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Receiver operating characteristic curves were constructed to assess the value of measuring neck and waist circumference and waist-to-hip ratio (WHR) as biomarkers of metabolic syndrome in college students (18 to 25 years of age). Participants (n=109) were 92% black, 62.4% female, 45.9% overweight or obese, and 20.2% prehypertensive or hypertensive. Overall, 41 (37.6%) students had one or more risk factors for metabolic syndrome. Percent body fat, assessed using whole-body air-displacement plethysmography, was positively correlated (P0.0001) with neck and waist circumference (as measured at the midpoint between the right lower rib and suprailiac crest; hereafter "midpoint"). Neck circumference correlated with low-density lipoprotein cholesterol (P ≤ 0.02) and both neck circumference and waist circumference-midpoint correlated with insulin (P ≤ 0.001) and triglycerides (P ≤ 0.002). The best-fit cutoffs were ≥ 83 cm waist circumference-midpoint and ≥ 88 cm waist circumference measured at the suprailiac crest for percent body fat in men and ≥ 75 cm waist circumference-midpoint for metabolic syndrome in women. The proportion of overweight and prehypertensive individuals among self-described healthy students underscores the need for screening tools that identify those who might benefit most from health interventions. Waist circumference-midpoint provides a simple yet sensitive method for the estimation of percent body fat and metabolic syndrome risk in primarily African-American college students. The novel use of neck circumference should be further investigated.

Through Value Enhanced Nutrition Assessment and other techniques, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) engages clients to set their own nutrition goals. A case series of 30 Hispanic children (2-4.5 years) at ≥85th body mass index (BMI) percentile and their caregivers were followed through an urban WIC clinic. The dyads received either standard counseling ( n = 15) or motivational interviewing (MI; n = 15) by one bilingual WIC nutritionist during 4 regularly scheduled visits over 6 months. Repeated measurements of anthropometric data, dietary patterns, and physical activity were obtained at each visit. Longitudinal bivariate analyses of caregiver concerns and goal selection were conducted along with mean comparisons of anthropometric and food frequency measures. Participation in counseling sessions as rated by the nutritionist was assessed by comparing Wilcoxon rank-sum scores. After counseling, children lost an adjusted mean weight of 0.878 kg (95% confidence interval = 0.280-1.717). A decline in median BMI of more than 3 percentiles ( P = .042) was observed with both counseling approaches. Caregiver-reported vegetable intake of children increased an average of one additional serving in the MI-counseled group by visit 3 ( P = .013) despite MI recipient caregivers being scored as significantly more distracted than standard WIC participants in the first visit ( P = .036). MI is a viable option for WIC counseling to improve diet and health outcomes in participants, particularly in addressing child BMI status and vegetable intake. Public health professionals should examine scalability of the MI approach among larger samples of WIC participants and other innovative techniques to improve client focus during counseling.

Eating disorders among young children are not well characterized. Diet and growth data were collected from toddlers (1-3 years old) at the time of diagnosis of infantile anorexia (IA) and up to 1 year after family counseling. Children (n = 62) were underweight (≤ −2 z-score weight-for-age). Boys (n = 34) had a greater ( P = .04) mean (standard error) weight-for-age percentile than girls (n = 28) and less evidence of wasting ( z-score weight-for-length = −1.8 (0.14) vs −2.3 (0.17), respectively; P = .04). After counseling, girls demonstrated better linear growth than boys (4.14 (0.18) vs 3.47 (0.18) cm/6 months, respectively; P < .002). Significant catch-up in length-for-age was observed across genders and diagnoses of 1.4 (2.07) growth percentiles and 0.13 (0.05) z-scores on the normal curve in 6 months ( P = .019). Head circumference correlated with dietary protein ( r = .23, P = .03), calcium ( r = .32, P = .004), and zinc ( r = .36, P = .001). Girls met or exceeded dietary reference intakes for energy, protein, iron, zinc, vitamin A, and calcium, and boys improved intake of these nutrients ( P < .05) but boys with IA fell short of recommended energy intake. Many children with IA reached tolerable upper intake levels for zinc and vitamin A, which warrants concern. These are the first data published on diet and growth among children with IA.

