Canadian Journal of Dietetic Practice and Research最新文献

Purpose: Dysphagia, common among adult patients in acute care settings, is associated with various complications. This study aimed to identify significant predictors of adverse health outcomes in hospitalized patients with dysphagia. Methods: A consulting committee meeting preceded a retrospective chart review involving 420 adult patients (mean age 72 years, 55% male) hospitalized at CHU de Québec-Université Laval, who underwent an interdisciplinary dysphagia assessment. Multivariate logistic and linear regression analyses were conducted to examine relationships between potential predictors and outcomes (in-hospital mortality and pneumonia), with age and sex as covariates. Results: The consulting committee agreed that most predictors of adverse health outcomes, identified through the research team's clinical experience and existing literature, were both important and applicable to clinical practice. Stroke, head and neck cancer, all types of malnutrition, and unauthorized food intake were the most significant predictors of mortality (P < 0.04, for all). Intellectual disability, chronic obstructive pulmonary disease, gastroesophageal reflux, and severe malnutrition were the most significant predictors of pneumonia (P ≤ 0.02, for all). Conclusion: This study highlights the importance of addressing malnutrition as a significant modifiable risk factor for mortality and pneumonia among hospitalized patients with dysphagia. These findings underscore the need to manage high-risk patients with dysphagia effectively.

A rapid assessment was conducted, including a literature review and key informant interviews, to explore optimal staffing levels and factors influencing staffing decisions across public health jurisdictions in Canada, including strategic plans and priorities. The literature review found no current guidance to plan for future public health dietitian workforce needs. An outdated staffing benchmark (1 full-time equivalent [FTE] per 50,000 population) is still referenced in some sources. Twenty-nine individuals from 25 jurisdictions across nine provinces participated via interviews or email. Eleven jurisdictions had public health nutrition-related strategic plans, with common priorities. Staffing numbers from 21 jurisdictions ranged from 1 FTE per 32,000 to 1 FTE per 316,000. Additional staffing challenges that surfaced included lost positions due to attrition or transitions to other roles, insufficient staff for programme needs, increased complexity and inconsistencies in public health dietitian roles and responsibilities across jurisdictions. There is an urgent need for updated workforce planning approaches for public health nutrition practice in Canada. Public health dietitians, leaders, and academics must collaborate to recognize and address this need.

Purpose: To assess nutritional quality of foods promoted in Canadian grocery flyers including level of processing, and whether adherence to dietary guidance varied by year, region, store type (regular or discount), or location in the flyer. Methods: Observational study; national sample of weekly digitized flyers (n = 53 flyers; n = 8,790 promoted foods and beverages) were collected from Canada's largest market-share national grocer, from 2014, 2017, and 2021. Flyer food items were extracted and coded manually into food groups and categories. Nutritional quality of promoted items was analyzed by three nutrient profiling systems including NOVA level of processing and Canada's Food Guide (CFG). Logistic regression models were used to examine odds of flyer foods aligning with dietary guidance. Results: Mean food items per flyer were 106 (SD = 66.4) in 2014; 174 (SD = 106.2) in 2017; and 215 (SD = 49.8) in 2021. Baked products (11%), non-alcoholic beverages (10.7%) and milk/dairy (10.2%) comprised the largest proportions of flyers. Least healthy/ultra-processed foods were most frequently advertised (CFG: 58.5%; NOVA: 51.2%); but followed by the most healthy/un/minimally processed (CFG: 33.6%: NOVA: 27.8%). Across geographic regions, odds of CFG alignment were similar, and no different in discount versus regular banners. Food items on the flyer cover page had consistently higher odds of CFG alignment. Conclusion: Consistent with past research, flyer foods frequently did not align with dietary guidance.

A common consequence of Parkinson's disease (PD) is constipation. Beyond its deleterious effect on the quality of life in affected persons, constipation is associated with gut microbiota dysbiosis and microbial-generated inflammatory metabolites, which may further disease progression. Management strategies are needed, and diet, specifically higher fiber dietary patterns or fiber supplements, may be recommended. However, therapeutic effectiveness and potential health benefits have been underexplored, and risks may be unappreciated. This perspective addresses whether high-fiber diets and fiber supplements to support laxation are efficacious, safe, and generally feasible for people with PD. Diverse sources of fiber from plant-based dietary patterns may be particularly critical for balancing microbiota and the microbial production of beneficial vs. inflammatory metabolites, although adherence to such dietary patterns may be challenging. Supplemental fiber may be needed to manage constipation symptoms. However, the potential safety issues related to fiber supplementation, such as appetite suppression, unintentional weight loss, and risk of malnutrition in the context of neurodegeneration, must also be considered. Slow colonic transit time and defecatory disorders of PD may be best managed with high intakes of bran or hull fibers resistant to microbial fermentation, which will significantly increase stool bulking. However, clinical trials are needed to confirm efficacy and dose-response.

