Kent State Interns

I was reading through my daily emails from the Academy when I came across an interesting article about bariatric surgery.  The American Society for Metabolic and Bariatric Surgery, the American Association of Clinical Endocrinologists and the Obesity Society recently recommended that eligibility for weight-loss surgery be expanded to include mildly or moderately obese patients with diabetes or metabolic syndrome.  These patients would have to have a BMI of 30-34.9 to be eligible.  The previous criteria was severe obesity (BMI above 40) or BMI greater than 35 with a serious health problem related to obesity.  You can read more from this news release here . -KC

This article is very interesting.  I have been reading lately that children who receive liver transplants can develop food allergies and sensitivities.  This study followed three different children who had developed food allergies and intolerances after a liver transplant to determine a long term prognosis. This is the article link Brian W.

I found this interesting article a couple of days ago.  It examines how the focus on clinical dietetics is enhanced when doctors and nurses have greater access to clinical dietitians.  Although it is a couple years old, I believe it still provides insight on how dietitians should make their voices known in a clinical setting because a lot of doctors and nurses are willing to listen and learn, and in the process you may learn something as well. Enjoy Brian W. This is the article link

I found this article a few days ago and wanted to share it with you all.  The 18 year old girl in this article has been eating Ramen noodles for 13 years and says she eats nothing but the noodles now.  She hates fruits and vegetables and doesn't want anything else to even touch her plate.  Due to these eating habits, her physician says she is malnourished and has the health of an 80 year old.  This is the article link Brian W.

Supplements are becoming more and more popular.  At my current rotation, we get a lot of questions about supplements, so my preceptor showed me a great process to evaluate them.  Here are a list of reputable websites that you can use.  Just go from one to the other with the name of the supplement and the brand. It will tell you the general information to more specifics on the brands.  Check them out, and use them during your counseling! http://www.nlm.nih.gov/medlineplus/druginfo/herb_All.html https://www.consumerlab.com/Search/-Review http://www.quackwatch.org/ -RR

I happened to catch the news this morning and saw Bob Harper from the Biggest Loser on the Today show. He has a new 3 week diet called Jump Start to Skinny. I was curious so I listened to the segment. The diet is based on 800 calories for women and 1200 calories for men. You can only have grains at breakfast as well. I wondered what everyone else's thoughts on this new diet craze are? All I could think was how unhealthy and hard to maintain long-term. I don't think I could make it 21 days. He claimed it was safe and very effective. I guess you would see weight loss if you starve to death for 21 days! Thoughts??? --Sarah Carlson Source: Bob Harper on the Today show 4/22/2013

Acne is a common disease that affects many adolescents and adults. The use of MNT for treatment is not a new idea but it is being looked at again. However, the findings have been mixed over the years. The research is showing a relationship between acne and dietary intake, this is not a cause-and-effect relationship but rather a correlation.                 The current research seems to support that poor dietary quality can in fact aggravate acne. The biggest point the article drove home was that it does not prevent acne but can alleviate the “flare-ups”.                 I was interested when I read this article because I have not heard much about the link between diet and acne since high school (which was a little while ago now). It is interesting to see how ideas resurface.      This edition of JAND was very good an...

     The rate of obesity is still increasing in many parts of the world. The sleeve gastrectomy and roux-en-y procedures are two common types of gastric bypass. This type of surgery seeks to help those who are morbidly obese and have failed at diets and exercise regimens in the past. However, when part of the GI tract is being bypassed and the size of the stomach is reduced to half or less, there are going to be changes in intake and with that, nutrient deficiencies.      Some of the most common nutrient deficiencies seen in this population and for many of those who have these gastric bypass procedures, are magnesium, phosphorous, calcium, and iron. Even those who took supplementation for these nutrients, had lower levels than recommended. This proves the importance of teaching this population how to choose the most nutrient dense foods and keeping an eye on their lab values for deficiencies. --Sarah Carlson Source: Andreu A, Delgado S, Fl...