Some short-term pediatric studies have suggested beneficial effects of low glycemic load (LGL) meals on feelings of hunger and on energy intake. However, the effects of LGL diets have not been systematically studied in obese Hispanic children, who stand to benefit from successful interventions.To examine the effects of LGL and high-GL (HGL) meals on appetitive responses and ad libitum energy intake of obese Hispanic youth.A total of 88 obese Hispanic youth aged 7-15 years were enrolled in a community-based obesity intervention program and randomly assigned to consume meals designed as either LGL (n = 45) or HGL (n = 43). After 12 weeks, participants were admitted for a 24-hour metabolic study. Following the morning test meal, subjects serially reported hunger, fullness, and satiety using a visual analog scale. Blood insulin and glucose were measured. After 5 hours, participants were fed another test meal and given a snack platter from which to eat ad libitum. All test food was weighed and the energy, macronutrients, and glycemic load (GL) of consumed foods were calculated.The HGL group had significantly higher insulin (p = 0.0005) and glucose (p = 0.0001) responses to the breakfast meal compared with the LGL group. There were no significant between-group differences in energy consumed from the snack platter (1303 vs. 1368 kcal, p = 0.5), or in the subjective feelings of hunger (p = 0.3), fullness (p = 0.5) or satiety (p = 0.3) between the two groups.Our study provides no evidence that, for obese Hispanic youth, changing the GL of the diet affects short-term hunger, fullness, satiety, or energy intake. ClinicalTrials.gov Identifier: NCT01068197.

Background: In transitioning from adolescence to adulthood, college students are faced with significant challenges to their health habits. Independence, stress, and perceived lack of time by college students have been known to result in poor eating and exercise habits, which can lead to increased disease risk. Objective: To assess the feasibility and to determine preliminary efficacy of an electronic wellness program in improving diet and physical activity in college students. Methods: A 24-week diet and physical activity program was delivered via email to 148 college students. The intervention involved weekly, tailored, and interactive diet and physical activity goals. The control group received nondiet and nonexercise-related health fact sheets. Anthropometric and blood pressure measurements, as well as food frequency and physical activity surveys were conducted at baseline, week 12, and week 24. Students’ choice of fruit as a snack was also monitored at study visits. Results: Students were 18-20 years old, 69% female, and from a diverse college campus (46% Caucasian, 23% Asian, 20% African American, 11% other). At week 24, 84% of students reported reading at least half of all emails. Mean change (standard error [SE]) from baseline of saturated fat intake was marginally significant between the treatment groups at week 24, 0.7 (SE 0.42) % kcal for control and -0.3 (SE 0.30) % kcal for intervention ( P =0.048). A significant difference in percent of snacks chosen that were fruit (χ 2 1 , N=221 = 11.7, P

For many young adults, college is a time of poor dietary habits such as consuming foods high in fat, sugar and total energy and low in fiber. These habits can contribute to long-term consequences. In order to analyze the dietary habits of college students there needs to be a validated assessment tool. We tailored an ALIVE!© Block food frequency questionnaire (FFQ) to this population. We recruited ninety-four University of Maryland, College Park students (ages 18-20, 68% female, 46% white/Caucasian, 23% Asian/Pacific Islander, 20% African American, 4% Hispanic, 3 % other). Students kept a food record for two weekdays and one weekend day. Food records were analyzed for nutrient content using Diet Analysis Plus 10th edition software. Trends in consumption of energy, carbohydrates, fiber, saturated fat, trans fat, and fruit and vegetable equivalents were reported. These data were then compared to FFQ data using Lin's concordance correlation coefficient (ρc). The FFQ tends to overestimate calories and saturate...

Standards of Excellence in Nutrition and Dietetics for an Organization is a self-assessment tool to measure and evaluate an organization's program, services, and initiatives that identify and distinguish the Registered Dietitian Nutritionist (RDN) brand as the professional expert in food and nutrition. The Standards of Excellence will serve as a road map to recognize RDNs as leaders and collaborators. Standards of Excellence criteria apply to all practice segments of nutrition and dietetics: health care, education and research, business and industry, and community nutrition and public health. Given the membership's call to action to be recognized for their professional expertise, the Academy of Nutrition and Dietetics Quality Management Committee developed four Standards of Excellence in Nutrition and Dietetics for Organizations: Quality of Leadership, Quality of Organization, Quality of Practice, and Quality of Outcomes. Within each standard, specific indicators provide strategies for an organization to demonstrate excellence. The Academy will develop a self-evaluation scoring tool to assist the organization in applying and implementing one or more of the strategies in the Standards of Excellence indicators. The organization can use the self-assessment tool to establish itself as a Center of Excellence in Nutrition and Dietetics. The role examples illustrate initiatives RDNs and organizations can take to identify themselves as a Center of Excellence in Nutrition and Dietetics. Achieving the Excellence level is an important collaborative initiative between nutrition and dietetics organizations and the Academy to provide increased autonomy, supportive management, respect within peers and community, opportunities for professional development, support for further education, and compensation for the RDN. For purposes of the Standards, "organization" means workplace or practice setting.

