (aged 18-64 years) seeking food assistance between November, 2020 and July, 2021. PHENOMENON OF INTEREST: Using food security as a multidimensional concept, in-depth interviews explored the impact of emergency food assistance on food availability, access, utilization, and stability. ANALYSIS: Applied thematic analysis was conducted to identify emergent themes. RESULTS: Participants (n = 18) were White (55.6%), female (72.2%), and aged 40-59 years (55.6%). Seven salient themes described participants' experience seeking food assistance (eg, the crisis resulting in seeking food assistance, mixed quality of pantry foods, and gaining firsthand insight on hunger). Although food assistance increased food availability and access, there were barriers to using the pantry foods (eg, foods not preferred, health/allergies). CONCLUSIONS AND IMPLICATIONS: Study findings suggest that first-time visitors seeking emergency food assistance during the coronavirus disease 2019 pandemic may be experiencing temporary cycles of financial instability, which could impact dietary quality. Because pantry foods are often the primary source of household food supply, client-focused emergency food distribution tailored to client needs can increase food availability, access, and utilization.

Estimation of 24-hour urinary creatinine excretion from patient variables: A novel approach to identify patients with low muscle mass and malnutrition and relationship to outcomes.

BACKGROUND: Low muscle mass has been correlated with adverse outcomes in patients who are critically ill. Methods to identify low muscularity such as computed tomography scans or bioelectrical impedance analyses are impractical for admission screening. Urinary creatinine excretion (UCE) and creatinine height index (CHI) are associated with muscularity and outcomes but require a 24-h urine collection. The estimation of UCE from patient variables avoids the need for a 24-h urine collection and may be clinically useful. METHODS: Variables of age, height, weight, sex, plasma creatinine, blood urea nitrogen (BUN), glucose, sodium, potassium, chloride, and carbon dioxide from a deidentified data set of 967 patients who had UCE measured were used to develop models to predict UCE. The model identified with the best predictive ability was validated and then retrospectively applied to a separate sample of 120 veterans who were critically ill to examine if UCE and CHI predicted malnutrition or were associated with outcomes. RESULTS: A model was identified that included variables of plasma creatinine, BUN, age, and weight and was found to be highly correlated, moderately predictive of UCE, and statistically significant. Patients with model-estimated CHI ≤ 60% had significantly lower body weight, body mass index, plasma creatinine, and sera albumin and prealbumin levels; were 8.0 times more likely to be diagnosed with malnutrition; and were 2.6 times more likely to be readmitted in 6 months. CONCLUSION: A model that predicts UCE offers a novel method to identify patients with low muscularity and malnutrition on admission without the use of invasive tests.

Investigation of the multidimensional determinants of negative nutrition coping strategies and tradeoffs in adults accessing food relief: A secondary data analysis.

BACKGROUND: Multidimensional determinants influence negative nutrition coping strategies and tradeoffs in households accessing food relief. AIMS: This study examined coping strategies and tradeoffs at different levels of food insecurity from individuals accessing food relief and how these behaviors relate to experience-based food insecurity dimensions and subpopulations at risk. METHODS: A secondary analysis of cross-sectional data from the Sunshine State Hunger Survey (SSHS) was conducted. The SSHS was a paper-based, 48-question survey, including questions about coping strategies and tradeoffs, use of food assistance programs, and food security. RESULTS: Out of 616 respondents who completed the survey, 73.9% identified as food insecure while 19.1%, as food secure. The average age of participants was 59.6 years and 62.6% were female. One-way analysis of variance indicated increases in negative nutrition coping strategies and tradeoffs with increasing levels of food insecurity status. The most common coping strategy reported by those with very low food security was "Eating less so children or others have enough food," while the most common tradeoff was "Trading off medicine or medical care for food." Two-step cluster analysis identified homogeneous subgroups by behavior and demographic characteristics: (1) late adult worriers, (2) middle adult traders, and (3) middle/late adult copers. CONCLUSION: Identifying coping strategies and tradeoffs used by participants accessing food relief is a multidimensional approach to addressing determinants of food insecurity. Future research on conceptual pathways is warranted to see if experience-based food insecurity variables help to understand relationships across a continuum, including barriers and influencers.

Documentation of the evidence-diagnosis link predicts nutrition diagnosis resolution in the Academy of Nutrition and Dietetics' diabetes mellitus registry study: A secondary analysis of Nutrition Care Process outcomes.

Objectives: To describe nutrition care documentation patterns and investigate predictors of nutrition diagnosis resolution. Methods: This is a secondary data analysis of a 2-year pragmatic, quasi-experimental study conducted in outpatient clinics where nutrition care was provided to adults with diabetes Type 1 or 2 from May 2017 to June 2019 (n = 564 patients). The main outcome measures were frequency of standardized Nutrition Care Process (NCP) terms, NCP links, nutrition diagnosis resolution and predictors of nutrition diagnosis resolution. Predictors of diagnosis resolution were identified using a multivariable logistic regression model. Results: The most prevalent resolved diagnoses were excessive carbohydrate intake (32%), undesirable food choices (21%) and excessive energy intake (13%). The top etiology was food and nutrition related knowledge deficit (57%) and interventions were drawn mainly from the Nutrition Education domain (64%). One hundred forty-six patient cases (26%) had at least one follow-up visit and 26% of those with a follow-up (n = 38) had a resolved diagnosis. The presence of the evidence-diagnosis NCP link in documentation predicted diagnosis resolution (OR = 2.80, 95% CI 1.30-6.02; p = 0.008). Conclusion: Most diagnoses were caused by patients' lack of knowledge and respective interventions focused on nutrition education. Odds of diagnosis resolution improved when the signs and symptoms of the diagnosis were documented during assessment (evidence-diagnosis NCP link). Training dietitians on NCP links may be important to resolve nutrition diagnoses. Presented findings are hypothesis generating.