Interesting findings about selenium and prostate cancer were presented at the AACR Annual Meeting in Washington DC at the beginning of April. Results from the Netherlands Cohort Study on diet and cancer indicate that higher levels of selenium over time may be protective against advanced prostate cancer. Milan Geybels and his colleagues analyzed data from 898 men who were diagnosed with advanced prostate cancer over 17.3 years of follow-up. More about the study can b e accessed at http://www.todaysdietitian.com/news/041213_news.shtml . JY - 4/18/13

 The obesity rate continues to rise and with that the prevalence of bariatric surgery is also on the rise. This is the last resort for individuals who cannot conquer their weight issues through diet and exercise alone. The RD's role is very important because the gut no longer functions as it did pre op and there are nutrient deficiencies in this population.  25-hydroxyvitamin D is the most common deficiency seen with bariatric patients. A vitamin D supplement does not always improve the deficiency. The dose needs to be quite substantial, about 50.000 IU per week.  Vitamin B6 and thiamin are other micronutrients that tend to be low or deficient in bariatric patients. These deficiencies are due to lack of adherence to the MTV regimen and altered absorption in the GI tract due to surgical procedure. Thus this is evidence for the importance of RDs on the bariatric team. The diet post op is imperative on the success of the surgery. The surgery alone will not keep the weight ...

Subjective Global Assessment (SGA) has been widely used for more than 25 years to assess the nutritional status of adults in clinical and research settings.  Researchers recently adapted and validated this tool for use in a pediatric population and renamed it Subjective Global Nutritional Assessment (SGNA).  The authors' study demonstrated the reliability and validity of SGNA in identifying malnutrition and risk of nutrition-related outcomes in pediatric surgery patients.  Other studies have also proven its ability to identify malnutrition in children.  The rating form itself is included in the article  here . KC

This article entitled “Motivational interviewing skills are positively associated with nutritionist self-efficacy” examined how physical and social self-concepts, motivational interviewing skills, and nutrition assessment skills are related to nutritionist self-efficacy.  The study sample was a group of 65 WIC dietitians who were either white or hispanic, and the main outcome examined was counseling self-efficacy on nutrition and physical activity topics with a language/cultural difference present.  There were many interesting relationships between variables demonstrated in the study.   For instance, perception of MI skills was positively associated with self-efficacy for counseling clients of a different culture, and Hispanic ethnicity and social self-concept were positively associated with self-efficacy in the present of cultural differences.  All of the findings of this study point to the importance of developing strong M...

In a 2013 article entitled “Development and validation of a measure of health literacy in the UK: the newest vital sign”, researchers sought to validate a new measure of health literacy in a UK population.   Health literacy is defined as “the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health”, and individuals with lower health literacy are at a greater risk for poor health.   The instrument examined in this study is known as the Newest Vital Sign health literacy instrument, and it is quick and easy, utilizes a nutrition label, and addresses both literacy and numeracy skills.   The process of amending and validating this instrument required three different steps.   The first was to do a study with experts in the field to ensure that the NVS was appropriate to use with a UK population, as opposed to a US population from wh...

    This article looked at many studies that had nutrition has the main or sub component for the treatment of PCOS. Many of the studies were looking at improving metabolic parameters and weight loss or maintenance. The researchers found, after analyzing the chosen studies, that were improvement in metabolic parameters and weight loss when the participants consumed a low-CHO and high protein diet. This was in comparison with a general healthful diet. One of the biggest improvements seen in with some of the participants was increased insulin sensitivity. Women that suffer from PCOS often have weight gain that is difficult to control.      Thus the evidence presented in this systematic review supports the implementation of low carbohydrate and high protein diets for women with PCOS in order to improve metabolic parameters and aid in weight loss. ---Sarah Carlson  Frearson M, Ko H, Marsh K, Misso K, et al. Dietary Composition in the Tr...

