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As the number of people with diabetes in the United States continues to rise, so does awareness for the role of nutrition counseling to prevent and treat this condition. Lifestyle changes to prevent chronic diseases are being promoted by many professional organizations. For adults, children, and adolescents with diabetes or at risk to develop diabetes, there is a positive role for moderate nutrition changes and regular physical activity.

After more than 25 years of credentialing dietetic professionals, the Commission on Dietetic Registration is revising the format for logging continuing professional education. As of 2001, the new system will be phased in over 5 years. Each registered dietetic professional will now plan a course of continuing education to meet personal and professional growth needs. This is a very exciting process and one that has many asking questions of "why, how, when, and where." This article is designed to put a perspective on the new process.

Nutritional status was monitored in two groups of patients infected with human immunodeficiency virus (HIV) for up to 16 months. Twenty-six subjects were recruited from patients enrolled in acquired immunodeficiency syndrome treatment protocols in the early stages of the disease. Body weight, percent body fat, serum albumin, total protein concentration, hemoglobin, hematocrit, and total lymphocyte count were monitored monthly. Four-day food intake records were kept every 4 months. In the 19 patients followed for 16 months (Group 1), a significant (p

Eighteen residents with non-insulin-dependent diabetes mellitus (NIDDM) from two skilled nursing facilities were monitored for glycemic control on diabetic and regular diets provided by the institution. Weekly fasting plasma glucose and 1-d dietary intake were followed for 16 wk: 4 wk on diabetic diets before and after an 8-wk regular-diet period. All residents were in good glycemic control (fasting plasma glucose 7.0 +/- 0.6 mmol/L) at entry into the study. During the regular-diet period, fasting plasma glucose increased an average of 0.6 mmol/L for all residents. Caloric intake increased during the regular-diet period although body weight did not change significantly. In both study periods nutrient intake of the residents met or exceeded the Recommended Dietary Allowances for the age group. These results indicate that the short-term substitution of regular for diabetic diets did not result in gross deterioration of glycemic control in patients with NIDDM confined to chronic-care facilities.

Obesity has reached what some scientists see as epidemic proportions. Clearly, a rethinking of the medical nutritional therapeutic approach is needed. Treatment programs must include a variety of health professionals to facilitate the lifestyle changes needed to treat this condition. There is a role in obesity management for registered dietitians, behaviorists, physicians, exercise physiologists, and geneticists. A chronic disease treatment model is being proposed. Are dietitians ready for the challenge? J Am Diet Assoc. 1998;98(suppl 2):S6–S8 .

A wealth of nutrition information has been published during the past decade on the healthful nature of nuts. As nut consumption increases, cardiovascular disease risk decreases. This cardioprotective effect of nut consumption is beyond what would be predicted from the fatty acid profile alone. Nuts are a rich source of many other nutrients and bioactive compounds, similar to other whole-plant foods, such as fruits and vegetables. Additional studies during the next decade will delineate additional healthful nutrients of these foods.

Diabetes mellitus is a serious and fairly common metabolic disorder that affects carbohydrate, protein and fat metabolism. Indications for nutritional support are no different for patients with diabetes than in any other patient group. The setting may be recovery from surgery or trauma and transition to solid food is anticipated, or, as a result of permanent injury or stroke, enteral feeding may be the permanent manner of nutrition delivery. Attention must be given to the selection of a macronutrient intake that will optimize blood glucose and lipid control. It is vital that blood glucose concentration be carefully monitored and that over- and underfeeding be avoided.

In the United States, the notion that low-fat, high-carbohydrate diets are essential for health has grown into an obsession, driven largely by an effort to reduce heart disease and, more recently, certain types of cancer. We know that saturated fatty acids are more closely associated with risk factors for heart disease than are unsaturated fatty acids. Many people believe that plant-based diets are healthy because they are low in fat. However, plant-based diets are not necessarily low-fat. In true plant-based diets, unsaturated fatty acids predominate, whereas saturated fatty acids come largely from animal sources such as dairy products and eggs. Plant-based diets include foods that contain fats, such as nuts and seeds and oils from grains and seeds. The fats in these foods are not associated with increased risk for heart disease. In addition, for people with insulin resistance, higher-fat diets protect against the heart disease risk factors of low HDL-cholesterol concentration, hypertriglyceridemia, hyperglycemia, and hyperinsulinemia. Because humans can synthesize fat from dietary carbohydrate, and because our adipose stores and circulating fatty acids reflect dietary intake, scientists understand the relations between the amounts and types of dietary fats and the types of fats found in body fat depots. Consuming dietary fats that are not associated with increased risk of disease can be a part of a healthful diet.