Purpose: Associations between anthropometry and child cardiometabolic risk (CMR) are understudied. We investigated cross-sectional associations between body mass index (BMI) z-score, waist circumference (WC), waist-to-height ratio (WHtR), blood pressure (BP), and serum biomarkers (triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol:HDL-cholesterol, C-reactive protein, glucose, insulin, and glycated hemoglobin (HbA1c)) among young children in the Guelph Family Health Study.Methods: This study included 210 children (1.5-6.2 years, from 171 families). Blood samples were provided by 46 of the participating children. BP and anthropometry were measured during a health assessment visit. Generalized estimating equations applied to regression models were used to determine associations between anthropometric measures and CMR factors, while controlling for relevant covariates.Results: WHtR was positively associated with diastolic BP ([Formula: see text] = 5.73; 95% confidence interval (CI) (1.12, 10.3)) and glucose ([Formula: see text] = 0.50; 95% CI (0.21, 0.79)), total cholesterol ([Formula: see text] = 0.87; 95% CI (0.02, 1.73)) and negatively associated with insulin ([Formula: see text] = -0.01; 95% CI (-18.6, 2.54)). BMI z-score was negatively associated with HbA1c ([Formula: see text] = -0.13; 95% CI (-0.23, -0.04)), and WC was positively associated with HDL-C ([Formula: see text] = 0.04; 95% CI (0.00, 0.08)). No other associations were significant.Conclusions: WHtR, more so than BMI z-score or WC, may show promise as a noninvasive screening tool for lipid- and/or BP-related risk in early childhood.

Purpose: Researchers explored the roles and responsibilities of dietitians in Nova Scotia during the first three waves of the COVID-19 pandemic.Methods: Twenty-two dietitians who had completed a survey agreed to participate in interviews to elucidate their views. Two group and 13 individual interviews were held with dietitians from diverse work sectors during the summer of 2021. Interviews were transcribed verbatim, organized using NVivo software, and analyzed thematically. The Social Ecological Model of Health framed the study by exploring the individual, interpersonal, community, organizational, and policy aspects of practice.Results: Major themes reflected constantly changing responsibilities, dealing with the impact of cancelled or delayed health services, coping with stress, and valuing/devaluing dietetics work. Professional education needs and conditions for successful practice were also identified.Conclusions: Dietitians' experiences varied depending on the sector in which they worked, with significant role changes unique to each sector. Emergency preparedness, infection control, health equity, and mental health/self-care were identified as areas for further education and development. The breadth of foundational dietetics training enabled dietitians to take on diverse responsibilities and leadership roles. This supports calls to enhance dietitians' scope of practice in Nova Scotia.

Oropharyngeal dysphagia (OD), or dysphagia, is associated with malnutrition, pneumonia, and hospital admissions, and affects up to 35% of older adults in the community. This study aimed to understand dysphagia assessment and management practices among registered dietitians (RDs), speech-language pathologists (SLPs), and occupational therapists (OTs) working with adults in Canadian primary care and to help identify gaps and opportunities to optimize dysphagia patient care.A 22-question online practice survey was administered to RDs, SLPs, and OTs recruited through professional associations and practice groups.A total of 126 respondents partially or fully completed the survey. Clinical swallowing evaluations/mealtime observations were the primary assessment method used by RDs (92%), SLPs (83%), and OTs (50%). Patient education, oral care, and diet modifications were indicated as the top three management strategies. Challenges identified in dysphagia care included patient adherence to management strategies and limited personnel for assessing and managing dysphagia. Inter-professional clinical care pathways, patient/caregiver resources, and professional training for dysphagia assessment were identified to be the most valued resources for providing care.Timely assessment and management are crucial for community-living individuals with dysphagia. Finding unique and sustainable ways to overcome challenges in managing dysphagia in primary care will help improve care for this vulnerable population.

Purpose: To explore Canadian Registered Dietitians' (RDs) roles and experiences in prenatal care.Methods: This cross-sectional study utilized an online, anonymous, original survey. Eligible RDs, who are members of Dietitians of Canada (DC) and provide care for pregnancy, were invited to participate through their publicly available online profiles on the DC website.Results: Of the 71 RDs who completed the survey, 97.1% provided nutrition care when requested by the client, 68.8% in times of complications, and 60.0% through referrals. RDs most frequently discussed topics on foods to avoid, supplementation, and healthy eating. Only 4.3% of RDs felt that other prenatal healthcare providers (HCPs) are providing adequate nutritional care, while all (100.0%) RDs believed that they should be the ones providing nutrition care for pregnancy, and most (88.6%) thought they should start providing nutrition counselling during preconception. Most (92.9%) respondents acknowledged that barriers exist in accessing RDs for nutrition advice. Recommendations for improving RD accessibility included increased government funding, involvement in standard care and referrals, awareness, and remote access.Conclusions: Canadian RDs would like to play a larger role in prenatal care through a more integrated approach with other prenatal HCPs and improved access to dietetic services for all pregnant people.