Journal of The American Dietetic Association最新文献

Childhood cancer survivors are at increased risk for chronic health conditions that may be influenced by their cancer treatment and unhealthy lifestyle behaviors. Despite the possibility that interventions targeting the survivor–parent dyad may hold promise for this population, a clearer understanding of the role of family factors and the lifestyle behaviors of both survivors and parents is needed. A mailed cross-sectional survey was conducted in 2009 to assess weight status (body mass index), lifestyle behaviors (eg, diet, physical activity), and the quality of the parent–child relationship among 170 childhood cancer survivors who were treated at MD Anderson Cancer Center and 114 of their parents (80% mothers). Survivors were more physically active and consumed more fruits and vegetables than their parents. However, fewer than half of survivors or parents met national guidelines for diet and physical activity, and their weight status and fat intakes were moderately correlated (r=.30−.57; P<0.001). Multilevel models showed that, compared with survivors with better than average relationships, those with poorer than average relationships with their parents were significantly more likely to consume high-fat diets (P<0.05). Survivors and their parents may thus benefit from interventions that address common lifestyle behaviors, as well as issues in the family environment that may contribute to an unhealthy lifestyle.

The objective of this study was to compare the quick-and-easy undernutrition screening tools, ie, Short Nutritional Assessment Questionnaire and Malnutrition Universal Screening Tool, in patients undergoing cardiac surgery with respect to their accuracy in detecting undernutrition measured by a low-fat free mass index (FFMI; calculated as kg/m²), and secondly, to assess their association with postoperative adverse outcomes. Between February 2008 and December 2009, a single-center observational cohort study was performed (n=325). A low FFMI was set at ≤14.6 in women and ≤16.7 in men measured using bioelectrical impedance spectroscopy. To compare the accuracy of the Malnutrition Universal Screening Tool and Short Nutritional Assessment Questionnaire in detecting low FFMI sensitivity, specificity, and other accuracy test characteristics were calculated. The associations between the Malnutrition Universal Screening Tool and Short Nutritional Assessment Questionnaire and adverse outcomes were analyzed using logistic regression analyses with odds ratios and 95% confidence intervals (CI) presented. Sensitivity and receiver operator characteristic-based area under the curve to detect low FFMI were 59% and 19%, and 0.71 (95% CI: 0.60 to 0.82) and 0.56 (95% CI: 0.44 to 0.68) for the Malnutrition Universal Screening Tool and Short Nutritional Assessment Questionnaire, respectively. Accuracy of the Malnutrition Universal Screening Tool improved when age and sex were added to the nutritional screening process (sensitivity 74%, area under the curve: 0.72 [95% CI: 0.62 to 0.82]). This modified version of the Malnutrition Universal Screening Tool, but not the original Malnutrition Universal Screening Tool or Short Nutritional Assessment Questionnaire, was associated with prolonged intensive care unit and hospital stay (odds ratio: 2.1, 95% CI: 1.3 to 3.4; odds ratio: 1.6, 95% CI: 1.0 to 2.7). The accuracy to detect a low FFMI was considerably higher for the Malnutrition Universal Screening Tool than for the Short Nutritional Assessment Questionnaire, although still marginal. Further research to evaluate the modified version of the Malnutrition Universal Screening Tool, ie, the cardiac surgery–specific Malnutrition Universal Screening Tool, is needed prior to implementing.

Background

There is a growing interest in studying the influence of child-care center policies on the health of preschool-aged children.

Objective

To develop a reliable and valid instrument to quantitatively evaluate the quality of written nutrition and physical activity policies at child-care centers.

Design

Reliability and validation study. A 65-item measure was created to evaluate five areas of child-care center policies: nutrition education, nutrition standards for foods and beverages, promoting healthy eating in the child-care setting, physical activity, and communication and evaluation. The total scale and each subscale were scored on comprehensiveness and strength.

Setting

Analyses were conducted on 94 independent policies from Connecticut child-care centers participating in the Child and Adult Care Food Program.

Statistical analyses performed

Intraclass correlation coefficient was calculated to measure inter-rater reliability, and Cronbach's α was used to estimate internal consistency. To test construct validity, t tests were used to assess differences in scores between Head Start and non–Head Start centers and between National Association for the Education of Young Children–accredited and nonaccredited centers.

Results

Inter-rater reliability was high for total comprehensiveness and strength scores (intraclass correlation coefficient=0.98 and 0.94, respectively) and subscale scores (intraclass correlation coefficient=0.84 to 0.99). Subscales were adequately internally reliable (Cronbach's α=.53 to .83). Comprehensiveness and strength scores were higher for Head Start centers than non–Head Start centers across most domains and higher for National Association for the Education of Young Children–accredited centers than nonaccredited centers across some but not all domains, providing evidence of construct validity.

Conclusions

This instrument provides a standardized method to analyze and compare the comprehensiveness and strength of written nutrition and physical activity policies in child-care centers.

Medical nutrition therapy is reported to contribute to wound healing. However, effective intervention requires an accurate estimation of individual energy needs, which, in turn, relies on accurate methods of assessment. The primary aims of this systematic review and meta-analysis were to evaluate the resting energy expenditure (REE) of patients with pressure ulcers (PUs) compared to matched control groups and the potential estimation bias of REE predictive equations. The recommended daily energy requirements of patients with PUs were also assessed, along with their energy balance (daily energy requirement vs intake). All language, original, full-text research articles published between January 1, 1950, and July 31, 2010, were searched through electronic databases. Relevant studies were also identified by reviewing citations. Observational (case-control and case-series) studies providing data on measured REE were initially included. Data extracted were measured REE, predicted REE, and daily energy intake. Five studies were included in the meta-analysis. Compared to controls (n=101), patients with PUs (n=92) presented higher measured REE (weighted mean 20.7±0.8 vs 23.7±2.2 kcal/kg/day; P<0.0001). In these patients, measured REE was also higher than predicted REE (calculated using the Harris-Benedict formula in all studies; 21.0±1.0 kcal/kg/day; P<0.0001), whereas energy intake (n=78; 21.7±3.1 kcal/kg/day) was significantly lower (P<0.0001) than total daily requirement, which was calculated as 29.4±2.7 kcal/kg/day. Patients with PUs are characterized by increased REE and reduced energy intake. In the estimation of REE using the Harris-Benedict formula, a correction factor (×1.1) should be considered to accurately assess energy needs. Moreover, an energy intake of 30 kcal/kg/day seems appropriate to cover the daily requirements of patients with PUs.