The relation between the self-reported intake of various dietary constituents and insulin-mediated glucose disposal was evaluated in 52 healthy volunteers. Insulin-mediated glucose uptake was independently associated with degree of obesity (inversely) and estimates of level of physical activity (directly). An independent relation between increased intake of vitamin A and insulin action was shown, ie, the greater the intake of vitamin A, the more effective was insulin in stimulating glucose disposal. However, there was no independent relation noted between insulin-mediated glucose disposal and estimates of the intake of carbohydrate, protein, amount or kind of fat, fiber, or vitamins C and E. Furthermore, the 20 individuals with estimates of vitamin A consumption > 10 000 IU/d had significantly lower plasma glucose (P < 0.01) and insulin (P < 0.05) responses to oral glucose, and insulin-mediated glucose disposal values that were higher (P < 0.005) than those of the 20 individuals whose estimated vitamin A intake was < 8000 IU/d. These results suggest that vitamin A intake, but not intakes of vitamin C and E, fiber, fat, or carbohydrate is associated with enhanced insulin-mediated glucose disposal.

Objective To identify older adults with poor nutritional status among the independent-living elderly applying for meals-on-wheels, and to compare how a self-assessment tool and more traditional criteria identify nutritional risk. Design Descriptive study. Subjects/setting Meals-on-wheels applicants (n=230) between 60 and 90 years of age (mean age=77.4±7 years) who were free from terminal illness. Nutrition assessment data were collected in the home of each participant. Main outcome measures Risk assessment for poor nutritional status was determined using anthropometric, dietary, and laboratory data and with a Nutrition Screening Initiative (NSI) self-assessment tool — the "DETERMINE Your Nutritional Health" checklist. Statistical analyses Differences were assessed using Student's t test for unpaired data. Results Seventy-four percent of study participants were found to be at risk for poor nutritional status according to the study criteria, and 98% were at risk for poor nutritional status according to the NSI self-assessment tool. Conclusions The majority of the applicants for meals-on-wheels were at risk for poor nutritional status. Thus, many independent-living older adults may need additional nutrition assessment and intervention to remain independent and in good nutritional status. J Am Diet Assoc. 1996; 96:570-573.

It has been shown that addition of fructose to an oral fat load results in higher postprandial concentrations of triglyceride. The present study, performed in 11 healthy volunteers, was initiated to see whether the effect of fructose on fat-induced lipemia also involved changes in postprandial concentrations of triglyceride-rich lipoproteins of intestinal origin. Vitamin A was used to label intestinal lipoproteins, and the retinyl palmitate concentrations were determined in plasma and in the Sf > 400 and Sf 20-400 lipoprotein fractions (Sf denotes the Svedberg flotation index). Addition of fructose (50 g) to a standard (40-g oral) fat load resulted in higher postprandial concentrations of triglyceride and retinyl palmitate in plasma and the Sf > 400 lipoprotein fraction (P < 0.001, analysis of variance), and the higher the fasting plasma triglyceride concentration, the greater the magnitude of the fructose effect (r = 0.83, P < 0.002). These data show that triglyceride-rich lipoproteins of intestinal origin play a role in the fructose-induced accentuation of postprandial lipemia.

benefit for meeting nutrient requirements up to a certain level of variety in food groups beyond which the meeting of nutrient requirements was not improved. In exploring issues of dietary quality and variety in a French population, Drewnowski et al (5) found that dietary variety scores correlated inversely with a dietary quality index, indicating that a good diet may be achieved at the expense of variety. In their study, dietary quality was largely based on total fat and saturated fat intakes. When they applied a dietary diversity score based on the number of food groups consumed per day, they found that low diversity scores were associated with low energy intakes. When Drewnowski et al examined dietary variety based on numbers of foods eaten, not classified within food groups, they found no increase in energy intake with increasing variety. In fact, they found improved dietary quality scores with increased variety. However, unlike the current study, the ranges of total energy intake were within 300 kcal (1.2 MJ) (6).