At my WIC rotation, a dietitian gave me a handout from a conference she attended on motivational interviewing in 2008.  It was presented by KSU counseling students, and centered on the analogy of motivational interviewing to dancing: the steps are basic and fundamental, and may seem simple  - learning to use motivational interviewing is like dancing - you have to practice the steps!  I thought this article offered a new perspective on motivational interviewing - and also may help with our assignment! Researchers have identified 7 "helper behaviors or dance steps" which the counselor can facilitate to increase client involvement and change talk (Moyers et al., 2005).  When counselors used steps 1-3, clients actually showed an immediate increase in their change talk (Moyers and Martin, 2006). The presenters use the acronym A utonomy/Support, C ollaboration, E vocation, D irection and E mpathy to summarize the motivational interviewing "music" 7 Dance Steps 1. Advi...

Found an interesting article online on the Today’s Dietitian magazine site on Probiotics & IBD. The article by Sherry Coleman Collins, MS, RD, discusses the benefits of probiotics for IBD patients after a regimen of steroids and antibiotics. The article also discusses the different bacterial strains that benefit different types of inflammatory bowel diseases like Crohn’s disease and ulcerative colitis. Article can be accessed at http://www.todaysdietitian.com/newarchives/040113p34.shtml  JY 4/9/13

I found this interesting article examining the effect of productivity and time use of professionals in a clinical field when they have a student with them.  This article examines both the effects in the occupational therapy field and the nutrition/dietetics field.  A very interesting read.  Enjoy! Click Here Brian W.

Previous studies have demonstrated that depression can have a number of negative effects on dietary intake, ranging from skipping meals, lacking motivation to eat, selecting poor food choices, and others.   It has also been shown that depression is a common problem in HIV patients, with prevalence estimates of up to 37% of HIV patients affected.   With this in mind, researchers from Australia sought to determine how depression affects dietary intake in patients suffering from HIV, and their findings were published in the International Journal of STD & AIDS .   The study sample was composed of 58 HIV patients and was split into a depressed group (n=21) and a non-depressed group (n=37).   Dietary intake was evaluated through a diet history, food frequency questionnaire, and 24-hour recall conducted by a dietitian, and depression level was measured using a depression scale.   As far as macronutrient intake is concerned, the depressed patients consume...

The Nutrition Care Manual has a section that discusses the importance of nutrition and hydration issues at the end of life and ethical issues. “The goals of care must first be established in order to provide appropriate nutritional therapy. In end-of-life care, the registered dietitian’s assessment requires the practitioner to consider not only the clinical nutrition needs of the person, but the medical goals of the patient (restorative, supportive, palliative, or comfort). The dietitian must also address the psychosocial, spiritual, behavioral, and philosophical issues facing the patient as well.” “Palliative care is the active, total care of a patient when curative measures are no longer an option. Palliative care, including nutrition-related care, does not imply indifference or inferior care. Nutrition goals are no longer curative; reversing malnutrition may not be possible or appropriate. Patient choice, optimal quality of life, and maintaining dignity are paramount. Clari...

In the Nutrition Care Manual, I came across the nutrition interventions for patients with burns. "Most individuals with burns covering less than 20% total body surface are able to consume a high-energy, high-protein nutrition intervention composed of snacks, enteral supplements, or nutrient-enriched shakes to meet nutrition needs. Individuals with larger burns or who are unable to consume sufficient energy and protein, meeting less than 75% of goal energy and protein intake for more than 3 days, should receive nocturnal feedings as a supplement to oral intake based on kilocalorie count results or, if oral intake is negligible, enteral nutrition to meet 100% of nutritional goals. Generally, feedings are initiated at 20 mL/hour to 40 mL/hour and increased to a goal rate over 24 to 48 hours." "Special consideration should be given to the effects of dressing changes, hydrotherapy, burns to the hands and/or face, sedation, and pain medications that may interfere with f...