A diet and exercise intervention program was delivered by e-mail to college students for 24 weeks to assess whether the program helped improve health habits. The intervention involved tailored, int...

Clinical indicators of nutrition care are needed to help improve patient outcomes. To identify potential indicators of nutrition care, 1 dietitian in a trauma service prospectively documented every immediate action she undertook to prevent or correct an adverse, nutrition-related outcome. A total of 101 acute nutrition interventions were provided with 93 (5.2%) of the 1777 nutrition evaluations conducted over the 10-month period. Patient overfeeding triggered 1 of every 3.5 acute nutrition interventions. Most instances of overfeeding were linked to the lack of an interdisciplinary plan of nutrition care. This was troubling because of the severity of illness among the overfed patients (25% mortality). Other categories that necessitated acute intervention included electrolyte imbalance and underfeeding. Several nutritional problems identified by this study are appropriate for use as rate-based and sentinel event indicators to improve the quality of nutrition care.

Metabolic complications from overfeeding critically ill patients are serious and sometimes fatal. Nutrition care is best provided through repeated evaluation of patients' responses to feeding. Nutrition support may need to be modified over time to maintain metabolic stability and promote recovery. This article describes the etiology of 10 metabolic complications of overfeeding. Guidelines for recommending macronutrients are discussed, as are factors that could increase the risk of overfeeding. Patients who are very small, very large, or very old are particularly vulnerable to overfeeding. Overfeeding protein has led to azotemia, hypertonic dehydration, and metabolic acidosis. Excessive carbohydrate infusion has resulted in hyperglycemia, hypertriglyceridemia, and hepatic steatosis. High-fat infusions have caused hypertriglyceridemia and fat-overload syndrome. Hypercapnia and refeeding syndrome have also been caused by aggressive overfeeding. Dietitians can prevent or curtail the metabolic complications of overfeeding by identifying patients at risk, providing adequate assessment, coordinating interdisciplinary care plans, and delivering timely and appropriate monitoring and intervention. Dietitians need to document complications, interventions, and the outcomes of their clinical care to evaluate the appropriateness of existing nutrition guidelines. J Am Diet Assoc. 1998;98:795-806 .

Infants who are dependent on parenteral nutrition (PN) sometimes develop PN-associated cholestasis (PNAC). A compassionate use protocol, approved by the U.S. Food and Drug Administration and the institutional review board, guided enrollment of hospitalized infants with PNAC (1 year of age, PN dependence for3 weeks). Plasma concentrations of essential fatty acids were monitored before and after a soybean-based PN lipid, infused at 3 g/kg body weight/d, was replaced by an experimental fish oil-based intravenous fat emulsion (FO-IVFE) at 1.0 g/kg/d. All participants were born premature (n = 10; 20% male). At enrollment, infants were (mean ± SD) 86.5 ± 53.5 days of life and weighed 2.24 ± 0.87 kg; direct bilirubin was 5.5 ± 1.3 mg/dL. After treatment, blood concentrations significantly increased from baseline (P.017) for circulating eicosapentaenoic acid (6.3 ± 3.0 to 147.8 ± 53.1 µg/mL), docosahexaenoic acid (20.7 ± 6.5 to 163.7 ± 43.4 µg/mL), pristanic acid (0.01 ± 0.01 to 0.17 ± 0.03 µg/mL), and phytanic acid (0.06 ± 0.03 to 0.64 ± 0.15 µg/mL). In contrast, total plasma ω-6 fatty acids (including linoleic acid) decreased (P.017). The triene/tetraene ratio remained below the threshold value of 0.2 that defines ω-6 deficiency. No adverse effects were observed attributable to FO-IVFE. Discontinuation of FO-IVFE was typically due to infants (body weight 3.76 ± 1.68 kg) transitioning to enteral feeding rather than for resolution of hyperbilirubinemia (direct bilirubin 7.9 ± 4.8 mg/dL). These exploratory results suggest that FO-IVFE raises circulating ω-3 fatty acids in premature infants without development of ω-6 deficiency in the 8.3 ± 5.8-week time frame of this study.