Validity and reliability of a questionnaire measuring EBDPs among registered dietitian nutritionist.

BACKGROUND: There is a lack of a valid and reliable instrument that measures objective and subjective knowledge of evidence-based dietetic practices (EBDP) among registered dietitian nutritionists (RDNs). The present study aimed to develop and assess the validity and reliability of an EBDP Questionnaire (EBDPQ) with objective knowledge items (i.e., quiz items) among RDNs in the USA. METHODS: Subscales from four existing evidence-based practice (EBP) instruments were combined and modified for dietetics. Content and face validity and internal consistency were used to assess the full survey. Survey responsiveness and test-retest reliability were evaluated within the objective knowledge subscale. Content experts (n = 11) and nutrition professionals (n = 16) completed validation reviews. Doctoral students enrolled in a research course (n = 12) were used to analyse survey responsiveness. Internal and test-retest relability analyses utilised RDN participants (time point 1, n = 482; time point 2, n = 335). RESULTS: Content validation resulted in a 38-item questionnaire. Average percent agreement among face validity reviewers was 95.1%. Only the pre-validation version of the objective knowledge subscale resulted in significantly higher post-course scores (Mdn = 11.50) compared to the pre-course (Mdn = 9.75, p = 0.05). The validated instrument had excellent internal consistency (Cronbach's α = 0.91); however, the objective knowledge subscale was low (Cronbach's α = 0.41). A good degree of reliability was found between the two time points (intraclass correlation coefficient = 0.71). CONCLUSIONS: The EBDPQ demonstrated adequate validity and reliability among RDNs. Future research should assess construct validity, with the responsiveness and objective knowledge subscale requiring additional evaluation through an EBDP course.

Determinant factors associated with the use of evidence-based dietetics practice among registered dietitian nutritionists.

AIMS: There is a lack of research assessing perceived and actual evidence-based dietetics practice knowledge among registered dietitian nutritionists. This cross-sectional research examined the association between determinant factors (i.e., education attainment) and objective knowledge (i.e., quiz items) of evidence-based dietetics practices. Other determinant factors associated with perceived knowledge and skill, attitudes, behaviours and outcomes related to evidence-based dietetics practice were also assessed. Perceived knowledge items were compared to objective knowledge items to evaluate the accuracy of self-assessed evidence-based dietetics practice knowledge among dietitians in the United States. METHODS: A modified and adapted evidence-based practice survey was emailed to registered dietitian nutritionists in the United States via the Commission on Dietetic Registration database between November and December 2020. Analysis of variance assessed the relationship between highest degree held and actual knowledge of evidence-based dietetics practices. Multiple linear regression and ordinal logistic regression determined participant-level characteristics associated with survey subscales and survey items, respectively. Pearson's correlation coefficient evaluated the relationship between subjective and objective items. RESULTS: Four hundred and eighty-two dietitians completed the survey. Each increase in degree type was associated with an increase in objective knowledge score (all comparisons p < 0.001). Other determinants included recency of degree completion and peer-reviewed publications. Moderate positive associations (r = 0.35, p < 0.001) were found between subjective and objective measures. CONCLUSION: Graduate-level education, recency of degree completion and peer-reviewed publications were supportive of evidence-based dietetics practice-related outcomes. Future research should evaluate the efficacy of training, particularly among those further from their highest completed degree.

Food insecurity among older adults living in low- and middle-income countries: a scoping review.

BACKGROUND AND OBJECTIVES: Food insecurity is considered an increasing public health problem worldwide with adverse effects, especially among older adults. Although the literature related to food insecurity among older adults in low- and middle-income countries (LMIC) is expanding, little is known about existing patterns and knowledge gaps in these settings. This scoping review aims to provide a comprehensive overview of the current research related to food insecurity among older adults in LMIC. RESEARCH DESIGN AND METHODS: A systematic search was conducted in November 2021 and revised in July 2022 on six databases using terms related to food insecurity and older adults. Data were extracted and the emerging themes from the main findings were summarized using a Social-Ecological Model (SEM). RESULTS: Forty-one studies met the inclusion criteria. Almost half (48.8%) were published in the last two years and utilized a quantitative approach (n=38). Only one study was conducted in a low-income country. Using the SEM, most studies included in this review focused on addressing the relationship between food insecurity with intrapersonal factors. DISCUSSION AND IMPLICATIONS: Several gaps in the current literature were identified. There is a lack of longitudinal and qualitative studies available on this topic. Also, only fifteen LMIC were represented in the literature. A critical point in this review is that only a few studies addressed the relationship between food insecurity and the policy/social structure, institutional, community and interpersonal levels. These identified gaps can serve as a guide for future research on this topic.