Obesity-related clinical decision support tools in electronic health records (EHRs) can improve pediatric care, but the degree of adoption of these tools is unknown. DocStyles 2015 survey data from US pediatric healthcare providers (n = 1,156) were analyzed. Multivariable logistic regression identified provider characteristics associated with three EHR functionalities: automatically calculating body mass index (BMI) percentile (AUTO), displaying BMI trajectory (DISPLAY), and flagging abnormal BMIs (FLAG). Most providers had EHRs (88%). Of those with EHRs, 90% reporting having AUTO, 62% DISPLAY, and 54% FLAG functionalities. Only provider age was associated with all three functionalities. Compared to providers aged > 54 years, providers < 40 years had greater odds for: AUTO (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.58–5.70), DISPLAY (aOR, 2.07; 95% CI, 1.38–3.12), and FLAG (aOR, 1.67; 95% CI, 1.14–2.44). Future investigations can elucidate causes of lower adoption of EHR functions that display growth trajectories and flag abnormal BMIs.
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Barium sulfate is commonly used to prepare contrast media for videofluorograpy. The flow characteristics of thickened liquids formulated for oropharyngeal imaging are known to be greatly affected by the addition of barium. In this study, thickened barium liquids were prepared by mixing a commercial xanthan gum (XG)-based thickener (Visco-up®) at different concentrations (0.1%–3.0%) with barium powder (Baritop HD®), and differences in the viscosity between thickened non-barium and thickened barium liquids were investigated. In addition, the thickness levels of thickened barium liquids, which are based on the National Dysphagia Diet (NDD) and International Dysphagia Diet Standardization Initiative (IDDSI) guidelines, were classified by measuring the viscosity (NDD) and gravity flow through a syringe (IDDSI) with 0.1%–3.0% thickener concentrations. The apparent viscosity (ηa,50) values of thickened barium liquids were much higher than those of thickened non-barium liquids, indicating that the addition of barium to the XG-based thickener resulted in further thickening. Standard recipes for preparing thickened barium liquids with desirable thickness levels were also established, showing the different thickener concentrations corresponding to the different NDD and IDDSI levels.
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This study aimed to examine nutrition care management for in-patients with dysphagia and to evaluate knowledge on nutrition care related to dysphagia among dietitians in clinical settings. A total of 554 questionnaires were distributed to dietitians at hospitals located in Seoul and Gyeonggi Province in Korea, and 147 responses were used for data analysis after excluding responses with significant missing data. Study participants worked at general hospitals (37.2%), long-term care hospitals (24.3%), hospitals (19.2%), and tertiary hospitals (11.5%). Prior education and training related to dysphagia was received by 69.9% of the respondents. The percentage of hospitals that had diet guidelines for dysphagia was 68.0%. Dysphagia diets of 2 levels and 3 levels were provided in 55.1% and 34.7% of the hospitals, respectively. Overall 74.7% of the dietitians responded that they provided information on dysphagia diets to in-patients and caregivers, but only 45.7% of dietitians did so in the long-term care hospitals. Among the respondents who used commercial thickening agents, 77.2% used only one type of commercial thickening agent. Patients or caregivers (75.7%) or nurses (34.5%) were reported to modify viscosity of liquid. Dietitians showed low levels of knowledge on nutrition care related to dysphagia (a mean of 5.14 based on possible scores from 0 to 10 points). To promote nutritional consumption and prevent malnutrition and aspiration, hospitals need the standardized diet guidelines, and dietitians should improve their expertise in nutritional care for patients with dysphagia.
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Flaxseed is one of the rich sources of α-linolenic acid and lignan. Flaxseed and its components have antioxidant, hypolipidemic and hypoglycemic effects. The study aimed to investigate the effect of flaxseed enriched yogurt on glycemic control, lipid profiles and blood pressure in patients with type 2 diabetes. A randomized, open-labeled, controlled clinical trial was conducted on 57 patients with type 2 diabetes. Participants were assigned to receive 200 g 2.5% fat yogurt containing 30-g flaxseed or plain yogurt daily for 8 weeks. Anthropometrics and biochemical parameters were evaluated at the beginning and end of the study. After 8 weeks of supplementation, Hemoglobin A1c was significantly decreased in the intervention group compared to control (p = 0.007). Also, at the end of the study, significant differences were seen between the flaxseed enriched yogurt and control groups in triglycerides and total cholesterol concentrations (p = 0.04 and p = 0.01), systolic blood pressure and diastolic blood pressure (p = 0.02 and p = 0.002, respectively). However, we did not find any difference between 2 groups in low-density lipoprotein, high-density lipoprotein, body weight and waist circumference (p > 0.05). Our results showed that the addition of flaxseed to yogurt can be effective in the management of type 2 diabetes.