Assessing energy requirements is a fundamental activity in clinical dietetics practice. A study was designed to determine whether published linear regression equations were accurate for predicting resting energy expenditure (REE) in fasted Hispanic children with obesity (aged 7 to 15 years). REE was measured using indirect calorimetry; body composition was estimated with whole-body air displacement plethysmography. REE was predicted using four equations: Institute of Medicine for healthy-weight children (IOM-HW), IOM for overweight and obese children (IOM-OS), Harris-Benedict, and Schofield. Accuracy of the prediction was calculated as the absolute value of the difference between the measured and predicted REE divided by the measured REE, expressed as a percentage. Predicted values within 85% to 115% of measured were defined as accurate. Participants (n=58; 53% boys) were mean age 11.8±2.1 years, had 43.5%±5.1% body fat, and had a body mass index of 31.5±5.8 (98.6±1.1 body mass index percentile). Measured REE was 2,339±680 kcal/day; predicted REE was 1,815±401 kcal/day (IOM-HW), 1,794±311 kcal/day (IOM-OS), 1,151±300 kcal/day (Harris-Benedict), and, 1,771±316 kcal/day (Schofield). Measured REE adjusted for body weight averaged 32.0±8.4 kcal/kg/day (95% confidence interval 29.8 to 34.2). Published equations predicted REE within 15% accuracy for only 36% to 40% of 58 participants, except for Harris-Benedict, which did not achieve accuracy for any participant. The most frequently accurate values were obtained using IOM-HW, which predicted REE within 15% accuracy for 55% (17/31) of boys. Published equations did not accurately predict REE for youth in the study sample. Further studies are warranted to formulate accurate energy prediction equations for this population.

Parenteral nutrition-associated conjugated hyperbilirubinemia (PNAC), commonly defined as direct bilirubin ≥2 mg/dL (34.2 μmol/L), is primarily a pediatric disease with premature infants being the most susceptible. Severe morbidity and increased mortality are associated with bilirubin >10 mg/dL (171.0 μmol/L). The lack of knowledge regarding the cause of PNAC has stymied development of prevention and treatment strategies. A systematic search of published reports was conducted to provide data on histopathology of PNAC and to review prospective, randomized, controlled trials in hospitalized infants. In experiments of young animals, parenteral nutrition (PN) with and without soy oil emulsion is directly linked to hyperbilirubinemia, and the effects are exaggerated by overfeeding. In infants, the most consistently reported risk factor for PNAC is the duration of PN. The only known effective modality is the transition to full enteral feeding and discontinuation of PN. Emerging clinical research is evaluating the role of lipid source (soy vs fish) and motility agents, such as erythromycin. Different trace element preparations are associated with varying severity of cholestasis, a finding that also deserves more study. This article reviews the prevalence, risk factors, clinical presentation, and treatment options for PNAC in neonatal intensive care units.

The goal of this study was to examine the prevalence of vitamin D insufficiency and deficiency among urban African-American (AA) youth with asthma compared with control subjects without asthma.A cross-sectional case-control study was conducted at an urban pediatric medical center. Total 25-hydroxyvitamin D insufficiency (30 ng/mL) and deficiency (20 ng/mL) were assessed in urban self-reported AA patients, aged 6 to 20 years, with (n = 92) and without (n = 21) physician-diagnosed asthma.Blood samples were available for 85 (92%) cases. The prevalence of vitamin D insufficiency and deficiency were significantly greater among cases than control subjects (73/85 [86%] vs 4/21 [19%], adjusted odds ratio = 42 [95% confidence interval: 4.4 to 399] for insufficiency and 46/85 [54%] vs 1/21 [5%], adjusted odds ratio = 20 [95% confidence interval: 1.4 to 272] for deficiency).Most of this sample of urban AA youth with persistent asthma were vitamin D deficient or insufficient. Given the emerging associations between low vitamin D levels and asthma, strong consideration should be given to routine vitamin D testing in urban AA youth, particularly those with asthma.

Decisions about bylines, although seemingly straightforward, can "breed ill-will," "wreck friendships," and "even damage careers" if decisions are not in accord with professional guidelines and common sense. Editors have attempted to promote responsible authorship by creating Uniform Requirements. According to the International Committee of Medical Journal Editors, each author must have made a substantial contribution to all 3 of the following conditions to qualify for authorship: conceiving and designing the work represented by the article or analyzing and interpreting data; drafting the article or revising it critically for important intellectual content; and giving final approval of the version to be published. Despite these guidelines, bylines continue to include grafters and guests. Researchers believe guidelines for authorship are necessary but suggest the existing Uniform Requirements may be overly restrictive and easily misinterpreted. Editors will need to work with researchers to reach consensus on realistic and appropriate guidelines for authorship. J Am Diet Assoc. 1999;99:77-79 .