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The purpose of this study was to investigate the effects of isoflavone on serum lipids and antioxidant enzymes activities in growing rats fed high lard diet. Twenty four female Sprague-Dawley rats (body weight 50–60 g) were divided into three groups, control, high fat (HF, lard 200 g/kg diet) and high fat + isoflavone (HFI, lard 200 g/kg diet + isoflavone 310.9 mg/kg diet) for 4 weeks. The results of study indicated that body weight gain was not different by isoflavone diet. Mean intake was significantly lower in HF group and HFI group than control group. Food efficiency ratio was significantly higher in HF group and HFI group than control group. The level of serum triglyceride and total cholesterol were significantly lower in HFI group than control group and HF group. The level of high-density lipoprotein cholesterol, was significantly higher in control group than HF group and HFI group. The level of low-density lipoprotein cholesterol was not significantly different by experimental diets, but atherogenic index (AI) was significantly lower in control group and HFI group than HF group. Contents of total cholesterol and triglyceride in liver tissues were found to be insignificant. The concentration of lipid peroxidation, malondialdehyde was significantly lower in control groups and HFI group than HF group. And antioxidant enzymes in liver tissue were not significantly different by lard and isoflavone supplemented diets. In conclusion, it seems possible that isoflavone supplemented high fat diet may produce positive results on level of serum triglyceride, serum total cholesterol, AI and concentration of malondialdyhyde.
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Children living in the internally displaced person (IDP) camp are at higher risk of stunting. This cross-sectional study aimed to assess the prevalence and to identify the associated factors of stunting among children aged 6–59 months at Myaing-Gyi-Ngu IDP camp in Kayin State, Myanmar. According to the World Health Organization Child Growth Standards, children with a height-for-age Z-scores below −2 standard deviation of the reference median (HAZ ≤ −2) were classified as stunted. Multiple logistic regression analysis was performed to identify the strong predictors. Prevalence of stunting has been found very high (59.4%). Adjusted model revealed that children living with illiterate mothers (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.07–3.24), being third/later-birth child (OR, 1.88; 95% CI, 1.13–3.14), consuming less than 4 food groups (OR, 4.22; 95% CI, 1.94–9.16), and older age of child (OR, 6.36 for 13–24 months; 95% CI, 2.74–14.74, 7.45 for 25–36 months; 95% CI, 3.21–17.25 and 12.75 for 37–59 months; 95% CI, 5.51–29.52) had higher odds of becoming stunted. The levels of support availability, presumed support and support received of mothers were generally low, but no significant associations were observed. In conclusion, this study showed high prevalence of stunting, but low dietary diversity and social support in the IDP camp. Due to the significant association of dietary diversity scores with stunting, interventions aiming at improving dietary diversity should be taken to reduce the stunting among children in the IDPs camp.
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Obesity is a substantial public health challenge across the globe. The use of resistant starch has been proposed as a probable management strategy for complications of obesity. We investigated the effects of resistant starch intake on lipid profiles, glucose metabolism, antioxidant status, lipid peroxidation marker, blood pressure, and anthropometric variables in subjects with overweight or obesity. In this 12-week, randomized, double-blind, placebo-controlled, 2 × 2 crossover trial, 21 Participants (mean age, 35 ± 7.0 years; body mass index, 32.4 ± 3.5 kg/m2) were given 13.5 g Hi-Maize 260 or placebo daily for 4 weeks, separated by a 4-week washout period. Changes in total antioxidant status (p = 0.04) and serum concentrations of insulin in 52.4% participants with insulin levels above 16 µIU/mL at the baseline (p = 0.04) were significantly different in the three phases. In addition, the mean of serum high-density lipoprotein cholesterol after the intervention was significantly higher than after baseline value (p = 0.04). We found no significant differences in serum concentrations of total cholesterol, triacylglycerol, low-density lipoprotein cholesterol, fasting blood sugar, insulin, homeostatic model assessment of insulin resistance, quantitative insulin sensitivity check index, superoxide dismutase activity, malondialdehyde, blood pressure, and anthropometric variables in the three phases of baseline, after intervention with resistant starch and after placebo. Resistant starch consumption improved serum insulin concentrations, lipid profiles, and antioxidant status in subjects with overweight or obesity.
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Gastroesophageal reflux disease (GERD) is closely related to respiratory issues. We reported the case about the nutrition intervention given to a male infant with congenital bronchomalacia, GERD, and recurrent pneumonia. During the first and second pediatric intensive care unit (PICU) stays, his nutrition status and nutrient intake were good. However, during the 18 days of the third PICU admission, his nutrient intake decreased to 75%–80% of his estimated calorie requirement and his Z-score for weight-for-age dropped to −1.4. We conducted nutritional interventions to improve GERD symptoms and nutritional status include avoiding overfeeding by feeding small amounts frequently, using a pre-thickened formula mixed with a high-calorie formula, and feeding through transpyloric tube. As a result, his daily nutrient intakes gradually increased and his Z-score for weight-for-age was normal. In conclusion, it is important to implement individualized intensive nutritional management to ensure adequate nutrition and growth status in infants with lung disease and GERD.
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