Few data are available to establish recommendations for trace element supplementation during critical illness. This study quantified the loss of several elements and assessed the adequacy of manganese and selenium in parenteral nutrition (PN).Men with traumatic injuries were grouped by renal status: adequate (POLY; n = 6), acute failure with continuous venovenous hemofiltration (CVVH; n = 2), or continuous venovenous hemodiafiltration (CVVHD; n = 4). PN supplied 300 microg/d manganese and 60 microg/d selenium. Urine and effluent (from artificial kidneys) were collected for 3 days and analyzed for boron, manganese, nickel, and silicon using inductively coupled plasma atomic emission spectrometry, and for selenium using atomic absorption spectrometry.POLY manganese and selenium excretion averaged (standard deviation [SD]) 7.9 (3.3) microg/d and 103.5 (22.4) microg/d, respectively. All elements except selenium were detected in dialysate (prior to use). CVVHD effluent contained 3.5 and 7.3 times more manganese and nickel than CVVH ultrafiltrate, respectively. Loss of manganese averaged 2.6%, 21%, and 73% of PN amounts for POLY, CVVH, and CVVHD groups, respectively.Minimal loss of manganese compared with the amount in PN suggests that excessive amounts are retained. POLY patients excreted more selenium than was in PN, indicating negative balance. POLY losses of boron and silicon were less than that published for healthy adults, reflecting less than typical intake, whereas loss during CVVH was in the normal reference range, possibly because of added intake from boron contamination of replacement fluids. All patients lost more nickel than amounts published for healthy adults.Current guidelines of 60-100 microg/d of parenteral manganese may be excessive for trauma patients. The uptake of manganese and nickel from contaminants in CVVHD dialysate should be investigated.

Achieving appropriate growth and nutrient accretion of preterm and low birth weight (LBW) infants is often difficult during hospitalization because of metabolic and gastrointestinal immaturity and other complicating medical conditions. Advances in the care of preterm-LBW infants, including improved nutrition, have reduced mortality rates for these infants from 9.6 to 6.2% from 1983 to 1997. The Food and Drug Administration (FDA) has responsibility for ensuring the safety and nutritional quality of infant formulas based on current scientific knowledge. Consequently, under FDA contract, an ad hoc Expert Panel was convened by the Life Sciences Research Office of the American Society for Nutritional Sciences to make recommendations for the nutrient content of formulas for preterm-LBW infants based on current scientific knowledge and expert opinion. Recommendations were developed from different criteria than that used for recommendations for term infant formula. To ensure nutrient adequacy, the Panel considered intrauterine accretion rate, organ development, factorial estimates of requirements, nutrient interactions and supplemental feeding studies. Consideration was also given to long-term developmental outcome. Some recommendations were based on current use in domestic preterm formula. Included were recommendations for nutrients not required in formula for term infants such as lactose and arginine. Recommendations, examples, and sample calculations were based on a 1000 g preterm infant consuming 120 kcal/kg and 150 mL/d of an 810 kcal/L formula. A summary of recommendations for energy and 45 nutrient components of enteral formulas for preterm-LBW infants are presented. Recommendations for five nutrient:nutrient ratios are also presented. In addition, critical areas for future research on the nutritional requirements specific for preterm-LBW infants are identified.

Whether standard nutrition support is sufficient to compensate for mineral loss during continuous renal replacement therapy (CRRT) is not known.Adult men with traumatic injuries were recruited; one-half of recruits required CRRT for acute renal failure. All urine and effluent (from CRRT) were collected for 72 hours. Urine, effluent, and dialysate were analyzed for magnesium, calcium, and zinc using atomic absorption spectrometry. Urea nitrogen in blood, urine, and effluent were determined by measuring conductivity changes after the addition of urease. Blood was analyzed for magnesium and calcium as part of routine care. Intake was calculated from orders and intake records.Patients receiving CRRT (n = 6) lost 23.9+/-3.1 mmol/d (mean +/- SEM) of magnesium and 69.8+/-2.7 mmol/d of calcium compared with 10.2+/-1.2 mmol/d and 2.9+/-2.5 mmol/d, respectively, lost in patients not in acute renal failure (n = 6; p.01). Zinc intake was significantly greater than loss in both groups (p.03). Urea nitrogen excretion did not differ between groups. Serum magnesium was 0.75+/-0.04 mmol/L for CRRT patients, significantly lower than the 0.90+/-0.03 mmol/L for control patients (p.01). Total blood calcium was below normal in both groups; ionized calcium was below normal in CRRT patients.CRRT caused significant loss of magnesium and calcium, necessitating administration of more magnesium and calcium than was provided in standard parenteral nutrition formulas. However, additional zinc was not required. CRRT removed amounts of urea nitrogen similar to amounts removed by normally functioning kidneys.